Furcations Flashcards
Goals of Therapy
(4)
Arrest the active
disease
Prevent further
loss of attachment
Regenerate lost
periodontium
Prevent disease
reoccurrence
Objectives of Furcation Therapy
(3)
Access for home
care
Access for
maintenance
Establish
physiologic bone
and tissue
architecture
Overview of Furcation Therapy
(6)
Classification
Furcation anatomy
Diagnosis
Etiology
Treatment options
Long-term studies
Goldman-incipient or Glickman-Grade I
- Pocket formation into the flute of the
furca, but the inter-radicular bone is
intact
Goldman-cul-de-sac or Glickman-Grade II
(shallow and deep)
(2)
- 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
Goldman-through and through or
Glickman-Grade III
- Complete loss of inter-radicular bone
with pocket formation allowing probe to
pass completely to the other side
Glickman-Grade IV
- Loss of attachment and gingival
recession that has made the furcation
clearly visible to clinical examination
Hamp (75)-
classification of the horizontal
component of furcation involvement
Hamp
* Degree 1:
* Degree 2:
* Degree 3:
horizontal loss less than 3 mm
horizontal loss >3 mm but not the total
width of furcation area
through and through
Tarnow (84):
classification of the vertical
component of furcation involvement
Tarnow
* Subclass A:
* Subclass B:
* Subclass C:
vertical loss up to 1/3 of
furca (1-3 mm)
vertical loss up to 2/3 of
furca (4-6 mm)
vertical loss into the apical
third (>7mm)
Grade/Class II or Grade/Class III furcation
involvement automatically places patient into
Stage III or Stage IV Periodontitis.***
Clinically probing the furcations
* Standard “straight” probing:
* “Curved” probing (Nabers) with a curved
probe:
with a
straight probe only measures the vertical
attachment loss, and the extent of the
horizontal loss will not be detected
will determine the horizontal
attachment loss
Nabers Probe (used to detect
furcations)
Location of furcation entrances for maxillary molar
* Mesial furcation:
* Distal furcation:
* Buccal furcation:
toward palatal 1/3 so probe from
palatal
in mid 1/3 (under contact point) so
probe from palatal (or buccal)
from buccal!
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
3
22
65
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
9
8
18
Cervical Enamel Projections
* Grade I, II, III depending on …
Incidence ranges from —% from
various studies, (mandibular second molar
has highest incidence). Studies of Asian
populations have far higher incidence.
Implications of CEPs: (1)
extension
towards and into the furcation
17-33
epithelial attachment
Cervical Enamel Projections
Grade I, II, and III
Masters and Hoskins 64: –% of
mandibular molars, 1% of max molars;
associated with –% isolated furcation
involvements
Swan and Hurt 76: –% in molars
Lieb 67: no relationship between CEPs
and isolated furcation involvement
28.6
90
32.6
Root Trunk Length
Maxillary first molars
* Mesial: – mm
* Facial: – mm
* Distal: – mm
3
4
5
Mand. first molars
* Buccal: – mm
* Lingual: – mm
* (Also, note the
inclination of the
mandibular molars is
to the —)
3
4
midline
Surface Area of Maxillary 1st Molar
Component Surface Area %
Root trunk (part of root from CEJ to
where root divides):
Mesio-Buccal Root:
Palatal Root:
Disto-Buccal Root (most commonly
removed):
32
25
24
17
Furcation Root Trunk Length
Maxillary
Molars
Mesial:
Facial:
Distal:
3 mm
4 mm
5 mm
Furcation Root Trunk Length
Mandibular
Molars
Buccal:
Lingual:
3 mm
4 mm
Furcation Root Trunk Length
Maxillary 1st
Bicuspid
Mesial:
8 mm
Anatomical Considerations
Maxillary First Bicuspid furcation location
* — mm (Booker, 85)
Furcation Root Concavities
* Found 100% of time on mesial surface of
mandibular first molar and –% on distal
surface (Bower 79)
* Found –% on mesial-buccal, –% on
distal-buccal, and –% on palatal
surfaces of maxillary first molars
7.9
99
94, 31, 17
Furcal concavities on the mandibular molars
occur —% on the mesial root and —% on the
distal root
100
99
Concavities on the
maxillary first molar
furcal root surfaces:
–% on the mesio-
buccal,(0.1 -0.7mm)
–% on the distal-
buccal (0.1 mm) and
–% on the palatal
root (0.1mm) (C).
94
31
17
Furcation Entrance Diameter (Bower, 79)
–% are 1.0 mm or less
–% are 0.75 mm or less
81
58
Width of new curette blade
— mm
0.75-1.25
Therefore, –% of furcations cannot be
instrumented with hand instruments.
58
Limited furcation entrance diameter:
–% are less than .75 mm and –%
are less than 1.00 mm
58
81
Pulp interrelationship
* Incidence of lateral canals is –%** in
furcation area (Gutman, 78)
28
Bifurcational ridges (Interradicular
ridges)
* –% of mandibular first molars have
ridges in mesial-distal direction, and –%
have ridges in buccal-lingual direction
(Everett, 58)
73
63
— can affect
periodontium by way of lateral
canals and apical foramen
Pulpal status
Bifurcation ridges: –% in
mesial-distal, and –% in
buccal-lingual direction
73
63
Etiology of Furcation Bone Loss
(5)
Plaque (advancing plaque front-
Waerhaug, 80)**
Developmental Anomalies
Iatrogenic
Pulpal Involvement (via lateral
canals, endo-perio lesions)
Occlusal Trauma (Glickman)
