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Furcation: The Problem and Its Management
Furcation: The Problem and Its Management
Management
Definition
It can be defined as: an area of complex
anatomic morphology that may be difficult or
impossible to be debrided by routine
periodontal instrumentation.
Anatomical Considerations
Root trunk
Furcation entrance
Root surface anatomy
Enamel projections
Accessory canals
Root Trunk
Represents the undivided
region of the root.
The height of the root
trunk is the distance
between the CEJ and the
separation line between
two root cones
Furcation Entrance
Entrance: the
transitional area
between the
undivided and the
divided part of
the root
Fornix: the roof of
the furcation
Furcation Entrance Diameter
How does the furcation
entrance diameter relate to
the blade width of a new
curette?
– Blade width of new Gracey
curette = 0.75mm
– 60% of molar furcation
entrances < 0.75 mm
– Mandibular molars: buccal
wider than lingual
maxillary molars:
mesial > distal > buccal
Root Concavities
Mandibular Molars
– 100% mesial roots
– 99% distal roots
Maxillary Molars
– 94% mesiobuccal
roots
– 31% distobuccal roots
– 17% palatal roots
Cervical Enamel Projections
These projections
may favor the onset
of periodontal lesions
in the affected
furcations
Enamel Pearls
Glickman`s Classification(1953)
Class I Incipient Furcation
This is an early lesion. The
pocket is suprabony,
involving the soft tissue.
There is slight bone loss in
the furcation area.
Radiographic change is not
usual since bone loss is
minimal. A periodontal
probe will detect root
outline or may sink into a
shallow V-shaped notch into
the crestal area
Class I Incipient Furcation
Mandibular Molars
Buccal Furcation
Mandibular Molars
Lingual Furcation
Endodontic treatment
Provisional restoration
RSR
Periodontal surgery
Mesial or Distal
Maxillary Class II
Furcations
Alloplasts
– Hydroxyapatite
Non-porous
Porous
– Bioglass
Extraction
Attachment loss is so extensive that no root can
be maintained
If tooth/gingival anatomy will not allow proper
plaque control
For endodontic or restorative reason
Osseointegrated implant substitute
Prognosis
Hirshfeld and Wasserman. “A long term
survey of tooth loss in 600 treated periodontal
patients.” J Perio 1978
Function
Ease of Care
Esthetics
Confort
Health
Value