FURCATION

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FURCATION
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DEFFINITION

• The furcation is an area of complex anatomic
  morphology, that may be difficult or impossible
  to debride by routine periodontal instrumentation.

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Etiologic Factors

• bacterial plaque
• local anatomic factors (e.g., root trunk length,
  root morphology)
• local developmental anomalies (e.g., cervical
  enamel projections)

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Diagnosis

• clinical examination
• Careful probing (Nabors probe)
• Transgingival sounding

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Local Anatomic Factors

• Root trunk length
• Root length
• Root form
• Interradicular dimension
• Anatomy of furcation
• Cervical enamel projections

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Root Trunk Length

• The distance from the cementoenamel junction to
  the entrance of the furcation can vary
  extensively

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Anatomy of the Bony Lesions

• Pattern of Attachment Loss
• Horizontal bone loss can expose the
  furcation as thin facial/lingual plates of bone
• The treatment response in deep, multiwalled
  bony defects is different from that in areas of
  horizontal bone loss.
• Other Dental Findings

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Indices of Furcation Involvement

• Glickman's classification

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Grade I

• incipient or early stage
• pocket is suprabony
• primarily affects the soft tissues
• Early bone loss
• radiographic changes

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Grade II

• essentially a cul-de-sac
• definite horizontal component
• Radiographs may or may not depict the furcation
  involvement

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Grade III

• bone is not attached to the dome of the furcation
• periodontal probe completely through the
  furcation
• display the defect as a radiolucent area

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Grade IV

• interdental bone is destroyed
• soft tissues have receded apically
• furcation opening is clinically visible

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Other Classification Indices

• Hamp et al modified a three-stage classification
  system
• Easley and Drennan and Tarnow and Fletcher
• A
  B C
• vertical depth- 1-3mm 4-6mm
  gt7mm
• Furcations-IA,IB,IC
• IIA,IIB,IIC
• IIIA,IIIB,IIIC

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Treatment

• objectives of furcation therapy
• (1) facilitate maintenance
• (2) prevent further attachment loss
• (3) obliterate the furcation defects as a
  periodontal maintenance problem

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Therapeutic Classes of Furcation Defects

• Class I Early Defects
• oral hygiene, scaling,
  and root planing
• Class II
• Localized flap procedures with odontoplasty,
  osteoplasty, and ostectomy.
• GTR(Guided tissue regeneration)
• Classes II to IV Advanced Defects
• Periodontal surgery, endodontic therapy, and
  restoration of the tooth may be required to
  retain the tooth.

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Nonsurgical Therapy
Oral Hygiene Procedures
Scaling and Root Planing
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Surgical Therapy

• Osseous Resection
• Regeneration(GTR)
• Root Resection
• Hemesection
• Extraction
• Dental Implants

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Root ResectionProcedure
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Hemisection Procedure
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Dental Implants
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MCQ-1

• Which of the following author have described
  classification system that consider both
  horizontal and vertical attachment loss in the
  extent of furcation involvement
• (a)Glickman
• (b)Hamp
• (c) Nyman
• (d)Tarnow

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MCQ-2

• The furcation lesion have definite horizontal
  component,radiographs may or may not depict the
  furcation involvement
• (a)Grade I
• (b)Grade II
• (c)Grade III
• (d)Grade IV

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MCQ-3

• Which is the best treatment modality of isolated
  deep class II furcations
• (a)Scaling and Rootplaning
• (b)Odantoplasty and Osteoplasty
• (c)Flap debridement with osteoplasty and
  odantoplasty
• (d) Rootresection and Hemisection

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MCQ-4

• Which of the following have good candidates for
  regeneration procedure
• (a)Class I furcation
• (b)Class II furcaton
• (c)Class III furcation
• (d)Class IV furcation

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MCQ-5

• Which of the following probe is used for the
  diagnosis of furcation defects
• (a)U.N.C Probe
• (b)WHO Probe
• (c)CPITN Probe
• (d)Nabers Probe