Furcations Part 1 and 2 Flashcards
what are the goals of furcation therapy
- arrest the active disease
- prevent further loss of attachment
- regenerate lost periodontium
- prevent disease reocurrence
what are the objectives of furcation therapy
- access for home care
- access for maintenance
- establish physiologic bone and titssue architecture
what are the ways to classify furcations
- goldman- incipient or glickman - grade 1
what is goldman incipient or glickman grade 1
pocket formation into the flute of the furca but the inter radicular bone is intact
what is goldman cul de sac or glickman grade II
- can be shallow or deep
- loss of inter radicular bone with pocket formation of varying depths into the furca, but not completely through to the other side
what is 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
what is glickman grade IV
loss of attachment and gingival recession that has made the furcation clearly visible to clinical exam
what is Hamp (75)
classification of the horizontal component of furcation involvement
what is hamp degree 1
horizontal loss less than 3mm
what is hamp degree 2
horizontal loss greater than 3mm but not the total width of furcation area
what is hamp degree 3
through and through
what is tarnow classification
classification of the vertical component of furcation involvement
what is subclass A tarnow
vertical loss up to 1/3 of furca (1-3mm)
what is subclass B tarnow
vertical loss up to 2/3 of furca (4-6mm)
what is subclass C tarnow
vertical loss into the apical third (greater than 7mm)
what furcation involvement automatically places patient into stage III or stage IV periodontitis
grade/class II or grade/class III furcation
what are the 2 ways to dx by clinically probing the furcations
- 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 attachment loss
what is the nabers probe used for
used to detect furcations
where are the furcation entrances for maxillary molar
- 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
what is the probing, radiographic dx for maxillary molars
-3% dx by probing alone
- 22% dx by radiographs alone
-65% diagnosed using both clinical and radiographs
what is the probing, radiographic dx for mandibular molars
-9% dx by probing alone
- 8% dx by radiographs alone
-18% dx by both radiographic and clinical exam
what are the grades of CEPs
grade I, II, or III depending on extension towards and into the furcation
what is the incidence of CEPs
ranges from 17-33%
- mandibular second molar has the highest incidence
- asian populations have far higher incidence
what are the implications of CEPs
epithelial attachment
what is the percentage of CEPs on mandibular molars, max molars
- 28.6% of mandibular molars
- 1% of maxillary molars
- associated with 90% of isolated furcation involvements
what percentage of CEPs in molars
32.6%
is there a relationship between CEPs and furcations
no
what is the root trunk length of maxillary first molars
- mesial: 3mm
- facial: 4mm
- distal: 5mm
what is the root trunk length of mandibular first molars
- buccal: 3mm
- lingual: 4mm
- also note the inclination of the mandibular molars is to the midline
what is the surface area percentage of maxillary first molar
- root trunk ( part of root from CEj to where root divides): 32
- MB root: 25
- palatal root: 24
DB root: 17
which root of the maxillary first molar is the most commonly removed
DB root
what is the furcation root trunk length for maxillary 1st premolars
mesial: 8mm
where are the furcation root concavities
- found 100% of time on mesial surface of mandibular first molar and 99% on distal surface
- found 94% on MB, 31% on DB, and 17% on palatal surfaces of maxillary first molars
where are furcal concavities on the mandibular molars
100% on the mesial root and 99% on the distal root
where are the concavities on the maxillary frist molar furcal root surfaces
- 94% on the MB (0.1-0.7mm) 31% on the DB (0.1mm) and 17% on the palatal root (0.1mm)
what are the furcation entrance diameters
- 81% are 1mm or less
- 58% are 0.75 or less
- width of new curette blade 0.75-1.25mm
what percentage of furcations cannot be instrumented with hand instruments
58%
describe the limited furcation entrance diameter
- 58% are less than .75mm and 81% are less than 1mm
what is the pulp interrelationship
incidence of lateral canals is 28% in furcation area
what are bifurcational ridges (interradicular ridges)
73% of mandibular first moalrs have ridges in MD direction and 63% have ridges in BL direction
pulpal status can affect:
periodontium by the way of lateral canals and apical foramen
where are the bifurcation ridges
73% in MD, 63% in BL direction
what is the etiology of furcation bone loss
- plaque (advancing plaque front)
- developmental anomalies
- iatrogenic
- pulpal involvement
- occlusal trauma
what are the factors to consider before treatment
- horizontal and vertical osseous support
- strategic value of the tooth
- involvement of multiple teeth
- support of retained roots
- length of roots
- degree of root divergence
- presence of sinus or external oblique ridge
- access for oral hygiene
- patients age and type of disease
what are the treatment alternatives
- extraction
- scale and root plane
- odontoplasty
- flap debridement or osseous surgery
- tunnel procedure
- root resection
- regeneration- class I and a shallow class II
when would extraction be indicated
in cases of multiple furcated teeth
when would you scale and root plane
- instrumentation is difficult due to furcation entrance diameter and furcation anatomy
- ultrasonics may be best modality for furcation instrumentation. no difference with grade I furcations but more effective in grade II and grade III
what is odontoplasty and when is it indicated
- removing the roof of the furcation may improve the patients access for plaque control
- indicated with grade I and shallow grade II furcations
- must be conservative or root sensitivity can result
- rarely used
