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Transcript of Furction
Involvement and Treatment
Dr. Maria AlKhamis, MDS.
Invasion of bifurcation or trifurcation of multirooted teeth by inflammatory Periodontal diseases.
The furcation is an area of complex anatomic morphology that may be
to debride by routine periodontal instrumentation or keep it plaque free by routine home care.
The presence of furcation involvement can potentially lead to a
less favorable prognosis
for the affected tooth or teeth.
Local anatomical factors.
The anatomic region of a multirooted tooth where the roots diverge.
Degree of separation.
Tooth size; 1st > 2nd Molar.
3 Root Cones
3 Furaction entrance.
R. Trunk height; 1st < 2nd Molar.
Degree of separation and divergence
from 1st to 2nd molar.
Fenestration or dehiscence.
of the maxillary 1st premolars have 2 root cones.
Mesiodistal furcation at
middle or apical
third of root complex ( 8 mm apical to CEJ ).
Tooth size; 1st > 2nd molar.
2 Root Cones =
2 Furaction entrance.
R. Trunk height; 1st < 2ndMolar.
Clinical Examination is
to diagnosis and treatment planning.
Should include both periapical and bitewing views.
Location of the interdental bone and bone level within the root complex should be examined.
Truma from Occlusion.
The elimination of the microbial plaque from the exposed surfaces of the root complex.
The establishment of an anatomy of the affected surfaces that facilitates proper self-performed plaque control.
Non surgical treatment ; oral hygiene, scaling and root planning.
Reduce the inflammation in the gingiva.
Healing will reestablish a normal gingival anatomy with the soft tissue
to the hard tissue walls of the furcation entrance.
Scaling and Root Planning
It is a
resective surgical treatment
Reflection of a full thickness flap.
Removal of inflammatory soft tissue.
Odontoplasty to eliminate or
reduce the horizontal component of the defect and
to widen the furcation entrance.
Recontouring of the alveolar bone crest to reduce the buccal-lingual dimension of bone in the furcation area.
Positioning and suturing of the flap.
GTR at mandibular molars.
It is a technique used to treat deep degree II and III furcation defects in
divergence between the mesial and distal roots .
The procedure includes the surgical exposure and management of the entire furcation area of the affected molar.
During maintenance topical application of CHX and fluoride varnish should be done.
Surgical procedure should done with Caution to not increase tooth sensitivity and caries.
involves the sectioning of the root complex and the maintenance of all roots.
involves the sectioning and the removal of one or two roots of a multirooted tooth.
Can be done on
Root Separation and Resection
The length of the root trunk.
The divergence between the root cones.
The length and the shape of the root cones.
Fusion between root cones.
Amount of remaining support around individual roots.
Stability of individual roots.
Access for oral hygiene devices.
Factors to be considered
Teeth that are critically
to the overall dental treatment plan.
sufficient attachment remaining
Teeth for which a more predictable or cost-effective method of therapy is not available.
Teeth in patients with
good oral hygiene
and low activity for caries.
Root-resected teeth require endodontic treatment and usually cast restorations.
Indications of RSR
1- Endodontic treatment.
2- Provisional restoration.
4- Periodontal surgery.
5- Final prosthetic restoration.
Sequence of Treatment
Remove the root(s) that will
the furcation and
the production of a maintainable architecture on the remaining roots.
Remove the root with the
greatest amount of bone and attachment loss.
Remove the root with the
greatest number of anatomic problems.
Remove the root that
future periodontal maintenance.
Which root to remove?
Hemisection is the splitting of a two-rooted tooth into two separate portions – bicuspidization - .
Performe on mandibular molars with buccal and lingual degree II or III furcation involvements.
Extraction of teeth with through-and-through furcation defects and advanced attachment loss may be the most appropriate therapy for some patients.
Predictable outcome of Guided Tissue Regeneration therapy was demonstrated
only in degree II furcation involved mandibular molars.
Less favorable results have been reported in other types of furcation defects.
In past, hopeless long-term prognosis.
1- Thorough diagnosis.
2- Selection of Pt. with good oral hygiene.
3- Careful surgical and restorative treatment.
CARRANZA'S Clinical Periodontology, 10th edition, Ch. 68.
Clinical Periodontology and Implant Dentistry, 5th edition, Ch. 39.