Furcations Part 3 and 4 Flashcards
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 is extraction indicated
in cases of multiple furcated teeth preserving all of the molars may be impossible for several reasons. extractions with implants, or another prosthesis may be indicated
when would scaling and root planing be indicated
- 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 an odontoplasty and when is it indicated
-removing the roof of the furcation may improve patients access for plaque control. indicatd with grade I and shallow grade II furcations
- must be conservative or root sensitivity can result
- an option but rarely used
when is flap debridement/osseous surgery indicated
- significant reduction in effectiveness of non surgical subgingival plaque removal if pocket depth is greater than 3mm
- flap debridement would be more effective for furcation access
what are the indications for tunnel preparation
- creation of a furcation tunnel used with deep grade II and grade III furcations
- must have divergent roots and good pt home care
- disadvantage of caries, and pulpal issues
caries seen in ______ of 156 tunnels with rigoroud maintenance, fluoride, and CHX with ____ success
24%; 76%
what are the indications for root resections
- severe bone loss
- close root proximity
- inability to perform home care
- strategic tooth
- root fracture
- unable to treat involved tooth with endo but able to complete end within 2 weeks if vital root amputation
what is the indication for root resection
- 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
failures of root resection mainly due to:
root fracture
what are the possible causes of root resection failure
- root fracture
- endodontic
- cement washout
- periodontal
what are contraindications for root resection
- severe bone loss on retained roots
- unable to do endo on retained roots
- fused roots apical to furcation
- poor plaque control
- mobile teeth
- long root trunk length
- poor medical health
- economics
- age and type of periodontitis
for regeneration, osseous grafting success depends on:
morphology of the defect
why are furcations poor candidates for grafting
due to lack of vascularity
