Furcation Management- Review Flashcards
Goals of furcation therapy:
- arrest active disease
- prevent further loss of attachment
- regenerate lost periodontium
- prevent disease reoccurrence
Objectives of furcation therapy:
- access for home care
- access for maintenance
- establish physiologic bone and tissue architecture
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)
True
Etiology of furcation bone loss:
- plaque (advancing plaque front 1mm from JE) attachment loss
- developmental anomalies (furcation concavities)
- Iatrogenic erros
- pulpal involvement (via lateral canals or endo-perio lesions)
- occlusal trauma
Diagnosis of furcations can be done using ____ as well as ____.
probes & radiographs
Type of probing that measures the VERTICAL attachment loss (extend of horizontal loss will not be detected)
standard “straight” probe
Type of probing that determines horizontal attachment loss:
Nabers “curved” probe
What is used to probe furcations?
nabers probe
If a mesial furcation is detected, where should the probe be placed to access it?
probe to access it from the palate
Location of furcation entrances for maxillary molars:
Mesial furcation:
Distal furcation:
Buccal furcation:
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
Most commonly used classifications for furcations:
Goldman and glickman
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)
Goldman: Incipient
Glickman: Grade 1
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
Goldman: Cul-de-sac
Glickman: Grade 2 (shallow and deep)
What treatment should be done for Goldman cul-de-sac or glickman grade 2?
Would need to reflect a flap because tissues is gong o be up to CEJ
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
Goldman through and through
Glickman Grade III
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
Glickman grade IV
In addition to Goldman and Glickman, what are the two other classification systems for furcations?
Hamp & Tarnow
Classification of the HORIZONTAL component of furcation involvement:
Hamp classification
Describe the following degrees of HAMP classification:
Degree 1:
Degree 2:
Degree 3:
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
Classification of the VERTICAL component of furcation involvement:
Tarnow
Describe the following subclasses of Tarnow classification:
Subclass A:
Subclass B:
Subclass C:
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)
Anatomical considerations for furcation management include:
- cervical enamel projections
- root trunk length
- furcation root concavities
- furcation entrance diameter
- pulpal interrelationship
- bifurcational ridges
How common do we see cervical enamel projections (CEP)
17-33%
What teeth are most commonly effected by CEPs?
mandibular 2nd molars
What populations are most commonly affectedly CEPs?
asians
CEPs are classified into grade 1, 2, and 3 depending on:
extension towards and into the furcation
What classification of CEP is the most extended into the furcation?
grade 3
Implications of CEPs:
epithelial attachment (loss of epithelial attachment due to epithelium only being able to attach to enamel)
What is the recommended treatment for CEPs?
use high speed bur to remove enamel projection (then place fluoride)
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.
All statements true
81% of furcations are ____ in diameter
58% of furcations are ____ in diameter
less than or equal to 1mm
less than or equal to 0.75mm
What is the width of a new curette blade?
What does this mean?
0.75-1.25 mm
Therefore 58% of furcations cannot be instrumented with hand instruments
Pulpal status can affect the periodontium by ways of:
- lateral canals
- accessory canals
- apical foramen
T/F: incidence of lateral canals is 28% in the fraction area. Lateral canals can lead to perio endo
both statements true
T/F: Primary endodontic lesions with perio involvement have the best prognosis
false- with no perio involvment
Bifurcationial ridges/interradicular ridges are most commonly associated with:
mandibular 1st molar
MD> BL
Furcation treatment is based on:
grade of furcation
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
Grade I furcation
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
Grade II (shallow)
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
Grade II (deep)
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
Grade III
Odontoplasty may be indicated in:
Grade I and shallow Grade II furcations
When would a tunnel procedure be indicated?
deep grade II and grade III furcations
- Must have divergent roots and good patient homecare
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.
root resecton
- 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
root resection
Root resection failure reasons (most to least common)
- root fracture
- periodontal
- endodontic
- cement washout
- 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
Contraindication to root resection
T/F: Success of implants was 97% at 13 years where as root resection success was 96.8% at 15 years
True
T/F: Regeneration is usually done on Class I and Class II shallow
True
