Furcation Management- Review

Question 1

Goals of furcation therapy:

Answer 1

1. arrest active disease
2. prevent further loss of attachment
3. regenerate lost periodontium
4. prevent disease reoccurrence

Question 2

Objectives of furcation therapy:

Answer 2

1. access for home care
2. access for maintenance
3. establish physiologic bone and tissue architecture

Question 3

T/F: Grade/Class II or Grade/Class III furcation involvement automatically places a patient into stage III or IV periodontitis (according to 2017 AAP classification change)

Answer 3

True

Question 4

Etiology of furcation bone loss:

Answer 4

1. plaque (advancing plaque front 1mm from JE) attachment loss
2. developmental anomalies (furcation concavities)
3. Iatrogenic erros
4. pulpal involvement (via lateral canals or endo-perio lesions)
5. occlusal trauma

Question 5

Diagnosis of furcations can be done using ____ as well as ____.

Answer 5

probes & radiographs

Question 6

Type of probing that measures the VERTICAL attachment loss (extend of horizontal loss will not be detected)

Answer 6

standard “straight” probe

Question 7

Type of probing that determines horizontal attachment loss:

Answer 7

Nabers “curved” probe

Question 8

What is used to probe furcations?

Answer 8

nabers probe

Question 9

If a mesial furcation is detected, where should the probe be placed to access it?

Answer 9

probe to access it from the palate

Question 10

Location of furcation entrances for maxillary molars:

Mesial furcation:
Distal furcation:
Buccal furcation:

Answer 10

Mesial furcation: located toward palatal 1/3 so probe from PALATAL

Distal furcation: located in the mid 1/3 (under contact point) so probe from PALATAL OR BUCCAL

Buccal furcation: probe from BUCCAL

Question 11

Most commonly used classifications for furcations:

Answer 11

Goldman and glickman

Question 12

Classify the following:

• pocket formation into the flute of the furca, but the inter-radicular bone is intact
• loss of attachment
• bone bone loss if from buccal to lingual or palatal to buccal (not losing bone in a horizontal direction)

Answer 12

Goldman: Incipient
Glickman: Grade 1

Question 13

Classify the following:

• Loss of inter-radicular bone with pocket formation of varying depths into the fulcra, but not completely through to the other side (interradicular bone intact)
• shallow or deep
• bone loss is starting to be lost horizontally

Answer 13

Goldman: Cul-de-sac
Glickman: Grade 2 (shallow and deep)

Question 14

What treatment should be done for Goldman cul-de-sac or glickman grade 2?

Answer 14

Would need to reflect a flap because tissues is gong o be up to CEJ

Question 15

Classify the following:

• complete loss of inter-radicular bone with pocket formation allowing probe to pass completely to the other side
• AKA “isolated root”
• Soft tissue way may still be intact making it difficult to access and difficult for patient to clean

Answer 15

Goldman through and through
Glickman Grade III

Question 16

Classify the following:

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

Answer 16

Glickman grade IV

Question 17

In addition to Goldman and Glickman, what are the two other classification systems for furcations?

Answer 17

Hamp & Tarnow

Question 18

Classification of the HORIZONTAL component of furcation involvement:

Answer 18

Hamp classification

Question 19

Describe the following degrees of HAMP classification:

Degree 1:
Degree 2:
Degree 3:

Answer 19

Degree 1: less than 3mm of horizontal loss
Degree 2: greater than 3 mm of horizontal loss but not all the way through
Degree 3: through and through

Question 20

Classification of the VERTICAL component of furcation involvement:

Answer 20

Tarnow

Question 21

Describe the following subclasses of Tarnow classification:

Subclass A:
Subclass B:
Subclass C:

Answer 21

Subclass A: vertical loss up to 1/3 of the furca (1-3mm)

Subclass B: vertical loss up to 2/3 of the furca (4-6mm)

Subclass C: vertical loss into the apical 1/3 (greater than 7mm)

Question 22

Anatomical considerations for furcation management include:

Answer 22

1. cervical enamel projections
2. root trunk length
3. furcation root concavities
4. furcation entrance diameter
5. pulpal interrelationship
6. bifurcational ridges

Question 23

How common do we see cervical enamel projections (CEP)

Answer 23

17-33%

Question 24

What teeth are most commonly effected by CEPs?

Answer 24

mandibular 2nd molars

Question 25

What populations are most commonly affectedly CEPs?

Answer 25

asians

Question 26

CEPs are classified into grade 1, 2, and 3 depending on:

Answer 26

extension towards and into the furcation

Question 27

What classification of CEP is the most extended into the furcation?

Answer 27

grade 3

Question 28

Implications of CEPs:

Answer 28

epithelial attachment (loss of epithelial attachment due to epithelium only being able to attach to enamel)

Question 29

What is the recommended treatment for CEPs?

Answer 29

use high speed bur to remove enamel projection (then place fluoride)

Question 30

T/F: 94% of the time on the MB surface of the maxillary 1st molar there is a concavity present. 100% of the time there is a root concavity on the mesial surface of the mandibular fist molar, and 99% of the time on the distal surface of the mandibular 1st molar.

Answer 30

All statements true

Question 31

81% of furcations are ____ in diameter 58% of furcations are ____ in diameter

Answer 31

less than or equal to 1mm less than or equal to 0.75mm

Question 32

What is the width of a new curette blade? What does this mean?

Answer 32

0.75-1.25 mm Therefore 58% of furcations cannot be instrumented with hand instruments

Question 33

Pulpal status can affect the periodontium by ways of:

Answer 33

1. lateral canals 2. accessory canals 3. apical foramen

Question 34

T/F: incidence of lateral canals is 28% in the fraction area. Lateral canals can lead to perio endo

Answer 34

both statements true

Question 35

T/F: Primary endodontic lesions with perio involvement have the best prognosis

Answer 35

false- with no perio involvment

Question 36

Bifurcationial ridges/interradicular ridges are most commonly associated with:

Answer 36

mandibular 1st molar MD> BL

Question 37

Furcation treatment is based on:

Answer 37

grade of furcation

Question 38

List the grade of furcation based on the following treatment: - control of inflammation thought plaque control and root preparation - adjustment of occlusion if indicated at re-evaluation - odontoplasty if indicated

Answer 38

Grade I furcation

Question 39

List the grade of furcation based on the following treatment: - control of inflammation through plaque control and root preparation - adjustment of occlusion if indicated at re-evaluation - odontoplasty if indicated -flap debridement /osseous surgery or potential regeneration

Answer 39

Grade II (shallow)

Question 40

List the grade of furcation based on the following treatment: - control of inflammation (difficult) - adjustment of occlusion if indicated at re-evaluation - flap debridement/osseous surgery - root resection - osseous regeneration - tunnel preparation - extraction

Answer 40

Grade II (deep)

Question 41

List the grade of furcation based on the following treatment: - control of inflammation (difficult) - adjustment of occlusion if indicated at re-evaluation - flap debridement (difficult) - root resection - tunnel preparation - extraction

Answer 41

Grade III

Question 42

Odontoplasty may be indicated in:

Answer 42

Grade I and shallow Grade II furcations

Question 43

When would a tunnel procedure be indicated?

Answer 43

deep grade II and grade III furcations * Must have divergent roots and good patient homecare

Question 44

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. ____ may be indicated.

Answer 44

root resecton

Question 45

- severe bone loss - close root proximity - inability to perform home care - strategic tooth - root fracture - unable to treat with endo - DEEP grade 2 & grade 3

Answer 45

root resection

Question 46

Root resection failure reasons (most to least common)

Answer 46

1. root fracture 2. periodontal 3. endodontic 4. cement washout

Question 47

- severe bone loss on retained roots - unable to do endo on retained root - fuse roots apical to furcation - poor plaque control - mobile teeth - long root trunk length - poor medical health - economics/cost - age - type of periodontitis

Answer 47

Contraindication to root resection

Question 48

T/F: Success of implants was 97% at 13 years where as root resection success was 96.8% at 15 years

Answer 48

True

Question 49

T/F: Regeneration is usually done on Class I and Class II shallow

Answer 49

True