A 28-year-old male patient reported to the
Department of Periodontology with chief
complaint of a dull pain in right lower back
teeth for past 10 days.
Pain –dull gnawing persistent pain
aggravates with mastication.
Extraorally – no abnormality of lymph nodes
and TMJ detected
Intraorally Oral hygiene was fair
No soft tissue abnormality
Region of complaint- 46:
Bluish red localized inflammation of the gingiva with
exudate. Probing depth of 5mm buccally, 6mm
interdentally on mesial and 6mm on distal aspect.
Premature contacts were present wrt to 16 leading to
trauma from occlusion
Nabers probe was used to check for furcation involvement.
There was partial penetration of probe, did not pass through
Radiograph - radiolucency
involving the furcation wrt
46. Loss of mild crestal interdental bone mesially and
Widening of PDL space in the
inter-radicular region wrt 46.
Loss of lamina dura evident in
the roof of furcation –
Grade II furcation
Non surgical therapy ( scaling and root planing) was done
and patient was kept on maintenance for 1 month.
Occlusal correction done to correct trauma from
Patient recalled after I month for evaluation and treatment
Osseous defect debrided
Post op healing after 15 days
After 6 months
Radiographic picture after 6
50 year old female patient had reported to
the department of periodontology with the
chief complaint of deposits on teeth .
Patient was hypertensive , on medication.
Health check up was done one month
back and BP was 140/80.
Dental history- lower anterior teeth had been
extracted uneventfully 2 years back as
they were mobile and grossly decayed
On clinical examination
Extraorally – no abnormality of TMJ, lymph
Intraorallypoor oral hygeine
Generalized probing depth of more than 5mm
Grade I mobility in 36 associated with probing
depth of buccally 7mm, interdentally 9 mm
on distal and 7mm on mesial aspect.
Proximal caries on the mesial aspect.
36- Furcation involvement with nabers probe
– through and through involvement, not
Radiographically- loss of interdental bone
upto apical third wrt to distal root involving
On endodontic evaluation- Tooth was non
Chronic generalized periodontitis
Grade III for 36???
Non surgical periodontal therapy( scaling and
Root canal treatment for 36
Periodontal treatment for 36
Raising mucoperiosteal flap
Naber s probe – grade III
Placement of bone graft
A furcation is defined as the anatomic
area of a multirooted tooth where the
Furcation invasion refers to pathologic
resorption of bone within a furcation.
( American Academy of Periodontology, 2001)
GLICKMAN’S CLASSIFICATION 1953
• Incipient or early stage
• Soft-tissue lesion or pocket extending
into flute of furcation
• Suprabony pocket
• Inter-radicular bone intact or slight
• Radiographic evidence of bone loss
usually not there
• Pocket formation & loss of inter-
radicular bone of varying depths into
the furcation but not through and
• Portion of PDL and bone remain
• ‘ Cul de sac’ with a horizontal
• Partial penetration of probe ;
Radiographs may or may not
depict involvement esp. in maxillary
• Complete loss of inter-
• Radiographic evidence--
• Pocket formation --
completely probable to
the opposite side of the
• Furcation not visible
clinically– occluded by
• Same as Grade III except that loss of periodontal attachment &
gingival recession -- furcation clearly visible to a clinical examination.
GRADE 2, 3 AND 4.
Tarnow & Fletcher (1984)
Takes into account vertical bone loss from roof of furcation apically
Subclass A: Vertical destruction to one third of the total inter
radicular height (3 mm or less).
Subclass B: Vertical destruction reaching two thirds of the inter
radicular height (4 to 6 mm).
Subclass C: Inter radicular osseous destruction into or beyond the
apical third (> 7 mm).
The buccal furcation entrance of maxillary
molars and buccal and lingual furcation
entrances of the mandibular molars are
normally accessible for examination using
either of the following:
a) A curved graduated periodontal probe
b) An explorer
c) A small curette
Probing of maxillary premolars often difficult due to
Flap explorative (surgical) procedure in the area
Distal furcation - located midway bucco-lingually -probing from both sides
Mesial furcations- located 2/3rd towards palate -probed from palatal aspect
Should include both paralleing periapical and vertical bite
Slight radiographic change in the furcation area should
be investigated clinically, esp if there is bone loss on
Diminished radiodensity in furcation area in which
outlines of bony trabeculae are visible suggests furcation
Whenever there is marked bone loss in relation to a
single molar root, it may be assumed that the furcation is
Three broad strategies of furcation therapy
(Kalkwarf & Reinhardt R.A 1988)
I. Maintenance of the existing Furcation
Scaling and root planing
Obstruction of Furcation
II. Increasing access to the Furcation
Gingivectomy/Apical positioned flap
III. Elimination of the Furcation
Root amputation/ resection
Recommended methods of
GTR at mandibular molars
Indications of surgical
A significant amount of horizontal involvement
of one or more furcations of multirooted teeth
Inability to adequately instrument the furcation
by scaling and root planing
Severe bone loss accompanying the furcation
which may require regenerative techniqiues
Carried out mostly in advanced grade II and
grade III and grade IV furcations
1.‘Cul de sac’ involvement of furcation according to Glickman’s classification of
2.The classification of furcation involvement based on vertical component was
Hamp and Co-workers
Tarnow and Fletcher
3.Which of following tooth furcation involvement has a better prognosis?
Maxillary 1st premolar
None of the above
4. The clinical probing of a furcation is done with the help of:
William’s graduated probe
UNC 15 probe
d. All of the above
5.The root most commonly removed in root resection procedure
in maxillary 1st molar is :
d. Any of the above
6.Probing of mesial furcation of maxillary molars is done from: