Furcations- Review Flashcards
Goals of furcation therapy include:
- arrest active disease
- prevent further loss of attachment
- regenerate loss periodontium
- prevent disease recurrence
Objectives of furcation therapy include:
- access for home care
- access for maintenance
- establish physiologic bone and tissue architecture
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
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
Diagnosis of furcations can be done using ____ as well as ____
probes; radiographs
Type of probing that measures the VERTICAL attachment loss (extent of horizontal loss will not be detected):
Standard “straight” probing
Type of probing that determines horizontal attachment loss:
Nabers “curved” probing
What is used to probe furcations?
Nabers probe
If a mesial furcation is detected, where should the probe be placed to access it:
palate
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
Most commonly used classification for furcations:
Goldman & Glickman
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
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)
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
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
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
In addition to Goldman and Glickman, what are two other classification systems?
Hamp & Tarnow
Classification of the HORIZONTAL component of furcation involvement:
Hamp classification
Classification of the VERTICAL component of furcation involvement:
Tarnow classification
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
Classification of the VERTICAL component of furcation involvement:
Tarnow
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)
Anatomical considerations for furcation management include:
- cervical enamel projections
- root trunk length
- furcation root concavities
- furcation entrance diameter
- pulpal interrelationship
- bifurcational ridges
How commonly do we see cervical enamel projections (CEP)?
17-33%
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:
- lateral canals
- accessory canals
- 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:
- root fracture
- periodontal
- endodontic
- 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
