1. MANAGEMENT OF FURCATION INVOLVEMENT BY VARIOUS APPROACHES
DR ABHAYA CHANDRA DAS
PG STUDENT
DEPT. OF PERIODONTICS
REGIONAL DENTAL COLLEGE
GUWAHATI

2. INTRODUCTION
Furcation involvement refers to a condition in which the bifurcations and trifurcations of multi-rooted teeth are invaded by periodontal disease process
Characterized by bone resorption and attachment loss in the interradicular space (Newmann et al, 2010).

3. CLASSIFICATION
Glickman (1953): Based on horizontal component of furcation area

4. CLASSIFICATION Grade A: 1-3 mm Grade B: 4-6 mm Grade C: > 6 mm
Tarnow and Fletcher (1984): Based on vertical component of furcation area. Measured the distance between fornix to the alveolar bone of the adjacent two roots
Grade A: 1-3 mm
Grade B: 4-6 mm
Grade C: > 6 mm

5. ETIOLOGY
Furcation involvement is not a separate entity; only the invasion of periodontal disease to the furcation.
Bacterial plaque is the cause as that of periodontitis.

6. PREDISPOSING FACTORS Aberrant root morphology Enamel projection
Length of the root trunk
Degree of root separation

7. DIAGNOSIS
Probing
Radiograph

8. OBJECTIVES OF FURCATION THERAPY
Elimination of the microbial plaque
Establishment of an anatomy at furcation area that facilitates self-performed plaque control
Obliteration of the furcation area

9. Approaches for management
Grade I furcation defect:
-Scaling and root planing
-Furcation plasty
Grade II furcation defect:
-Regenerative techniques(GTR with or without graft)

10. Grade III and IV furcation defect:. - Obliteration of the furcation
Grade III and IV furcation defect: - Obliteration of the furcation - Tunnel Preparation - Root Resection - Hemisection - Tooth Extraction

11. CASE REPORTS

12. CASE- 1
A 48 year old male reported to the OPD, Department of Periodontics, RDC, Guwahati with chief complaint of pain in relation to left mandibular 1st molar (36).
On intraoral examination, grade IV furcation defect was found in 36

13. Management Scaling and root planing was done
36 and 37 treated endodontically
Open debridement was carried out by giving internal bevel incision and furcation areas were obliterated using GIC.
After 3 months, porcelain-fused metal crowns were fixed on 36 and 37.

14. Management Buccal view Lingual view
(After reflection of the full thickness flap)

15. Buccal view Lingual view (After placement of GIC)
Postoperative 3 months

16. Advantages of GIC as a occlusive barrier
Biocompatible, easy to place and not expensive.
Does not require an extra effort for stability
It is permanently bonded to the tooth surface, no second surgery or sitting is required
Attachment of long junctional epithelium to the glass ionomer cement is reported (Claudia et al, 2004)
Complete coverage of the defect by gingival flap is not required
Bacteriostatic in nature due to release of fluoride

17. Bridge containing 36 and 37 fixed Reduced 36 and 37 for PFM crowns

18. CASE-2
A 36 year old male reported to the OPD, Department of Periodontics, RDC, Guwahati with chief complaint of food impaction and dull pain in relation to 36.
On intraoral examination, grade IV furcation defect was found in 36.

19. Buccal view
Lingual view

20. Management
Scaling and root planing was done
Gingival curettage was carried out in relation to 36 and a tunnel was prepared in the furcation area to make the area cleansable physiologically as well as mechanically

21. Preparation of the tunnel
Suture placed

22. Buccal view Lingual view
(Postoperative 10 days)

23. Buccal view Lingual view (Postoperative 6 months)

24. CASE-3
A 38 year old male reported to the OPD, Department of Periodontics, RDC, Guwahati with chief complaint of dull pain in relation to 16.
On intraoral examination, through and through, grade III furcation defect was found in 16.

25. Management Scaling and root planing was done 16 treated endodontically
Open debridement was carried out by giving internal bevel incision
Distobuccal root of 16 was resected

26. Resection of distobuccal root
Reflection of Full thickness flap

27. Suture placed
Resected root

28. 10 Days Months
(Postoperative)

29. CONCLUSION
There are various approaches for management of furcation defects.
Caries and fractures are common complication in tunnel preparation and root resection procedures.
Obliteration of furcation area seems to be a better option for grade IV furcation defects. This is possible with GIC considering the fact that it is biocompatible with tooth and soft tissues along with its various properties.
However, further study involving more sample is required to reach at conclusion.

30. ACKNOWLEDGEMENT
Organizing Committee of IX ISP NATIONAL PG CONVENTION, TIRUPATI.
Professor and lecturers
Deptt of Periodontics
Regional Dental College
Guwahati-32.