Furcation involvements

Question 1

Etiological Factors

Answer 1

Bacterial Plaque = Inflammatory periodontal disease process extends to interradicular bone resorption and formation of furcation defect

Long-standing inflammation of periodontal disease

Question 2

Classification of Furcation Lesions (Glickman’s Classification)

Answer 2

Grade I- Incipient/Early Stage furcation involvement. Suprabony and primarily affects soft tissues
Early bone loss may have occurred with increase in probing depth. No radiographic bone loss

Grade II
Can affect one or more furcations- of the same tooth
Cul-de-sac with definite horizontal component
PDL remains intact. If multiple defects are present, they don not communicate with each other because a portion of the alveolar bone remains attached to the tooth
Horizontal probing of the furcation determines whether the defect is early or advanced. Vertical bone loss may be present and Radiographically may be seen

Grade III
No bone is attached to dome of furcation
Early grade III, opening may be filled with soft tissue and may not be visible. The clinician may not even be able to pass a periodontal probe completely through the furction because of the interference with the bifurcation ridges or facial-lingual bony margins. Radiographically can be seen

Grade IV
Interdental bone is destroyed. Soft tissues have receded apically so that the furcation opening is clinically visible
Tunnel therefore exists between the roots of such an affected tooth. Periodontal probe passes readily from one aspect of another tooth

Question 2

Classification of pockets

Answer 2

1. Gingival pockets
(Pseudopocket)- formed by gingival enlargement without destruction of the underlying tissues. The sulcus is deepened because of the increased bulk of the gingiva

**2. Periodontal pockets **
Destruction of supporting periodontal tissues

Question 3

Two types of periodontal pockets

Answer 3

1. Suprabony (Supracrestal/Supraalveolar)
Bottom of the pocket is coronal to the underlying alveolar bone. Horizontal bone loss

**2. Intrabony ** (Infrabony, subcrestal,intraalveolar)
Bottom of the pocket is apical to the level of the adjacent alveolar bone and the lateral pocket wall lies between the tooth surface and alveolar bone. Bone loss is vertical

Question 3

How to diagnose furcations

Answer 3

1. 1). Clinical Assessment
A). Probing
Nabers Probe

B). Bone sounding/transgingival probing
Done prior to flap reflection
Aids in telling thickness height and shape of underlying base)

2. 2). Radiographic Assessment
NB: Bone loss is always greater than it appears in radiograph
Intraoral periapicals, vertical bitewings to detect furcation invasion
* Location of interdental bone and bone level within root complex should be examined
* Maxillary furcations may not always be possible to pick up due to superimposition of palatal root= angulate central beam in a different direction

Question 4

Clinical Features of Furcation Defects

Answer 4

1. Mandibular first molars are most common sites and maxillary premolars are least common
2. Clinically visible furcation
3. Suprabony and infrabony pockets
4. Periodontal abscesses
5. Root caries and tooth mobility are common

Question 5

Microscopic features of furcation defects

Answer 5

1. Rootward extension of periodontal pocket
In early stages, there is widening of PDL with cellular and inflammatory fluid exudation, followed by epithelial proliferation into furcation area from adjoining periodontal pocket
2. Extension of inflammation into bone leads to resorption and reduction in bone height
Bone destructive pattern may produce horizontal loss or there may be angular osseous defects- associated with infrabony pockets. Plaque, calculus and bacterial debris occupy the denuded furcation space

Question 6

Definition of furcation

Answer 6

Pathological resorption of bone within the furcation