FURCATION

DEFFINITION The furcation is an area of complex anatomic morphology, that may be difficult or impossible to debride by routine periodontal instrumentation.

Etiologic Factors bacterial plaque local anatomic factors (e.g., root trunk length, root morphology) local developmental anomalies (e.g., cervical enamel projections)

Diagnosis clinical examination Careful probing (Nabors probe) Transgingival sounding

Local Anatomic Factors Root trunk length Root length Root form Interradicular dimension Anatomy of furcation Cervical enamel projections

Root Trunk Length The distance from the cementoenamel junction to the entrance of the furcation can vary extensively

Anatomy of the Bony Lesions Pattern of Attachment Loss Horizontal bone loss can expose the furcation as thin facial/lingual plates of bone The treatment response in deep, multiwalled bony defects is different from that in areas of horizontal bone loss. Other Dental Findings

Indices of Furcation Involvement Glickman's classification

Grade I incipient or early stage pocket is suprabony primarily affects the soft tissues Early bone loss radiographic changes

Grade II essentially a cul-de-sac definite horizontal component Radiographs may or may not depict the furcation involvement

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

Grade IV interdental bone is destroyed soft tissues have receded apically furcation opening is clinically visible

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

Treatment objectives of furcation therapy (1) facilitate maintenance (2) prevent further attachment loss (3) obliterate the furcation defects as a periodontal maintenance problem

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.

Nonsurgical Therapy Oral Hygiene Procedures Scaling and Root Planing

Surgical Therapy Osseous Resection Regeneration(GTR) Root Resection Hemesection Extraction Dental Implants

Root ResectionProcedure

Hemisection Procedure

Dental Implants

MCQ-1 Which of the following author have described classification system that consider both horizontal and vertical attachment loss in the extent of furcation involvement (a)Glickman (b)Hamp (c) Nyman (d)Tarnow

MCQ-2 The furcation lesion have definite horizontal component,radiographs may or may not depict the furcation involvement (a)Grade I (b)Grade II (c)Grade III (d)Grade IV

MCQ-3 Which is the best treatment modality of isolated deep class II furcations (a)Scaling and Rootplaning (b)Odantoplasty and Osteoplasty (c)Flap debridement with osteoplasty and odantoplasty (d) Rootresection and Hemisection

MCQ-4 Which of the following have good candidates for regeneration procedure (a)Class I furcation (b)Class II furcaton (c)Class III furcation (d)Class IV furcation

MCQ-5 Which of the following probe is used for the diagnosis of furcation defects (a)U.N.C Probe (b)WHO Probe (c)CPITN Probe (d)Nabers Probe