furcation management 3 and 4

Question 1

what caused this furcation involvement

Answer 1

iatrogenic

Question 2

endo-perio lesions potential causes

Answer 2

could be from perforations or lateral canals

Question 3

trauma from occlusion furcal involvement sign

Answer 3

would see an individual furcal invovlement on the affected tooth

Question 4

what has happened?

Answer 4

root fx with endo, leads to perio issues (j-shaped lesions)

Question 5

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?

Answer 5

 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

Question 6

Treatment Alternatives
 Extraction?
 scale?
 Odontoplasty?
 Flap? or?
 Tunnel?
 resection?
 Regeneration? (which classes?)

Answer 6

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)

Question 7

when could extractions be useful

Answer 7

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

Question 8

when could SRP be useful?
which instrument is very useful?

Answer 8

• 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.

Question 9

use of odontoplasty with furcations:
indications?
issues?

Answer 9

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.

Question 10

Flap Debridement/Osseous Surgery uses with furcations

Answer 10

• 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.

Question 11

tunnel prep:
* Creation of ?
* Disadvantage of?
* Caries seen in what % with good home care?

Answer 11

• 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

Question 12

indications for root resections:
* bone loss?
* root proximity?
* Inability to perform?
* Strategic?
* fx?
* Unable to treat involved root with? but?

Answer 12

• 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)

Question 13

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?

Answer 13

• 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*.

Question 14

what is always indicated when removing roots?

Answer 14

RCT and crown

Question 15

root resection failure causes?

Answer 15

mainly root fx, majority is non-perio related

Question 16

hemisection

Answer 16

cut tooth in half at furcation and remove one half to turn M into PM

crown used

Question 17

bucuspidization

Answer 17

molar turned to two PM with a sectioning thru the furcation (crowns used)

Question 18

Contraindications for root resection
*bone loss?
* Unable to do what with reatined roots?
* Fused roots?
* plaque control?
* Mobility?
* root trunk length?
* medical health?
* Economics?

Answer 18

• 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

Question 19

regeneration use with furcations:
* Osseous grafting success depends
on? Furcations are ? candidates for
grafting due to?
* Guided Tissue Regeneration
(GTR) can be effective when?

Answer 19

• 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

Question 20

ways for epithelial exclusion

Answer 20

non-resorable membrane or coronally positioned flap (pull soft tissue up to prevent entry into furcation allowing bone and PDL to heal)

Question 21

Grade I furcation tx
* Control of? through?
* Adjustment of?
* Odontoplasty?

Answer 21

• Control of inflammation through
  plaque control and root preparation
• Adjustment of occlusion if indicated at reevaluation
• Odontoplasty if indicated (??)

Question 22

 Grade II furcation (shallow) tx
* Control of ? through?
* Adjustment of?
* Odontoplasty?
* Flap?

Answer 22

• 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

Question 23

 Grade II (deep) furcation tx
 Control of?
 Adjustment of ?
 Flap?
 Root?
 regeneration?
 Tunnel?
 Extraction?

Answer 23

 Control of inflammation (difficult)
 Adjustment of occlusion if indicated
at reevaluation
 Flap debridement/osseous surgery
 Root resection
 Osseous regeneration
 Tunnel preparation
 Extraction

Question 24

Grade III furcation tx
 Control of?
 Adjustment of?
 Flap?
 Root?
 Tunnel?
 Extraction?

Answer 24

 Control of inflammation (difficult)
 Adjustment of occlusion if indicated
at reevaluation
 Flap debridement (difficult)
 Root resection
 Tunnel preparation
 Extraction

Question 25

Root Resection vs. Implants

Answer 25

 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.