Furcation management Flashcards
What needs to be done when there is furcation involvement?
Elimination of the microbial plaque from the surfaces of the root complex.
The establishment of an anatomy of the affected surfaces that facilitates proper self performed plaque control.
Which treatment is best for furcation involvement management for class 1 furcation?
SRD (scaling and root debridement)
Odontoplasty
What treatment is best for furcation involvement management for class 2 furcations?
SRD (scaling and root debridement)
Odontoplasty
GTR (guided tissue regeneration)
Tunnel preparation
What is the best treatment for furcation involvement management for class 3 furcation?
SRD
OFD
Tunnel preparation (taking out more bone to create more space for tooth to be cleaned more easily by patient)
Root resections (removing extra root)
Extractions
What does non-surgical furcation treatment depend on?
Non-surgical treatment depends on patient compliance to attend regular maintenance visits
What factors are important to consider with treatment?
Degree of furcation involvement
Amount of remaining periodontal support
Probing depth
Tooth mobility
Endodontic conditions
Available sound tooth substance
What tips should be used for debriding furcations?
Curette width 0.8 - 1.06
US tip 0.88mm measured 1mm from the tip and 1.06mm measured 2mm from the tip
Furcation opening is less than 1mm
Difficult to access with hand instrument
US slightly better than curettes in narrow furcation areas\
GR 1 furcation relatively stable with SRP
What is the advantage of surgery vs non-surgical debridement?
Open flap debridement 1 - 3% calculus remaining vs 34 - 47% with closed debridement in furcation area.
What are the benefits of doing regenerative treatment over surgical treatment?
GTR +/- bone grafts for EMD - varying results
Not for class III furcations
Most suited for Md molars class 2 buccal and lingual and Mx Buccal furcation class 2
2/3 completely closed & the rest convert to Cl I
Outcome is less favourable & unpredictable in Cl III furcation or Cl II mesial and distal mx furcations
What is the function of root resections?
Cna eliminate involvement of furcations
What is the ideal tooth for root resection?
Class 2 or 3 involved molar
Severe bone loss around 1 or more roots
Root fracture, perforations, and resorption
Reamining roots should have adequate bony support - favourable crown-root ratio
Sound endodontic and restorative prognosis
Tooth has minimal mobility (Gr 1 mobile or nil)
What are the contraindications for root resection
Teeth with a poor crown-root ratio on remaining roots
Inadequate bone support on roots to be retained
Long root trunks
Fused roots
Teeth where endodontic & restorative treatment not feasible on remaining roots
Poor surgical access & inability to perform oral hygiene procedures
What are root tunneling procedures?
Treatment of teeth with Degree II or III furcation involvement where furcation is opened up to allow interproximal brush or floss to fit through.
The problem with this is that the furcation remains vulnerable to root caries and plaque accumulation. This can be fixed with topical fluoride.
Tunneling is generally limited to mandibular molars but may be combined with root amputation in maxillary molars
What are the risks associated with tunneling procedures?
Can result in high root caries risk
