Furcations
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Questions and Answers

What is the primary concern when exposed dentine is present in a furcation area?

  • It leads to deeper probing depths.
  • It increases the risk of sensitivity and root caries. (correct)
  • It complicates the probing process.
  • It creates aesthetic issues for the patient.

    • Which factor is NOT associated with the assessment of furcation during examination?

  • Probing depths and recession
  • Radiographic evidence of bone loss
  • Signs of gingival inflammation
  • Patient's aesthetic considerations (correct)

    • What is the role of the Nabers Probe in furcation examination?

  • To evaluate the sensitivity of exposed dentine.
  • To identify overhanging restorations.
  • To assess the aesthetic impact of gum recession.
  • To measure the depth and severity of the furcation involvement. (correct)

    • Which secondary factor could complicate the treatment of a tooth with a furcation?

    <p>All of the above</p> Signup and view all the answers

    What imaging technique is preferred for identifying bone loss in a furcation area?

    <p>Periapical radiograph</p> Signup and view all the answers

    What is the term used to describe the anatomical area where the roots divide in multi-rooted teeth?

    <p>Furcation</p> Signup and view all the answers

    Which of the following cannot present furcation involvement?

    <p>Single-rooted teeth</p> Signup and view all the answers

    What anatomical factor is NOT considered when assessing furcation involvement?

    <p>Cervical restoration margin</p> Signup and view all the answers

    Which classification factor is NOT directly associated with grading furcation involvement?

    <p>Patient's age</p> Signup and view all the answers

    Which treatment option is typically considered for furcation-involved teeth?

    <p>Surgical intervention</p> Signup and view all the answers

    What is the primary purpose of assigning a grade to a furcation involvement?

    <p>To assist in monitoring clinical findings</p> Signup and view all the answers

    Which of the following statements is true regarding furcations?

    <p>Variations can exist in the anatomy of furcation areas.</p> Signup and view all the answers

    What challenge does furcation involvement present to clinicians?

    <p>It complicates the assessment and management procedures.</p> Signup and view all the answers

    What characterizes Glickman Classification Grade I furcation?

    <p>Curvature of the concavity can be detected but not penetrated.</p> Signup and view all the answers

    In Glickman Classification Grade II, what is the probe's ability?

    <p>It partially enters the furcation but does not pass completely through.</p> Signup and view all the answers

    Which grade of Glickman Classification indicates that the furcation is completely visible due to gingival recession?

    <p>Grade IV</p> Signup and view all the answers

    What is the primary consideration regarding root trunk length?

    <p>It indicates the distance from the cementoenamel junction to the furcation entrance.</p> Signup and view all the answers

    Enamel pearls are characterized as:

    <p>Extensions of enamel beyond the cementoenamel junction in an apical direction.</p> Signup and view all the answers

    What is a primary challenge for clinicians managing teeth with furcations?

    <p>Accessing and cleaning the furcation effectively.</p> Signup and view all the answers

    How does interradicular dimension influence furcation assessment?

    <p>It affects the degree of separation and diverging number of roots.</p> Signup and view all the answers

    What can be a significant impact on patients with a furcation involvement?

    <p>Increased risk of periodontal disease progression.</p> Signup and view all the answers

    What is the primary factor affecting the success of root separation surgery?

    <p>Length and shape of roots</p> Signup and view all the answers

    Which factor is not considered essential for the success of root resection surgery?

    <p>Length of the non-affected roots</p> Signup and view all the answers

    Which of the following is critical when monitoring a tooth with furcation involvement?

    <p>Grade and record furcation</p> Signup and view all the answers

    Which condition does not influence consistent plaque control?

    <p>Patient's age</p> Signup and view all the answers

    What should be considered if furcation progression occurs?

    <p>Referring to a periodontal specialist</p> Signup and view all the answers

    What is a primary objective in the treatment of teeth with furcation involvement?

    <p>Maintain function of the tooth</p> Signup and view all the answers

    Which of the following is NOT considered a treatment option for a tooth with furcation involvement?

    <p>Regular dietary adjustments</p> Signup and view all the answers

    What type of surgery is designed to use barrier membranes to facilitate the growth of new tissue and bone?

    <p>Guided Tissue Regeneration</p> Signup and view all the answers

    Which method is specifically mentioned for optimal plaque control in patients with furcation involvement?

    <p>Using an interdental brush</p> Signup and view all the answers

    What is one possible further treatment option for advanced furcation involvement?

    <p>Root Separation</p> Signup and view all the answers

    Which of the following factors complicate the treatment of furcation involvement?

    <p>Access difficulties for clinicians</p> Signup and view all the answers

    Which surgical procedure involves both removal of tooth substance and remodeling of alveolar bone?

    <p>Furcation Plasty</p> Signup and view all the answers

    What is an important aspect of patient education in the management of furcation involvement?

    <p>Understanding optimal oral hygiene practices</p> Signup and view all the answers

    What condition primarily affects the bone structure surrounding multi-rooted teeth in periodontal disease?

    <p>Furcation involvement</p> Signup and view all the answers

    Which imaging modality is commonly used for a detailed assessment of furcation involvement?

    <p>Cone-beam computed tomography (CBCT)</p> Signup and view all the answers

    Which characteristic is least likely to be identified during the clinical examination of furcation involvement?

    <p>Absence of periodontal pockets</p> Signup and view all the answers

    What is a common treatment modality for managing teeth with furcation involvement?

    <p>Osseous surgery</p> Signup and view all the answers

    Which classification system is used to categorize the severity of furcation involvement?

    <p>Glickman classification</p> Signup and view all the answers

    What bacterial factor is most commonly associated with furcation involvement?

    <p>Porphyromonas gingivalis</p> Signup and view all the answers

    Which of the following factors contributes most to the complexity of treating furcation-involved teeth?

    <p>Anatomical variation of the furcation</p> Signup and view all the answers

    Which clinical sign is least likely associated with furcation involvement in periodontal assessments?

    <p>Pulp vitality</p> Signup and view all the answers

    Study Notes

    Furcations

    • Furcation is the anatomical area where the roots of a tooth divide.
    • A furcation defect involves bone loss at the branching point of the tooth's roots.
    • Furcation defects only occur on multi-rooted teeth, not single-rooted teeth.
    • The lecture aims to help students recognize the clinical presentation of a furcation-involved tooth, understand its impact on the patient, and identify available treatment options.

    Learning Outcomes

    • Define the term "furcation."
    • Identify the challenges for patients and clinicians in managing furcation.
    • Consider anatomical factors impacting furcation assessment and treatment.
    • Explain assessment measures and classification for furcations.
    • Discuss treatment options for furcation-involved teeth.
    • Understand the role of dental hygienists/therapists in furcation treatment.

    What is a Furcation?

    • A furcation defect is the loss of bone at the point where the roots of a tooth diverge.
    • Clinicians should consider which teeth are multi-rooted.

    Key Anatomical Features of a Tooth with Furcation Involvement

    • Root Complex: The overall structure of the roots.
    • Root Trunk Length: The distance from the cementoenamel junction to the entrance of the furcation.
    • Root Cones Length: The length of individual root parts.
    • Fornix: The space between the roots.
    • Inter-radicular Bone Level: The level of bone between the roots.
    • Bone Loss: The amount of bone lost due to periodontal disease.
    • Divergence: The angle at which the roots spread apart.

    Different Types of Multi-Rooted Teeth

    • Analyzing different multi-rooted teeth provides various perspectives on assessing the furcation area.
    • Understand the variations in root morphology.

    Grading According to Clinical Presentation

    • The amount of bone loss and gingival recession help determine the severity of furcation involvement and the numerical grading.
    • Grading is essential for proper recording and monitoring of clinical findings.

    Furcation Index (Glickman 1953)

    • A classification system for furcation defects.
    • This system categorizes the severity of bone loss in a furcation defect.
    • The Grades are I, II, III and IV.

    Glickman Classification - Grades I, II, III, IV

    • Grade I: Probe curvature can be detected, but the probe tip cannot enter the space between the roots.
    • Grade II: Probe penetrates into the furcation, but does not pass completely through to the other side.
    • Grade III: Probe passes completely through the furcation; the furcation defect is clinically unobvious.
    • Grade IV: Probe passes completely through the furcation, while the furcation entrance is visible due to gingival recession.

    Furcation Indices Universally Accepted

    • Glickman (1953)
    • Hamp, Nyman, and Lindhe (1975)
    • Lindhe (1983)
    • Tarnow and Fletcher (1984)

    Root Trunk Length

    • The distance from the cementoenamel junction to the furcation entrance.
    • This factor should be considered in the context of tooth morphology.

    Root Length

    • Overall length of the tooth root influences treatment.
    • This factor bears importance in the context of tooth morphology.

    Interradicular Dimensions

    • The space between the roots.
    • The degree of separation of the roots affects treatment.
    • Consideration of interradicular dimensions should be made for tooth morphology.

    Cervical Enamel Projections/Enamel Pearls

    • Enamel projections extending beyond the cementoenamel junction(CEJ).
    • These should be considered during furcation assessments.

    Challenges for Patients/Clinicians

    • Patients with furcation defects may experience unsightly smiles or difficulty cleaning the area.
    • Clinicians may face access and treatment challenges due to root morphology or anatomical variations.

    Impact on the Patient

    • Unsightly smile (for some)
    • Food packing
    • Difficulty with cleaning
    • Exposing dentine/Sensitivity
    • Possible root caries
    • Impact on prognosis

    Examination/Assessment Following Furcation Identification

    • Examine/assess gingival tissues for inflammation, probing depths and recession.
    • Obtain radiographs
    • Gather patient concerns/history
    • Evaluate secondary factors.

    Instruments for Debridements

    • Use of power-driven scaler, and specific instrument types (depending on clinician personal choice).
    • The practitioner must be aware that not all furcation areas are the same, meaning instruments must be chosen accordingly to each case.

    Initial Treatment Options

    • Patient education and motivation is key
    • Oral hygiene coaching for optimal plaque control
    • Non-surgical periodontal therapy
    • Careful monitoring

    Restorative Treatment Options

    • Endodontic therapy
    • Periodontal surgery
    • Possible restorative treatment

    Further Treatment Options (Referring for Surgery Options)

    • Guided Tissue Regeneration(GTR)
    • Guided Bone Regeneration(GBR)
    • Root Resection
    • Root Separation
    • Furcation Plasty

    Furcation Plasty

    • Removal of tooth substance(Odontoplasty)
    • Alveloar bone remodeling(osteoplasty) at the furcation defect entrance

    Guided Tissue/Bone Regeneration Surgery

    • The use of barrier membranes to guide new bone and gingival tissue growth.

    Root Separation Surgery

    • Sectioning the root complex and maintaining all roots.
    • Success depends on root length and shape, root divergence, stability, successful RCT, and thorough plaque control by patient

    Root Resection Surgery

    • Sectioning and removing one or more roots.
    • Success depends on the length, stability and amount of support of root and a successful RCT. Effective plaque control.

    Conclusion: Tooth with Furcation Involvement

    • Monitoring is essential for managing further furcation progression.

    Importance of Monitoring a Tooth with Furcation

    • Record and grade furcation.
    • Repeat assessments at appropriate recall intervals.
    • Reinforce oral hygiene instructions

    Prognosis

    • Consider general periodontal status, patient age, plaque control, smoking habits, and bruxism when determining prognosis.

    Furcation Lecture: Summary

    • Carefully examine furcation areas when performing a periodontal examination.
    • Inform, educate, and advise the patient.
    • Select and implement the correct treatment modality for the furcation.
    • Monitor the furcation and refer to a periodontist if furcation progession occurs (progression/worsening of furcation).

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