1. Furcation Recession Mobility
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Clinical Parameters
Furcation Recession
Mobility

2. Learning Outcomes

3. 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

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. Furcations
Slimline access
Radiographic assessment

11. 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

12. 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

13. 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

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

15. 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

16. 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

17. 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

18. Gingival Recession
Toothbrush Trauma

19. Gingival Recession
Trauma from denture

20. Gingival Recession
Oral Piercing

21. Gingival Recession
Orthodontics

22. Gingival Recession
Prominent Roots

23. Gingival Recession
Frenal Attachment

24. 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

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

26. Treatment Options Surgical treatment: Laterally positioned flap
Connective tissue graft