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Perio II > Furcations Part 1 and 2 > Flashcards

Furcations Part 1 and 2 Flashcards

1
Q

what are the goals of furcation therapy

A
  • arrest the active disease
  • prevent further loss of attachment
  • regenerate lost periodontium
  • prevent disease reocurrence
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2
Q

what are the objectives of furcation therapy

A
  • access for home care
  • access for maintenance
  • establish physiologic bone and titssue architecture
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3
Q

what are the ways to classify furcations

A
  • goldman- incipient or glickman - grade 1
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4
Q

what is goldman incipient or glickman grade 1

A

pocket formation into the flute of the furca but the inter radicular bone is intact

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5
Q

what is goldman cul de sac or glickman grade II

A
  • 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
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6
Q

what is goldman through and through or glickman grade III

A

complete loss of inter radicular bone with pocket formation allowing probe to pass completely to the other side

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7
Q

what is glickman grade IV

A

loss of attachment and gingival recession that has made the furcation clearly visible to clinical exam

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8
Q

what is Hamp (75)

A

classification of the horizontal component of furcation involvement

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9
Q

what is hamp degree 1

A

horizontal loss less than 3mm

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10
Q

what is hamp degree 2

A

horizontal loss greater than 3mm but not the total width of furcation area

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11
Q

what is hamp degree 3

A

through and through

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12
Q

what is tarnow classification

A

classification of the vertical component of furcation involvement

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13
Q

what is subclass A tarnow

A

vertical loss up to 1/3 of furca (1-3mm)

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14
Q

what is subclass B tarnow

A

vertical loss up to 2/3 of furca (4-6mm)

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15
Q

what is subclass C tarnow

A

vertical loss into the apical third (greater than 7mm)

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16
Q

what furcation involvement automatically places patient into stage III or stage IV periodontitis

A

grade/class II or grade/class III furcation

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17
Q

what are the 2 ways to dx by clinically probing the furcations

A
  • 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
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18
Q

what is the nabers probe used for

A

used to detect furcations

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19
Q

where are the furcation entrances for maxillary molar

A
  • 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
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20
Q

what is the probing, radiographic dx for maxillary molars

A

-3% dx by probing alone
- 22% dx by radiographs alone
-65% diagnosed using both clinical and radiographs

21
Q

what is the probing, radiographic dx for mandibular molars

A

-9% dx by probing alone
- 8% dx by radiographs alone
-18% dx by both radiographic and clinical exam

22
Q

what are the grades of CEPs

A

grade I, II, or III depending on extension towards and into the furcation

23
Q

what is the incidence of CEPs

A

ranges from 17-33%
- mandibular second molar has the highest incidence
- asian populations have far higher incidence

24
Q

what are the implications of CEPs

A

epithelial attachment

25
Q

what is the percentage of CEPs on mandibular molars, max molars

A
  • 28.6% of mandibular molars
  • 1% of maxillary molars
  • associated with 90% of isolated furcation involvements
26
Q

what percentage of CEPs in molars

A

32.6%

27
Q

is there a relationship between CEPs and furcations

A

no

28
Q

what is the root trunk length of maxillary first molars

A
  • mesial: 3mm
  • facial: 4mm
  • distal: 5mm
29
Q

what is the root trunk length of mandibular first molars

A
  • buccal: 3mm
  • lingual: 4mm
  • also note the inclination of the mandibular molars is to the midline
30
Q

what is the surface area percentage of maxillary first molar

A
  • root trunk ( part of root from CEj to where root divides): 32
  • MB root: 25
  • palatal root: 24
    DB root: 17
31
Q

which root of the maxillary first molar is the most commonly removed

A

DB root

32
Q

what is the furcation root trunk length for maxillary 1st premolars

A

mesial: 8mm

33
Q

where are the furcation root concavities

A
  • 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
34
Q

where are furcal concavities on the mandibular molars

A

100% on the mesial root and 99% on the distal root

35
Q

where are the concavities on the maxillary frist molar furcal root surfaces

A
  • 94% on the MB (0.1-0.7mm) 31% on the DB (0.1mm) and 17% on the palatal root (0.1mm)
36
Q

what are the furcation entrance diameters

A
  • 81% are 1mm or less
  • 58% are 0.75 or less
  • width of new curette blade 0.75-1.25mm
37
Q

what percentage of furcations cannot be instrumented with hand instruments

A

58%

38
Q

describe the limited furcation entrance diameter

A
  • 58% are less than .75mm and 81% are less than 1mm
39
Q

what is the pulp interrelationship

A

incidence of lateral canals is 28% in furcation area

40
Q

what are bifurcational ridges (interradicular ridges)

A

73% of mandibular first moalrs have ridges in MD direction and 63% have ridges in BL direction

41
Q

pulpal status can affect:

A

periodontium by the way of lateral canals and apical foramen

42
Q

where are the bifurcation ridges

A

73% in MD, 63% in BL direction

43
Q

what is the etiology of furcation bone loss

A
  • plaque (advancing plaque front)
  • developmental anomalies
  • iatrogenic
  • pulpal involvement
  • occlusal trauma
44
Q

what are the factors to consider before treatment

A
  • 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
45
Q

what are the treatment alternatives

A
  • extraction
  • scale and root plane
  • odontoplasty
  • flap debridement or osseous surgery
  • tunnel procedure
  • root resection
  • regeneration- class I and a shallow class II
46
Q

when would extraction be indicated

A

in cases of multiple furcated teeth

47
Q

when would you scale and root plane

A
  • 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
48
Q

what is odontoplasty and when is it indicated

A
  • 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
49
Q
A

Perio II (13 decks)

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