Clinical Parameters

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Clinical Parameters

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• Furcation Recession
• Mobility

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Learning Outcomes
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Furcations Clinical Considerations

• May or may not be clinically exposed
• Bifurcation 2 rooted tooth
• Trifurcation 3 rooted tooth
• Radiographs may aid diagnosis
• Suspect furcation involvement when pockets
  measure 5-6 mm
• Increased risk for root caries, root resorption,
  recession sensitivity, pulp involvement, abscess
  formation

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Furcations

• Extension of bone loss between roots of teeth
• Teeth with furcation involvement are high risk
  for continued attachment loss
• Detection of furcation faciliated by using a
  specially designed furcation probe

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Probing Furcations

• No. 2 Nabers furcation probe a narrow Michigan
  O periodontal probe
• Move probe towards location of the furcation
  curve into furcation area

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Probing Furcations

• Access to furcations
• Mesial surface max. molars
• Best to approach from palatal direction b/c
  mesial furcation is palatal to midpoint of mesial
  surface
• Distal surface of max. molars
• Located more towards midline
• Detected from buccal or palatal approach

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Probing Furcations

• Most common site mand. First molar
• Least common site max. first bicuspid

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Furcations Classification, Characteristics,
Treatment
Furcation Characteristics Treatment Options
Grade I Initial involvement, may penetrate area up to 3 mm Slight bone loss Suprabony pockets No radiographic changes Perio debridement Odontoplasty
Grade II Bone lost on one or more aspects, gt 3 mm but not through through Horizontal depth varies Vertical bone loss possible Possible radiographic visibility Perio debridement Flap with odontoplasty osteoplasty Guided tissue regeneration (more success with mand. Molars) Root resection
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Furcations Classification, Characteristics,
Treatment
Furcation Characteristics Treatment Options
Grade III Interradicular bone absent Access on fa/li blocked by gingiva Through through Radiographically visible Perio debridement Flap procedure Odontoplasty Root resection hemisection
Grade IV Interradicular bone absent Clinically visible Through through Radiographically visible Debridement Flap surgery
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Furcations

• Slimline access

• Radiographic assessment

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Root Resection Hemisection

• Root resection
• Performed on vital or endodontically treated
  teeth
• Hemisection
• Splitting of two rooted tooth into two parts
• Following sectioning, one or both roots can be
  retained

• Classification

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Mobility

• Risk factor for PD
• Measure extent, determine cause
• Normal physiologic movement not graded
• Degree of mobility not always correlated to
  amount of bone loss

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Causes of Mobility

• Mobility may be related to
• Trauma from occlusion
• Loss of periodontal support
• Gingival inflammation
• Pregnancy hormonal changes
• Periodontal surgery
• Minor mobility can usually be maintained
• Increasing mobility more frequent PMT and/or
  referral for surery

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Classification of Mobility

• Nomenclature used varies across systems
• Class I etc.
• Grade I etc.
• I mobility etc.
• Grade 1 etc.
• 1, 2, 3

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Classification of Mobility

• Nnormal physiologic mobility
• Grade Islight mobility, up to 1 mm of horizontal
  displacement in a facial-lingual direction
• Grade IImoderate mobility, gt 1 mm of horizontal
  displacement
• Grade IIIsevere mobility, greater than 1 mm of
  movement in any direction (horizontal vertical)
• Nield-Gehrig Houseman, 1996
• Mobility can be measured using 2 instrument
  handles

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Recession

• Disturbance to the gingiva results in an apical
  shift of the gingiva margin
• Actual recession
• Level of the epithelial attachment on tooth
• Apparent recession
• Level of the crest of the gingival margin

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Etiology of Gingival Recession

• Causes
• Mechanical trauma hard brush, vigorous
  technique
• Crown margins
• Periodontal disease
• Occlusal trauma
• Defects in bone

• Causes
• Trauma from teeth in opposing jaw
• Oral habits, oral piercing
• Poorly designed partial dentures
• Tooth position
• Healing response following periodontal surgery

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Gingival Recession

• Toothbrush Trauma

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Gingival Recession

• Trauma from denture

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Gingival Recession

• Oral Piercing

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Gingival Recession

• Orthodontics

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Gingival Recession

• Prominent Roots

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Gingival Recession

• Frenal Attachment

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Symptoms/signs

• Client usually complains of
• Sensitivity
• Aesthetics
• Complications
• Increased sensitivity
• Loss of tissue from root surface (erosion,
  abrasion) protective cementum removed
• Caries
• Greater risk for PD greater surface area for
  plaque retention

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Treatment Options

• Depends on cause
• Nonsurgical treatment includes
• Debridement
• Oral self-care instruction
• Local medicaments for sensitivity

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Treatment Options

• Surgical treatment
• Laterally positioned flap
• Connective tissue graft