furcation management parts 1 and 2

Question 1

Goals of Therapy
Arrest the?
Prevent further?
Regenerate?
Prevent?

Answer 1

Arrest the active disease
Prevent further loss of attachment
Regenerate lost periodontium
Prevent disease reoccurrence

Question 2

Objectives of Furcation Therapy
Access for?
Access for?
Establish?

Answer 2

Access for home care
Access for maintenance
Establish physiologic bone and tissue architecture

Question 3

 Goldman-incipient or Glickman-Grade I furcations

Answer 3

• Pocket formation into the flute of the
  furca, but the inter-radicular bone is
  intact.

Question 4

 Goldman-cul-de-sac or Glickman-Grade II furcation

Answer 4

• Loss of inter-radicular bone with pocket formation of varying depths into the furca, but not completely through to the other side.
• Can be shallow or deep

Question 5

 Goldman-through and through or Glickman-Grade III

Answer 5

• Complete loss of inter-radicular bone
  with pocket formation allowing probe to
  pass completely to the other side

Question 6

 Glickman-Grade IV

Answer 6

• Loss of attachment and gingival
  recession that has made the furcation
  clearly visible to clinical examination

Question 7

hamp classification, degrees?

Answer 7

Hamp- classification of the horizontal component of furcation involvement
* Degree 1: horizontal loss less than 3mm
* Degree 2: horizontal loss >3mm but not the total width of furcation area
* Degree 3: through and through

Question 8

Tanrow classification

Answer 8

Tarnow: classification of the vertical component of furcation involvement
* Subclass A: vertical loss up to 1/3 of furca (1-3 mm)
* Subclass B: vertical loss up to 2/3 of furca (4-6 mm)
* Subclass C: vertical loss into the apical third (>7mm)

Question 9

Grade/Class II or Grade/Class III furcation involvement automatically places patient into what stages of periodontitis

Answer 9

Stage III or Stage IV Periodontitis.***

Question 10

Diagnosis of furcal involvement
 Clinically probing the furcations

Answer 10

• Standard “straight” probing with a
  straight probe only measures the vertical attachment loss, and the extent of the horizontal loss will not be detected
• “Curved” probing (Nabers) with a curved probe will determine the horizontal attatchement loss

Question 11

Location of furcation entrances for maxillary molar

Answer 11

• Mesial furcation toward palatal 1/3 so probe from palatal
• Distal furcation in mid 1/3 (under contact point) so probe from palatal (or buccal)
• Buccal furcation from buccal!

Question 12

Radiographic and Clinical Diagnosis
 Study looked at 72 pts with chronic
periodontitis and 90% of the 303 maxillary molars had furcation bone loss.
* % diagnosed by probing alone,
* % by radiographs alone and
* % diagnosed using both clinical and
radiographs.

Answer 12

 Study looked at 72 pts with chronic
periodontitis and 90% of the 303 maxillary molars had furcation bone loss.
* 3% diagnosed by probing alone,
* 22% by radiographs alone and
* 65% diagnosed using both clinical and
radiographs.

Question 13

 Study evaluated 312 mandibular molars and 35% had furcation involvement.
* % were diagnosed by probing alone
* % diagnosed by radiographs alone,
* % diagnosed by a both of
radiographic and clinical examination.

Answer 13

 Study evaluated 312 mandibular molars
and 35% had furcation involvement.
* 9% were diagnosed by probing alone
* 8% diagnosed by radiographs alone,
* 18% diagnosed by a both of
radiographic and clinical examination.

Question 14

Cervical Enamel Projections
* Grades?
 Incidence ranges? common demo?
 Implications of CEPs:

Answer 14

• Grade I, II, III depending on extension
  towards and into the furcation
   Incidence ranges from 17-33% from
  various studies, (mandibular second molar has highest incidence). Studies of Asian populations have far higher incidence.
   Implications of CEPs: epithelial attachmen

Question 15

CEP grades

Answer 15

Question 16

Root Trunk Length
Maxillary first molars

Answer 16

• Mesial: 3 mm
• Facial: 4 mm
• Distal: 5 mm

Question 17

Root Trunk Length Mand. first molars

Answer 17

• Buccal: 3 mm
• Lingual: 4 mm
• (Also, note the inclination of the
  mandibular molars is to the midline)

Question 18

Surface Area of Maxillary 1st Molar

Answer 18

Question 19

Maxillary 1st
Bicuspid root trunk length

Answer 19

8mm

Question 20

Furcation Root Concavities
* Found % of time on mesial surface of
mandibular first molar and % on distal
surface?
* Found % on mesial-buccal, % on
distal-buccal, and % on palatal
surfaces of maxillary first molars?

Answer 20

• Found 100% of time on mesial surface of mandibular first molar and 99% on distal surface
• Found 94% on mesial-buccal, 31% on
  distal-buccal, and 17% on palatal

Question 21

Furcal concavities on the mandibular molars occur % on the mesial root and % on the distal root.

Answer 21

Furcal concavities on the mandibular molars occur 100% on the mesial root and 99% on the distal root.

Question 22

Concavities on the maxillary first molar
furcal root surfaces:
% on the mesio- buccal,(0.1 -0.7mm)
% on the distal-
buccal (0.1 mm)
% on the palatal root (0.1mm)

Answer 22

94% on the mesio- buccal,(0.1 -0.7mm)
31% on the distal- buccal (0.1 mm) and
17% on the palatal root (0.1mm) (C)

Question 23

Anatomical Considerations
 Furcation Entrance Diameter
 % are 1.0 mm or less
 % are 0.75 mm or less
 Width of new curette blade?
 Therefore?

Answer 23

 81% are 1.0 mm or less
 58% are 0.75 mm or less
 Width of new curette blade: 0.75-1.25 mm
 Therefore, 58% of furcations cannot be instrumented with hand instruments

Question 24

Anatomical Considerations
 Pulp interrelationship

Answer 24

• Incidence of lateral canals is 28%** in
  furcation area

Question 25

Anatomical Considerations:
Bifurcational ridges at man molars

Answer 25

• 73% of mandibular first molars have ridges in mesial-distal direction, and 63% have ridges in buccal-lingual direction

Question 26

Etiologies of Furcation Bone Loss

Answer 26

 Plaque (advancing plaque front)
 Developmental Anomalies
 Iatrogenic
 Pulpal Involvement (via lateral canals, endo-perio lesions)
 Occlusal Trauma