furcation management 3 and 4 Flashcards
what caused this furcation involvement
iatrogenic
endo-perio lesions potential causes
could be from perforations or lateral canals
trauma from occlusion furcal involvement sign
would see an individual furcal invovlement on the affected tooth
what has happened?
root fx with endo, leads to perio issues (j-shaped lesions)
Factors to Consider Before Treatment
osseous support?
Strategic value?
many teeth?
Support of?
Length of?
Degree of?
Presence of?
Access for?
age and type of?
Horizontal and vertical osseous support
Strategic value of the tooth
Involvement of multiple teeth
Support of retained roots
Length of roots
Degree of root divergence
Presence of sinus or external oblique ridge
Access for oral hygiene
Patient’s age and type of disease
Treatment Alternatives
Extraction?
scale?
Odontoplasty?
Flap? or?
Tunnel?
resection?
Regeneration? (which classes?)
Treatment Alternatives
Extraction
Scale and root plane
Odontoplasty??
Flap debridement or osseous surgery
Tunnel procedure
Root resection
Regeneration (Class I and a shallow
Class II)
when could extractions be useful
In cases of multiple furcated teeth,
preserving all of the molars may be
impossible for several reasons. Extractions with implants, or another prosthesis may be indicated
when could SRP be useful?
which instrument is very useful?
- Instrumentation is difficult due to furcation entrance diameter and furcation anatomy.
- Ultrasonics may be best modality for
furcation instrumentation. No difference with Grade I furcations but more effective in Grade II and Grade III.
use of odontoplasty with furcations:
indications?
issues?
Removing the roof of the furcation may improve patient’s access for plaque control.
Indicated with Grade I and shallow Grade II furcations.
Must be conservative or root sensitivity can result. An option, but
rarely used.
Flap Debridement/Osseous Surgery uses with furcations
- Remember, significant reduction in
effectiveness of non-surgical subgingival plaque removal if pocket depth is greater than 3 mm. - Flap debridement would be more
effective for furcation access.
tunnel prep:
* Creation of ?
* Disadvantage of?
* Caries seen in what % with good home care?
- Creation of a furcation tunnel used with deep Grade II and Grade III furcations. Must have divergent roots and good patient home care.
- Disadvantage of caries, and pulpal
issues. - Caries seen in 24% of 156 tunnels with rigorous maintenance, fluoride, and CHX
indications for root resections:
* bone loss?
* root proximity?
* Inability to perform?
* Strategic?
* fx?
* Unable to treat involved root with? but?
- Severe bone loss
- Close root proximity
- Inability to perform home care
- Strategic tooth
- Root fracture
- Unable to treat involved root with
endodontics (but able to complete
endodontics within two weeks if vital root amputation)
Root Resection
* when is this done?
* Study of 100 teeth (50 max. and 50
mand. molars) after ten years found that %? were still in function. Failures mainly caused by?
- If access for plaque control cannot be
done in a furcation with severe bone loss on one of the roots but good support on the possible remaining roots. (one root removed other retained, still do RCT) - Study of 100 teeth (50 max. and 50
mand. molars) after ten years found that 62% were still in function. Failures mainly caused by root fracture*.
what is always indicated when removing roots?
RCT and crown
root resection failure causes?
mainly root fx, majority is non-perio related
hemisection
cut tooth in half at furcation and remove one half to turn M into PM
crown used
bucuspidization
molar turned to two PM with a sectioning thru the furcation (crowns used)
Contraindications for root resection
*bone loss?
* Unable to do what with reatined roots?
* Fused roots?
* plaque control?
* Mobility?
* root trunk length?
* medical health?
* Economics?
- Severe bone loss on retained roots
- Unable to do endodontics on retained roots
- Fused roots apical to furcation
- Poor plaque control
- Mobile teeth
- Long root trunk length
- Poor medical health
- Economics
- Age and type of periodontitis
regeneration use with furcations:
* Osseous grafting success depends
on? Furcations are ? candidates for
grafting due to?
* Guided Tissue Regeneration
(GTR) can be effective when?
- Osseous grafting success depends on morphology of the defect. Furcations are poor candidates for
grafting due to lack of vascularity. - Guided Tissue Regeneration (GTR) can be effective with bone replacement grafts
ways for epithelial exclusion
non-resorable membrane or coronally positioned flap (pull soft tissue up to prevent entry into furcation allowing bone and PDL to heal)
Grade I furcation tx
* Control of? through?
* Adjustment of?
* Odontoplasty?
- Control of inflammation through
plaque control and root preparation - Adjustment of occlusion if indicated at reevaluation
- Odontoplasty if indicated (??)
Grade II furcation (shallow) tx
* Control of ? through?
* Adjustment of?
* Odontoplasty?
* Flap?
- Control of inflammation through plaque control and root preparation
- Adjustment of occlusion if indicated at reevaluation
- Odontoplasty if indicated (??)
- Flap debridement/osseous surgery or potential regeneration
Grade II (deep) furcation tx
Control of?
Adjustment of ?
Flap?
Root?
regeneration?
Tunnel?
Extraction?
Control of inflammation (difficult)
Adjustment of occlusion if indicated
at reevaluation
Flap debridement/osseous surgery
Root resection
Osseous regeneration
Tunnel preparation
Extraction
Grade III furcation tx
Control of?
Adjustment of?
Flap?
Root?
Tunnel?
Extraction?
Control of inflammation (difficult)
Adjustment of occlusion if indicated
at reevaluation
Flap debridement (difficult)
Root resection
Tunnel preparation
Extraction
Root Resection vs. Implants
Comparison of success of root-resected molars and molar implants in use up to 15 yrs.
Success of implants was 97% for 1472 implants at 13 yrs.
Success of 701 root resections (various combinations) was 96.8% at 15 yrs.
