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DR.AMITHBABU.C.B
M.Sc.D-ENDO
 


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iIt can be defined as: an area of complex
anatomic morphology that may be difficult
or impossible to be debrided by routine
periodontal instrumentation.
iArea of complex anatomic morphology that may
be difficult or impossible to debride.
iThe presence of furcation involvement is one
clinical finding that can lead to a diagnosis of
advanced periodontitis and potentially to a less
favorable prognosis for the affected tooth or teeth
  
iManagement of teeth with furcation has always
been a periodontal challenge
iHowever teeth with furcation involvement can be
maintained for many years if appropriately treated
 ^
i^rimary: Inflammatory periodontal disease
iOther possible etiologies
iEndodontic involvement
iEnamel extensions and pearls
iOcclusal trauma
iRoot fracture
   
iRoot trunk length
iRoot length
iRoot form
iInter radicular dimension
iAnatomy of furcation
 
i^ortion of the root between cemento-enamel
junction and the separation of the roots.
iTeeth may have very short root trunks moderate
root trunk length or roots that may be fused to a
point near the apex
iWhen the root trunk is short the furcation will
become involved early in the disease process.
iWhen the root trunk is long the furcation will be
invaded later but will be more difficult for
instrumentation.
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iRepresents the undivided
region of the root.
iThe height of the root
trunk is the distance
between the CEJ and the
separation line between
two root cones
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iIt is directly related to quantity of attachment
supporting the tooth

iTeeth with long root trunks and short roots may

have lost a majority of their support by the time
the furcation becomes affected.

iTeeth with long roots and short to moderate root

trunk are more readily treated because sufficient
attachment remains to meet functional demands
  
iAll root surfaces facing the furcation exhibit some
degree of concavity or depression in an occluso-
apical direction.
iThis may make instrumentation for plaque
removal and root planing almost impossible but
these concavity increases the attachment area of
the tooth and produce a root shape that is
resistant to torque.
iIt is common in mesiobuccal root of maxillary first
molar and mesial root of mandibular first and
second molar

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iClosely approximated or fused roots can
preclude adequate instrumentation during
scaling, root planing and surgery.

iTeeth with widely separated roots present more

treatment options and are more readily treated.
  
 
iEntrance: the transitional
area between the undivided
and the divided part of the
root
iFornix: the roof of the
furcation
  
 
iHow does the furcation entrance
diameter relate to the blade width of a
new curette?
iBlade width of new Gracey curette =
0.75mm
i60% of molar furcation entrances <
0.75 mm
iMandibular molars: buccal wider than
lingual maxillary molars:
i mesial > distal > buccal
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iThe presence of bifurcational ridges, a concavity in the
dome and accessory canals complicate the treatment and
periodontal maintenance.
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iMandibular Molars
i100% mesial roots
i99% distal roots

iMaxillary Molars
i94% mesiobuccal
roots
i31% distobuccal roots
i17% palatal roots
 # # 
# $ # $
 # 
^% 
i13% of molars have
CE^s

iThese projections may

favor the onset of
periodontal lesions in the
affected furcations
   
  
&'()
iGrade I: the enamel projection extends from the
cemento-enamel junction of the tooth towards the
furcation entrance.
iGrade II: the enamel projection approaches the
entrance to the furcation . It does enter the
furcation , and therefore no horizontal component
is present.
iGrade III : the enamel projection extends
horizontally into the furcation
 *   +&',-
i !!


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iThis 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
 

 . 
iThe level of bone loss allows
for the insertion of the
periodontal probe into the
concavity of the root trunk
 

  
iIn 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
 

  
iThe level of bone loss allows for
the insertion of a periodontal
probe into the furcation area
between the roots
 

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· This type of probe penetrates
completely from one side to the
other side characterized by
severe bone destruction in the
furcation area. It is clearly shown
in the radiographs as a
radiolucent area in between the
roots, especially in the lower
molars.
 
/
iA tunnel therefore exists
between the roots of such an
affected tooth.
iThus the periodontal probe
passes readily from one aspect
of tooth to the other.
iIn grade IV furcation the
interdental bone is destroyed,
and the soft tissues have
receded apically so that the
furcation opening is clinically
visible.

 0   
iThis provides information relative to vertical component of
furcation involvement.
iClass I: incipient involvement in which the fluting coronal to
the furcation involvement is affected but there is no definite
horizontal component to the furca.
iClass II: Type 1- a definite horizontal loss of attachment into
the furcation, but the pattern of bone loss is essentially
horizontal.
iThere is no definite buccal or lingual ledge of the bone.
iType2- there is a buccal or lingual bony ledge and a
definite vertical component to attachment loss
i Class III:
iA through and through loss of attachment in the
furcation .
iAs with class II furcation defects , the pattern of
attachment loss may be:
i 1. horizontal
i 2. vertical
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· 1..
iClass I - Furcation defect is less than 3 mm is depth.
iClass II - Furcation defect is at least 3 mm in depth (and
thus, in general, surpassing half of the buccolingual
thickness of the tooth) but not through-and-through (i.e.
there is still some interradicular bone attached to the
angle of the furcation. The furcation defect is thus a cul-
de-sac.
iClass III - Furcation defect encompassing the entire width
of the tooth so that no bone is attached to the angle of the
furcation
 |23 *   
+&'4))
· Vertical bone loss is
measured in mm from the
roof of the furcation
 
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iIn its early stages, there is a widening of
periodontal space with cellular and inflammatory
fluid exudation, followed by epithelial proliferation
into the furcation area from the adjoining pocket.
iExtension of inflammation into the bone leads to
the resorption and reduction in bone height.
iThe bone destructive pattern may produce
horizontal loss, or there may be angular osseous
defects associated with infrabony pockets
 
!
!
iEarlier the recognition ± simpler the treatment

iThorough clinical examination

  .
i To determine the presence and
extent of furcation involvement ,

i The position of attachment

relative to the furca,

i The extent and configuration

of the furcation defect.
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iMandibular Molars
iBuccal Furcation

i^lace the probe between

the two buccal roots from
the buccal aspect
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iMandibular Molars
iLingual Furcation

i^lace the probe between

the two lingual roots from
the lingual aspect
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iShould include both
periapical and
bitewing
iLocation of the
interdental bone and
bone level within the
root complex should
be examined
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iThe morphology of the affected tooth

iThe position of the tooth relative to the adjacent
teeth.
iThe local anatomy of the alveolar bone.
iThe configuration of any bony defects.
iThe presence and extent of other dental
diseases
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