Furcations medium

Furcation Anatomy

• Furcations present differently: LL6 and LL7 both have radiographic furcations but LL6 has more bone loss than LL7.
• Inter-radicular bone loss present.

Furcations and Anatomical Features

• Furcation index grade important to consider:
• Root trunk length.
• Root length.
• Interradicular dimensions.
• Cervical enamel projection and enamel pearls – can be found on radiographs.

Furcation Grading

• Glickman classification
• Grade 1: Probe can detect the curvature of the concavity between roots, but cannot enter the space.
• Grade 2: Probe penetrates the furcation, but doesn’t pass through to the other side.
• Grade 3: Probe passes completely through the furcation, but not clinically visible as soft tissue still fills the furcation defect.
• Grade 4: Furcation is clinically visible, the opening is large enough to expose the inter-radicular area.

Radiographic & Anatomical Features

• Radiographs can show root morphology, impacting treatment assessment.
• Root divergence – degree of separation between roots – measured in mm.
• Interradicular dimensions are the spaces between roots, which can be measured on radiographs.
• Cervical enamel projections and enamel pearls can be identified on radiographs and when probing.
• These can be difficult to clean and act as plaque retention areas which can increase risk of furcation involvement.

Furcation Impact on Patients

• Patient aesthetics: Furcation involvement can be unsightly, particularly with a broad smile.
• Challenging cleaning: Food packing, difficult to clean, sensitivity to exposed dentine, increased risk of root caries.
• Prognosis: Reduced prognosis, but often manageable with good patient care and intervention.

Furcation Assessment

• Assess gingival tissue: Look for signs of redness, swelling, inflammation, and suppuration
• Probing depths – select the right probe and record recession.
• Secondary local factors: Overhanging restorations, crown margins, calculus, accessory root canals.
• Radiograph assessment is essential to identify inter-radicular bone loss.

Furcation Assessment Tools

• Nabers probe: Curved, calibrated probe aiding accessibility for assessment.
• Peri apical radiograph: preferred for assessing furcations and bone as they are easier to reproduce and compare over time.

Furcation Treatments

• Primary goal: Prevent further attachment loss, maintain function of the tooth, and patient education on oral hygiene.
• Secondary local factors: Remove plaque, overhangs , calculus, excess cement.
• Specific oral hygiene advice: Utilize power flossing, interspace brushes, interdental brushes for access to the furcation.

Furcation Treatment Challenges

• Complex treatments: Often require specialist intervention with challenging access for both clinician and patient.
• Varied presentation: Different furcation involvement often needs specific, tailored treatment.

Furcation Treatment Considerations

• Accessory canals: If identified, can often indicate the need for Root Canal Therapy (RCT).
• Hand scalers: Specific curettes and power driven scalers are used to remove plaque and debris in the furcation.
• Patient education: Reinforce the importance of thorough oral hygiene to prevent further deterioration.

This quiz covers the anatomy and grading of furcations in teeth. It includes the Glickman classification system for assessing furcation involvement and highlights important anatomical features and radiographic findings. Test your understanding of inter-radicular bone loss and the implications for dental health.