This document discusses furcation involvement and its classification and treatment. It defines furcation as an area of complex anatomy that is difficult to clean. Furcation involvement usually results from periodontal disease affecting the root trunk where two or more roots meet. It describes Glickman's classification of furcation from Class I to IV, based on the degree of bone and soft tissue loss. Treatment options discussed include non-surgical root preparation, antimicrobials, open debridement, surgical treatments like osseous resection, root resection, hemisection, regeneration, grafts, and extraction. Maintaining furcated teeth requires eliminating plaque and establishing anatomy to facilitate cleaning.

1. Predented by
Ummarah yaqoob
Furcation and Its surgical
treatment

2. Definition
 It can be defined as: an area of complex
anatomic morphology that may be difficult or
impossible to be debrided by routine
periodontal instrumentation.

3. Furcation involvement
 Bone loss usually caused as a result of
periodontal disease affecting the base of
root trunk of a tooth where 2 or more roots
meet.

4. Glickman`s Classification(1953)
Classification

5. Class I Incipient Furcation
This is an early lesion. The
pocket is suprabony,
involving the soft tissue.
There is slight bone loss in
the furcation area.
Radiographic change is not
usual since bone loss is
minimal. A periodontal
probe will detect root
outline or may sink into a
shallow V-shaped notch into
the crestal area

6. Class II Patent Furcation
In this, bone is destroyed
in one or more aspects of
the furcation, but a
portion of the alveolar
bone and periodontal
ligament remain intact,
permitting only partial
penetration of the probe
into the furca.
Radiographs may or
may not reveal this type
of furcation.

7. Class II Patent Furcation
vertical bone loss may
be present.
The level of bone loss
allows for the insertion
of a periodontal probe
into the furcation area
between the roots.

8. Class III Communicating or Through
and Through Furcation
In this grade of furcation ,
the bone is not attached to
the dome of furcation .
Properly exposed and
angled radiographs of
early classIII furcations
display the defect as a
radiolucent area .

9. Class IV
In class iv the interdental
bone is destroyed, and
the soft tissues have
receeded apicaly so that
the opening is clinically
visible .
Periodontal probe passes
readily from one aspect
of the tooth to another.

10. Treatment
 Objectives
 The elimination of the microbial plaque from
the exposed surfaces of the root complex.
 The establishment of an anatomy of the
affected surfaces that facilitates proper self-
performed plaque control.

11. Non-Surgical Root Preparation
 Scaling & root planing
– Most effective in grade I and shallow grade II.
– Deeper sites respond less favorably

12. In most situations, it
results in the resolution
of the inflammatory
lesion in the gingiva.

13. Antimicrobials
 Adjunct to scaling and root planning
– Chlorhexidine
– Tetracycline fibers
 No clinically significant difference in clinical
parameters after irrigation

14. 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.

16. Surgical treatment
 Osseous resection
 Root resection.
 Hemisection.
 Tunnel prepration.
 Regeneration of furcation defects.
 Extraction.
 Dental implants.

17. Osseous Surgery
 Most effective in grade II furcation
 Osteoplasty and ostectomy
techniques
– Remove the lip of defect to
reduce horizontal depth
– Bone ramps into the furcation to
enhance plaque control
– Reduce probing depths

18. Root Resection
 Indicated in multirooted
teeth with Grade II or
grade IV

19.  May be performed on vital teeth or
endodontically treated teeth.
 It is preferable to perform endodontic therapy
before resectioon.
 Teeth not suitable for resection are….
 Teeth serving as abutment.
 Molars with advanced bone loss in inter
radicular and interproximal areas.


20. 
 WHICH ROOT TO REMOVE .
 Remove the root that will elimnate the
furcation .
 Remove the root with greatest amount of
bone loss and attachment loss.
 Remove the root that best contributes to
the elimnation of periodontal problems of
adjacent teeth.
 Remove the root with greatest number of
anatomic problems .

21. Hemisection
 Hemisection is the spiliting of a 2 rooted tooth
into 2 separate portions .
 Also called as bicuspidisation or seperation.
 Most likely to be performed on mandibular
molars with buccal and lingual classII or
classIII furcation involvement.

22.  After sectioning of the teeth one or both
roots can be retained .
 Narrow interradicular zones can
complicate the surgical procedure .

23. Hemisection

24.  Grade III furcation
– Permits plaque removal
– Root caries (4% stannous
fluoride)
– 25% failure rate at 5 years
– Recurrent periodontitis

25. Regeneration of Furcation Defects
 Guided tissue regeneration
 GTR is suitable in
reconstruction of tow walled or
3 walled furcation
involvements.
 Less favorable results have
been reported in other types of
furcation defects.
 GTR could be considered in
areas with isolated degree II
furcation defects.

27. Osseous Grafting
 Autogenous bone
 Allografts
– Freeze dried bone
– Demineralized Freeze dried bone
 Alloplasts
– Hydroxyapatite
 Non-porous
 Porous
– Bioglass

28. Extraction
 Extraction is preffered when attachment loss is
so extensive that no root can be maintained.
 Teeth with through and through furcation
defects are extracted.
 If tooth/gingival anatomy will not allow proper
plaque control
 For endodontic or restorative reason

29.  Preffered in patients with socio economic
drawbacks who cant perform adequate
treatments.

30. Dental implants
 The advent of osseointegrated dental
implants as an alternative abutment
source has a major impact on retention of
teeth with advanced furcation problems .
 The high level of predictibility of
osseointegration may motivate the
therapists and patient to consider removal
of teeth with a poor prognosis and to seek
an implant supported prosthetic
treatment plan.

31. Thank you