This document discusses furcation involvement, which refers to the progression of periodontal disease between the roots of multi-rooted teeth. It first defines furcation involvement and notes that it presents challenges for diagnosis and treatment. It then discusses the etiology of furcation involvement, including plaque-associated inflammation and pulpo-periodontal disease. It also describes Glickman's classification system for the horizontal component of furcation involvement, including four grades based on the amount of interradicular bone loss present. The presence of furcation involvement can indicate advanced periodontitis and affect the prognosis for the affected tooth.
The document discusses the endodontic-periodontal interrelationship. It begins by introducing how Simring and Goldberg first described this relationship in 1964. It then discusses the classifications of endodontic and periodontal lesions put forth by various studies. The document covers the anatomical considerations between the pulp and periodontium like apical foramina, lateral canals, and dentinal tubules which allow communication between the two tissues. It also discusses the etiological factors involved like bacteria, fungi, and viruses that can lead to endodontic or periodontal diseases.
This document discusses furcation involvement, including classifications, diagnosis, treatment options, and prognosis. It notes that furcation involvement indicates advanced periodontitis and poorer prognosis. Treatment depends on the grade of involvement and may include nonsurgical therapy like scaling and root planing, surgical approaches like furcation plasty, regenerative techniques like GTR, or extraction. Prognosis is best for grade I and II furcations treated nonsurgically or with furcation plasty, and poorer for grade III and IV furcations. Long-term success requires eliminating plaque, establishing anatomy to facilitate cleaning, and preventing further attachment loss.
Pathologic tooth migration (PTM) refers to tooth displacement resulting from a disturbance in factors that maintain normal tooth position. PTM is common in periodontal patients, with prevalence studies finding rates of 30-55%. The primary factor in PTM is periodontal bone loss resulting from periodontal disease. Other factors include occlusal changes from tooth loss, soft tissue pressures, oral habits, and periapical or gingival inflammation. Treatment involves periodontal therapy, sometimes with adjunctive orthodontics or prosthodontics, while prevention focuses on periodontal disease control and management of predisposing occlusal and habit factors.
This document discusses endo-perio lesions, which involve both the dental pulp and surrounding periodontium. It describes the various types of lesions, including primary endodontic, primary periodontal, endo-secondary perio, and perio-secondary endo lesions. It also discusses diagnostic factors, treatment approaches, and case studies involving endo-perio lesions from 2014 to 2020. The optimal treatment is described as endodontic therapy preceding periodontal treatment to support healing, with regenerative procedures and adjuncts like ozone gas showing promise.
1) The document discusses furcation involvement in multi-rooted teeth due to periodontal disease. It defines furcation defects and provides terminology to describe root anatomy involved in furcation defects.
2) Classification systems for furcation defects from Hamp and Glickman are presented, ranging from initial horizontal bone loss to complete bone loss exposing the furcation.
3) Diagnosis and treatment options for different degrees of furcation involvement are outlined, including furcation plasty, tunnel preparation, root separation/resection, guided tissue regeneration, and extraction.
The presentation shows the relation between the restorative dentistry and the periodontium , explaining the per-prothetic surgeries and the biological consideration including the biological width. Also, mention how to restore the open embrasures between teeth (the black triangle).
This document discusses supportive periodontal treatment (SPT). It outlines the goals and phases of periodontal treatment, including preliminary, non-surgical, surgical, restorative, and maintenance phases. SPT, also called periodontal maintenance therapy, involves procedures performed at regular intervals to help patients maintain oral health after initial periodontal treatment. The document emphasizes that SPT is important to prevent recurrence of periodontal disease by supporting patients' efforts to control infections through regular professional cleanings and monitoring. Compliance with the SPT recall system and maintaining good oral hygiene are also highlighted as important factors that influence disease progression risk.
AGGRESSIVE PERIODONTITIS
PRESENTER
DR. REBICCA RANJIT
DEPT. OF PERIODONTOLOGY & ORAL IMPLANTOLOGY
Why is there localisation of disease to 1st molars and incisors in LAP?
Often subjects present with attachment loss that does not fit the specific diagnostic criteria (AP or chronic periodontitis).
Schenkein et al. 1995: cigarette smoking was shown to be a risk factor for patients with generalized forms of AgP.
Smokers with GAP had more affected teeth and greater mean levels of attachment loss than patients with GAP who did not smoke.
IgG2 serum levels as well as antibody levels against A.a. are significantly depressed in subjects with GAP who smoked.
The document discusses the endodontic-periodontal interrelationship. It begins by introducing how Simring and Goldberg first described this relationship in 1964. It then discusses the classifications of endodontic and periodontal lesions put forth by various studies. The document covers the anatomical considerations between the pulp and periodontium like apical foramina, lateral canals, and dentinal tubules which allow communication between the two tissues. It also discusses the etiological factors involved like bacteria, fungi, and viruses that can lead to endodontic or periodontal diseases.
This document discusses furcation involvement, including classifications, diagnosis, treatment options, and prognosis. It notes that furcation involvement indicates advanced periodontitis and poorer prognosis. Treatment depends on the grade of involvement and may include nonsurgical therapy like scaling and root planing, surgical approaches like furcation plasty, regenerative techniques like GTR, or extraction. Prognosis is best for grade I and II furcations treated nonsurgically or with furcation plasty, and poorer for grade III and IV furcations. Long-term success requires eliminating plaque, establishing anatomy to facilitate cleaning, and preventing further attachment loss.
Pathologic tooth migration (PTM) refers to tooth displacement resulting from a disturbance in factors that maintain normal tooth position. PTM is common in periodontal patients, with prevalence studies finding rates of 30-55%. The primary factor in PTM is periodontal bone loss resulting from periodontal disease. Other factors include occlusal changes from tooth loss, soft tissue pressures, oral habits, and periapical or gingival inflammation. Treatment involves periodontal therapy, sometimes with adjunctive orthodontics or prosthodontics, while prevention focuses on periodontal disease control and management of predisposing occlusal and habit factors.
This document discusses endo-perio lesions, which involve both the dental pulp and surrounding periodontium. It describes the various types of lesions, including primary endodontic, primary periodontal, endo-secondary perio, and perio-secondary endo lesions. It also discusses diagnostic factors, treatment approaches, and case studies involving endo-perio lesions from 2014 to 2020. The optimal treatment is described as endodontic therapy preceding periodontal treatment to support healing, with regenerative procedures and adjuncts like ozone gas showing promise.
1) The document discusses furcation involvement in multi-rooted teeth due to periodontal disease. It defines furcation defects and provides terminology to describe root anatomy involved in furcation defects.
2) Classification systems for furcation defects from Hamp and Glickman are presented, ranging from initial horizontal bone loss to complete bone loss exposing the furcation.
3) Diagnosis and treatment options for different degrees of furcation involvement are outlined, including furcation plasty, tunnel preparation, root separation/resection, guided tissue regeneration, and extraction.
The presentation shows the relation between the restorative dentistry and the periodontium , explaining the per-prothetic surgeries and the biological consideration including the biological width. Also, mention how to restore the open embrasures between teeth (the black triangle).
This document discusses supportive periodontal treatment (SPT). It outlines the goals and phases of periodontal treatment, including preliminary, non-surgical, surgical, restorative, and maintenance phases. SPT, also called periodontal maintenance therapy, involves procedures performed at regular intervals to help patients maintain oral health after initial periodontal treatment. The document emphasizes that SPT is important to prevent recurrence of periodontal disease by supporting patients' efforts to control infections through regular professional cleanings and monitoring. Compliance with the SPT recall system and maintaining good oral hygiene are also highlighted as important factors that influence disease progression risk.
AGGRESSIVE PERIODONTITIS
PRESENTER
DR. REBICCA RANJIT
DEPT. OF PERIODONTOLOGY & ORAL IMPLANTOLOGY
Why is there localisation of disease to 1st molars and incisors in LAP?
Often subjects present with attachment loss that does not fit the specific diagnostic criteria (AP or chronic periodontitis).
Schenkein et al. 1995: cigarette smoking was shown to be a risk factor for patients with generalized forms of AgP.
Smokers with GAP had more affected teeth and greater mean levels of attachment loss than patients with GAP who did not smoke.
IgG2 serum levels as well as antibody levels against A.a. are significantly depressed in subjects with GAP who smoked.
Lower 3rd molar impaction,its assessment and the buccal approach vz the lingu...Waikhom Singh
The clinical and radiological assessment of lower 3rd molar impaction,as well as the comparison between the buccal approach and the lingual split technique of trans-alveolar extraction of impacted lower 3rd molar is illustrated..
This document discusses furcation involvement in multi-rooted teeth. It defines furcation as the anatomic area where tooth roots diverge, which can be difficult to clean. The document classifies furcation involvement into various grades based on the amount of bone loss and discusses clinical features, diagnosis, and various surgical treatment options like furcationplasty, tunneling, root resection, and guided tissue regeneration depending on the grade of involvement. Maintaining good oral hygiene is important for prognosis. The goal of management is to eliminate periodontal defects in the furcation area through various regenerative and resective procedures.
This document provides an overview of resective osseous surgery. It discusses the historical background, definitions, objectives, indications, and advantages/disadvantages of osseous surgery. It also covers normal alveolar bone morphology, bone destruction patterns in periodontal disease, and factors that determine bone morphology. Key aspects of the document include descriptions of osteoplasty, ostectomy, and the goals of resective osseous surgery to eliminate pockets and create a physiological bone contour.
Adjunctive role of Orthodontic Therapy in PeriodontologyNavneet Randhawa
This document summarizes the adjunctive role of orthodontic therapy in periodontology. Some key points:
- Orthodontic tooth movement can benefit adult patients by correcting tooth malposition that makes cleaning difficult and increases periodontal disease risk.
- Light, prolonged orthodontic forces can move teeth without damaging tissues if excellent oral hygiene is maintained. However, some tissue necrosis is unavoidable.
- Tooth movement through cortical bone can create dehiscences if the bone is not remodeled quickly enough in front of the tooth.
- Tooth movement into existing infrabony pockets or compromised bone areas does not further periodontal attachment loss if the area is first treated and hygiene is
This document discusses furcation involvement in multi-rooted teeth. It begins with definitions of anatomical terms related to furcations. It then discusses various classifications of furcation involvement, ranging from initial/incipient involvement to more advanced through-and-through defects. Epidemiology, etiology, diagnosis and factors affecting treatment outcomes are also covered. The document concludes with an overview of management approaches, which include maintaining the furcation, increasing access, removing the furcation, or closing it with new attachment.
This document summarizes the classification of osseous defects caused by periodontal disease. It describes different types of horizontal bone loss including osseous craters and bulbous bony contours. It also discusses vertical/angular bone loss and classifications proposed by Glickman and Goldman/Cohen. Furcation involvement is classified using scales proposed by Glickman and Tarnow/Fletcher. Understanding the nature of these bone alterations is important for effective diagnosis and treatment planning.
This document discusses various surgical techniques for preserving the interdental papilla during periodontal regeneration procedures. It describes the conventional papilla preservation flap technique introduced by Takei in 1985, as well as several modifications including the modified papilla preservation flap, simplified papilla preservation flap, interproximal tissue maintenance technique, and whale's tail technique. The advantages and disadvantages of each technique are summarized. A novel entire papilla preservation technique introduced in 2015 is also outlined, which aims to completely preserve the interdental papilla.
The document discusses furcation involvement and its management. It begins with an introduction that defines furcation and notes that its presence indicates advanced periodontitis with poor prognosis. It then covers etiology, diagnosis, classification, anatomy, and other factors related to furcation involvement. For treatment, it discusses non-surgical options like scaling and root planing for early defects. For more advanced defects, surgical therapies like furcation plasty, tunnel preparation, root resection, and extraction may be used. The prognosis depends on the degree of furcation involvement and response to treatment.
The document discusses treatment planning in periodontics. It begins by defining treatment planning and outlining the short and long-term goals. These include eliminating infection and inflammation and reconstructing a healthy dentition. The treatment plan is the blueprint and involves decisions about emergency treatment, extractions, nonsurgical and surgical therapies, restorations, and maintenance. Phases of treatment are discussed including preliminary, nonsurgical, surgical, and maintenance phases. Factors in deciding whether to extract or preserve a tooth are also outlined.
advanced diagnostic aids in periodonticsMehul Shinde
Advanced diagnostic aids provide more precise tools and technologies for diagnosis. New probes allow for controlled pressure and automated measurement. Digital radiography provides advantages like reduced radiation dose and immediate imaging. Techniques like digital subtraction radiography and cone-beam computed tomography improve detection of bone changes over time. Overall, advances in clinical, radiographic, microbiological and host-response assessments enhance diagnosis of disease presence, type and progression.
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
Scaling and root planing (SRP) is a non-surgical treatment for periodontitis that aims to remove dental plaque and calculus from tooth surfaces. It involves scaling to remove deposits and root planing to smooth root surfaces. The goals are to eliminate periodontitis by removing irritants and restoring a healthy environment for tissue healing. The long-term effectiveness depends on factors like patient compliance, disease severity, and anatomical challenges. Overhanging restorations can interfere with cleaning and disturb the ecological balance, allowing disease-causing bacteria to proliferate.
The orthodontist can avoid fenestration and dehiscence by determining alveolar morphology through imaging such as CBCT prior to treatment. Heavy forces, ectopic tooth positions, and movement beyond the limits of the alveolar housing can cause bone loss. Fenestrations are more common in the maxilla, especially around molars and canines, while dehiscences occur more in the mandible around incisors. Rapid maxillary expansion can also cause fenestrations and dehiscences. Maintaining an appropriate force level and following the limits of the alveolar bone can help minimize these risks.
The document discusses the treatment plan for periodontal therapy. It defines the treatment plan as the blueprint for case management that includes all procedures needed to establish and maintain oral health. The goals of treatment are to eliminate inflammation, correct conditions that cause it, and establish healthy gum contours. Treatment involves nonsurgical procedures, possible surgery, restorations, and a maintenance phase with periodic checkups. The treatment plan guides the phases of therapy and overall management of the patient's periodontal condition.
This document discusses interdisciplinary periodontics and covers several topics:
- The periodontic-endodontic relationship, including pathways of communication between tissues and classification of endo-perio lesions.
- The prosthodontic-periodontic relationship and biological considerations like the concept of biological width.
- The orthodontic-periodontal relationship and how orthodontic treatment can affect periodontally compromised patients.
- It provides details on the diagnosis, characteristics, and treatment planning of different types of endo-perio lesions. Guidelines are presented for margin placement and preventing biological width violation in restorative treatments.
ROS is a substractive method of having positive bone architecture. it includes osteotomy and ostectomy procedures. osteotomy is to remove non supporting bone and ostectomy is to remove supporting bone for having positive bony architecture. there is definitive osseous surgery and compromise osseous surgery. transgingival probing is a method of determining osseous topography. various hand and rotary instruments are use for this procedure.
This document discusses dental implants and the importance of soft tissue and bone health for implant success. It covers topics like osseointegration between implants and bone, gingival shrinkage during healing, the peri-implant soft tissue seal, the need for keratinized gingiva, and maintaining the biological width of peri-implant soft tissues. Patient factors like age, smoking, and diseases as well as local bone quality can influence implant success. Proper implant placement and surgical technique are important to support the overlying soft tissues long-term.
The document discusses the relationship between pulpal and periodontal diseases. It states that diseases of the pulp or periodontium can lead to secondary diseases in the other via the apical foramen, lateral canals, or dentinal tubules. Both endodontic and periodontal examinations are important to diagnose the origin of lesions. Treatment should focus first on the primary disease, but both may need treatment if the secondary disease is established.
This brief lecture talk about very important topic in endodontic diagnosis and it is the Endodontic-Periodontal Relationship. It's directed to the level of mind of undergraduate students. I tried to keep it as simple and coherent as possible
Lower 3rd molar impaction,its assessment and the buccal approach vz the lingu...Waikhom Singh
The clinical and radiological assessment of lower 3rd molar impaction,as well as the comparison between the buccal approach and the lingual split technique of trans-alveolar extraction of impacted lower 3rd molar is illustrated..
This document discusses furcation involvement in multi-rooted teeth. It defines furcation as the anatomic area where tooth roots diverge, which can be difficult to clean. The document classifies furcation involvement into various grades based on the amount of bone loss and discusses clinical features, diagnosis, and various surgical treatment options like furcationplasty, tunneling, root resection, and guided tissue regeneration depending on the grade of involvement. Maintaining good oral hygiene is important for prognosis. The goal of management is to eliminate periodontal defects in the furcation area through various regenerative and resective procedures.
This document provides an overview of resective osseous surgery. It discusses the historical background, definitions, objectives, indications, and advantages/disadvantages of osseous surgery. It also covers normal alveolar bone morphology, bone destruction patterns in periodontal disease, and factors that determine bone morphology. Key aspects of the document include descriptions of osteoplasty, ostectomy, and the goals of resective osseous surgery to eliminate pockets and create a physiological bone contour.
Adjunctive role of Orthodontic Therapy in PeriodontologyNavneet Randhawa
This document summarizes the adjunctive role of orthodontic therapy in periodontology. Some key points:
- Orthodontic tooth movement can benefit adult patients by correcting tooth malposition that makes cleaning difficult and increases periodontal disease risk.
- Light, prolonged orthodontic forces can move teeth without damaging tissues if excellent oral hygiene is maintained. However, some tissue necrosis is unavoidable.
- Tooth movement through cortical bone can create dehiscences if the bone is not remodeled quickly enough in front of the tooth.
- Tooth movement into existing infrabony pockets or compromised bone areas does not further periodontal attachment loss if the area is first treated and hygiene is
This document discusses furcation involvement in multi-rooted teeth. It begins with definitions of anatomical terms related to furcations. It then discusses various classifications of furcation involvement, ranging from initial/incipient involvement to more advanced through-and-through defects. Epidemiology, etiology, diagnosis and factors affecting treatment outcomes are also covered. The document concludes with an overview of management approaches, which include maintaining the furcation, increasing access, removing the furcation, or closing it with new attachment.
This document summarizes the classification of osseous defects caused by periodontal disease. It describes different types of horizontal bone loss including osseous craters and bulbous bony contours. It also discusses vertical/angular bone loss and classifications proposed by Glickman and Goldman/Cohen. Furcation involvement is classified using scales proposed by Glickman and Tarnow/Fletcher. Understanding the nature of these bone alterations is important for effective diagnosis and treatment planning.
This document discusses various surgical techniques for preserving the interdental papilla during periodontal regeneration procedures. It describes the conventional papilla preservation flap technique introduced by Takei in 1985, as well as several modifications including the modified papilla preservation flap, simplified papilla preservation flap, interproximal tissue maintenance technique, and whale's tail technique. The advantages and disadvantages of each technique are summarized. A novel entire papilla preservation technique introduced in 2015 is also outlined, which aims to completely preserve the interdental papilla.
The document discusses furcation involvement and its management. It begins with an introduction that defines furcation and notes that its presence indicates advanced periodontitis with poor prognosis. It then covers etiology, diagnosis, classification, anatomy, and other factors related to furcation involvement. For treatment, it discusses non-surgical options like scaling and root planing for early defects. For more advanced defects, surgical therapies like furcation plasty, tunnel preparation, root resection, and extraction may be used. The prognosis depends on the degree of furcation involvement and response to treatment.
The document discusses treatment planning in periodontics. It begins by defining treatment planning and outlining the short and long-term goals. These include eliminating infection and inflammation and reconstructing a healthy dentition. The treatment plan is the blueprint and involves decisions about emergency treatment, extractions, nonsurgical and surgical therapies, restorations, and maintenance. Phases of treatment are discussed including preliminary, nonsurgical, surgical, and maintenance phases. Factors in deciding whether to extract or preserve a tooth are also outlined.
advanced diagnostic aids in periodonticsMehul Shinde
Advanced diagnostic aids provide more precise tools and technologies for diagnosis. New probes allow for controlled pressure and automated measurement. Digital radiography provides advantages like reduced radiation dose and immediate imaging. Techniques like digital subtraction radiography and cone-beam computed tomography improve detection of bone changes over time. Overall, advances in clinical, radiographic, microbiological and host-response assessments enhance diagnosis of disease presence, type and progression.
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
Scaling and root planing (SRP) is a non-surgical treatment for periodontitis that aims to remove dental plaque and calculus from tooth surfaces. It involves scaling to remove deposits and root planing to smooth root surfaces. The goals are to eliminate periodontitis by removing irritants and restoring a healthy environment for tissue healing. The long-term effectiveness depends on factors like patient compliance, disease severity, and anatomical challenges. Overhanging restorations can interfere with cleaning and disturb the ecological balance, allowing disease-causing bacteria to proliferate.
The orthodontist can avoid fenestration and dehiscence by determining alveolar morphology through imaging such as CBCT prior to treatment. Heavy forces, ectopic tooth positions, and movement beyond the limits of the alveolar housing can cause bone loss. Fenestrations are more common in the maxilla, especially around molars and canines, while dehiscences occur more in the mandible around incisors. Rapid maxillary expansion can also cause fenestrations and dehiscences. Maintaining an appropriate force level and following the limits of the alveolar bone can help minimize these risks.
The document discusses the treatment plan for periodontal therapy. It defines the treatment plan as the blueprint for case management that includes all procedures needed to establish and maintain oral health. The goals of treatment are to eliminate inflammation, correct conditions that cause it, and establish healthy gum contours. Treatment involves nonsurgical procedures, possible surgery, restorations, and a maintenance phase with periodic checkups. The treatment plan guides the phases of therapy and overall management of the patient's periodontal condition.
This document discusses interdisciplinary periodontics and covers several topics:
- The periodontic-endodontic relationship, including pathways of communication between tissues and classification of endo-perio lesions.
- The prosthodontic-periodontic relationship and biological considerations like the concept of biological width.
- The orthodontic-periodontal relationship and how orthodontic treatment can affect periodontally compromised patients.
- It provides details on the diagnosis, characteristics, and treatment planning of different types of endo-perio lesions. Guidelines are presented for margin placement and preventing biological width violation in restorative treatments.
ROS is a substractive method of having positive bone architecture. it includes osteotomy and ostectomy procedures. osteotomy is to remove non supporting bone and ostectomy is to remove supporting bone for having positive bony architecture. there is definitive osseous surgery and compromise osseous surgery. transgingival probing is a method of determining osseous topography. various hand and rotary instruments are use for this procedure.
This document discusses dental implants and the importance of soft tissue and bone health for implant success. It covers topics like osseointegration between implants and bone, gingival shrinkage during healing, the peri-implant soft tissue seal, the need for keratinized gingiva, and maintaining the biological width of peri-implant soft tissues. Patient factors like age, smoking, and diseases as well as local bone quality can influence implant success. Proper implant placement and surgical technique are important to support the overlying soft tissues long-term.
The document discusses the relationship between pulpal and periodontal diseases. It states that diseases of the pulp or periodontium can lead to secondary diseases in the other via the apical foramen, lateral canals, or dentinal tubules. Both endodontic and periodontal examinations are important to diagnose the origin of lesions. Treatment should focus first on the primary disease, but both may need treatment if the secondary disease is established.
This brief lecture talk about very important topic in endodontic diagnosis and it is the Endodontic-Periodontal Relationship. It's directed to the level of mind of undergraduate students. I tried to keep it as simple and coherent as possible
This document discusses the relationship between periodontal and endodontic diseases. It begins by establishing that the tooth, pulp, and supporting structures should be viewed as one biologic unit. There are various pathways by which communication can occur between the pulp and periodontium, including developmental pathways like lateral canals, pathological pathways caused by trauma or resorption, and iatrogenic pathways from dental procedures. Pulpal and periodontal problems are responsible for over 50% of tooth mortality. The document goes on to classify periodontal-endodontic lesions based on whether the primary source of disease is endodontic or periodontal and whether secondary involvement occurred.
This document discusses furcation involvement and its treatment. It defines furcation, describes the etiology and classification of furcation defects. It discusses diagnosis and examines factors like root morphology. It classifies furcation defects into grades I to IV based on the extent of involvement. Surgical and non-surgical treatment options are presented, including root resection and hemisection procedures. Prognosis depends on preventing further disease and maintaining oral hygiene.
1. The document discusses the relationship between endodontic and periodontal diseases and lesions. It defines endodontic lesions as inflammatory processes affecting the periapical tissues due to root canal infections, and periodontal lesions as inflammatory processes affecting the periodontal tissues due to dental plaque.
2. There are several classifications of perio-endo lesions including primary endodontic/periodontal lesions, and combined lesions where the diseases interact. Communication between the pulp and periodontium can occur through pathways like the apical foramen or lateral canals.
3. Diagnosis involves tests like vitality testing, radiographs, and probing, while treatment depends on the type of lesion and may involve endodontic, periodontal
This document discusses periodontic-endodontic lesions, which can originate from infections of the periodontium or dental pulp. It describes the anatomical connections between the tissues and various classifications of lesions. Microorganisms like Fusobacterium and Prevotella are often involved in both periodontal and pulp lesions. Accessory canals and dentinal tubules allow communication between tissues. Diagnosis considers factors like tooth vitality, lesion localization, and radiographic findings. Treatment involves completing endodontic therapy followed by periodontal treatment to address the underlying etiologies.
1. The document discusses endo-perio lesions, which involve both pulpal pathology and periodontal tissues.
2. It classifies endo-perio lesions based on etiology and proposed treatment and discusses various pathways of communication between the pulp and periodontium.
3. Diagnosis involves examining chief complaints, associated etiology, clinical tests, radiographs, and pulp vitality tests to determine if the lesion is primarily endodontic, primarily periodontal, or a true combined lesion.
CLINICAL IMPLICATIONS OF ENDOPERIO LESIONS.pptxSonaAnnsKuria
The actual relationship between periodontal and pulpal disease was first described by Simring and Goldberg in 1964. Since then, the term “perio-endo” lesion has been used to describe lesions due to inflammatory products found in varying degrees in both the periodontium and the pulpal tissues. The pulp and periodontium have embryonic, anatomic and functional inter-relationships. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. A perio-endo lesion can have a varied pathogenesis which ranges from quite simple to relatively complex one. Knowledge of these disease processes is essential in coming to the correct diagnosis. This is achievable by careful history taking, examination and the use of special tests. The prognosis and treatment of each endodontic-periodontal disease type varies. Primary periodontal disease with secondary endodontic involvement and true combined endodontic-periodontal diseases require both endodontic and periodontal therapies. The prognosis of these cases depends on the severity of periodontal disease and the response to periodontal treatment. This enables the operator to construct a suitable treatment plan where unnecessary, prolonged or even detrimental treatment is avoided.
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Introduction
The endodontium and periodontium are closely related and diseases of one tissue may lead to the involvement of the other. The differential diagnosis of endodontic and periodontal diseases can sometimes be difficult but it is of vital importance to make a correct diagnosis so that the appropriate treatment can be provided. Endodontic-periodontal lesions present challenges to the clinician as far as diagnosis and prognosis of the involved teeth are concerned. Etiologic factors such as bacteria, fungi, and viruses as well as various contributing factors such as trauma, root resorptions, perforations, and dental malformations play an important role in the development and progression of such lesions. The endo-perio lesion is a condition characterized by the association of periodontal and pulpal disease in the same dental element. The relationship between periodontal and pulpal disease was first described by Simring and Goldberg in 1964.1 Since then, the term ‘perio-endo lesion’ has been used to describe lesions due to inflammatory products found in varying degrees in both periodontium and pulpal tissues.
Inter Relationship between pulpal & periodontal tissues
The effect of periodontal inflammation on dental pulp is controversial and conflicting studies abound.2–10 It has been suggested that periodontal disease has no effect on the pulp before it involves the apex.5 On the other hand, several studies suggested that the effect of periodontal disease on the pulp is degenerative in nature including an increase in calcifications, fibrosis, and collagen resorption, in addition to the direct inflammatory sequelae.11,12 Dental pulp and periodontium have embryonic..
This document reviews periodontic-endodontic lesions that originate from infections of the periodontium or dental pulp. Pulpal infections can spread to the periodontium through lateral and accessory canals, causing retrograde peri-odontitis. Conversely, periodontal disease can spread to the pulp through these same pathways. The diagnosis of whether a lesion originated from the periodontium or pulp can be difficult, as the clinical and radiographic features may be similar. Determining pulp vitality is important for differential diagnosis and treatment planning.
This document discusses furcation involvement in multi-rooted teeth. It begins with definitions of furcation involvement from 1950-1968. The primary cause is plaque accumulation leading to inflammation. Local anatomical factors like root trunk length, root form, and furcation anatomy affect the progression of furcation involvement. Clinical diagnosis involves probing the furcation and correlating with radiographs. Treatment depends on the grade of involvement and may include nonsurgical approaches like scaling and root planing or surgical therapies such as osseous resection or extraction.
This document discusses aggressive periodontitis, including its definition, classification, clinical characteristics, diagnostic criteria, and treatment modalities. Aggressive periodontitis is defined as a rare, severe form of periodontitis characterized by early onset and familial aggregation. It can be localized or generalized. Treatment involves nonsurgical and surgical therapies like scaling and root planing as well as adjunctive systemic or local antibiotics. Maintaining frequent periodontal maintenance visits is important for long-term disease control.
periodontitis associated with endodontic lesionsParth Thakkar
Periodontitis can be associated with endodontic lesions through several pathways connecting endodontic and periodontal tissues. Anatomical pathways like accessory canals, exposed dentinal tubules, and enamel-cementum disjunction allow bacteria and their byproducts to travel between the pulp and periodontium. Lesions can originate from either a primary endodontic or periodontal problem, with the other area becoming secondarily involved. It is important to diagnose the origin of combined lesions to determine the proper treatment sequence.
Interrelationship between periodontics and endodonticsUniversity
This document discusses the interrelationship between periodontics and endodontics. It describes how pathological conditions in the dental pulp can influence the periodontium, such as how pulp necrosis is associated with inflammatory involvement of the periodontal tissue. It also discusses how endodontic treatment measures and conditions like root perforations and vertical root fractures can impact the periodontium. Finally, it explores how periodontal disease can in turn influence the condition of the dental pulp.
Periodontal changes in ortho treatment/certified fixed orthodontic courses by...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses periodontal-endodontic lesions, including:
- The relationship between the periodontium and pulp and pathways of communication between them.
- Classifications of lesions based on origin as primary endodontic, periodontal, or combined.
- Diagnosis involves determining the origin of the lesion and ruling out other causes.
- Treatment depends on the classification but generally involves endodontic treatment, periodontal treatment, or both to fully resolve the lesion. Prognosis depends on the extent and chronicity of the periodontal involvement.
Dentigerous cyst in maxilla in a young girlMausumi Iqbal
This document describes a case report of a rare dentigerous cyst in an 8-year-old girl arising from an unerupted maxillary premolar that had invaded the right maxillary sinus. Clinically, the patient presented with swelling in the right upper jaw. Radiographs revealed a partially formed tooth surrounded by a radiolucent area. The cyst was surgically removed via enucleation along with the displaced tooth. Histopathological examination confirmed the diagnosis of a dentigerous cyst.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Gingival recession—can orthodontics be a cure? evidence from a case presentationEdwardHAngle
A 35-year-old woman presented with severe gingival recession and a unilateral Class II malocclusion. Her treatment plan involved orthodontic correction of the malocclusion using brackets that torqued roots more onto the bone. It also involved changing her dental hygiene methods to use an oscillating toothbrush gently. After 28 months of orthodontic treatment, her malocclusion was corrected and her gingival recession improved without needing grafting. Three months later, her teeth had settled well into their new positions.
Dense Evaginatus: Management Using Novel Materials A Case ReportQUESTJOURNAL
ABSTRACT: Dens evaginatus is an uncommon developmental anomaly of human dentition characterized by a projection of enamel and dentin that usually encloses pulp tissue. Most commonly found as the tubercle on the occlusal surface of mandibular premolars and lingual surface of anterior teeth.Due to occlusal trauma this tubercle tends to fracture thus exposing the pathway to the pulp chamber of teeth. This case reports about the presentation of dens evaginatus in mandibular premolar 35 which was associated with open apex and chronic apical periodontitis. Root canal treatment was performed with tooth 35. DFDBA apical barrier and Biodentine as an apical plug was placed showing successful management of the same.
This document discusses the interface between endodontic and orthodontic treatment. It addresses several topics:
1) How orthodontic tooth movement can affect the pulp and cause inflammation, changes in blood flow, and neural responses. Teeth with mature roots or a history of trauma are more at risk.
2) How orthodontic forces can cause root resorption in a small number of patients, particularly of maxillary incisors. Resorption may be similar in root-filled and vital teeth.
3) That endodontically treated teeth can be moved orthodontically similarly to vital teeth, though replacement resorption or injury to tissues could prevent movement. Maintaining the apical seal
Similar to Furcation Involvement & Its Treatment: A Review (20)
Evaluation of effect of gestational diabetes mellitus on composition of the i...Dr. Anuj S Parihar
Background: Gestational diabetes mellitus (GDM) is one of the commonly occurring high‑risk obstetric complications that accounts for 4%–9% of total pregnancies. The present study
was an attempt to assess the effect of GDM on composition of the neonatal oral microbiota.
Materials and Methods: In this study, oral samples from 155 full‑term vaginally delivered newborns were collected with sterile swabs. Seventy‑five mothers diagnosed with GDM group and 80 were nondiabetic mothers (control). The oral microbiota was evaluated and analyzed by SPSS software.
Results: The mean gestational age in Group I was 38.1 weeks and in Group II was 39.6 weeks. Firmicutes was present in 38.1% in Group I versus 77.6% in Group II patients, Actinobacteria was seen in 15.2% in Group I and 7.4% in Group II, Bacteroidetes in 27.6% in Group I and 7.9% in Group II, Proteobacteria in 9.5% in Group I and 3.8% in Group II, and Tenericutes in 9.6% in Group I and 3.3% in Group II. There was a significant difference in major genera Prevotella, Bacteroidetes, Bifidobacterium, Corynebacterium, Ureaplasma, and Weissella in both groups (P < 0.05).
Conclusion: There was increased bacterial microbiota in neonates born to mothers with GDM as compared to neonates born to nondiabetic mothers. Assessment of initial oral microbiota of neonates could help in assessing the early effect of GDM on neonatal oral microbial flora.
Comparative Evaluation of Serum Tumor Necrosis Factor a in Health and Chronic...Dr. Anuj S Parihar
Background: Tumor necrosis factor‑alpha (TNF‑α), a “major inflammatory cytokine,” not only plays an important role in periodontal destruction but also is extremely toxic to the host. Till date, there are not many studies comparing the levels of TNF‑α in serum and its relationship to periodontal disease.
Aim: Our study aimed to compare the serum TNF‑α among the two study groups, namely, healthy controls and chronic periodontitis patients and establish a correlation between serum TNF‑α and various clinical parameters. Hence, an attempt is made to estimate the level of TNF‑α in serum, its relationship to periodontal disease and to explore the possibility of using the level of TNF‑α in serum as a biochemical “marker” of periodontal disease. Materials and Methods: Forty individuals
participated in the study and were grouped into two subgroups. Group A – 20 systemically and periodontally healthy controls. Group B – twenty patients with generalized chronic periodontitis.
The serum samples were assayed for TNF‑α levels by enzyme‑linked immunosorbent assay method.
Results: The mean serum TNF‑α cytokines for Group B Generalized chronic periodontitis (GCP) was 2.977 ± 1.011, and Group A (healthy) was 0.867 ± 0.865. The range of serum TNF‑α was from (0.867 to 2.977). Serum TNF‑α cytokines had highly significant correlation with all clinical parameters (plaque index, probing pocket depth, clinical attachment loss, and gingival index) among all study participants (P = 0.001). Conclusion: These observations suggest a positive association
between periodontal disease and increased levels of TNF‑α in serum. It can be concluded that there is a prospect of using the estimation of TNF‑α in serum as a “marker” of periodontal disease in future. However, it remains a possibility that the absence or low levels of TNF‑α in serum might indicate a stable lesion and elevated levels might indicate an active site but only longitudinal studies taking into account, the disease “activity” and “inactivity” could suggest the possibility of using
TNF‑α in serum as an “Indicator” of periodontal disease.
This document provides an overview of the nervous system and several cranial nerves. It begins with an introduction to the nervous system and its organization into the central and peripheral nervous systems. Key terms like neuron, nucleus, tract, nerve, and plexus are defined. The 12 pairs of cranial nerves are then introduced, and five specific cranial nerves - V (trigeminal), VII (facial), IX (glossopharyngeal), X (vagus), and XII (hypoglossal) are examined in more detail, including their nuclear connections, functional components, course through the body, and branches. Clinical testing and applied anatomy are also discussed for each nerve.
Oral Health–Related Quality of Life in Children and Adolescents of Indian pop...Dr. Anuj S Parihar
Background: Kids and teenagers are more prone to oral diseases. Poor oral health has a significant impact on oral well-being–associated quality of life. Thus, we performed an investigation to examine the outcome of oral health status on
the quality of life of children and adolescents in Indian population, by using the Oral Health Impact Profile-14 (OHIP-14).
Materials and Methods: A total of 100 children, ranging between 1 and 19 years of age who attended Indian hospitals from November 2016 to October 2019, were included in the study. The DMFT Index (Decayed, Missing, and Filled Teeth) and OHIP-14 were used as data collection tools. Association of the total OHIP-14 score and seven subscales associated with it was evaluated using Spearman’s correlations.
Results: The results showed statistically noteworthy association between the toothbrushing regularity, number of dental appointments, history of oral trauma, smoking, and subdomains of OHIP-14 (P < 0.05)
Conclusion: Dental and oral health of an individual has a great impact on their quality of life.
Evaluation of Microleakage and Microgap of Two Different Internal Implant–Abu...Dr. Anuj S Parihar
Aim: The higher success rate (>90%) of dental implants over 5 years has made this treatment option favorable for dental surgeons as well as for patients. The present in vitro study was conducted to assess microleakage and microgap of two dissimilar internal implant–abutment associations.
Materials and methods: Forty dental implants were divided into two groups: trilobe internal connection fixtures in group I and internal hexagonal geometry fixtures in group II. For the immersion of implant abutment assemblies, sterilized tubes containing 4 mL of Staphylococcus aureus broth culture were incubated at 37°C for 2 weeks. Gram’s stain and biochemical reactions were used for identification of colonies.
Results: The mean log10 colony-forming unit (CFU) in group I was 8.6 and was 9.3 in group II. The disparity among two groups was found to be significant (p < 0.05). The mean microgap in group I was 7.2 μm and was 10.4 μm in group II. The disparity among the two groups was found
to be significant (p < 0.05).
Conclusion: Authors found that microscopic space between implant and abutment may be the site of penetration of bacteria. There was significant higher log10 CFU in dental implant fixtures with an internal hexagonal geometry compared to the dental implant fixtures with a trilobe internal connection.
A must read seminar on Dental Implants for Under-Graduates and Post-Graduates.
If you have any doubts regarding Dental Implants or any topic if you are unable to understand then do feel free to contact me on my Email address: Dr.anujparihar@gmail.com
Periodontally accelerated osteogenic orthodontics: A perio-ortho ambidextrous...Dr. Anuj S Parihar
The interdisciplinary collaboration of periodontics and orthodontics has allowed teeth to be moved 2–3 times faster, reducing the time required for traditional orthodontic therapy considerably. Periodontally accelerated osteogenic orthodontics (PAOO), also known as Wilckodontics, is a combination of a selective decortication facilitated orthodontics and alveolar augmentation. With this technique, there is no dependence on the pre‑existing alveolar volume. This case report describes the treatment of permanent mandibular molar protraction in a 14‑year‑old patient undergoing orthodontic therapy using PAOO with piezosurgery.
A 10 years retrospective study of assessment of prevalence and risk factors o...Dr. Anuj S Parihar
Aim: The present study was conducted to determine the prevalence rate of dental implants failure and risk factors affecting dental implant outcome.
Materials and Methods: The present retrospective study was conducted on 826 patients who received 1420 dental implants in
both genders. Length of implant, diameter of implant, location of implant, and bone quality were recorded. Risk factors such as habit of smoking, history of diabetes, hypertension, etc., were recorded.
Results: In 516 males, 832 dental implants and in 310 females, 588 dental implants were placed. Maximum dental implant failure was seen with length <10 mm (16%), with diameter <3.75 mm, and with type IV bone (20.6%). The difference found to be significant (P < 0.05). Maximum dental implant failures were seen with smoking (37%) followed by
hypertension (20.8%), diabetes (20.3%), and CVDs (18.7%). Healthy patients had the lowest failure rate (4.37%).
Conclusion: Dental implant failure was high in type IV bone, dental implant with <3.75 mm diameter, dental implant with length <10.0 mm, and among smokers..
Assessment of correlation of periodontitis in teeth adjacent to implant and p...Dr. Anuj S Parihar
Aims: The present study was conducted to determine correlation between peri‑implantitis and periodontitis in adjacent teeth. Materials and Methods: The present study was conducted on 58 patients with 84 dental implants. They were divided into two groups, group I (50) was with peri‑implantitis and group II (34) was without it. In all patients, probing depth (PD), gingival recession (GR), and clinical attachment loss (CAL) was calculated around implant, adjacent to implant and on contralateral side. Obtained data were statistically analyzed using statistical software IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp with one‑way analysis of variance. Results: Males were 30 with 52 dental implants and females were 28 with 32 dental implants. CAL was 5.82 ± 0.52 in group I and 3.62 ± 0.63 in group II (P = 0.001) around implants. PD was 4.28 ± 1.26 in group I and 2.20 ± 0.52
in group II around adjacent teeth (P = 0.002). PD around contralateral teeth was significant (P = 0.05) in group I (3.18 ± 1.01) and group II (2.71 ± 0.73). Conclusion: Periodontitis has negative effect on implant success. Teeth adjacent to dental implant plays an important role in deciding the success or failure of implant. Maintenance of periodontal health is of paramount importance for successful implant therapy.
Evaluation of role of periodontal pathogens in endodontic periodontal diseasesDr. Anuj S Parihar
Aim: This study aimed to correlate periodontal pathogens in endodontic periodontal diseases. Methodology: This study was conducted on 40 patients of both genders. All the participants were obtained from department of endodontics and periodontology with history of endo‑perio lesion in same teeth. Polymerase chain reaction was performed and correlation was established. Results: This study included 18 males and 22 females. The mean age of male was 42.5 years and female was 41.3 years. Specimens of Tannerella forsythia were isolated from 94% endodontium and 92% periodontium, Porphyromonas gingivalis from 71% endodontium and 55% periodontium,
Aggregatibacter actinomycetemcomitans from 12% endodontium and 58% periodontium. The difference was significant (P < 0.05). Bacteria in endodontic‑periodontal infection confirmed statistically significant correlation between absolute quantitation of T. forsythia and P. gingivalis (r = 0.412, P < 0.05), P. gingivalis and A. actinomycetemcomitans (r = 0.524, P < 0.05), and T. forsythia and A. actinomycetemcomitans (r = 0.427, P < 0.05). Conclusion: There was correlation between targeted bacterial species levels from concurrent endodontic‑periodontal diseases. Thus, it can be suggested that dentinal tubules may be the pathway for spread of bacteria.
Crestal bone loss around dental implants after implantation of Tricalcium pho...Dr. Anuj S Parihar
Background and Aims: Bone loss around dental implants is generally measured by monitoring changes in marginal bone level using radiographs. After the first year of implantation, an implant should have <0.2 mm annual loss of marginal bone level to satisfy the criteria of success. However, the success rate of dental implants depends on the amount of the crestal bone around the implants. The main aim of this study was to evaluate and compare the crestal bone loss around implants placed with particulate β‑Tricalcium Phosphate Bone Graft and platelet concentrates. Methods: 50 individuals received hundred dental implants. Each individual received one dental implant in the edentulous site filled with β‑Tricalcium Phosphate Bone Graft along (β‑TCP) with Platelet‑ Rich Plasma (PRP)
(Group A) and another in edentulous site filled only with β‑Tricalcium Phosphate Bone Graft (Group B) in the posterior edentulous region. All the 100 implants were prosthetically loaded after a healing period of three months. Crestal bone loss was measured on mesial, distal, buccal and lingual side of each implant using periapical radiographs 3 months, 6 months and 9 months after implant placement. Results: The average crestal bone loss 9 months after the implants placement in Group A and Group B was 2.75 mm and 2.23 mm respectively, the value being statistically significant (P < 0.05). In both Group A and Group B, the average crestal bone loss was maximum on the lingual side followed by buccal, distal and mesial sides. Conclusion: β‑TCP is a promising biomaterial for clinical
situations requiring bone augmentation. However, the addition of PRP results in decreased bone loss around the dental implants.
Assessment of Lingual Concavities in Submandibular Fossa Region in Patients r...Dr. Anuj S Parihar
Aim: The present study was aimed at assessing the lingual concavities in the submandibular fossa region in patients requiring dental implants with the help of cone beam computed tomography (CBCT). Materials and methods: The present study included 140 patients who visited the department with the missing mandibular posterior teeth. CBCT images were obtained using planmeca machine. Cross sections of 1 mm of submandibular fossa in the region of 1st and 2nd molar were studied and Type I to III lingual concavities were analyzed by a radiologist. Results: Type I lingual concavity (< 2 mm) was seen in 23%, type II (2-3 mm) in 62% and Type III (> 3 mm) in 15% of patients. The difference was significant (p < 0.05). Males had slightly higher mean ± S.D value at 1st molar (2.6 mm ± 0.94) and 2nd molar (2.8 mm ± 0.90) on the left side and (2.7 mm ± 0.92) at 1st molar and (2.9 mm ± 0.93) at 2nd molar on the right side. The difference was nonsignificant (p > 0.05). Females had mean ± S.D value at 1st molar (2.3 mm ± 0.90) and (2.5 mm ± 0.92) at 2nd molar on the left side and (2.4 mm ± 0.91) at 1st molar and (2.8 mm ± 0.93) at 2nd molar. The difference was nonsignificant (p > 0.05. The difference between both genders was statistically nonsignifi-cant (p > 0.05). Conclusion: Type I bone is the best for placing an implant. The chances of complications are more in type II and III bone. CBCT provides necessary information before planning implant in the edentulous area. Clinical significance: Cone beam computed tomography (CBCT) is the best radiographic aid which is effective in delin-eating different types of bone in the mandibular posterior region.
Correlation of Clinical Attachment Level (CAL) and C - Reactive Protein (CRP)...Dr. Anuj S Parihar
Periodontal disease, caused mainly by bacteria, is characterized by inflammation and destruction of the attachment apparatus of the teeth. Periodontitis is a multi-factorial disease with microbial dental plaque as the initiator of periodontal disease. Studies indicate that the periodontal lesion is not strictly a localized process but may lead to systemic alterations in the immune function. The present study intends to evaluate the correlation of clinical attachment level and C-reactive protein levels in
smoker and non-smoker patients with chronic generalized periodontitis. A total of fifty patients were included in the study, and they were divided into two group. Group A consisting of 25 patients who are smokers and they are having chronic generalized periodontitis, while Group B consist of 25 patients who are nonsmokers and having chronic generalized periodontitis. In the study clinical parameters we checked were Oral hygiene index – Simplified (OHI-S), Gingival Index (GI), Probing pocket depth (PPD) and Clinical Attachment level (CAL). Furthermore, CRP was evaluated as well between
Group-A (Smokers with chronic generalized periodontitis) and Group-B (Nonsmokers with chronic generalized periodontitis). The results showed higher OHI – S, PPD, CAL and CRP levels in Group - A (Smokers having chronic generalized periodontitis) than Group - B (Nonsmokers having chronic generalized periodontitis). GI score was higher in Group - B as compared to Group - A. Increased levels of clinical attachment level
(CAL) were seen in smokers suffering from chronic periodontitis. Significantly an increased level of C - reactive protein (CRP) was seen in smokers suffering from chronic periodontitis. Correlation between Clinical attachment level (CAL) and Creactive protein levels (CRP) was very strongly positive and significant. Suggesting, as value of CAL increases, CRP also increases.
Healing Effects of Hydroalcoholic Extract of Guava (Psidium guajava) Leaf on ...Dr. Anuj S Parihar
Oral mucositis (OM) is a common inflammatory complication among cancerous patients as an adverse effect of chemotherapy and radiotherapy. The aim of this study is to evaluate the healing effects of hydroalcoholic extract of Psidium
Guajava leaf on oral induced mucositis induced by 5-fluorouracil using histopathologic and tissue antioxidative markers assessment in male dark brown rats. In a prospective randomized double blind animal study, OM was induced in 64 male dark brown rats that allocated in 4 groups by 5-FU (60 mg/kg) on days 0, 5, and 10 of the study. The cheek pouch was scratched with a sterile needle on once daily on days 3 and 4. Starting from day 12, gel base, topical form and 600 mg/kg dietry form of hydroalcoholic extract of Psidium Guajava leaf were administered per day. Pouch histopathology score, superoxide dismutase, glutathione peroxidase, total antioxidant capacity were evaluated on day 14 and 18. DPPH scavenging activity and total phenolic content also were measured. Histopathology scores of mucositis were lower in the systemic and topical treatment groups than the gel base and control groups (P<0.05). Higher activities of SOD, GPX and TAC were detected in the topical and systemic treatment groups in comparison to the others (P<0.05). The extract was rich in total phenolic content as antioxidant. The use of extract of Psidium Guajava leave may be associated with reduced intensity of OM, increased concentration of SOD, GPX and TAC on induced
OM in dark brown rats undergoing 5-FU consumption.
Assessment of Survival Rate of Dental Implants in Patients with Bruxism: A 5-...Dr. Anuj S Parihar
Background: Dental implants are associated with failure such as early or late failure. Systemic conditions such as diabetes, hypertension, and bruxism affect the success rate. The
present study was conducted to assess complications in dental implants in bruxism patients.
Materials and Methods: This 5‑year retrospective study was conducted on 450 patients (640 dental implants) who received implants during the period and followed up for 5 years from June 2010 to June 2015. Among these patients, 124 had bruxism habit. Dental radiographs or patients’ recalled records were evaluated for the presence of complications such as fracture of implant, fracture of ceramic, screw loosening, screw fracture, and decementation of unit. Results: In 240 males
and 210 females, 380 implants and 260 implants were inserted, respectively. The difference was statistically nonsignificant (P = 0.1). A total of 145 screw‑type and 130 cemented‑type fixations
had complications. The difference was statistically nonsignificant (P = 0.5). Complications were seen in single crown (45), partial prostheses (125), and complete prostheses (105). The difference was statistically significant (P = 0.012). The common complication was fracture of ceramic (70) in cemented‑type fixation and fracture of ceramic (85) in screw‑type fixation. The difference was statistically significant (P = 0.01). Forty‑two single crowns showed decementation, 85 partial prostheses had fracture of ceramic/porcelain, and 50 complete prostheses showed fracture of ceramic/porcelain. The failure rate was 42.9%. Survival rate of dental implants in males with bruxism habit was 90% after 1 year, 87% after 2 years, 85% after 3 years, 75% after 4 years, and 72% after 5 years. Survival rate of dental implants in females with bruxism habit was 92% after 1 year, 90% after 2 years, 85% after 3 years, 75% after 4 years, and 70% after 5 years. The difference among
genders was statistically nonsignificant (P = 0.21).
Conclusion: Bruxism is a parafunctional habit which affects the survival rate of dental implants. There is requirement to follow certain specific protocols in bruxism patients to prevent the developing complications.
Prevalence,riskfactors and treatment needs of traumatic dental injuries to an...Dr. Anuj S Parihar
The document summarizes a study that assessed the prevalence of traumatic dental injuries (TDIs) to permanent anterior teeth among 6-15 year old schoolchildren in Bhopal, India. The study found an overall TDI prevalence of 8.6%. Boys had a higher prevalence than girls at a ratio of 2.22:1. Falls at home were the most common cause, and overjet greater than 5.5 mm and inadequate lip coverage were significant risk factors. Most fractured cases occurred with Class I malocclusion. While TDIs were common, many injuries went untreated.
Gingival crevicular fluid turnover markers in premenopausal vs postmenopausal...Dr. Anuj S Parihar
1) The study evaluated levels of bone biomarkers RANKL and OPN in the gingival crevicular fluid of 50 women undergoing orthodontic treatment, dividing them into premenopausal (n=25) and postmenopausal (n=25) groups.
2) Baseline levels of RANKL and OPN were significantly different between the two groups but increased similarly with treatment in both.
3) Within each group, biomarker levels increased significantly from baseline to 24 hours after orthodontic force activation.
4) However, the changes in biomarker levels with treatment were not significantly different between the premenopausal and postmenopausal groups.
Local Drug Delivery Modalities in Treatment of Periodontitis: A ReviewDr. Anuj S Parihar
Periodontitis is an inflammatory disease that causes destruction of
tooth supporting tissues, characterized by multifactorial etiology
with pathogenic bacteria being the primary etiologic agents that
dwells the subgingival area. Local drug delivery system consists of
antimicrobial dosages that produces more constant and prolonged
concentration profiles within the subgingival tissue and provides
better access into the periodontal pockets. It addresses the critical
distress of exposing the patient to adverse effects of systemic
administration. This article reviews the literature and presents
novel trends such as osteoblast activators, growth factors, and
herbal products in the local drug delivery system.
This document discusses different types of bone grafts used in periodontics. It describes autografts, which are transplanted from one site to another within the same individual, as the gold standard due to their osteoinductive properties. Autografts can be obtained from both extraoral sites like the hip or iliac crest, as well as intraoral sites like the tuberosity, tori, or osseous coagulum collected from the surgical site. The document outlines the advantages and disadvantages of various graft materials and their properties like osteoinduction, osteoconduction, and osteogenesis that facilitate bone regeneration.
Dental Plaque
Soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity, including removable & fixed restorations”
Bowen , 1976
Bacterial aggregations on the teeth or other solid oral structures
Lindhe, 2003
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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1. Parihar AS et al. Furcation Involvement & Its Treatment.
81Journal of Advanced Medical and Dental Sciences Research |Vol. 3|Issue 1| January-March 2015
FURCATION INVOLVEMENT & ITS TREATMENT: A
REVIEW
Anuj Singh Parihar, Vartika Katoch
Department of Periodontics, People’s College Of Dental Science and Research Centre, Bhopal,
Madhya Pradesh, India
Corresponding Author: Dr. Anuj Singh Parihar, People’s College of Dental Sciences &
Research Centre, Bhopal, Madhya Pradesh, India, E-mail address: dr.anujparihar@gmail.com
This article may be cited as: Parihar AS, Katoch V. Furcation Involvement & Its Treatment:
A Review. J Adv Med Dent Scie Res 2015;3(1):81-87.
NTRODUCTION:
Periodontal disease is characterised by
the loss of connective tissue attachment
induced by the presence of periodontal
pathogens within the gingival sulcus.1
The
destruction of periodontal tissues progresses
in the apical direction affecting all
periodontal tissues: cementum, periodontal
ligament & alveolar bone. The degree to
which a lesion progresses is affected by
several factors: inflammatory response, type
of bacteria present, organic conditions
&local factors. In the posterior segments of
dentition, numerous factors play a role in
influencing the onset & progression of
periodontal disease. The progress of
inflammatory periodontal disease, if
unabated, ultimately results in attachment
loss sufficient enough to affect the
bifurcation or trifurcation of multi-rooted
teeth & this is one of the most serious
sequels of periodontitis. The furcation is an
area of complex anatomic morphology that
may be difficult or impossible to debride by
routine periodontal instrumentation. Routine
home care methods may not keep the
furcation area free of plaque.2
The etiology
of periodontal disease is complex and so is
its management. One of the most compelling
challenges faced in management of
periodontal disease in multi-rooted teeth is
furcation involvement. Involvement of the
furcae in multi-rooted teeth by chronic
periodontitis is a common event resulting
from loss of bone adjacent to and within the
furcae. Extension of the periodontal disease
process between the roots of multi-rooted
teeth is believed strongly to influence the
prognosis of the involved teeth. Nevertheless
Conservation of natural dentition has been
the aim of periodontics since time
immemorial.
Some authors recommended extraction of the
teeth with furcation invasions rather than
trying to retain them.3
Long-term studies on
treated periodontal patients have reported
that molar teeth with prior furcation
involvement were the most frequently lost
teeth, probably because of their complex
anatomy. Nevertheless these same studies
showed that in the majority of patients who
responded well to treatment, many molar
teeth with furcation involvement were
retained for periods as long as 40-50years.3
Way back in 1884, Farrar reported the so-
called radical and heroic treatment of
alveolar abscess by amputation of roots of
teeth ‘In order to enable the nature to have a
I
Review Article
Abstract: The presence of furcation involvement is one clinical finding that can lead to a
diagnosis of advanced periodontitis and potentially to a less favourable prognosis for the
affected tooth or teeth. Furcation involvement therefore presents both diagnostic and
therapeutic dilemmas. This review explains the vast aspects of furcation involvement in
form of etiology, classification, diagnosis and different treatment modalities in detail.
Key Words: Furcation, periodontitis, plaque.
2. Parihar AS et al. Furcation Involvement & Its Treatment.
82Journal of Advanced Medical and Dental Sciences Research |Vol. 3|Issue 1| January-March 2015
better chance for cure.’ He absolutely
correctly stated that ‘If an entire tooth should
be extracted from a diseased socket, the
treatment might be termed highly radical’
and further that such treatment might not
only be unwise and unnecessary but
absolutely wrong and unscientific.4
Though a
century has passed since the description of
this heroic attempt of root amputation to save
the tooth and in spite of all the development
in modern periodontics and endodontics,
furcation involvement still remains a
challenge and a problem that has not actually
been solved.
The presence of furcation involvement is one
clinical finding that can lead to a diagnosis
of advanced periodontitis and potentially to a
less favourable prognosis for the affected
tooth or teeth. Furcation involvement
therefore presents both diagnostic and
therapeutic dilemmas.
ETIOLOGY:
1. Plaque associated inflammation:
Extension of inflammatory periodontal
disease processes into the furcation area
leads to interradicular bone resorption and
formation of furcation defect. Glickman
(1950) concluded from microscopic
features that furcation involvement is a
phase in root ward extension of
periodontal pocket.
2. Pulpo-periodontal disease
The high percentage of molar teeth with
patent accessory canals opening into the
furcation suggests that pulpal disease
could be an initiating cofactor in the
development of furcation involvement. If
there is no established periodontal
furcaion involvement, these pulpal lesions
are initially pure endodontic sinus tracts
draining through the periodontal ligament
and gingival sulcus. If detected and treated
early by endodontic therapy, these
furcation defects resolve with regeneration
of new interfurcal bone and attachment. If
not detected and treated before plaque and
calculus are allowed to form on the root
surface adjacent to the endodontic therapy,
these furcation defects resolves with
regeneration of new interfurcal bone and
attachment. If not detected and treated
before plaque and calculus are allowed to
form on the root surface adjacent to the
endodontic sinus tract, the furcation
involvement becomes a combined endo-
perio defect and prognosis becomes poor.
CLASSIFICATION OF FURCATION
INVOLVEMENT:
A) Horizontal Component of Furcation
Involvement:
1) GLICKMAN (1953)5
Grade I Involvement: Grade I is the
incipient or early lesion. The pocket is supra
bony, involving the soft tissue; there is slight
bone loss in the furcation area. Radiographic
change is not usual, as bone is minimal.
Grade II Involvement: In grade II cases,
bone is destroyed on one or more aspects of
furcation, but a portion of the alveolar bone
and PDL remains intact, permitting only
partial penetration of the probe into the
furcation. The lesion is essentially a cul-de-
sac. The depth of the horizontal component
of the pocket will determine whether the
furcation involvement is early or advanced.
The radiograph may or may not reveal the
grade II furcation involvement.
Grade III Involvement:
The interradicular bone is completely absent,
but the facial and/or lingual orifices of the
furcation and occluded by gingival tissue.
Therefore the furcation opening cannot be
seen clinically, but is essentially a through-
and-through tunnel. There may be a crater-
like lesion in the interradicular area, creating
an apical or vertical component along with
the horizontal loss of bone. If the radiograph
of the mandibular molars is taken as a proper
angle and the roots are divergent, these
lesions will appear on the radiograph as a
radiolucent area between the roots. The
maxillary molars present a diagnostic
difficulty owing to roots overlapping each
other.
Grade IV Involvement:
The interradicular bone is completely
destroyed. The gingival tissue is also
3. Parihar AS et al. Furcation Involvement & Its Treatment.
82Journal of Advanced Medical and Dental Sciences Research |Vol. 3|Issue 1| January-March 2015
better chance for cure.’ He absolutely
correctly stated that ‘If an entire tooth should
be extracted from a diseased socket, the
treatment might be termed highly radical’
and further that such treatment might not
only be unwise and unnecessary but
absolutely wrong and unscientific.4
Though a
century has passed since the description of
this heroic attempt of root amputation to save
the tooth and in spite of all the development
in modern periodontics and endodontics,
furcation involvement still remains a
challenge and a problem that has not actually
been solved.
The presence of furcation involvement is one
clinical finding that can lead to a diagnosis
of advanced periodontitis and potentially to a
less favourable prognosis for the affected
tooth or teeth. Furcation involvement
therefore presents both diagnostic and
therapeutic dilemmas.
ETIOLOGY:
1. Plaque associated inflammation:
Extension of inflammatory periodontal
disease processes into the furcation area
leads to interradicular bone resorption and
formation of furcation defect. Glickman
(1950) concluded from microscopic
features that furcation involvement is a
phase in root ward extension of
periodontal pocket.
2. Pulpo-periodontal disease
The high percentage of molar teeth with
patent accessory canals opening into the
furcation suggests that pulpal disease
could be an initiating cofactor in the
development of furcation involvement. If
there is no established periodontal
furcaion involvement, these pulpal lesions
are initially pure endodontic sinus tracts
draining through the periodontal ligament
and gingival sulcus. If detected and treated
early by endodontic therapy, these
furcation defects resolve with regeneration
of new interfurcal bone and attachment. If
not detected and treated before plaque and
calculus are allowed to form on the root
surface adjacent to the endodontic therapy,
these furcation defects resolves with
regeneration of new interfurcal bone and
attachment. If not detected and treated
before plaque and calculus are allowed to
form on the root surface adjacent to the
endodontic sinus tract, the furcation
involvement becomes a combined endo-
perio defect and prognosis becomes poor.
CLASSIFICATION OF FURCATION
INVOLVEMENT:
A) Horizontal Component of Furcation
Involvement:
1) GLICKMAN (1953)5
Grade I Involvement: Grade I is the
incipient or early lesion. The pocket is supra
bony, involving the soft tissue; there is slight
bone loss in the furcation area. Radiographic
change is not usual, as bone is minimal.
Grade II Involvement: In grade II cases,
bone is destroyed on one or more aspects of
furcation, but a portion of the alveolar bone
and PDL remains intact, permitting only
partial penetration of the probe into the
furcation. The lesion is essentially a cul-de-
sac. The depth of the horizontal component
of the pocket will determine whether the
furcation involvement is early or advanced.
The radiograph may or may not reveal the
grade II furcation involvement.
Grade III Involvement:
The interradicular bone is completely absent,
but the facial and/or lingual orifices of the
furcation and occluded by gingival tissue.
Therefore the furcation opening cannot be
seen clinically, but is essentially a through-
and-through tunnel. There may be a crater-
like lesion in the interradicular area, creating
an apical or vertical component along with
the horizontal loss of bone. If the radiograph
of the mandibular molars is taken as a proper
angle and the roots are divergent, these
lesions will appear on the radiograph as a
radiolucent area between the roots. The
maxillary molars present a diagnostic
difficulty owing to roots overlapping each
other.
Grade IV Involvement:
The interradicular bone is completely
destroyed. The gingival tissue is also
4. Parihar AS et al. Furcation Involvement & Its Treatment.
82Journal of Advanced Medical and Dental Sciences Research |Vol. 3|Issue 1| January-March 2015
better chance for cure.’ He absolutely
correctly stated that ‘If an entire tooth should
be extracted from a diseased socket, the
treatment might be termed highly radical’
and further that such treatment might not
only be unwise and unnecessary but
absolutely wrong and unscientific.4
Though a
century has passed since the description of
this heroic attempt of root amputation to save
the tooth and in spite of all the development
in modern periodontics and endodontics,
furcation involvement still remains a
challenge and a problem that has not actually
been solved.
The presence of furcation involvement is one
clinical finding that can lead to a diagnosis
of advanced periodontitis and potentially to a
less favourable prognosis for the affected
tooth or teeth. Furcation involvement
therefore presents both diagnostic and
therapeutic dilemmas.
ETIOLOGY:
1. Plaque associated inflammation:
Extension of inflammatory periodontal
disease processes into the furcation area
leads to interradicular bone resorption and
formation of furcation defect. Glickman
(1950) concluded from microscopic
features that furcation involvement is a
phase in root ward extension of
periodontal pocket.
2. Pulpo-periodontal disease
The high percentage of molar teeth with
patent accessory canals opening into the
furcation suggests that pulpal disease
could be an initiating cofactor in the
development of furcation involvement. If
there is no established periodontal
furcaion involvement, these pulpal lesions
are initially pure endodontic sinus tracts
draining through the periodontal ligament
and gingival sulcus. If detected and treated
early by endodontic therapy, these
furcation defects resolve with regeneration
of new interfurcal bone and attachment. If
not detected and treated before plaque and
calculus are allowed to form on the root
surface adjacent to the endodontic therapy,
these furcation defects resolves with
regeneration of new interfurcal bone and
attachment. If not detected and treated
before plaque and calculus are allowed to
form on the root surface adjacent to the
endodontic sinus tract, the furcation
involvement becomes a combined endo-
perio defect and prognosis becomes poor.
CLASSIFICATION OF FURCATION
INVOLVEMENT:
A) Horizontal Component of Furcation
Involvement:
1) GLICKMAN (1953)5
Grade I Involvement: Grade I is the
incipient or early lesion. The pocket is supra
bony, involving the soft tissue; there is slight
bone loss in the furcation area. Radiographic
change is not usual, as bone is minimal.
Grade II Involvement: In grade II cases,
bone is destroyed on one or more aspects of
furcation, but a portion of the alveolar bone
and PDL remains intact, permitting only
partial penetration of the probe into the
furcation. The lesion is essentially a cul-de-
sac. The depth of the horizontal component
of the pocket will determine whether the
furcation involvement is early or advanced.
The radiograph may or may not reveal the
grade II furcation involvement.
Grade III Involvement:
The interradicular bone is completely absent,
but the facial and/or lingual orifices of the
furcation and occluded by gingival tissue.
Therefore the furcation opening cannot be
seen clinically, but is essentially a through-
and-through tunnel. There may be a crater-
like lesion in the interradicular area, creating
an apical or vertical component along with
the horizontal loss of bone. If the radiograph
of the mandibular molars is taken as a proper
angle and the roots are divergent, these
lesions will appear on the radiograph as a
radiolucent area between the roots. The
maxillary molars present a diagnostic
difficulty owing to roots overlapping each
other.
Grade IV Involvement:
The interradicular bone is completely
destroyed. The gingival tissue is also
5. Parihar AS et al. Furcation Involvement & Its Treatment.
82Journal of Advanced Medical and Dental Sciences Research |Vol. 3|Issue 1| January-March 2015
better chance for cure.’ He absolutely
correctly stated that ‘If an entire tooth should
be extracted from a diseased socket, the
treatment might be termed highly radical’
and further that such treatment might not
only be unwise and unnecessary but
absolutely wrong and unscientific.4
Though a
century has passed since the description of
this heroic attempt of root amputation to save
the tooth and in spite of all the development
in modern periodontics and endodontics,
furcation involvement still remains a
challenge and a problem that has not actually
been solved.
The presence of furcation involvement is one
clinical finding that can lead to a diagnosis
of advanced periodontitis and potentially to a
less favourable prognosis for the affected
tooth or teeth. Furcation involvement
therefore presents both diagnostic and
therapeutic dilemmas.
ETIOLOGY:
1. Plaque associated inflammation:
Extension of inflammatory periodontal
disease processes into the furcation area
leads to interradicular bone resorption and
formation of furcation defect. Glickman
(1950) concluded from microscopic
features that furcation involvement is a
phase in root ward extension of
periodontal pocket.
2. Pulpo-periodontal disease
The high percentage of molar teeth with
patent accessory canals opening into the
furcation suggests that pulpal disease
could be an initiating cofactor in the
development of furcation involvement. If
there is no established periodontal
furcaion involvement, these pulpal lesions
are initially pure endodontic sinus tracts
draining through the periodontal ligament
and gingival sulcus. If detected and treated
early by endodontic therapy, these
furcation defects resolve with regeneration
of new interfurcal bone and attachment. If
not detected and treated before plaque and
calculus are allowed to form on the root
surface adjacent to the endodontic therapy,
these furcation defects resolves with
regeneration of new interfurcal bone and
attachment. If not detected and treated
before plaque and calculus are allowed to
form on the root surface adjacent to the
endodontic sinus tract, the furcation
involvement becomes a combined endo-
perio defect and prognosis becomes poor.
CLASSIFICATION OF FURCATION
INVOLVEMENT:
A) Horizontal Component of Furcation
Involvement:
1) GLICKMAN (1953)5
Grade I Involvement: Grade I is the
incipient or early lesion. The pocket is supra
bony, involving the soft tissue; there is slight
bone loss in the furcation area. Radiographic
change is not usual, as bone is minimal.
Grade II Involvement: In grade II cases,
bone is destroyed on one or more aspects of
furcation, but a portion of the alveolar bone
and PDL remains intact, permitting only
partial penetration of the probe into the
furcation. The lesion is essentially a cul-de-
sac. The depth of the horizontal component
of the pocket will determine whether the
furcation involvement is early or advanced.
The radiograph may or may not reveal the
grade II furcation involvement.
Grade III Involvement:
The interradicular bone is completely absent,
but the facial and/or lingual orifices of the
furcation and occluded by gingival tissue.
Therefore the furcation opening cannot be
seen clinically, but is essentially a through-
and-through tunnel. There may be a crater-
like lesion in the interradicular area, creating
an apical or vertical component along with
the horizontal loss of bone. If the radiograph
of the mandibular molars is taken as a proper
angle and the roots are divergent, these
lesions will appear on the radiograph as a
radiolucent area between the roots. The
maxillary molars present a diagnostic
difficulty owing to roots overlapping each
other.
Grade IV Involvement:
The interradicular bone is completely
destroyed. The gingival tissue is also
6. Parihar AS et al. Furcation Involvement & Its Treatment.
82Journal of Advanced Medical and Dental Sciences Research |Vol. 3|Issue 1| January-March 2015
better chance for cure.’ He absolutely
correctly stated that ‘If an entire tooth should
be extracted from a diseased socket, the
treatment might be termed highly radical’
and further that such treatment might not
only be unwise and unnecessary but
absolutely wrong and unscientific.4
Though a
century has passed since the description of
this heroic attempt of root amputation to save
the tooth and in spite of all the development
in modern periodontics and endodontics,
furcation involvement still remains a
challenge and a problem that has not actually
been solved.
The presence of furcation involvement is one
clinical finding that can lead to a diagnosis
of advanced periodontitis and potentially to a
less favourable prognosis for the affected
tooth or teeth. Furcation involvement
therefore presents both diagnostic and
therapeutic dilemmas.
ETIOLOGY:
1. Plaque associated inflammation:
Extension of inflammatory periodontal
disease processes into the furcation area
leads to interradicular bone resorption and
formation of furcation defect. Glickman
(1950) concluded from microscopic
features that furcation involvement is a
phase in root ward extension of
periodontal pocket.
2. Pulpo-periodontal disease
The high percentage of molar teeth with
patent accessory canals opening into the
furcation suggests that pulpal disease
could be an initiating cofactor in the
development of furcation involvement. If
there is no established periodontal
furcaion involvement, these pulpal lesions
are initially pure endodontic sinus tracts
draining through the periodontal ligament
and gingival sulcus. If detected and treated
early by endodontic therapy, these
furcation defects resolve with regeneration
of new interfurcal bone and attachment. If
not detected and treated before plaque and
calculus are allowed to form on the root
surface adjacent to the endodontic therapy,
these furcation defects resolves with
regeneration of new interfurcal bone and
attachment. If not detected and treated
before plaque and calculus are allowed to
form on the root surface adjacent to the
endodontic sinus tract, the furcation
involvement becomes a combined endo-
perio defect and prognosis becomes poor.
CLASSIFICATION OF FURCATION
INVOLVEMENT:
A) Horizontal Component of Furcation
Involvement:
1) GLICKMAN (1953)5
Grade I Involvement: Grade I is the
incipient or early lesion. The pocket is supra
bony, involving the soft tissue; there is slight
bone loss in the furcation area. Radiographic
change is not usual, as bone is minimal.
Grade II Involvement: In grade II cases,
bone is destroyed on one or more aspects of
furcation, but a portion of the alveolar bone
and PDL remains intact, permitting only
partial penetration of the probe into the
furcation. The lesion is essentially a cul-de-
sac. The depth of the horizontal component
of the pocket will determine whether the
furcation involvement is early or advanced.
The radiograph may or may not reveal the
grade II furcation involvement.
Grade III Involvement:
The interradicular bone is completely absent,
but the facial and/or lingual orifices of the
furcation and occluded by gingival tissue.
Therefore the furcation opening cannot be
seen clinically, but is essentially a through-
and-through tunnel. There may be a crater-
like lesion in the interradicular area, creating
an apical or vertical component along with
the horizontal loss of bone. If the radiograph
of the mandibular molars is taken as a proper
angle and the roots are divergent, these
lesions will appear on the radiograph as a
radiolucent area between the roots. The
maxillary molars present a diagnostic
difficulty owing to roots overlapping each
other.
Grade IV Involvement:
The interradicular bone is completely
destroyed. The gingival tissue is also
7. Parihar AS et al. Furcation Involvement & Its Treatment.
82Journal of Advanced Medical and Dental Sciences Research |Vol. 3|Issue 1| January-March 2015
better chance for cure.’ He absolutely
correctly stated that ‘If an entire tooth should
be extracted from a diseased socket, the
treatment might be termed highly radical’
and further that such treatment might not
only be unwise and unnecessary but
absolutely wrong and unscientific.4
Though a
century has passed since the description of
this heroic attempt of root amputation to save
the tooth and in spite of all the development
in modern periodontics and endodontics,
furcation involvement still remains a
challenge and a problem that has not actually
been solved.
The presence of furcation involvement is one
clinical finding that can lead to a diagnosis
of advanced periodontitis and potentially to a
less favourable prognosis for the affected
tooth or teeth. Furcation involvement
therefore presents both diagnostic and
therapeutic dilemmas.
ETIOLOGY:
1. Plaque associated inflammation:
Extension of inflammatory periodontal
disease processes into the furcation area
leads to interradicular bone resorption and
formation of furcation defect. Glickman
(1950) concluded from microscopic
features that furcation involvement is a
phase in root ward extension of
periodontal pocket.
2. Pulpo-periodontal disease
The high percentage of molar teeth with
patent accessory canals opening into the
furcation suggests that pulpal disease
could be an initiating cofactor in the
development of furcation involvement. If
there is no established periodontal
furcaion involvement, these pulpal lesions
are initially pure endodontic sinus tracts
draining through the periodontal ligament
and gingival sulcus. If detected and treated
early by endodontic therapy, these
furcation defects resolve with regeneration
of new interfurcal bone and attachment. If
not detected and treated before plaque and
calculus are allowed to form on the root
surface adjacent to the endodontic therapy,
these furcation defects resolves with
regeneration of new interfurcal bone and
attachment. If not detected and treated
before plaque and calculus are allowed to
form on the root surface adjacent to the
endodontic sinus tract, the furcation
involvement becomes a combined endo-
perio defect and prognosis becomes poor.
CLASSIFICATION OF FURCATION
INVOLVEMENT:
A) Horizontal Component of Furcation
Involvement:
1) GLICKMAN (1953)5
Grade I Involvement: Grade I is the
incipient or early lesion. The pocket is supra
bony, involving the soft tissue; there is slight
bone loss in the furcation area. Radiographic
change is not usual, as bone is minimal.
Grade II Involvement: In grade II cases,
bone is destroyed on one or more aspects of
furcation, but a portion of the alveolar bone
and PDL remains intact, permitting only
partial penetration of the probe into the
furcation. The lesion is essentially a cul-de-
sac. The depth of the horizontal component
of the pocket will determine whether the
furcation involvement is early or advanced.
The radiograph may or may not reveal the
grade II furcation involvement.
Grade III Involvement:
The interradicular bone is completely absent,
but the facial and/or lingual orifices of the
furcation and occluded by gingival tissue.
Therefore the furcation opening cannot be
seen clinically, but is essentially a through-
and-through tunnel. There may be a crater-
like lesion in the interradicular area, creating
an apical or vertical component along with
the horizontal loss of bone. If the radiograph
of the mandibular molars is taken as a proper
angle and the roots are divergent, these
lesions will appear on the radiograph as a
radiolucent area between the roots. The
maxillary molars present a diagnostic
difficulty owing to roots overlapping each
other.
Grade IV Involvement:
The interradicular bone is completely
destroyed. The gingival tissue is also