Furcation Classes in Periodontal Disease

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Questions and Answers

What is the definition of Class I furcation?

Vertical loss of periodontal tissue support not exceeding 1/3 of the width of the tooth

Total destruction of the periodontal tissues in the furcation area

Horizontal loss of periodontal tissue support exceeding 1/3 of the width of the tooth

Horizontal loss of periodontal tissue support not exceeding 1/3 of the width of the tooth (correct)

What is the purpose of using graduated curved periodontal probes or explorers in clinical probing?

To measure the width of the tooth

To locate the entrance of the mesial furcation

To assess the horizontal loss of periodontal tissue support (correct)

To examine the buccal and lingual furcas of the mandibular molars

What is the characteristic of Class III furcation?

Horizontal loss of periodontal tissue support not exceeding 1/3 of the width of the tooth

Vertical loss of periodontal tissue support not exceeding 1/3 of the width of the tooth

Horizontal loss of periodontal tissue support exceeding 1/3 of the width of the tooth

Horizontal 'through and through' destruction of the periodontal tissues in the furcation area (correct)

What is the purpose of probing the mesial furcation from the palatal aspect of the tooth in maxillary molars?

To locate the entrance of the mesial furcation, which is closer to the palatal than to the buccal tooth surface Signup and view all the answers

What type of probes are used to examine the furcation area?

Naber probes Signup and view all the answers

What is the characteristic of Class II furcation?

Horizontal loss of periodontal tissue support exceeding 1/3 of the width of the tooth but not encompassing the total width of the furcation area Signup and view all the answers

What is the purpose of radiographic analysis in the diagnosis of furcation?

To confirm the findings of clinical probing Signup and view all the answers

What is the main purpose of root resection in teeth with deep degree II and III involvement?

To allow access to the furcation area for cleaning Signup and view all the answers

In root separation, which part of the tooth is maintained?

All roots of the tooth Signup and view all the answers

What is the definition of Class IV furcation?

Gingiva recession, exposing the furcation opening clinically Signup and view all the answers

What is the primary indication for tooth division?

Extensive furcation involvement of lower molars with similar bone loss around both roots Signup and view all the answers

What is the purpose of raising buccal and lingual flaps in root resection?

To access the furcation area for cleaning Signup and view all the answers

Why is it difficult to identify the presence and degree of furcation involvement in premolars?

Due to limited access for probing Signup and view all the answers

What is the instrument used to make the cut in root resection?

A tapered diamond bur Signup and view all the answers

What type of radiographs should be obtained to confirm findings made during probing of a furcation-involved tooth?

Both paralleling periapical and vertical bite-wing radiographs Signup and view all the answers

What is the outcome of tooth division?

A two-rooted molar is converted into two single-rooted teeth Signup and view all the answers

What may cause inconsistencies between findings from clinical probing and radiographs?

Superimposition of the palatal root and remaining bone structures Signup and view all the answers

What is the primary indication for hemisection?

Furcation involvement of lower molars with extensive bone resorption around one root Signup and view all the answers

What should be examined in radiographs to confirm findings made during probing of a furcation-involved tooth?

Both the interdental bone level and the bone level within the root complex Signup and view all the answers

What is the final step after hemisection?

The tooth will be crowned usually forming part of the bridge to replace the missing portion Signup and view all the answers

What is the importance of differential diagnosis in the treatment of a furcation-involved tooth?

To rule out other possible causes of the lesion Signup and view all the answers

What is the significance of testing the vitality of the affected tooth in differential diagnosis?

To rule out pulpal pathosis Signup and view all the answers

What is a possible cause of a lesion in the periodontal tissues of the furcation?

Either occlusal overload or pulpal pathosis Signup and view all the answers

When should the treatment of a furcation-involved tooth be initiated?

After a proper differential diagnosis of the lesion has been made Signup and view all the answers

What is the reason for performing tooth hemisection and root resection after flap elevation?

To prevent leaving 'over hangs' of the tooth substance behind Signup and view all the answers

What is the primary aim of GTR technique in treating furcation defects?

Formation of new connective tissue attachment Signup and view all the answers

What should be done to the root that will be retained in the place before root resection and hemisection?

Performing endodontic treatment Signup and view all the answers

What is the function of barrier membrane in GTR technique?

To guide the fibroblast cell of periodontal ligament to contact the root surface Signup and view all the answers

Why should the distal root of a 1st mandibular molar be maintained from the endodontic point of view?

It has a single wide root canal Signup and view all the answers

What is a factor to consider when selecting a root to be retained following root separation?

The amount of supporting tissues remaining around the various roots Signup and view all the answers

What is the type of bone graft that is transferred from one position to another within the same individual?

Autogenous bone graft Signup and view all the answers

What is the advantage of combining GTR with bone grafts?

It has some advantages over either technique used alone Signup and view all the answers

What is often a consideration when deciding which root to maintain in a 1st mandibular molar?

The periodontal aspect Signup and view all the answers

What should be done to the root canal of the root to be removed during endodontic treatment?

Making a small cavity at the entrance of the canal and packing it with amalgam Signup and view all the answers

What type of membrane is not resorbed by the body?

Non-resorbable membrane Signup and view all the answers

What is the type of graft that is taken from a donor of another species?

Xenograft Signup and view all the answers

What is a reason why root resection of maxillary 1st premolars is rare?

Due to the anatomy of the tooth Signup and view all the answers

What is the type of material that is used as a substitute for bone grafts?

Alloplastic material Signup and view all the answers

What is an important factor to consider when deciding which root to maintain in a multi-rooted tooth?

The stability of the individual roots Signup and view all the answers

What is the primary component of the newly formed connective tissue attachment in GTR technique?

Periodontal ligament fibers Signup and view all the answers

Study Notes

Furcation Involvement Classification

Class I (initial): horizontal loss of periodontal tissue (PD) support not exceeding 1/3 of the width of the tooth
Class II (partial): horizontal loss of PD tissue support exceeding 1/3 of the width of the tooth but not encompassing the total width of the furcation area
Class III (total) denotes horizontal “through and through” destruction of the PD tissues in the furcation area
Class IV: gingiva recession, exposing the furcation opening clinically

Diagnosis

Examination includes clinical probing and radiographic analysis
Probing: using graduated curved periodontal Probe, explorers or small curettes (Fig7)
Special furcation probes (Naber probes) are available with millimeter indications
Clinical examination of furcas on proximal tooth surfaces may be more difficult due to neighboring teeth and contact area
Mesial furcation should be probed from the palatal aspect of the tooth, while the furca in the distal surface is probed from either the buccal or the palatal aspect (Figs 7-8)

Radiographic Analysis

Radiographs must be obtained to confirm findings made during probing of a furcation-involved tooth
Examination includes both paralleling “periapical” and vertical “bite-wing” radiographs
Location of the interdental bone and bone level within the root complex should be examined (Fig9)

Situations of Inconsistent Findings

Clinical probing and radiographs may show inconsistent findings
Localized but extensive attachment loss within the root complex of a maxillary molar may not appear in the radiograph due to superimposition of the palatal root and remaining bone structures (Fig10)

Differential Diagnosis

A lesion in the inter-radicular space of a multi-rooted tooth may be associated with problems originating from the root canal or occlusal overload
Pulpal pathosis may cause a lesion in the periodontal tissues of the furcation
Vitality of the affected tooth must be tested to differentiate between plaque-associated and pulpal pathosis lesions

Treatment Options

Root resection/Separation: sectioning of the root complex and maintenance of all roots
Root resection: removal of one or more roots from a multi-rooted tooth to allow access to the furcation area for cleaning (Fig3.A)
Tooth division: indicated for extensive furcation involvement of lower molars where bone loss around both roots is similar
Hemisection: indicated for furcation involvement of lower molars where there is extensive bone resorption around one of the roots (Fig3C)

Factors in Selecting Root to be Retained

Amount of supporting tissues remaining around the various roots
Stability of the individual roots
Root and root canal anatomy with respect to endodontic and restorative treatment procedures
Periapical condition of the roots
Position of the various teeth (roots) in the alveolar process in relation to adjacent and opposing teeth
Oral hygiene of the patient
General health of the patient
Neighboring teeth should be healthy

Guided Tissue Regeneration (GTR) Techniques

Aim: formation of new connective tissue attachment consisting of periodontal ligament fibers embedded into bone & cementum
Barrier membrane adapted to fit over the defect & the root of the tooth to guide fibroblast cell of periodontal ligament to contact the root surface during healing (Fig4)
Membranes: non-resorbable and bioresorbable

Bone Substitute Materials or Bone Grafting

Autogenous bone grafting: grafts transferred from one position to another within the same individual
Allografts: grafts transferred between genetically dissimilar members of the same species
Xenografts: grafts taken from a donor of another species
Alloplastic materials: synthetic or inorganic implant materials used as substitutes for bone grafts
Examples: hydroxyapatite, tricalcium phosphate
Combinations of GTR with bone grafts have been shown to have some advantages over either technique used alone

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Description

Identify the different classes of furcation in periodontal disease, including Class I, Class II, and Class III. Understand the criteria for each class and their characteristics.