1. Treatment of Furcation-Involved Teeth
FURCATION INVOLVEMENT AND TREATMENT
Treatment of Furcation-Involved Teeth
Dr. OMAR ALHUNI
Diplomate, American Board of Periodontology
Residency specialty training in Periodontics
Master of Sciences in Dentistry, Saint Louis University
Bachelor of Dental Surgery, Garyounis University

2. Gingivitis: inflammation of gingiva soft tissues
Periodontitis: inflammation of deeper structures plus destruction of periodontium
The destruction of periodontal tissues progresses in the apical direction affecting all periodontal tissues
The progress of periodontal disease results in attachment loss sufficient enough to affect the bifurcation or trifurcation of multirooted teeth.

3. Terminology
Anatomy
Etiology
Classiffication
Diagnosis
Differential Diagnosis
Prognosis
Treatment

4. Terminology Furcation: area between individual root cones
Root cone: divided region
Root trunk: undivided region
Root complex: portion of tooth apical to the CEJ

5. Anatomy Mean distance to furcation from CEJ ~7mm
Teeth with furcations:
Maxillary Premolar
Maxillary Molar
Mandibular Molar
Maxillary Premolars:
40% of cases have 2 roots
Furcation in middle or apical third of root
Mean distance to furcation from CEJ ~7mm

6. Anatomy Maxillary molars 1st and 2nd molars have 3 roots
1st molar has shorter root trunk than 2nd
CEJ to Furcations for 1st molar
Mesial ~3mm
Buccal ~4mm
Distal ~5mm
Buccal furcation more narrow than mesial and distal
Mesial-the furcation entrance is located more palatally.
Distal – located at midpoint of tooth in buccal –palatal dimension

7. Anatomy Mandibular molars: Two roots w/ mesial root larger than distal
Mesial root more vertical
Distal root projects to the D
Root trunk on 1st shorter than 2nd
Buccal =3mm
Lingual =4mm

8. Etiology Primary Factor: bacterial plaque Contributing Factors:
Iatrogenic Factors
TFO
Furcation Location
Thickness of Overlying Gingiva and Bone
Cementicles
Cervical Enamel Projections: 50% of mandibular 2 molar
Enamel Pearls 8% of maxillary 2 molar
Intermediate bifurcation ridge 73% of mandibular molar
Accessory pulp canals: 28% of molar

9. CLASSIFICATION Glickman Classification – horizontal probing
Grade 1 – incipient, pocket formation into furcation fluting, interradicular bone is intact.
Grade 2 – moderate, loss of interradicular bone but not through and through
Grade 3 – through and through, gingival tissue occludes orifices
Grade 4 – exposed, high and dry
Tarnow & Fletcher – vertical probing
Subclass A – vertical loss 0-3 mm
Subclass B – vertical loss 4-6 mm
Subclaass C – vertical loss > 6mm

10. HAMP CLASSIFICATION 1975
Degree I- horizontal penetration into furcation <3 mm
Degree II- horizontal penetration into furcation >3 mm
Degree III- Through-and through furcation

11. Diagnosis Clinical Assessment:
The Naber's probe is used to detect and measure the involvement of furcaton
Radiographic Assessment:
intraoral periapical radiographs and vertical “bitewing” radiographs for detection of furcation invasion.

12. Differential Diagnosis
Pulpal pathosis:
Vitality must always be tested
Endodontic tx fails to resolve after 2 months then defect associated with marginal periodontitis
Trauma from occlusion:
Occlusal interferences may cause inflammation and tissue destrauction
Occlusal adjustment always precedes perio therapy

13. PROGNOSIS:
Prognosis of involved tooth depends on several factors like:
General condition of the patient.
Poor results in smokers
Tooth type and degree of furcation involvement.
maxillary premolars with furcation involvement = poor or hopeless prognosis
Tooth or root morphology
Teeth with long root trunks and short roots = poor or hopeless prognosis
Operator’s skill and experience

14. Treatment Objectives for Tx:
Eliminate of the microbial plaque from the exposed surfaces of the root complex
Establish anatomy of the affected surfaces that facilitate proper self-performed plaque control
Tx :Options
ScRp ( Nonsurgical)
furcation plasty (surgical)
GTR (Mand molars)
Tunnel preparation
Root resection
Extraction

15. ScRp Nonsurgical Treatment Results in resolution of inflammation
Re-establish normal gingival anatomy

16. Furcation plasty Resective tx to eliminate the defect
Odontoplasty and osteoplasty
Used mainly at buccal and lingual furcations
Steps:
Release flap for access
Remove inflammatory soft tissue and ScRp
Odontoplasty eliminating horizontal defect and opening furcation
Recontour alveolar bone
Apically position flap

17. GTR
Regeneration:
Reproduction or reconstitution of a lost or injured part (Bone Fill)
Principles of GTR
space creation
clot stabilization
wound protection
Position Paper
Most studies reported favorable results in Class II mandibular furcations.

18. Tunnel Preparation
Treatment for deep Class II and Class III mand molars
Best Tx for short trunks, wide seperation angle, long divergence
Includes surgical exposure of the entire furcation
Allows for easy cleaning for pt
Increases risk for root sensitivity and root caries

19. Root Separation and Resection(RSR)
Involves sectioning of the root complex and maintaining all roots
Root resection
Involves sectioning w the removal of 1-2 roots
GENERAL GUIDELINES:
Remove the root that will eliminate the furcation
Remove the root with the greatest amount of bone and attachment loss.
Remove the root with the greatest number of anatomic problems.

20. Extraction: Considered when loss of support is extensive
Restore w/ implant if possible
Fugazzotto , 2001:

21. Class I :
Scaling and root planing
Furcation plasty
Class II:
GTR (mandibular molars)
Tunnel preparation
Root resection
Extraction/implant placement
Class III:
Tunnel preparation
Root resection
Extraction/implant placement

22. Diplomate, American Board of Periodontology
Dr. OMAR ALHUNI
Diplomate, American Board of Periodontology
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