Furcations- Review Flashcards by Annabella Moody

Goals of furcation therapy include:

arrest active disease
prevent further loss of attachment
regenerate loss periodontium
prevent disease recurrence

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Objectives of furcation therapy include:

access for home care
access for maintenance
establish physiologic bone and tissue architecture

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T/F: Grade/Class II or Grade/Class III furcation involvement automatically places a patient into stage III-IV peridontitis - according to 2017 AAP classification

True

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Etiology of furcation bone loss:

Plaque (advancing plaque front 1mm from JE) attachment loss
developmental anomalies (furcation concavities)
iatrogenic errors
Pulpal involvement (via lateral canals or endo-perio lesions)
occlusal trauma

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Diagnosis of furcations can be done using ____ as well as ____

probes; radiographs

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Type of probing that measures the VERTICAL attachment loss (extent of horizontal loss will not be detected):

Standard “straight” probing

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Type of probing that determines horizontal attachment loss:

Nabers “curved” probing

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What is used to probe furcations?

Nabers probe

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If a mesial furcation is detected, where should the probe be placed to access it:

palate

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Location of furcatino entrances for maxillary molars:

Mesial furcation:
Distal furcation:
Buccal furcation:

Mesial furcation: located towards palatal 1/3 so probe from PALATAL

Distal furcation: located in the mid 1/3 under contact point so probe from PALATAL or BUCCAL

Buccal furcation: probe from BUCCAL

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Most commonly used classification for furcations:

Goldman & Glickman

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Classify the following:

-Pocket formation into the flute of the furca, but the interradicular bone is intact

-Loss if attachment

-Bone loss is from buccal to lingual or palatal to buccal (not losing bone in a horizontal direction)

Goldman incipient
Glickman grade I

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Classify the following:

-Loss of interradicular bone with pocket formation of varying depths in to the furca, but NOT completely through to the other side
(Interraducular bone in tact)

-Can be shallow or deep

-Bone loss is starting to be lost horizontally

Goldman cul-de0sac or Glickman grade II (shallow & deep)

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What treatment should be done for Goldman cul-de-sac or Glickman grade II?

Would need to reflect a flap because tissue is going to be up to CEJ

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Classify the following:

-Complete loss of interradicular bone with pocket formation, allowing probe to pass completely to the other side

-AKA: Isolated root

-Soft tissue way may still be intact making it difficult to access and difficult for patient to clean

Goldman through & through or Glickman Grade III

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Classify the following:

-Loss of attachment and gingival recession that has made the furcation clearly visible to clinical examination

-accessible and visible to clinical examination due to soft tissue recession

Glickman Grade IV

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In addition to Goldman and Glickman, what are two other classification systems?

Hamp & Tarnow

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Classification of the HORIZONTAL component of furcation involvement:

Hamp classification

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Classification of the VERTICAL component of furcation involvement:

Tarnow classification

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Describe the following degrees of HAMP classification:

Degree 1:
Degree 2:
Degree 3:

Degree 1: less than 3 mm of horizontal loss

Degree 2: greater than 3 mm of horizontal loss but NOT all the way through

Degree 3: through and through

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Classification of the VERTICAL component of furcation involvement:

Tarnow

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Describe the following subclasses of Tarnow Classification:

Subclass A:
Subclass B:
Subclass C:

Subclass A: Vertical loss up to 1/3 of furca (1-3mm)

Subclass B: Vertical loss up to 2/3 of furca (4-6mm)

Subclass C: Vertical loss into the apical 1/3 of furca (>7mm)

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Anatomical considerations for furcation management include:

cervical enamel projections
root trunk length
furcation root concavities
furcation entrance diameter
pulpal interrelationship
bifurcational ridges

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How commonly do we see cervical enamel projections (CEP)?

17-33%

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What teeth are most commonly effected by CEPs?

Mandibular second molars

What populations are most commonly affected by CEPS?

Asians

CEPs are classified into grade I, II or III depending on:

Extension toward and into the furcation

What classification of the CEP is MOST extended in the furcation?

Grade III

Implications of CEPs:

Epithelial attachment (loss of epithelial attachment due to epithelium only being able to attach to enamel)

What is the recommended treatment for CEPs?

Take high-speed bur to remove enamel projection (then place fluoride)

T/F: 94% of the time on the MB surface of the maxillary first molar there is a concavity. 100% of the time on the mesial surface of the mandibular first molar there is a concavity

Both statements true

81% of furcations are _____ in diameter 58% of furcations are ____ in diameter

Less than or equal to 1mm Less than or equal to 0.75mm

What is the width of a new currette blade? What does this mean?

0.75-1.25mm Therefore 58% of furcations cannot be hand instrumented with hand instruments

Pulpal status can affect the periodontium by ways of:

1. lateral canals 2. accessory canals 3. apical foramen

T/F: Incidence of lateral canals is 28% in the furcation area. Lateral canals can lead to perio-endo

Both statements true

T/F: Primary endodontic lesions with perio involvement have the best prognosis

False- with NO PERIO INVOLVEMENT

Bifurcational ridges/Interradicular ridges are most commonly associated with:

Mandibular first molar MD > BL

Furcation treatment is based on:

Grade of furcation

List the grade of furcation based on the following treatment: -control of inflammation through plaque control & root preparation -adjustment of occlusion if indicated at re-eval -odontoplasty if indicated

Grade I furcation

List the grade of furcation based on the following treatment: -control of inflammation through plaque control and root preparation -adjustment of occlusion if indicated at re-eval -odontopalsty if indicated -flap debridement/osseous surgery or potential regeneration

Grade II (shallow)

List the grade of furcation based on the following treatment: -control of inflammation (difficult) -adjustment of occlusion if indicated at re-eval -flap debridement/osseous surgery -root resection -osseous regeneration -tunnel preparation -extraction

Grade II deep

List the grade of furcation based on the following treatment: -control of inflammation (difficult) -adjustment of occlusion if indicated at re-eval -flap debridement (difficult) -root resection -tunnel preparation -extraction

Grade III furcation

Odontoplasty may be indicated in:

Grade I and shallow grade II furcations

When would a tunnel procedure be indicated?

Deep grade II & grade III furcations *must have divergent roots and good patient homecare

If access for plaque control cannot be done in a furcation with severe bone loss on of the roots but good support on the possible remaining roots ____ may be indicated

Root resection

-severe bone loss -close root proximity -inability to perform homecare -strategic tooth -root fracture -unable to treat with endo -deep grade II and grade III

Root resection

Root resection failure reasons from most to least common:

1. root fracture 2. periodontal 3. endodontic 4. cement washout

-severe bone on retained roots -unable to do endo on retained root -fused roots apical to furcation -poor plaque control -mobile teeth -long root trunk length -poor medical health -economics/cost -age -type of periodontitis

Contraindications to root resection

T/F: Success of implants was 97% at 13 years whereas root resection success was 96.8% at 15 years

True

T/F: Regeneration is usually done on Class I and Class II shallow

True

According to Dr. Taos lecture, what is the acceptable perio maintenance recall interval in a patient with a history of periodontitis and ACCEPTABLE HOMECARE?

3 months

According to Dr. Thein's lecture, _____ % of Stage III-IV periodontitis patients are treated by general practicioners

66%

T/F: You should always quote fees of a specialist that you are referring a patient to in order to give the patient a better idea of the cost of treatment

False

According to Dr. Thein's lecture, what is the best way to make sure a patient goes through with referral to a specialist?

Help make the appointment for your patient with your staff, while the patient is still at your office

What is the main reason that you should refer your patient to a specialist?

It is the standard of care

T/F: You should keep your lines of communication open with your patients and the referral office, etc.

True

According to the 2017 AAP classification, which of the following is correct?

Peri-implantitis is a pathologic plaque-induced condition associated with inflammation and supporting bone loss that is IRREVERSIBLE

Which of the following is NOT defined by the 2017 AAP classification?

ailing failing implant

What is the prevalence of peri-implant mucositis in patients?

62.6%

What is the prevalence of peri-implant mucositis in patients?

28-51%

Patient presents with windows of exposed bone. What is this condition called?

Fenestrations