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Furcation ppt
- 2. DEFFINITION • The furcation is an area of complex anatomic morphology, that may be difficult or impossible to debride by routine periodontal instrumentation.
- 3. DEFFINITION • The furcation is an area of complex anatomic morphology, that may be difficult or impossible to debride by routine periodontal instrumentation.
- 4. DEFFINITION • The furcation is an area of complex anatomic morphology, that may be difficult or impossible to debride by routine periodontal instrumentation.
- 5. Etiologic Factors • Bacterial plaque • Local anatomic factors (e.g., root trunk length, root morphology) • Local developmental anomalies (e.g., cervical enamel projections)
- 6. Local Anatomic Factors • Root trunk length • Root length • Root form • Interradicular dimension • Anatomy of furcation • Cervical enamel projections
- 7. Root Trunk Length • The distance from the cementoenamel junction to the entrance of the furcation can vary extensively
- 8. Root length • This is directly related to the quantity of attachment supporting the tooth • Teeth with long roots and short to medium root trunks are more readily treated because sufficient attachments remains to meet functional demands.
- 9. Anatomy of furcation • Presence of bifurcational ridges, a concavity in the dome and possibly accesory canals complicates scaling, root planning and surgical therapy
- 10. Interradicular Dimension • Degree of seperation is an imp factor in Rx planning • Closely approximated or fused roots can preclude adequate instrumentation during scaling,root planning & surgery • Teeth with widely seperated roots present more treatment options.
- 11. Cervical Enamel Projections • 13% of molars have CEPs • These projections may favor the onset of periodontal lesions in the affected furcations
- 12. Diagnosis • clinical examination • Careful probing (Nabors probe)
- 13. Indices of Furcation Involvement • Glickman's classification
- 14. Grade I • incipient or early stage • pocket is suprabony • primarily affects the soft tissues • Early bone loss • radiographic changes
- 15. Grade I • incipient or early stage • pocket is suprabony • primarily affects the soft tissues • Early bone loss • radiographic changes
- 16. Grade II • essentially a cul-de-sac • definite horizontal component • Vertical bone loss may be present • Radiographs may or may not depict the furcation involvement
- 17. Grade II • essentially a cul-de-sac • definite horizontal component • Radiographs may or may not depict the furcation involvement
- 18. Grade II • essentially a cul-de-sac • definite horizontal component • Radiographs may or may not depict the furcation involvement
- 19. Grade III • bone is not attached to the dome of the furcation • periodontal probe completely through the furcation • display the defect as a radiolucent area
- 20. Grade III • bone is not attached to the dome of the furcation • periodontal probe completely through the furcation • display the defect as a radiolucent area
- 21. Grade III • bone is not attached to the dome of the furcation • periodontal probe completely through the furcation • display the defect as a radiolucent area
- 22. Grade IV • interdental bone is destroyed • soft tissues have receded apically • furcation opening is clinically visible
- 23. Grade IV • interdental bone is destroyed • soft tissues have receded apically • furcation opening is clinically visible
- 24. Other Classification Indices • Hamp et al modified a three-stage classification system • Easley and Drennan and Tarnow and Fletcher A B C vertical depth- 1-3mm 4-6mm >7mm Furcations-IA,IB,IC IIA,IIB,IIC IIIA,IIIB,IIIC
- 25. Treatment • objectives of furcation therapy (1) facilitate maintenance (2) prevent further attachment loss (3) obliterate the furcation defects as a periodontal maintenance problem
- 26. Therapeutic Classes of Furcation Defects • Class I: Early Defects oral hygiene, scaling, and root planing • Class II • Localized flap procedures with odontoplasty, osteoplasty, and ostectomy. • GTR(Guided tissue regeneration) • Classes II to IV: Advanced Defects • Periodontal surgery, endodontic therapy, and restoration of the tooth may be required to retain the tooth.
- 27. Nonsurgical Therapy Oral Hygiene Procedures Scaling and Root Planing
- 28. Antimicrobials • Adjunct to scaling and root planning – Chlorhexidine – Tetracycline fibers
- 29. Open Debridement • Greater calculus removal than closed • Ultrasonic – Narrow furcations – Dome of furcation • Surgical access and increased operator experience significantly enhance calculus removal in molar furcation.
- 31. Surgical Therapy • Osseous Resection • Regeneration(GTR) • Root Resection • Hemesection • Extraction • Dental Implants
- 32. Osseous Surgery • Most effective in grade II furcation • Osteoplasty and ostectomy techniques – Remove the defect to reduce horizontal depth – Bone ramps into the furcation to enhance plaque control – Reduce probing depths
- 33. Osseous Grafting • Autogenous bone • Allografts – Freeze dried bone – Demineralized Freeze dried bone • Alloplasts – Hydroxyapatite • Non-porous • Porous – Bioglass
- 35. Hemisection • Mandibular molars – Grade III furcation – Need widely separated roots – Soft tissue positioned below level of pulp chamber
- 37. Dental Implants
- 38. • Grade III furcation – Permits plaque removal – Root caries (4% stannous fluoride) – 25% failure rate at 5 years – Recurrent periodontitis
- 39. Prognosis • The keys to long time success appear to be 1. thorough diagnosis 2.Selection of patients with good oral hygiene 3.Excellence in nonsurgical therapy 4.Careful surgical and restorative management