Furcation Management

Question 1

PERIODONTAL FURCATION INVOLVEMENT is:

Answer 1

Loss of periodontal attachment and bone in the root separation area of multirooted teeth, due to progression of periodontitis

Question 2

Label

Answer 2

Question 3

Maxillary molars
Usually have how many roots?

Answer 3

3 = MB, DB + P, db is smaller

Question 4

Mandibular molars
How many roots

Answer 4

2 - Mesial + Distal

Question 5

Furcation - special anatomy

What is a furcation ridge ?

Answer 5

Furcation ridges = ridges of cementum in the furcation area

Question 6

What problem do both Cervical enamel projections and Enamel pearls cause?

Answer 6

Plaque retentive

Question 7

When you have furcations why is endodontic diagnosis so important ?

Answer 7

Question 8

What might accessory canals in furcation region cause

Answer 8

Accessory canals in the furcation region are frequent and might represent a communication pathway between endodontic and periodontal pathologies

Question 9

What might Primary endodontic lesions resemble ?

Answer 9

Primary endodontic lesions might resemble a furcation class III periodontal defect, when the fistulous sinus tract drains through the inter‐radicular space

Question 10

Maxillary first molar
How do we enter furcation:
Buccally?
Mesially?
Distally?

Answer 10

Question 11

Premolars
How Do we enter furcation space?

Answer 11

Question 12

Mandibular molar
How do we enter furcation

Answer 12

Question 13

What probe should you use to locate furcations and how do you use to measure the horizontal component of the furcation?
What is there a risk of?

Answer 13

1. Nabers probe as it is curved.
2. Rotate the probe to measure the horizontal component of the furcation.

Question 14

In addition to Nabers probe what can we use for furcation diagnosis

Answer 14

Radiograph

Question 15

Radiographic diagnosis of furcation
1 - How is it diagnosed?
2 - Are furcations often missed clinically? What can we do for this

Answer 15

1-
• Image of radiolucency in proximity of root separation area
• Triangular shadow in the proximal furcation area

2 - Yes esp grade 3 in maxillary molars so we can sometimes use CBCT

Question 16

Furcation
How do we measure the horizontal involvement of furcation?

Answer 16

Degree I = horizontal loss of periodontal support up to 3mm

Degree II = horizontal loss of periodontal support > 3mm but not through

Degree III = through and through loss of periodontal support

Also referred to as class 1-3

Question 17

Furcation
Although the main measurement is horizontal for furcation - degrees - what can we use to measure VERTICAL involvement

Need to know??

Answer 17

Class A, B ,C
(Tarnow and fletcher)

Question 18

Question 19

How is furcation linked with tooth loss?

Answer 19

Tooth with no furcation highest change of survival

As you go from furcation degree 1 to 3 (through and through ), have increased risk of tooth loss

However even if we have a furcation tooth we can still retain it for long time with correct treatment

Question 20

what is done if:
- no furcation on probing
- probing degree I
- probing degree II or III

Answer 20

Question 21

SECTION 2 - FURCATION MANAGEMENT STRATEGIES

Question 22

Furcations
What are aims of therapy

Answer 22

Question 23

Furcation management
What are the 5 different options ?

Answer 23

Root resection = removing one root and leaving remaining
Tunnelling = allowing access for furcation so patient can clean in between furcation

Question 24

1. Non surgical therapy

Does it work as well as on non furcated tooth

Answer 24

Less predictable response with teeth with furcations

Hard to clean / remove calculus in furcation areas for both dentist and patient

Question 25

1. Non surgical therapy What is the width of furcation entrance What instruments can we use?

Answer 25

Question 26

1 non surgical debridement tools and their width

Answer 26

Question 27

What curette tips are advised for manual furcation debridement and why?

Answer 27

Micro mini-five curette As its 0.6mm and furcation entrances are normally between 0.75 to 0.1 in first molars.

Question 28

What is more useful in furcation debridement of degree 2 and 3 furcations than curettes

Answer 28

Ultrasonic furcation tips

Question 29

Manual furcation debridement

Answer 29

Curettes

Question 30

What ultrasonic tips are advised for ultrasonic furcation debridement and why?

Answer 30

They are curved and are at 0.5-0.6mm which is perfect for the 0.7-1.1mm entrance for furcations.

Question 31

Question 32

REGENERATIVE THERAPY What are the 3 aims with regenerative therapy for furcations?

Answer 32

Question 33

REGENERATIVE THERAPY What are 4 options of regenerative therapy for furcations?

Answer 33

Question 34

RESECTIVE THERAPY What are the 2 aims with resective therapy for furcations?

Answer 34

Question 35

RESECTIVE THERAPY What are 3 options of resective therapy for furcations?

Answer 35

Question 36

Resective therapy

Question 37

TUNNELLING What are the 2 aims

Answer 37

Question 38

For degree I furcation what are the treatment options ?

Answer 38

Supportive periodontal therapy

Question 39

For degree II furcations, what are the treatment options?

Answer 39

1. Regeneration - mainly mandibular with good interdental bone peaks 2. Supportive periodontal therapy 3. Access flap 4. Resection / Tunnelling (Regen techniques more successful than open flap debridement )

Question 40

For degree III furcations, what are the treatment options

Answer 40

1. Resection/ Tunnelling 2. Supportive periodontal therapy 3. Access flap 4. Extraction

Question 41

Implant vs keeping molars with FI

Answer 41

Implant also lead to reduced bone quantity and quality , risk of peri implantitis

Question 42

When can tunnelling be successful

Answer 42

If root divergence exceeds 30 degrees

Question 43

what are the patient AND tooth factors to consider in furcation decisions making

Answer 43

Question 44

If a restoration is used to block a furcation what can occur as a downside?

Answer 44

Caries