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Furction

Involvement and Treatment
by

Maria AlKhamis

on 8 April 2016

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Transcript of Furction

Furction
Involvement and Treatment
Treatment
Root Complex
Anatomic Terminology
and Consideration

Furcation:
Maxillary Molars
Maxillary Premolar
Interradicular Dimension
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
difficult

or
impossible
to debride by routine periodontal instrumentation or keep it plaque free by routine home care.

Furcation Involvement
The presence of furcation involvement can potentially lead to a
less favorable prognosis
for the affected tooth or teeth.

Bacterial Plaque
(Primary Factor)
.
Local anatomical factors.
Age.
Etiologic Factors
Root Trunk
Root Cones
The anatomic region of a multirooted tooth where the roots diverge.

Fornix
Entrance
Degree of separation.
Divergence.

Tooth size; 1st > 2nd Molar.
3 Root Cones

=
3 Furaction entrance.

R. Trunk height; 1st < 2nd Molar.
Degree of separation and divergence
decresed
from 1st to 2nd molar.
Fenestration or dehiscence.
40%
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.

Mandibular Molars
Furcation Probing
Diagnosis
Hamp Classification
(1975)
Differential Diagnosis
Radiographic Analysis
Clinical Examination is
the Key

to diagnosis and treatment planning.
Careful
probing
and
radiographic
analysis.
Nabers Probe.
Should include both periapical and bitewing views.
Location of the interdental bone and bone level within the root complex should be examined.

Pulpal Pathosis.
Truma from Occlusion.

Degree
I
Degree
III
Degree
II
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.
Treatment Objectives
Non surgical treatment ; oral hygiene, scaling and root planning.
Furcation plasty.
Treatment Options
Degree I:
Reduce the inflammation in the gingiva.
Healing will reestablish a normal gingival anatomy with the soft tissue
properly adapted
to the hard tissue walls of the furcation entrance.
Scaling and Root Planning
It is a
resective surgical treatment

associated with
odontoplasty
and
osteoplasty.

Procedure:
Furcation Plasty
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.
Furcation plasty.
Tunnel prepration.
Root resection.
Tooth extraction.
GTR at mandibular molars.

Degree II
Tunnel prepration.
Root resection.
Tooth extraction.

Degree III
It is a technique used to treat deep degree II and III furcation defects in
mandibular molars
with:
Short
root trunk.
Wide
separation angle.
long
divergence between the mesial and distal roots .

Tunnel Preparation
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.
Root separation
involves the sectioning of the root complex and the maintenance of all roots.
Root resection
involves the sectioning and the removal of one or two roots of a multirooted tooth.

Can be done on
vital
or
endodontically
treated teeth.
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
important
to the overall dental treatment plan.
Teeth have
sufficient attachment remaining

for function.
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.
3- RSR.
4- Periodontal surgery.
5- Final prosthetic restoration.
Sequence of Treatment
Remove the root(s) that will

eliminate
the furcation and
allow
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
complicates
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.

Hemisection
Extraction of teeth with through-and-through furcation defects and advanced attachment loss may be the most appropriate therapy for some patients.

Seeking
Implant-supported prosthetic
treatment plan.
Extraction
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.
Regeneration
Prognosis
In past, hopeless long-term prognosis.
Now, For
long prognosis
:
1- Thorough diagnosis.
2- Selection of Pt. with good oral hygiene.
3- Careful surgical and restorative treatment.
Thank You
References:
CARRANZA'S Clinical Periodontology, 10th edition, Ch. 68.
Clinical Periodontology and Implant Dentistry, 5th edition, Ch. 39.
Full transcript