2. Definition
It can be defined as: an area of complex
anatomic morphology that may be difficult or
impossible to be debrided by routine
periodontal instrumentation.
4. Root TrunkRoot Trunk
Represents the undividedRepresents the undivided
region of the root.region of the root.
The height of the rootThe height of the root
trunk is the distancetrunk is the distance
between the CEJ and thebetween the CEJ and the
separation line betweenseparation line between
two root conestwo root cones
5. Furcation Entrance
Entrance:Entrance: thethe
transitional areatransitional area
between thebetween the
undivided and theundivided and the
divideddivided part ofpart of
the rootthe root
Fornix:Fornix: the roof ofthe roof of
the furcationthe furcation
6. Furcation Entrance Diameter
How does the furcation
entrance diameter relate to
the blade width of a new
curette?
– Blade width of new
Gracey curette = 0.75mm
– 60% of molar furcation
entrances < 0.75 mm
– Mandibular molars:
buccal wider than lingual
maxillary molars:
mesial > distal > buccal
11. Class I Incipient Furcation
This is an early lesion. The
pocket is suprabony,
involving the soft tissue.
There is slight bone loss in
the furcation area.
Radiographic change is not
usual since bone loss is
minimal. A periodontal
probe will detect root
outline or may sink into a
shallow V-shaped notch into
the crestal area
12. Class I Incipient Furcation
The level of bone loss
allows for the insertion
of the periodontal probe
into the concavity of the
root trunk
13. Class II Patent Furcation
In this, bone is destroyed
in one or more aspects of
the furcation, but a
portion of the alveolar
bone and periodontal
ligament remain intact,
permitting only partial
penetration of the probe
into the furca.
Radiographs may or
may not reveal this type
of furcation.
14. Class II Patent Furcation
The level of bone loss
allows for the insertion
of a periodontal probe
into the furcation area
between the roots.
15. Class III Communicating or Through
and Through Furcation
This type of probe
penetrates completely
from one side to the other
side characterized by
severe bone destruction in
the furcation area. It is
clearly shown in the
radiographs as a
radiolucent area in
between the roots,
especially in the lower
molars.
16. Class IV
As in Class III, but the
gingival tissues recede
apically so that furcation
is clearly visible.
24. Furcation Radiography
Should include both
periapical and bitewing
Location of the
interdental bone and
bone level within the
root complex should be
examined
25. Pulpal pathosis may some times cause a lesion
in the periodontal tissues of the furcation
Trauma from occlusion may cause
inflammation and tissue destruction within the
interradicular area of a multirooted tooth
Differential Diagnosis
26.
27. Objective of Treatment
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.
28. Non-Surgical Root Preparation
Scaling & root planing
– Most effective in grade I and shallow grade II.
– Deeper sites respond less favorably
29. In most situations, it
results in the resolution
of the inflammatory
lesion in the gingiva.
30. Antimicrobials
Adjunct to scaling and root planning
– Chlorhexidine
– Tetracycline fibers
No clinically significant difference in clinical
parameters after irrigation
31. Open Debridement
Greater calculus removal than closed
Ultrasonic
– Narrow furcations
– Dome of furcation
Surgical access and increased operator
experience significantly enhance calculus
removal in molar furcation.
32.
33. Osseous Surgery
Most effective in grade II furcation
Osteoplasty and ostectomy
techniques
– Remove the lip of defect to
reduce horizontal depth
– Bone ramps into the furcation to
enhance plaque control
– Reduce probing depths
34. Root Resection
Grade II or grade III Contraindications
– Inadequate bone
support
– Fused roots
– Inoperable
endodontically
– Patient considerations
35. Sequence of treatment at RSR
Endodontic treatment
Provisional restoration
RSR
Periodontal surgery
Final prosthetic restoration
36. Factors to be Considered
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
37. Hemisection
Mandibular molars
– Grade III furcation
– Need widely separated roots
– Soft tissue positioned below level of pulp
chamber
39. Root Separation
Root separation involves the sectioning of the
root complex and the maintenance of all roots
40. Grade III furcation
– Permits plaque removal
– Root caries (4% stannous
fluoride)
– 25% failure rate at 5 years
– Recurrent periodontitis
41. Regeneration of Furcation Defects
Guided tissue regeneration
Predictable outcome of GTR
therapy was demonstrated
only in degree II furcation
involved mandibular molars
less favorable results have been
reported in other types of
furcation defects
GTR could be considered in
areas with isolated degree II
furcation defects
42. Furcation Defects
Most predictable Mandibular or
Buccal Maxillary
Class II Furcations
Mesial or Distal
Maxillary Class II
Furcations
Class III Furcations
Least predictable
43.
44. Osseous Grafting
Autogenous bone
Allografts
– Freeze dried bone
– Demineralized Freeze dried bone
Alloplasts
– Hydroxyapatite
Non-porous
Porous
– Bioglass
45. Extraction
Attachment loss is so extensive that no root can
be maintained
If tooth/gingival anatomy will not allow proper
plaque control
For endodontic or restorative reason
Osseointegrated implant substitute
46. Prognosis
Hirshfeld and Wasserman. “A long term
survey of tooth loss in 600 treated periodontal
patients.” J Perio 1978
– 600 patients followed an average of 22 years
with recall every 4-6 months
– 1464 molars initially diagnosed with furcation
invasion
– 70% survival of furcated molars
47. Patients Factors
Determine patient`s goals and expectations
Screen for local, behavioral and systemic factors;
– Oral hygiene
– Compliance
– Stress
– Intraoral Accessibility
– Uncontrolled Diabetes
– Smoking
– Healing response to Previous Therapy