Furcation involvement perio

1. Furcation
Involvement and
Treatment

2. What is Furcation?
The furcation is the area located between individual root
cones and it refers to the anatomic area of a multirooted
tooth where the roots divide or diverge from the common
root trunk.

3. What is Furcation involvement?
 The term Furcation involvement refers to the
invasion of the bifurcation and trifurcation of multi-
rooted teeth by periodontal disease.
 Glossary of periodontal terms defines Furcation as
"the area of a multi-rooted tooth where the roots
diverge".
 It defines a furcation invasion as the "pathologic
resorption of bone within a Furcation”.

4. Terminology
 Root complex is the
portion of a tooth that is
located apical of the
cementoenamel junction
(CEJ) i.e., the portion
that normally is covered
with a root cementum.
 Root trunk
 Root cone

5. Diagnosis

6. Clinical diagnosis

7. Radiographic diagnosis

9. Glickman (1958)
Grade-I:
 Incipient or early stage of furcation involvement.
 Pocket is suprabony
 Radiographic changes are not usually found

10. Grade-II:
 can affect one or more of the furcation
of the same tooth
 Lesion is essentially a cul-de-sac, with
definite horizontal component
 Radiograph may or may not depict the
furcation involvement
Grade-III
 Bone is not attached to the dome of
the furcation
 Early grade III opening may be filled
with soft tissue and may not be visible
Grade-lV:
 Interdental bone is completely
destroyed
 Soft tissue is resided completely, so
furcation opening is clinically visible
 Tunnel exist between the roots

11. Etiology of furcation invasions
 Primary factor - Bacterial plaque
 Predisposing factors - Anatomical considerations
Root concavities
Enamel pearls and projections
Accessory pulp canals
Bifurcation ridges
Extension of inflammatory periodontal disease

12. Anatomic factors
1) Root trunk length and Entrance width
2) Root length
3) Root form
4) Interadicular dimension
5) Anatomy of furcation
6) Enamel projections

13. TREATMENT

14. Objectives
 Facilitate maintenance
 Prevent further attachment loss
 Obliterate furcation defects

15. The selection of therapeutic mode
varies with
A- The class of furcation involvement,
B- The extent and configuration of bone loss,
C- Other anatomic factors

16. Classes of treatment
Class I- incipient, furcation is not exposed
 Eliminate thick overhanging margins of restoration,
Cemento enamel pearls and facial grooves
 Odontoplasty and Recontouring
Class II- (shallow) horizontal component is involved
 Odontoplasty and Osteoplasty
This reduces the dome of the furcation and alters gingival contours to
facilitate the patient's plaque removal.

17. Class II (deep horizontal component)
 Reconstruction
 Root resection
 Hemisection
Class III
 Root resection
 Hemisection
 Tunnel preparation
Class IV
Extraction

18. SURGICAL TREATMENT
Root resection
Hemisection
Reconstruction
Extraction

19. Root resection
A root resection or amputation is done when
one of a tooth's damaged roots is removed while
keeping the healthy root or roots in place.
Indicated in :-
multirooted teeth with grade II to IV furcation
involvements

20. Which root to remove?
 Remove the root that will eliminate the furcation

21.  Remove the root that has greatest amount of bone
and attachment loss

25.  Remove the root with greatest number of anatomic
problems

27. Hemisection
 It is splitting of a two-rooted tooth into two separate
portions
 This process has been called bicuspidization or
separation as it changes the molar into two
separate roots.
 It is most likely to be performed on mandibular
molars with buccal and lingual class II or III
furcation involvements

29. Tunnel preparation

30. Regeneration
 Furcation defects with deep two-walled or significant
three-walled components may however be candidates
for regeneration procedures.
 These vertical bony deformities respond favorably to
a variety of other surgical procedures such as
debridement with or without membranes and bone
grafts.

35. Extraction