Furcation Involvements: closure.

The specimens were divided into four approxi-

mate age groups: 17-29, 30-44, 45-59, and 60 years
Incidence and Distribution and older. A l l skulls examined had 32 permanent teeth
so that an exactly even distribution of multirooted teeth
could be obtained. Only skulls with little or no caries
by were used, in order to eliminate the possibility of furcal
disease resulting from the extension of pulpal disease
D O M I N I C K C. L A R A T O , B . A . , D.D.S., M . S . D . *
into a lateral root canal adjacent to a furcation. The
number of the tooth and the specific location of the
BIFURCATION A N D TRIFURCATION involvements are
furcal involvement were recorded, i.e., whether bone
common periodontal lesions. They occur as a result of
1

resorption was located at the buccal pr lingual furca of

gingival inflammation and bone resorption adjacent to
lower molars and the buccal, mesial or distal aspects of
and within the furca of multirooted teeth. In time the
the roots of upper molars and first bicuspids. Furcal le-
tooth surface in the region of the furca is denuded as a
sions involving a combination of bone surfaces were
result of extensive bone loss. The degree of bone re-
also recorded. F r o m these readings, the distribution and
sorption and "tunneling" within the interradicular bone
incidence of furcal lesions were determined for each
of the furca will depend upon the extent of periodontal
age group.
breakdown, and is an indication of advanced periodon-
tal disease. The causative factors of periodontal disease
2

RESULTS
are also etiological factors i n the development of the
fureal lesion. 3
Of the 305 skull specimens, 188 had teeth with b i -
furcation or trifurcation involvements. Table 1 shows
Teeth with furcation involvements were usually diag-
the incidence of furcal involvements according to the
nosed as "hopeless," and recommended for extraction
four approximate age groups. It was found that with an
prior to the introduction of modern surgical techniques
increase i n age of the skull, there also occurred a pro-
for the treatment of periodontal bone defects. However,
gressive increase i n the incidence of furcal lesions. F o r
with recent advances i n periodontal therapy and the
example, i n the 17-29 age group the incidence was .05
willingness of the patient to practice good oral hygiene,
furcations per skull, whereas in the 60 plus group the
many teeth with furcation involvements can now be re-
incidence was .95 lesions per skull. Table 2 shows the
stored to normal function. Many papers have been writ-
ten concerning the treatment of furcal lesions. However,
TABLE 1
little information is available concerning the incidence, Number of Furcation Involvements per Skull,
distribution and most common location of bone destruc- for Each Age Group
tion within the furca, and the relationship between the
age of the individual and the incidence of furcation in- A verage No.
Total No. Total No. of of Furcation
volvements. Because of the importance and difficulty of Age of Skulls Furcation Involvements
treating teeth with furcal lesions, a study was designed to Group Examined Involvements per Skull
determine the following: 17-29 yrs. 40 2 .05
30-44 yrs. 59 22 .37
1. Which multirooted teeth most often exhibit furcal 45-59 yrs. 84 49 .58
lesions (bi- or trifurcation involvement). 60 plus yrs. 122 115 .95

2. The most common location of bone destruction Total 305 188

within the furca of each multirooted tooth.
TABLE 2
3. Whether the age of the individual is related to the Number of Furcal Lesions Involving Two or
incidence of furcal involvement. More Surfaces of Bone

MATERIALS AND METHODS Total No. of

Multiple
The experimental sample consisted of 305 dry human Total No. Total No. Surface
Age of Skulls of Furcation Furcation
skull specimens of Mexican origin from the skull collec- Group Examined Involvements Involvements
tion of the Atkinson Library of Applied Anatomy.†
17-29 yrs. 40 2 0
Definitive information concerning the age and sex of 30-44 yrs. 59 22 4 (4md)
the specimens was not available, and the age of each 45-59 yrs. 84 49 5 (3mx, 2md)
skull could only be estimated by the degree of suture 60 plus yrs. 122 115 20 (7mx, 13md)
Total 305 188 29 (10mx, 19md)
*Chief, Dental Service, Veterans Administration Hospital, (100%) (15%)
Newington, Conn. 06111.
tSchool of Dentistry, University of the Pacific, San Francisco, Key: mx = maxilla
Calif. md = mandible

Page 13/499
Page 14/500 LARATO

number of furcal lesions involving two or more surfaces The tables also show that the maxillary and mandibular
of bone. A total of 29 lesions out of 188 had furcation first permanent molars most commonly exhibit furcation
involvements affecting two or more surfaces of bone. involvements.

Tables 3 and 4 show the number of furcal lesions for Tables 5 and 6 show the frequency of the various
each tooth in each age group, i.e., tooth N o . 1 (maxil­ bone surfaces involved in the furcal lesions of each tooth
lary right third molar) had no furcation involvements in and in each age group. The total number of furcation
the 17-29 and 30-44 age groups, four furcal lesions in involvements for each particular tooth is shown at the
the 45-59 group and six lesions in the 60 plus group. bottom of Tables 5 and 6, i.e., for tooth N o . 1 in all
age groups, the buccal surface of bone was resorbed in
five cases, the mesial surface in five cases, and the distal
TABLE 3 surface in four cases. The total number of furcation i n ­
Number of Furcation Involvements in Maxilla
volvements for tooth N o . 1 was 10. Tables 5 and 6 also
Age Tooth Number show that in the maxilla the first permanent molars most
Group 1 2 3 5 12 14 15 16 frequently exhibited furcal disease, with the buccal sur­
17-29 yrs. 1 face of bone being most commonly involved and the
30-44 yrs. 4 5 2 3 mesial surface next. The incidence of furcation involve­
45-59 yrs. 4 5 5 5 3 ments in maxillary molars decreased the more posterior
60 plus yrs. 6 7 8 2 1 20 15 3
the position of the tooth in the arch. Maxillary bicuspids
Total No. 10 16 18 2 1 27 22 3 showed the lowest incidence of furcation involvement
Key for tooth numbers in maxillary arch: 1, right third per­ of all multirooted teeth. Taken as a whole, the buccal
manent molar; 2, right second permanent molar; 3, right first root surface of bone of the molars most commonly ex­
permanent molar; 5, maxillary right first permanent bicuspid;
12, left first permanent bicuspid; 14, left first permanent molar;
hibited furcal disease followed by the mesial surface in
15, left second permanent molar; 16, left third permanent molar. maxillary multirooted teeth. In the mandible, the first
molars had the highest incidence of furcal involvement
with the buccal surface of bone most frequently i n ­
TABLE 4
volved. F o r all lower molars, the buccal root surface
Number of Furcation Involvements in Mandible
was most commonly involved.
Age Tooth Number
Group 17 18 19 30 31 32
DISCUSSION
17-29 yrs. 1
30-44 yrs. 3 1 2 1 1 In examining the skull specimens it was found that
45-59 yrs. 4 5 5 9 2 2 the incidence of furcation involvement increases with an
60 plus yrs. 8 7 12 12 8 6
advance in the age of the skull. This was expected,
Total No. 16 12 18 23 11 9
since resorption of bone within a root furca can be an
Key for tooth numbers in mandibular arch: 17, left third per­ indication of advanced periodontal disease. This finding
manent molar; 18, left second permanent molar; 19, left first
is also in agreement with most epidemiological surveys
permanent molar; 30, right first permanent molar; 31, right sec­
ond permanent molar; 32, right third permanent molar. which have shown a positive correlation between aging

TABLE 5
Total Number of Bone Surfaces Involved in Maxillary Furcation Involvements

Age Tooth Number

Group 1 2 3 5 12 14 15 16
17-29 yrs. 1D
30-44 yrs. 2B, 2M 4B, 1M 1M, 1D 1B, 1D
45-59 yrs. 2B, 3M, 3B, 2M, 3B, 2M,
2D ID ID
60 plus yrs. 3B, 2M, 3B, 4M, 6B, 3M, 2M 1M, 1D 13B, 5M, 8B, 8M, 1B, 2M,
2D 2D 2D 5D 3D 1D
Total No. of 5B, 5M, 8B, 8M, 13B, 6M, 2M 1M, 1D 15B, 8M, 11B, 9M, 1B, 2M,
Surfaces 4D 3D 3D 8D 6D 1D
Total No. of
Furcation
Involvements 10 16 18 2 1 27 22 3
Key : Β = buccal bone
M = mesial bone
D = distal bone
 FURCATION INVOLVEMENTS Page 15/501

TABLE 6
Total Number of Bone Surfaces Involved in Mandibular Furcation Involvements

Age Tooth Number

Group 17 18 19 30 31 32
17-29 yrs. 1L
30-44 yrs. 2B, 3L 1B 2B 1B, 1L 1B
45-59 yrs. 1B, 4L 4B, 2L 5B 9B 1B, 1L 1B, 1L
60 plus yrs. 4B, 7L 6B, 3L 11B, 3L 12B, 12L 8B, 3L 4B, 2L
Total No. of
Surfaces 7B,15L 10B, 5L 17B, 3L 23B, 12L 10B, 5L 6B, 3L
Total No. of
Furcation
Involvements 16 12 18 23 11 9
Key: Β = buccal bone
L = lingual bone

and the severity of periodontal disease. Furcal disease

4, 5
was most common i n the first permanent molars. E p i ­
demiological surveys have shown that of all teeth, first
permanent molars have the highest mortality rate. In
general, the incidence of furcal involvement in molars
decreased, the more posterior the position of the tooth
in the jaws. Such a finding was not entirely expected,
since it is more difficult to clean and brush the second
and third molars. The possibility exists that the i n ­
creased frequency of furcal disease in the first perma­
nent molars is due to the longer period that these teeth
are in position and exposed to the destructive effects of
periodontal disease.
Furcation involvements i n the mandibular molars oc­
curred most often at the buccal aspect of the furca,
there were 73 buccal involvements vs. 43 lingual. In the
maxilla, the buccal surfaces of molars again most com­
monly exhibited furcal disease, and of the proximal root
surfaces, the mesial was most commonly affected. In
all, there were 53 buccal, 41 mesial and 25 distal i n ­
volvements. The finding that mesial furcal surfaces of
maxillary molars were denuded more often than the
distal surfaces is of particular interest. It is felt that
maxillary teeth with mesial furcation involvements have
a more favorable prognosis than those teeth with a distal
involvement. In such cases the patient finds it easier to
1
the individual and the number of furcation involve­
ments. The following findings were made:
1. The average number of furcation involvements i n ­
creases with age.
2. First permanent molars most commonly exhibit
furcal disease.
3. In the maxilla, the buccal aspects of molar furca­
tions are most often denuded as a result of periodontal
disease, followed by the mesial aspects.
4. In mandibular molars, the buccal aspect of the
furca is most frequently denuded as a result of perio­
dontal disease.
5. Of multirooted teeth, the maxillary bicuspids show
the lowest incidence of furcal disease.
6. The incidence of furcal disease decreases the more
posterior the position of the tooth in the arch.
7. The incidence of furcal disease seems to be re­
lated to the duration of time the tooth is in position in
the oral cavity.
BIBLIOGRAPHY
1. Prichard, J . : Advanced Periodontal Disease. Philadel­
phia and London, W. B . Saunders Co., 1965.

2. Glickman, I.: Clinical Periodontology, ed. 3. Philadel­

keep the mesial surface clean than the distal aspect of
the furcation.
SUMMARY
A total of 305 dry human skull specimens were ex­
amined to determine the incidence, distribution, most
common location, and relationship between the age of
phia and London, W. B. Saunders Co., 1964.
3. Glickman, I.: Clinical Periodontology, ed. 3. Philadel­
phia and London, W. B. Saunders Co., 1964.
4. Sandler, H . C. and Stahl, S. S.: The Measurement of
Periodontal Disease Prevalence. J. Amer. Dent. Ass., 58:93,
1959.
5. Marshall-Day, C. D., Stephens, R. G . and Quigley, L .
F., Jr. : Periodontal Disease. Philadelphia and London, W. B.
Saunders Co., 1965.