Furcation Involvement Quiz

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