Furcations Oral and Dental Sciences PDF

Furca&ons Oral and Dental Sciences Miss Felix GDC Learning Outcomes 1.2.3/1.11.4/1.11.5/1.8.2 Aim of this lecture To recognise the clinical presenta8on of a furca8on involved tooth, the impact of this on the pa8ent and the subsequent treatment modali8es available Learning Outcomes By the end o...

Furca&ons Oral and Dental Sciences Miss Felix GDC Learning Outcomes 1.2.3/1.11.4/1.11.5/1.8.2 Aim of this lecture To recognise the clinical presenta8on of a furca8on involved tooth, the impact of this on the pa8ent and the subsequent treatment modali8es available Learning Outcomes By the end of the session student should be able to: DeBne the term furca8on Iden8fy the challenges for the for the pa8ent and clinician in the management of furca8on Consider the anatomical factors that impact assessment and treatment of furca8on's Explain the assessment measures and classiBca8on for furca8ons Discuss poten8al treatment op8ons for furca8on involved teeth Interpret the role of the DH/DTH in the treatment of a furca8on involved tooth "ARA furcation involvement" area where roots divide What is a Furca&on - Bone loss& branching point > - multi-rooted only teeth Furca&on is the anatomical area where the roots divide. Therefore, a furca&on defect (also called furca&on involvement) refers to bone loss at the branching point of the roots. Furca&on can only be present on mul8-rooted teeth, not single-rooted teeth. Consider which teeth are mul& rooted ? 876446784 876678 Tooth morphology lectures  PA L Nabers probe-rounded calibrated toz identifies furcation Key anatomical features of a tooth with furca&on involvement loss Bone space betweenrook I space between root Consider the diHerent types of mul& rooted teeth Consider and observe the diNerent teeth and therefore diNerence in the furca8on area. Review tooth morphology lectures Not all furca&on's are the same Not all furca&ons are the same Look at the radiograph and spot the diNerences in the anatomy of the roots shown in the image Divergence Look at the image of the three lower molars spot the calculus diNerences of the root paRern. Y inter-ridicular bone loss Not all furca&on’s are the same: varia&ons with anatomical features Consider the furca8on index grade given Root trunk length Root length Interradicular dimensions Cervical enamel projec8on and enamel pearls Grading according to the clinical presenta&on grading 1 -> 4 The amount of bone loss and gingival recession determines the severity of the furca8on and therefore the numerical index grade. Alloca8ng a grade assists in the recording and subsequent monitoring of such a clinical Bnding. Furca&on index Glickman 1953 Glickman ClassiQca&on – Grade I charting symbol Class I: Curvature of the concavity between the roots can be detected with the probe 8p but it cannot enter the space. -not seen radiographically Glickman ClassiQca&on – Grade II chartSymbol Class II: Probe penetrates into the furca8on but does not completely pass through to the other side. not always seen radiographical - may see climically -feel I probe Glickman ClassiQca&on – Grade III Class III: Probe passes completely through the furca8on but is not clinically visible because the soW issue s8ll Blls the furca8on defect. but - probe into furcation area through not completely - clinically visible + radiograhical Glickman ClassiQca&on – Grade IV ① severe Class IV: Probe passes completely through the furca8on and the entrance to the furca8on is clinically visible because of gingival recession. - visible clinically completely through - probe Furca&on indices universally accepted Glickman 1953 Further details given in the lecture Hamp, Nyman & Lindhe 1975 Lindhe 1983 Tarnow & Fletcher 1984  Root trunk length : The distance from the cement enamel junc&on to the entrance of the furca&on and root length horter s long - apices set split closer to L root cos & root trunk furcation may while s not howa Consider the impact of these particular morphological features Root length Periapical PA radiography Consider the impact of these par&cular morphological features Interradicular dimensions roofs "mm" - space between Consider the degree of separa8on/ diNerence of number of roots diverging. Every tooth is diNerent  extension of Cervical Enamel Projections/ Enamel Pearls enamel - 2" local factor - plague retentive Observe the EP = Extension of enamel beyond pearl like item in the furcation the CEJ in an apical direction towards furcation area O hard tissue can be seen on radiograph Consider the impact  root exposure Sensitivity = food stuguation - - difficult to clean halitosis - - - access o aids unsightly - What are the challenges for the pa&ent / clinician when there is a tooth with a furca&on? - plaque retentive - caries risk (root caries) not. Pt - Risk of perio if managed by What is the impact on the pa&ent when they have a tooth with a furca&on? Unsightly for pa8ents with a broad smile Food packing Di_cult to clean Sensi8vity with exposed den8ne / possible root caries Impact on prognosis A furca&on is iden&Qed during an examina&on, what next ? appearance Gingival &ssues correct all contribute probe Pa&ent Probing assessment concerns depth to your of frucation ! Assessment of Furca&on Secondary Recession factors Radiograph ross-chec e/clinically  40 ball end ! Assessment / Grading of the furca&on - no need for tactile - sensation. Using the Nabers Probe probe furcation 9630 us use nabers probe h arch after detecting furcation - BPE https://www.iperiopal.com/nabers-probe-left Examina&on and recording of a furca&on Clinical loss of Gingival 8ssues - -redress attatchment Signs of inbamma8on Probing depths Juctional epithelium records previous - Recession - g margin to. & Consider the clinical signs of gingival inflammation Radiographic view to iden&fy bone loss in a furca&on. very useful for management of furcations. Which is the preferred choice of less detail for periodontal use image ? Periapical Introduction into Radiography lecture  local Secondary factors related to the tooth with a furca&on zost u us Over hanging restora8on Crown margin Possible accessory root canal Calculus deposit  Accessory/ root canal and its impact An accessory canal represents a junc8on of the main pulp canals or the pulp chamber, which communicates with the root surface. Frequently iden8Bed in the furca8on area and then there is the need for Root Canal Therapy (RCT) Relevant study below SEM study of morphologyc and incidence of accessory canals in the furcation region of permanent molars] - PubMed (nih.gov) Mul&ple challenges for the clinicians trea&ng pa&ents who have teeth with furca&on involvement Complex treatment considera8ons May need specialist interven8on Variance in presenta8on and treatment needs Challenging access , hard to reach for clinician and pa8ent Less favourable prognosis compared to a tooth who furcation www.xinweidds.com/Professionals/Immediate+Implant/1+Category,+table/2+Lower/4+Molars/ 1st+Molars/30-Class-IV-Furca-Ni-FB/Spongy-Layer-of+Bone/02+IMG_2417_lingual.jpg Treatment op&ons for a tooth with a furca&on  (donotwase Furca&on Treatment Objec&ves important rean ! Removal of bacterial plaque/ bioBlm -keep calcul Removal of secondary local factors = supialsob overhangs I plaqueeve Prevent further aRachment loss main Maintain func8on of tooth Pa8ent educa8on - OHI  ↓v poor dexterity manual dexterity of Pt = water floss essential Oral hygiene coaching for the pa&ent - Optimal plaque control ID brushes is essential in the long term Specific oral hygiene advice Into furcation with interspace brush and or interdental brush. - single-tufted brush (site specific SpeciQc instruments for debridement use in furca&on Personal choice Some instruments speciBcally designed tips Power driven scaler assorted forcation - working ends -perio Remember furac8ons are not all the same What are the ini&al treatment op&ons? of maintains Pa8ent educa8on and mo8va8on - importance OH good Oral hygiene coaching support Non surgical periodontal therapy Debribmeit Careful and regular monitoring = Pt recall intra-oral photos grading radiographs study models , , , Restora&ve treatment op&ons RCT Endodon8c therapy - Periodontal surgery Possible restora8ve treatment  scope Further treatment op&ons Refer for surgery (Beyond our Guided Tissue Regeneration (GTR) Root Resection Guided Bone Regeneration (GBR) Root Separation Furcation Plasty  outcome = easier to clean + more accessible Furca&on Plasty dentine Odontoplasty - Tooth substance is removed bone Osteoplasty – alveolar bone is remodelled at furca8on entrance Tooth substance is removed (odontoplasty) and the alveolar bone crest is remodelled (osteoplasty)at the level of the furca8on entrance Guided Tissue Regenera&on Surgery / Guided Bone Regenera&on Surgery Guided bone regenera8on ( GBR) and guided 8ssue regenera8on (GTR) are dental surgical procedures that use barrier membranes to direct the growth of new bone and gingival 8ssue. More about that in periodontal surgery lectures Root separa&on surgery Separa&on – sec8oning of root complex and maintenance of all roots Success depends on : Length and shape of roots Divergence/ stability of the root Successful RCT Good plaque control by pa8ent Root resec&on surgery Resec8on – sec8oning & removal of one or more roots Success depends on Length and shape and stability of remaining root Amount of support on remaining root Successful RCT Good plaque control by pa8ent Conclusion : A tooth with furca&on involvement The importance of monitoring a tooth with a furca&on 1 - 4 clinical notes , photos, rad , Grade and record furca8on Charting Repeat at appropriate recall interval Reinforce OHI Of so important Interes8ng addi8onal reading ar8cle Management of Furca8on-Involved Molars: Recommenda8on for Treatment and Regenera8on - PubMed (nih.gov) hRps://pubmed.ncbi.nlm.nih.gov/32559031/  General periodontal status Age Bone loss - Consistent plaque control Smoking Bone loss - Bruxism - pressure from masticatory ferce , Review periodontal aetiology lecture Furca&on Lecture : Summary slide Consider the speciBcs of a careful examina8on of furca8on areas when comple8ng periodontal examina8on Inform / educate / advise the pa8ent Consider the relevant treatment modality for the furca8on Maintain and monitor If furca8on progression occurs consider periodontal specialist referral. Image references hRps://www.jaypeedigital.com/book/9789386261731/chapter/ch54 hRps://www.seman8cscholar.org/paper/Prevalence-and-microscopic-features-of-enamel-from-Kaminagakura-Salmon/5831b8c973d33078d36ddc98da13e1c600db3be9/Bgure/0 hRps://pocketden8stry.com/13-radiographic-assessment-and-interpreta8on/ hRps://pocketden8stry.com/62-furca8on-involvement-and-treatment/hRps://www.spiedigitallibrary.org/conference-proceedings-of-spie/8925/89250J/Reliability-of-CBCT-as-an- assessment-tool-for-mandibular-molars/10.1117/12.2045782.short?SSO=1 https://www.yumpu.com/en/document/view/41216763/classifications-of-furcation-involvement hRps://www.yumpu.com/en/document/view/41216763/classiBca8ons-of-furca8on-involvement hRps://www.yumpu.com/en/document/view/41216763/classiBca8ons-of-furca8on-involvement hRps://www.yumpu.com/en/document/view/41216763/classiBca8ons-of-furca8on- involvementhRps://ct-dent.co.uk/opg-xray-panoramic-orthopantomogram/ hRps://semmelweis.hu/parodontologia/Bles/2018/12/parA3osz2018-PZS-furca8on.pdf hRps://ct-dent.co.uk/opg-xray-panoramic-orthopantomogram/ hRps://www.sciencedirect.com/science/ar8cle/pii/S1013905219305048 hRps://www.mdpi.com/2304-6767/6/3/34/htm hRps://www.slideshare.net/FarzanaNaB/furca8on-involvement-and-its-management-108793588 hRps://aap.onlinelibrary.wiley.com/doi/10.1902/cap.2017.170007 hRps://oakhillsperiodon8cs.com/wp-content/uploads/2016/09/service_periodontal_8ssueregen1 hRps://www.slideshare.net/FarzanaNaB/furca8on-involvement-and-its-management-108793588 hRps://www.quora.com/Which-procedure-removes-a-root-from-a-mul8-rooted-tooth hRp://www.jnda.com.np/ar8cle/2ygmcpkyve2.pdf hRps://www.researchgate.net/Bgure/ProBle-and-overhead-view-of-the-singl-tuWed-brush_Bg1_51542663 hRps://www.slideshare.net/seyedehmarziehhashem/treatment-of-furca8on-involved-teeth-endodon8cs-and-periodon8cs hRps://www.hu-friedy.com/products/periodontal/cureRes/furca8onhRps://www.jaypeedigital.com/book/9789386261731/chapter/ch54 HRps://www.jaypeedigital.com/book/9789350250372/chapter/ch44 hRps://pocketden8stry.com/short-root-anomaly-in-an-orthodon8c-pa8ent-2/ hRps://www.medicinenet.com/root_canal/ar8cle.htm hRps://www.researchgate.net/Bgure/Representa8ve-pa8ent-A-Preopera8ve-view-of-mandibular-right-molar-with-class-3_Bg2_338045943