Podcast
Questions and Answers
What percentage of mandibular molars are reported to have furcation accessory canals?
What percentage of mandibular molars are reported to have furcation accessory canals?
What could cause an endodontic pathosis in the furcation region?
What could cause an endodontic pathosis in the furcation region?
How does the presence of furcation involvement affect the risk of tooth loss in molars?
How does the presence of furcation involvement affect the risk of tooth loss in molars?
What methods should be used to confirm the vitality of the affected tooth?
What methods should be used to confirm the vitality of the affected tooth?
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Which degree of furcation involvement is associated with the highest risk of tooth loss?
Which degree of furcation involvement is associated with the highest risk of tooth loss?
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What aspect of occlusion should be evaluated during the assessment process?
What aspect of occlusion should be evaluated during the assessment process?
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What did Nibali find regarding molars with grade III furcation involvement over a 5-15 year period?
What did Nibali find regarding molars with grade III furcation involvement over a 5-15 year period?
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How can pulpal inflammation affect the periodontium?
How can pulpal inflammation affect the periodontium?
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Why are straight rigid probes inappropriate for furcation assessment?
Why are straight rigid probes inappropriate for furcation assessment?
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Which aspect should the mesial furcation of maxillary molars be probed from?
Which aspect should the mesial furcation of maxillary molars be probed from?
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Which of the following statements about lower molars is correct?
Which of the following statements about lower molars is correct?
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What should be noted if there is bleeding or suppuration from the furcal area?
What should be noted if there is bleeding or suppuration from the furcal area?
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What indicates a Class III furcation exists?
What indicates a Class III furcation exists?
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Which factor may impede full probing of a furcation?
Which factor may impede full probing of a furcation?
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What should clinicians consider during diagnosis of furcation involvement aside from periodontitis?
What should clinicians consider during diagnosis of furcation involvement aside from periodontitis?
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What is the primary purpose of recording recession in periodontal assessment?
What is the primary purpose of recording recession in periodontal assessment?
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What characterizes Class 1 furcation defects according to Hamp et al 1975?
What characterizes Class 1 furcation defects according to Hamp et al 1975?
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Which subclassification of furcation lesions includes vertical probing depths of 4-6mm?
Which subclassification of furcation lesions includes vertical probing depths of 4-6mm?
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What is the primary focus of the classification by Hamp et al 1975 regarding furcation defects?
What is the primary focus of the classification by Hamp et al 1975 regarding furcation defects?
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What is the lowest survival rate for Class II furcation involved molars after ten years, according to Tonetti et al. 2017?
What is the lowest survival rate for Class II furcation involved molars after ten years, according to Tonetti et al. 2017?
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According to the guidelines, how should the vertical component of a furcation defect be measured?
According to the guidelines, how should the vertical component of a furcation defect be measured?
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What type of probe should be used for probing depths over 4mm during a basic periodontal examination?
What type of probe should be used for probing depths over 4mm during a basic periodontal examination?
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What subclassification of periodontal support is measured to the coronal third of the root length?
What subclassification of periodontal support is measured to the coronal third of the root length?
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What is the implication of vertical subclassification in furcation lesions as suggested by Tonetti et al. 2017?
What is the implication of vertical subclassification in furcation lesions as suggested by Tonetti et al. 2017?
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Which subclass of furcation involvement showed the lowest survival rate after ten years?
Which subclass of furcation involvement showed the lowest survival rate after ten years?
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What is the recommended treatment for class II and class III molars with residual deep pockets?
What is the recommended treatment for class II and class III molars with residual deep pockets?
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Which treatment option is combined with mechanical plaque control to yield a good prognosis for Grade I furcation involvement?
Which treatment option is combined with mechanical plaque control to yield a good prognosis for Grade I furcation involvement?
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What is the survival rate of grade I furcation involved molars treated non-surgically after 5–9 years?
What is the survival rate of grade I furcation involved molars treated non-surgically after 5–9 years?
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Which treatment is NOT identified for managing furcation involvement?
Which treatment is NOT identified for managing furcation involvement?
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Among the treatment options, which is recognized for improving access for patient cleaning in furcation areas?
Among the treatment options, which is recognized for improving access for patient cleaning in furcation areas?
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What percentage of furcation involved molars has reasonable survival rates between 4 to 30.8 years?
What percentage of furcation involved molars has reasonable survival rates between 4 to 30.8 years?
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What is considered a high probability of tooth loss in patients with furcation involvement?
What is considered a high probability of tooth loss in patients with furcation involvement?
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Study Notes
Classification of Periodontal Furcation Defects
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Hamp et al (1975) classification is most common
- Class 1: Horizontal loss of periodontal tissue support less than 3mm
- Class 2: Horizontal loss of periodontal tissue support over 3mm, but not through and through
- Class 3: A through and through defect
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Tarnow and Fletcher (1984) further subclassified furcation lesions:
- A: Vertical probing depth 1-3mm
- B: Vertical probing depth 4-6mm
- C: Vertical probing depth >7mm
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Assessment: Measure vertical component from CEJ or restoration margin to periodontal pocket base
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Radiographic Assessment: Evaluate horizontal bone loss from CEJ or restoration margin to alveolar crest
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Tonetti et al (2017) used a vertical subclassification based on remaining periodontal support (coronal, middle, apical third).
Clinical Assessment
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Basic Periodontal Examination (BPE) utilizes Nabers probe
- In probing depths >4mm, accurately identify furcation invasion
- Avoid straight probes, as they curve and underestimate furcation extent.
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In upper molars, probing from the palatal aspect is optimal for mesial furcation entrance.
- Distal entrance can be probed buccal or palatal.
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Buccal entrances on maxillary molars generally more accessible than mesial or distal.
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Lower molars have more accessible entrances than upper molars
Soft Tissue Implications
- Class III furcation defects may have soft tissue covering the bony defect, preventing full probe penetration.
Indices for Assessment
- Bleeding and suppuration in the furcation area should be noted.
- Plaque and bleeding scores track oral hygiene.
- Record recession and mobility
Sensibility Testing
- Periodontal disease is not the only cause of furcation involvement.
- Consider alternative diagnostic possibilities in differential diagnosis
Prognosis
- Nibali (2016) showed furcation involvement doubles the risk for molar loss over 5-15 years.
- Degree of furcation involvement is directly correlated to increased risk of loss.
Treatment Options
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Monitor and review for potential progression of bone loss.
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Non-surgical instrumentation/PMPR with micro-gracey and ultrasonic instruments.
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Surgical options, including access flap, resection of pocket epithelium, furcation plasty, and periodontal regeneration (EMD, bone graft, or membrane).
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Root resection or root separation.
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Consideration of extraction or replacement.
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S3 Guidelines emphasize optimal plaque control (<20-25%) before periodontal surgery.
Grade I Furcation Involvement
- Non-surgical periodontal treatment often effective and associated with good prognosis (Rasperini 2020, Huynh-Ba et al 2009.)
- High survival rate (>90%) after 5-9 years with NSPT.
- If site accessible and patient can maintain good oral hygiene, professional mechanical plaque removal is suitable (Class A1).
Grade II Furcation Involvement
- Regenerative surgery often preferred over resective options (Jepson 2019, Nibali 2020).
- Non-surgical options may be suitable for some Class II furcations, depending on vertical and horizontal extent.
Grade III Furcation Involvement
- Non-surgical treatment may not be predictably successful and tooth extraction may be needed (Nibali 2020).
- Decision for extraction vs implant or other dental treatment can be complex.
Tunnel Preparation
- A technique to improve access for cleaning difficult furcation areas (for Class II and Class III defects in mandibular molars)
- Requires maintaining some bone support over roots.
- Important consideration of caries prevention.
Open Flap Debridement (OFD)
- A surgical technique to improve access for cleaning and debridement of furcation areas.
- Often effective in early-stage Class I/II furcations with good plaque control.
Root Amputation/Separation
- Root resection or separation may be indicated in molars where one root is severely compromised or when the entire root is not viable.
- Root separation often favored over resection for mandibular molars due to the generally shorter root trunk and greater bone support around the remaining roots.
Hemisection
- Outcomes for Hemisection are mixed but not plentiful (Erpenstein).
- Significant bone loss or significant mobility of the retained root may negatively impact long-term survival.
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Description
Test your knowledge on the intricate details of furcation involvement in mandibular molars. This quiz covers factors affecting tooth loss, assessment methods for vitality, and the implications of occlusion on dental health. Perfect for students in dental hygiene or endodontics!
