Furcations Flashcards
Where are furcations most prevalent
Svardstrom and Wennstrom
furcations are more prevalent in maxillary molars than mandibular molars.
Highest frequency was the distal aspect of max second molars, mesial aspect of second molars second most prevalent
What is a furcation fornix
The roof of the furcation
Nabers probe study for furcations
Eickholz and Kim - 3mm increments are a valid method for diagnosing furcations
Describe the HAMP classification
F0: No furcation involvement
F1: Probe can penetrate less than 3mm
F2: Furcation can be probed greater than 3mm but not through and through
F3: Through and through furcation involvement
Describe the Glickman Classification
Grade 1 - incipient suprabony lesion, no radiographic findings
Grade 2 - Furcation bone loss with a horizontal component, may be visible radiographically
Grade 3 - A through and through lesion that is filled with soft tissue so not clinically visible, visible radiographically
Grade 4 - through and through lesion that is clinically visible, radiographically visible
Describe the Tarnow Classification
Subclassifation of the Glickman classification measuring the vertical probing depth from the roof of the furcation
A: 0-3mm
B: 4-6mm
C: 7mm or more
What are the treatment options for furcation defects?
Nonsurgical debridement Surgical debridement Surgical exposure of the furcation Regeneration (GTR or EMD) Extraction Root Resection Tunnel Preparation
Is open/closed flap SRP effective in furcation lesions?
Cobb demonstrated less favorable response to SRP in molars with furcation involvement compared with those without furcation lesions and single rooted teeth.
Bower found that the furcation entrance is 1mm or less 81% of the time, and 0.7mm or less 58% of the time. THe typical Gracey curette is 0.75mm
Wylam found no significant difference between open and closed flap root planing
What are guidelines for root resection?
The tooth should be of critical importance to dental treatment, have enough attachment at present to function, no other cost-effective therapy is available, and patient has good OH
Tooth root that should be treated should eliminate the furcation, has the greatest periodontal bone loss, eliminates bone loss on adjacent teeth, has the most anatomical problems, would complicate future treatment the least. Most common tooth is the DB root of max first molar
What is the most successful treatment for HAMP grade 1, 2, 3, 4 furcations?
AAP 2015 consensus report
1: SRP, however regen can sometimes be helpful
2: Regeneration should be considered before resection or ext, membrane with bone graft and possibly EMD is more beneficial
3: favorable outcomes are limited
What factors influence the success of furcation treatment?
Bowers et all found poor response in smokers (62% chance of residual Grade II lesion vs non smokers at 14%)
increased distance between the roof of the furcation and the crest of the bone, increased distance between the roof of the furcation and the base of the defect, increased depth of the horizontal defect, and increased divergence of roots at the crest of the bone reduce the frequency of clinical closure.
Teeth with tunnel preparation and caries risk
Hellden et all found 25% caries rate
Feres et all only found caries risk in patients with previous root caries lesions
What anatomical factors are associated with furcation lesions?
Cementicles Restorations placed in the furcation Cementoenamel projections Intermediate bifurcation ridges Furcation and root concavities Accessory Pulp Canals Enamel Pearls
What percentage of molars have accessory canals in the furcation?
Gutmann found 28.4% of molars
29.4% of mandibular and 27.4% of maxillary molars
What is the frequency of cervical enamel projections?
Swan and Hurt found mandibular molars were 51%, while maxillary first molars were 13.6%
Roussa observed cervical enamel projections in 30% of the teeth examined
