Furcation management

Question 1

Define a furcation.

Answer 1

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

Question 2

What are furcation ridges?

Answer 2

Ridges of cementum in the furcation area.

Question 3

• Why can cervical enamel projections and enamel pearls cause furcation?

Answer 3

1. As they are both plaque retentive:

Question 4

What can be diagnosed endotontically that may have initally been mistaken for a furcation diagnosis?

Answer 4

Accessory canals in the furcation area (space between roots of molars) are common.

They can act as a pathway connecting endodontic (pulpal) and periodontal (gum) diseases.

A primary endodontic lesion may mimic a Class III furcation defect if a sinus tract drains through the furcation.

To differentiate between endodontic and periodontal origin, it’s important to:

Perform pulp vitality tests

Do periodontal probing

Preventive root canal treatment is not beneficial in managing furcation lesions — unless root resection is planned.

Question 5

For 1st maxillary molars how do you enter the furcation buccally?

Answer 5

buccal entrance: 3.5mm from the cej

Question 6

For 1st maxillary molars how do you enter the furcation mesially?

Answer 6

mesial entrance: 3mm from the cej

Question 7

For 1st maxillary molars how do you enter the furcation distally?

Answer 7

distal entrance: 5mm from the cej

Question 8

For 1st mandibular molars how do you enter the furcation mesio-distally?

Answer 8

mesio-distal entrance: 8mm from CEJ

Question 9

For 1st mandibular molars how do you enter the furcation buccally?

Answer 9

Buccal entrance: 3mm from CEJ

Question 10

For 1st mandibular molars how do you enter the furcation lingually?

Answer 10

lingual entrance: 4mm from CEJ

Question 11

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

Answer 11

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

Question 12

How is a furcation diagnosed radiographically?

Answer 12

radiolucency in root seperation area a triangular shadow

Question 13

What are the 3 degrees of furcation and what is the difference between each degree?

Answer 13

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 peridontal support

Question 14

If you get a probing degree of I for the furcation what treatment is needed?

Answer 14

Usually non surgical.

Question 15

If you get a probing degree of II or III for the furcation what treatment is needed?

Answer 15

-periapical radiograph, assesment of endodontic status and occlusion
- complex treatment planning
- consider cone beam ct

Then potentially surgical periodontal treatment.

Question 16

Then potentially surgical periodontal treatment.

Answer 16

reduce progression risk
maintain the tooth in a functional state
reduce preiodontal inflammation
improve patients quality of life

Question 17

Give 5 therapies for furcartions.

Answer 17

non surgical maintance
open flap debrigement/ furcation plasty
resective: hemisection, re=oot resection , tunnel
regenerative
extration

Question 18

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

Answer 18

Micro mini-five curette

As its 0.6mm and furcation entrances are normally between 0.75 to 1.1 in first molars.

Question 19

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

Answer 19

cavitron
ems pls2
ems pl4

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

Question 20

What are the 3 aims with regenerative therapy for furcations?

Answer 20

1. Furcation closure
2. reduction of furcation degree
3. increase of periodontal attachment and increce of vetical bone level

Question 21

What are 4 options with regenerative therapy for furcations?

Answer 21

1. GTR (guided tissue regeneration)
2. growth factors
3. stems cells
4. scaffolds

Question 22

What are the 2 aims with resective therapy for furcations?

Answer 22

1. eliminate furcation area - removal or roots or root seperation
2. facialite oral hygieen inse the furcated area

Question 23

What are 3 options with regenerative therapy for furcations?

Answer 23

Root separation: sectioning of the multi‐rooted tooth with maintenance of all the roots-

Root resection: sectioning of the multi-rooted tooth and the removal of one or two roots and the associated portion of the crown.

Root amputation: removal of one root without removal of the overhanging portion of the crown

Question 24

What are the 3 aims with tunneling for furcations?

Answer 24

This gives access to the furcation for the patient and dentist to enable maintenance and cleaning.

Question 25

For each degree, what treatment is provided?

Answer 25

For degree1: Non surgical and supportive periodontal therapy. For degree II furcations 1. Regeneration (mainly mandibular with good interdental bone peaks) 2. SPT 3. Access flap 4. Resection/tunneling For degree III furcations: 1. Resection/tunneling 2. SPT 3. Access flap 4. Extraction

Question 26

what are 4 reasons (counters) that might make you choose resective therapy over an implant?

Answer 26

Reduced bone quantity because of previous bone loss Reduced bone quality with high risk of type IV bone and higher risk of implant failure Higher risk of implant failure in periodontal patients High risk of peri-implantitis Also more cost-effective to try and save tooth.

Question 27

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

Answer 27

Caries build up.

Question 28

What patient factors must you consider with furcation decision making?

Answer 28

Smoking Medical health Economic factors Caries risk Oral hygiene dexterity

Question 29

What tooth factors must you consider with furcation decision making?

Answer 29

Strategic position Anatomy: root trunk, divergence Multiple furcations Endodontic status Mobility Bone levels Healthy residual tooth substance Chances of successful implant therapy Root-crown ratio