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Questions and Answers
What characterizes Grade I furcation involvement in the Glickman classification?
Which grade of furcation involvement indicates a 'through-and-through lesion'?
What is NOT a goal of treating furcation involvement?
In the context of Glickman classification, what does Grade IV indicate?
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What defines the early symptoms of Grade II furcation involvement?
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What is the primary goal of scaling and root planing in the treatment of FI Grade I?
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Which of the following procedures is specifically indicated for Furcation Involvement (FI) Grade II?
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What factor is NOT considered when determining the feasibility of root resection?
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What is the indication for performing a hemisection on a tooth?
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What is a contraindication for performing root resection?
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Study Notes
Furcation Involvement Classification
- Glickman Classification is based on the horizontal measurement of clinical attachment loss and bone deformity in the furcation
- Grade I is clinically not visible, early bone loss with increased probing depth, radiographic changes are not usually found
- Grade II is clinically not visible but has a cul-de-sac, radiographs may or may not depict the furcation involvement
- Grade III is clinically not visible or maybe slightly visible, a through-and-through lesion, radiographic display the defect as a radiolucent area in the crotch of the tooth
- Grade IV is clinically visible, a through-and-through lesion with gingival recession, radiographic display the defect as a radiolucent area in the crotch of the tooth
Treatment Goals
- Facilitate maintenance
- Prevent further attachment loss
- Obliterate the furcation defects as a periodontal maintenance problem
Treatment Classes
-
Grade I:
- Oral hygiene instruction
- Scaling and root planing
- Elimination of thick overhanging margins of restorations, facial grooves, or CEPs
-
Grade II:
- Scaling and root planing
- Furcationplasty (Odontoplasty and osteoplasty)
- Flap debridement
- Regeneration (Bone grafting, GTR)
- Root resection or Hemisection followed by RCT and crown
-
Grade III/IV:
- Scaling and root planing
- Flap debridement
- Regeneration (Bone grafting, GTR)
- Root resection or Hemisection followed by RCT and crown
- Extraction/implant placement
Non-Surgical Treatment
- Oral hygiene instruction and SRP may show significant improvement in some patients
- Use of additional cleaning aids like rubber tip and interdental brush
Furcationplasty
-
Prosedur:
- Flap dissection and reflection
- Cleaning of inflammatory tissue around the furcation
- Scaling and root planing
- Crown and root cleaning in the furcation area
- Odontplasty to eliminate or reduce horizontal defects and widen the furcation entrance
- Osteoplasty to reduce bone defects in the furcation area
- Flap repositioned and sutured
Root Resection
-
Indications:
- Multi-rooted teeth with Grade II-IV FI
- Important tooth for the overall treatment plan
- Adequate remaining attachment
- Good OH and low caries activity
- Unsuitable for other treatments
- Successful endodontic treatment with furcation involvement
-
Criteria for root selection:
- Eliminates the furcation and preserves tooth form
- Largest bone loss and attachment loss
- Eliminates periodontal problems
- Neighboring tooth has the least anatomical problem
- Easier periodontal maintenance
-
Factors to consider:
- Bone damage around one root
- Angulation and position of the tooth
- Divergence of roots
- Root length and curvature
-
Prosedur:
- Local anesthesia
- Probing around the root to be cut
- Mucoperiosteal flap
- Cutting the root with a cut bur
- Smoothing and contouring the cut root
- Scaling and root planing the root surface
- Flap repositioned and sutured
Hemisection
-
Prosedur:
- Local anesthesia
- Probing around the root to be cut
- Mucoperiosteal flap
- Dividing the root into mesial and distal parts
- Smoothing and contouring the cut root
- Scaling and root planing the root surface
- Flap repositioned and sutured
- Bicuspidization or separation of a molar into two parts
- Hemisection is the division of a two-rooted tooth into two separate parts.
Extraction
-
Indications:
- Inadequate plaque control
- High caries activity
- Inability to follow a maintenance program
- Socioeconomic factors that impede complex treatment
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Description
Test your knowledge on the Glickman Classification of furcation involvement, which evaluates bone loss and clinical attachment. Learn about the distinct grades of furcation involvement and the respective treatment goals necessary for effective periodontal maintenance.
