Furcation Involvement in Dentistry

Furcations

• Furcation is the anatomical area where the roots of a tooth divide.
• A furcation defect, also called furcation involvement, refers to bone loss at the branching point of the roots.
• Furcation defects only occur in multi-rooted teeth, not single-rooted ones.

GDC Learning Outcomes

• Learning outcomes relating to furcation, including 1.2.3, 1.11.4, 1.11.5, and 1.8.2 are in effect.

Aim of the Lecture

• The lecture aims to cover the clinical presentation of a furcation-involved tooth.
• It also will discuss the clinical presentation's impact on the patient and available treatment options.

Learning Outcomes

• Students will be able to clearly define the term furcation.
• They will understand the challenges for patients and clinicians in managing furcation issues.
• Relevant anatomical factors affecting furcation assessment and treatment will be included.
• Students will also learn assessment methods and classification for furcations.
• Potential treatment options for furcation-involved teeth will be discussed.
• The role of dental hygienists (DH) and dental therapists (DHT) in furcation treatment will be addressed.

What is a Furcation?

• Furcation is the area where a tooth's roots divide.
• A furcation defect represents bone loss at this area.

Key Anatomical Features

• Features of a tooth with furcation involvement include the root complex, root trunk length, fornix, root cones length, inter-radicular bone level, and the amount of bone loss.
• Divergence between roots is an important consideration.
• Different types of multi-rooted teeth show variations in furcation areas, and therefore these variations should be noted.

Not all Furcations are the Same

• Different roots have varying anatomical features, especially in multi-rooted teeth.
• These differences need to be observed and assessed appropriately.

Glickman Classification of Furcations

• Graded by evaluating how far a probe can enter between the roots, noting the level of bone loss.
• Grade I: The probe can curve between the roots but cannot enter the space.
• Grade II: The probe can enter the furcation, but does not fully penetrate on both sides.
• Grade III: The probe can fully penetrate the furcation, but healthy soft tissue likely still fills the area.
• Grade IV: The probe can fully penetrate the furcation, and a visible defect is present because of gingival recession.

Furcation Indices

• Universal indices such as Glickman (1953), Hamp et al (1975), Lindhe (1983), and Tarnow & Fletcher (1984) are commonly used in evaluating furcation level.

Root Trunk Length

• Root trunk length is the length from the cement-enamel junction (CEJ) to the furcation entrance.
• Variation in root trunk length can affect the difficulty and approach to treatment.
• Short root trunks are often associated with early disease or involvement.
• Long root trunks might be harder for clinicians to access for instrumentation.

Root Length

• Root length impacts treatment decisions and options.

Interradicular Dimensions

• Interradicular dimensions describe the amount of space between the roots in the furcation area.
• Variations in the degree of root separation should be noted, as this can affect treatment planning.

Cervical Enamel Projections/Enamel Pearls

• Enamel pearls are extensions of enamel beyond the CEJ in an apical direction toward the furcation area.
• The impact of enamel pearls on furcation assessment should be considered.

Challenges for Clinicians/Patients

• Challenges include the patient's esthetics (unsightly smile), difficulties in cleaning/oral hygiene, food packing in the furcation area, dental sensitivity, possible impact on prognosis.

Assessment/Grading of the Furcation

• A Nabers probe is a tool used for furcation assessment and grading.

Examination & Recording of Furcation

• A thorough examination of the gingival tissues, including signs of inflammation, probing depths, and recession, should be performed.
• Correct examination and assessment are crucial in proper diagnosis.

Radiographic View

• Radiographic views (e.g., periapical X-rays) are important for diagnosing bone loss in furcation areas.
• X-rays should be considered as part of the overall evaluation.

Secondary Factors

• Secondary factors include restorations (overhanging), possible accessory canals, and calcification deposits.

Accessory Root Canal and Its Impact

• Accessory root canals often occur in the furcation area, adding complexity to treatment planning.

Multiple Challenges for Clinicians

• Treating patients with furcation issues presents complexities, including complex treatment options, potential specialist involvement, varied presentations, challenging access, and less favourable prognoses.

Treatment Options

• Initial treatments may include patient education, oral hygiene support, and non-surgical periodontal therapy.

Restorative Treatment Options

• Restorative options may include endodontic therapy, periodontal surgery, and appropriate restorative treatment techniques.

Further Treatment Options

• Surgical treatments, such as guided tissue regeneration (GTR), guided bone regeneration (GBR), root resection, root separation, and furcation plasty, might be necessary for specific cases and severe involvement.

Furcation Plasty

• Tooth and alveolar bone reshaping, addressing the furcation defect.

Guided Tissue Regeneration (GTR)

• Surgical procedure using membranes to promote bone and tissue regeneration.

Root Separation Surgery

• Root splitting allows for the removal of diseased areas, facilitating treatment.

Root Resection Surgery

• Surgical removal of affected root.

Conclusion

• A tooth with a furcation defect requires thorough evaluation of all aspects, including its identification, detailed diagnosis, and appropriate treatment considerations.

Importance of Monitoring

• Monitoring a tooth with a furcation defect, including regular assessments and maintaining good oral hygiene, is essential.

Prognosis

• Factors impacting prognosis include overall periodontal health, the patient's age, plaque control, smoking habits, and bruxism.

Summary of Lecture

• The lecture emphasizes the importance of careful examination, patient education, consideration of furcation-specific treatment modalities, and possible referral to specialists.