Treatment of Class II and III Furcations

Study Notes

Treatment Options for Class II and Class III Furcations

Dentists employ various treatments such as scaling and root planing (SRP), furcation plasty, guided tissue regeneration (GTR), tunnel preparation, root separation, root amputation, and extraction.

Evaluation and Diagnosis of Furcation Involvement

Diagnosis relies on radiographs showing a triangular shadow over the mesial and distal roots of maxillary molars indicative of Class II or III involvement.
Probing measurements are equivalent to surgical furcation measurements for accurate assessment.

Classification of Furcation Involvement

Class I Furca: Mild horizontal loss of periodontal support not exceeding 1/3 root width, often without radiographic evidence.
Class II Furca: Loss exceeds 1/3 but does not encompass the entire root width; may have a vertical component.
Class III Furca: Complete loss of periodontal support through furcation area.
Class IV Furca: Class III with visible furcation due to gingival recession.

Hamp, Nyman, and Lindhe Classification of Furcation Defects

Class I: Depth < 3 mm.
Class II: Depth ≥ 3 mm, typically over half of the bucco-lingual thickness.
Class III: Defect covers the entire tooth width with no attached bone at the furcation angle.

Tarnow and Fletcher’s Vertical Bone Loss Classification

Subclass A: Vertical loss of 0-3 mm.
Subclass B: Vertical loss of 4-6 mm.
Subclass C: Vertical loss of 7 mm or more.

Etiology of Furcation Involvement

Caused primarily by inflammatory periodontal disease and local anatomical factors.
Genetic predisposition, root anatomy, and factors such as trauma or previous dental work can contribute to involvement.

Cervical Enamel Projections (CEPs)

90% of isolated furcation involvements are linked to CEPs.
Notably, 30% of mandibular molars and 15% of maxillary molars have CEPs, influencing treatment options.

Importance of Root Morphology

Short root trunks lead to earlier furcation involvement; easier treatment but harder to maintain.
Consideration must be given to root separation, enhancing access and maintenance.

Scaling and Root Planing (SRP)

Effective for Class I furcations; involves removing plaque and calculus.
Closed techniques can leave behind deposits, necessitating further treatment if healing does not occur.

Limitations of SRP

Small furcation entrances and complex root morphologies pose challenges for complete cleaning.

Furcation Plasty

Aimed at improving access and maintenance for Class I and shallow Class II furcas by modifying tooth and bone structure.

Guided Tissue Regeneration (GTR)

Uses a membrane to promote healing by allowing only periodontal ligament and bone elements to grow into the defect.
Results are variable and less favorable in Class II and III furcations.

Tunnel Preparation

A technique for managing deep Class II and III defects, creating a tunnel for enhanced cleaning access.

Root Separation and Hemisection

Involves splitting a multi-rooted tooth for better access and cleaning.
Hemisection refers to either splitting the roots or completely removing one half of the tooth.

Root Resection

Involves removing a compromised root to maintain access to remaining roots; primarily used in deep Class II and III furcations.

Prognosis of Root Separation and Resection

Average failure rates between 3-40%, with primary reasons for failure including root fracture and periodontal attachment loss.

Extraction Criteria

Considered when attachment loss is extensive and the tooth cannot be maintained.

Long-term Prognosis of Furcation-Involved Molars

Average success rate post-treatment is approximately 75%.

Successful Patient Outcomes

Defined by function, ease of care, esthetics, comfort, and overall health.

Single Implants in Molar Regions

Success rate averages around 96%, highlighting their viability as an option following tooth loss.

Description

This quiz focuses on the treatment options and diagnostic criteria for Class II and Class III furcations. Key topics include various surgical techniques and how to evaluate furcation involvement using radiographs and probing. Mastering these concepts is essential for dental professionals dealing with periodontal issues.

Treatment of Class II and III Furcations

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Questions and Answers

What are the treatment options for Class II and Class III furcations?

What is used in radiographs to evaluate Class II or Class III furcation involvement?

Class I furca involves extensive horizontal loss of periodontal support.

What defines a Class II furca?

What occurs in a Class III furca?

What is the primary indication for using Furcation Plasty?

What is a limitation of SRP?

What is a key requirement for independent root separation in a tooth?

Grade I Cervical Enamel Projections (CEPs) extend into the furcation.

What is the average prognosis for furcation-involved molars following treatment?

Which classification describes a furcation defect encompassing the entire width of the tooth?

During GTR, a membrane is placed over the defect to isolate __________.