DEEP DESCRIPTION OF FURCATION OF TOOTH ..CLASSIFICATION AND ITS CORRESPONDING MANAGEMENT HAVE BEEN DESCRIBED IN THIS PPT

1. FURCATION INVOLVEMENT AND
ITS MANAGEMENT
BY ,
FARZANA FATIMA NAFI
CRI

2. CONTENTS
Introduction-furcation definition
Etiology
Classification
Diagnosis
Treatment objectives
Procedures
Prognosis
Conclusion

3. DEFINITION
• By Glickman (1950): ommonly occuring condition in
which the bifurcation and trifurcation of multirooted
teeth are denuded by periodontal disease
• By Pichard (1965) : Bifurcation and trifurcation
involvements are common periodontal lesions which
occurs as a result of gingival inflammation and bone
resorption adjacent to and within the furca of multi
rooted teeth.
• Furcation is an area of complex anatomic
morphology that may be difficult or impossible to
debride by routine periodontal instrumentation.

4. ETIOLOGY OF FURCATION
Furcation involvement is not a separate
entity it is an invasion of periodontal
disease at the furcation level.

5.  Bacterial plaque
 Improper oral hygiene
 Age
 Dental caries
 Pulpal death
 Enamel projections
 Trauma from occlusion
ETIOLOGY OF PERIODONTAL
DISEASE

6. DIAGNOSIS
The following are to be recorded to evaluate
the degree of periodontal disease:
Probing pocket depth
Attachment loss
Furcation involvement- NABER'S PROBE
Radiograps - bitewing and periapcal

8. CLASSIFICATION
Based on Horizontal attachment loss :
→Glickman's Classification (1953)
→Hamp's Classification (1975)
•Based on Horizontal and Vertical components :
→Tarnow & Fetcher's classification (1984)
•Based on Combination & morphology of bone
deformity :
→Easley and Drennan's classification (1969)

9. GLICKMAN'S CLASSIFICATION
Glickman classified furcation involvement into
four grades as:
GRADE 1
GRADE 2
GRADE 3
GRADE 4

10. HAMP ET AL CLASSIFICATION
Hamp et al classied the furcation involvement imto three
degrees as:
Degree 1:
Horizontal loss of periodontal support not exceeding
1/3 of the width of the tooth.
Degree 2:
Horizontal loss of periodontal support more than 1/3 of
the width of the tooth bit not exceeding the overall width.
Degree 3:
Horizonta through and through loss of periodontal
support.

11. Grade 1:
Early stage of furcation
Incipient lesion
No radiographic changes
Grade 2:
Cul-de-sac with definite horizontal
component
Portion of bone remains in furcation area

12. Grade 3:
Bone is not attached to dome of furcation
Complete loss of interradicular bone
Radiolucency is seen
Grade 4:
Attachment loss and gingival recession
Probe passes through and through
Clinically visible

15. TREATMENT
OBJECTIVES
Elimination of bacterial plaque
Establishment of an anatomy to facilitate
self-performed plaque control
Protection of further loss of attachment

19. TREATMENT MODALITIES
Surgical therapy
Non-surgical therapy

20. Non-surgical therapy
SRP
ORAL HYGIENE PROCEDURES
*Advancement in non-surgical procedures

21. SRP
Scaling and Root planning
Indicated in GRADE 1 AND EARLY
GRADE 2

22. ORAL HYGIENE PROCEDURES
Meticulous oral hygiene practice by the
patients
Use of interdental aids,proxa tooth
brushes

23. Surgical procedures
Furcationplasty:
Indicated in grade 2
Tooth substance is removed(odontoplasty)
and alveolar crest bone is
removed(osteoplasty) at the level of
furcation extrance.

24. Furcationplasty Procedure
Reflection of flap
Removal of inflammed tissues
SRP
Odontoplasty
Osteoplasty
Suturing

26. TUNNEL PREPARATION
Used to treat grade 2 and 3
Procedure:
Hard and soft tissue resection is done
Enough space is created to allow
interdental aids to pass through
Flap positionef apicaly
Exposed root surface is treated with
chlorhexidine digluconate

29. ROOT RESECTION AND
SEPARATION
Root sectioning-Sectioning and removal of
one or two roots in multirooted tooth
Root separation-Sectioning of root
complex and maintenance of all roots
Indicated in deep grade 3 and 4

33. EXTRACTION
Indicated in deep grade 4

34. PROGNOSIS
Non-surgical:
Grade 1- 99-100%
Grade 2- 95%
Grade 3- 25%

35. Surgical
*Furcationplasty
43-96% at the end of observation over a
period of 5 years
*Tunnel preparation
42-92% at the end of 5 years
GTR
62-100% at the end of 5 years

36. Resective procedures
62-100% after 5 years
Failures are due to improper Sectioning
and Endodontic procedures

37. CONCLUSION
To conclude treatment modalities holds
good for grade 1 and 2
Keys for success
Thorough diagnosis
Selection of patients with good oral
hygiene
Proper surgical procedures.