Recession and furcation Flashcards
What is recession?
Non inflammatory condition characterised by apical retreat of the periodontium (where ID papilla normally stays normal level)
Aetiology of recession?
Primary factor being presence of alv bone loss on facial tooth aspect
Fenestration- window of bone loss
Dehiscence- lack of bone
Can be due to trauma (Improper tbing)
What does recession look like clinically?
Look for ‘Stillman’s cleft: (V shape in gum)
‘McCalls festoons’ (gum has rolled margin)
What does McCalls festoon look like?
Gum has a rolled margin
What is generalised recession associated with?
Dentine hypersensitivity, root caries, toothbrush abrasion
What is localised recession?
usually on lower anteriors due to frenum pull
How do you monitor recession?
Clinical measurements (LOA and pocket depths) Use double perio chart
What treatment is there for recession?
Eliminate the causative factors: modify the toothbrush technique
Eliminate areas of mild chronic inflammation
Frenectomy (removal of frenum)
Treat any hypersensitivity (Fluoride, desensitising agents)
Prevent caries (good OH)
What is furcation involvement?
The horizontal loss of support in areas where roots of multi-rooted teeth converge.
How do you diagnose a furcation?
Radiographs and clinical exam
Radiographs- periapical/bitewing
Clinically- Soft tissue may be filling defect
What teeth are affected by furcation?
Maxillary 1st premolars (2 roots- mesial & distal)
Maxillary Molars- 3 roots (Mesial, distal, buccal)
Mandibular molars- 2 roots (buccal & lingual)
What are the grades of furcation?
1- horizontal loss of support1/3 width of tooth
3- through-through defect
What is the prognosis of a furcation?
A furcation reduces the prognosis for a tooth for 2 reasons: Furcation involvement is difficult to clean (so more difficult to control disease)
Loss of vitality of the tooth may occur due to accessory canals running from pulp into furc area (these act as a conduct tube for bacteria).
What is the vitality testing?
Using Ethyl Chloride or elective pulp tester
How often should you do a vitality test with a furcation present?
Every year
How often should you re-grade a furcation?
Every 6 months
What treatment for a furcation?
To either expose the furcation for access of cleaning
or Induce regeneration of new bone
What treatment do you use for a grade 1 furcation?
OHI, Scale, polish, RSD
Furcation plasty
What treatment do you use for a grade 2 furcation?
OHI, Furcation plasty, tunnel prep, GTR, root resection, extraction
What treatment do you use for a grade 3 furcation?
OHI, Exraction, tunnel prep, root resection.
What is furcation plasty?
It is for patients access for cleaning
Involves reflection of flap
Removal of deposits and soft tissue from furc
Remove tooth substance to widen the entrance
+/- recontour bone
Replace flap
What problems can arise with furcation plasty?
Hypersensitivity, damage to pulp, root caries.
