Furcation Management Flashcards
PERIODONTAL FURCATION INVOLVEMENT is:
Loss of periodontal attachment and bone in the root separation area of multirooted teeth, due to progression of periodontitis
Label
Maxillary molars
Usually have how many roots?
3 = MB, DB + P, db is smaller
Mandibular molars
How many roots
2 - Mesial + Distal
Furcation - special anatomy
What is a furcation ridge ?
Furcation ridges = ridges of cementum in the furcation area
What problem do both Cervical enamel projections and Enamel pearls cause?
Plaque retentive
When you have furcations why is endodontic diagnosis so important ?
What might accessory canals in furcation region cause
Accessory canals in the furcation region are frequent and might represent a communication pathway between endodontic and periodontal pathologies
What might Primary endodontic lesions resemble ?
Primary endodontic lesions might resemble a furcation class III periodontal defect, when the fistulous sinus tract drains through the inter‐radicular space
Maxillary first molar
How do we enter furcation:
Buccally?
Mesially?
Distally?
Premolars
How Do we enter furcation space?
Mandibular molar
How do we enter furcation
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?
- Nabers probe as it is curved.
- Rotate the probe to measure the horizontal component of the furcation.
In addition to Nabers probe what can we use for furcation diagnosis
Radiograph
Radiographic diagnosis of furcation
1 - How is it diagnosed?
2 - Are furcations often missed clinically? What can we do for this
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
Furcation
How do we measure the horizontal involvement of furcation?
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
Furcation
Although the main measurement is horizontal for furcation - degrees - what can we use to measure VERTICAL involvement
Need to know??
Class A, B ,C
(Tarnow and fletcher)
How is furcation linked with tooth loss?
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
what is done if:
- no furcation on probing
- probing degree I
- probing degree II or III
SECTION 2 - FURCATION MANAGEMENT STRATEGIES
Furcations
What are aims of therapy
Furcation management
What are the 5 different options ?
Root resection = removing one root and leaving remaining
Tunnelling = allowing access for furcation so patient can clean in between furcation
- Non surgical therapy
Does it work as well as on non furcated tooth
Less predictable response with teeth with furcations
Hard to clean / remove calculus in furcation areas for both dentist and patient
- Non surgical therapy
What is the width of furcation entrance
What instruments can we use?
1 non surgical debridement tools and their width
What curette tips are advised for manual furcation debridement and why?
Micro mini-five curette
As its 0.6mm and furcation entrances are normally between 0.75 to 0.1 in first molars.
What is more useful in furcation debridement of degree 2 and 3 furcations than curettes
Ultrasonic furcation tips
Manual furcation debridement
Curettes
What ultrasonic tips are advised for ultrasonic furcation debridement and why?
They are curved and are at 0.5-0.6mm which is perfect for the 0.7-1.1mm entrance for furcations.
REGENERATIVE THERAPY
What are the 3 aims with regenerative therapy for furcations?
REGENERATIVE THERAPY
What are 4 options of regenerative therapy for furcations?
RESECTIVE THERAPY
What are the 2 aims with resective therapy for furcations?
RESECTIVE THERAPY
What are 3 options of resective therapy for furcations?
Resective therapy
TUNNELLING
What are the 2 aims
For degree I furcation what are the treatment options ?
Supportive periodontal therapy
For degree II furcations, what are the treatment options?
- Regeneration - mainly mandibular with good interdental bone peaks
- Supportive periodontal therapy
- Access flap
- Resection / Tunnelling
(Regen techniques more successful than open flap debridement )
For degree III furcations, what are the treatment options
- Resection/ Tunnelling
- Supportive periodontal therapy
- Access flap
- Extraction
Implant vs keeping molars with FI
Implant also lead to reduced bone quantity and quality , risk of peri implantitis
When can tunnelling be successful
If root divergence exceeds 30 degrees
what are the patient AND tooth factors to consider in furcation decisions making
If a restoration is used to block a furcation what can occur as a downside?
Caries
