Furcation Recession Mobility This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation In Slide Show, click on the right mouse button Select “Meeting Minder” Select the “Action Items” tab Type in action items as they come up Click OK to dismiss this box This will automatically create an Action Item slide at the end of your presentation with your points entered. Clinical Parameters Furcation Recession Mobility

Learning Outcomes

Furcations: Clinical Considerations May or may not be clinically exposed Bifurcation: 2 rooted tooth Trifurcation: 3 rooted tooth Radiographs may aid diagnosis Suspect furcation involvement when pockets measure 5-6 mm+ Increased risk for root caries, root resorption, recession sensitivity, pulp involvement, abscess formation

Furcations Extension of bone loss between roots of teeth Teeth with furcation involvement are high risk for continued attachment loss Detection of furcation faciliated by using a specially designed furcation probe

Probing Furcations No. 2 Naber’s furcation probe & a narrow Michigan O periodontal probe Move probe towards location of the furcation & curve into furcation area

Probing Furcations Access to furcations: Mesial surface max. molars: Best to approach from palatal direction b/c mesial furcation is palatal to midpoint of mesial surface Distal surface of max. molars Located more towards midline Detected from buccal or palatal approach

Probing Furcations Most common site: mand. First molar Least common site: max. first bicuspid

Furcations: Classification, Characteristics, Treatment Treatment Options Grade I Initial involvement, may penetrate area up to 3 mm Slight bone loss Suprabony pockets No radiographic changes Perio debridement Odontoplasty Grade II Bone lost on one or more aspects, > 3 mm but not through & through Horizontal depth varies Vertical bone loss possible Possible radiographic visibility Flap with odontoplasty & osteoplasty Guided tissue regeneration (more success with mand. Molars) Root resection

Furcations: Classification, Characteristics, Treatment Treatment Options Grade III Interradicular bone absent Access on fa/li blocked by gingiva “Through & through “ Radiographically visible Perio debridement Flap procedure Odontoplasty Root resection hemisection Grade IV Clinically visible “Through & through” Debridement Flap surgery

Furcations Slimline access Radiographic assessment

Root Resection & Hemisection Performed on vital or endodontically treated teeth Hemisection: Splitting of two rooted tooth into two parts Following sectioning, one or both roots can be retained Classification

Mobility Risk factor for PD Measure extent, determine cause Normal physiologic movement not graded Degree of mobility not always correlated to amount of bone loss

Causes of Mobility Mobility may be related to: Trauma from occlusion Loss of periodontal support Gingival inflammation Pregnancy & hormonal changes Periodontal surgery Minor mobility can usually be maintained Increasing mobility – more frequent PMT and/or referral for surery

Classification of Mobility Nomenclature used varies across systems: Class I etc. Grade I etc. I mobility etc. Grade 1 etc. 1, 2, 3

Classification of Mobility N=normal physiologic mobility Grade I=slight mobility, up to 1 mm of horizontal displacement in a facial-lingual direction Grade II=moderate mobility, > 1 mm of horizontal displacement Grade III=severe mobility, greater than 1 mm of movement in any direction (horizontal & vertical) Nield-Gehrig & Houseman, 1996 Mobility can be measured using 2 instrument handles

Recession Disturbance to the gingiva results in an apical shift of the gingiva margin Actual recession: Level of the epithelial attachment on tooth Apparent recession: Level of the crest of the gingival margin

Etiology of Gingival Recession Causes: Mechanical trauma: hard brush, vigorous technique Crown margins Periodontal disease Occlusal trauma Defects in bone Causes: Trauma from teeth in opposing jaw Oral habits, oral piercing Poorly designed partial dentures Tooth position Healing response following periodontal surgery

Gingival Recession Toothbrush Trauma

Gingival Recession Trauma from denture

Gingival Recession Oral Piercing

Gingival Recession Orthodontics

Gingival Recession Prominent Roots

Gingival Recession Frenal Attachment

Symptoms/signs Client usually complains of: Complications: Sensitivity Aesthetics Complications: Increased sensitivity Loss of tissue from root surface (erosion, abrasion) – protective cementum removed Caries Greater risk for PD: greater surface area for plaque retention

Treatment Options Depends on cause Nonsurgical treatment includes: Debridement Oral self-care instruction Local medicaments for sensitivity

Treatment Options Surgical treatment: Laterally positioned flap Connective tissue graft