Glickmans Classification 1958 Grade I Incipient involvement into

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Glickman’s Classification (1958) Grade I Incipient involvement into flute of furcation with suprabony pockets

Glickman’s Classification (1958) Grade I Incipient involvement into flute of furcation with suprabony pockets and no interradicular bone loss Grade II Any involvement of the interradicular bone without through-and-through probability 1

Glickman’s Classification (1958) Grade III Through-and-through loss of interradicular bone without exposure of furcation

Glickman’s Classification (1958) Grade III Through-and-through loss of interradicular bone without exposure of furcation with gingival coverage Grade IV Through-and-through loss of interradicular bone, with total exposure of furcation owing to gingival recession 2

Hamp, Nyman, Lindhe, 1975 Degree I : Horizontal loss of periodontal tissue support less

Hamp, Nyman, Lindhe, 1975 Degree I : Horizontal loss of periodontal tissue support less than 3 mm Degree II : Horizontal loss of support exceeding 3 mm, but not encompassing the total width of the furcation area Degree III : Horizontal through-and-through destruction 3

Lindhe, 1983 Degree I : Loss of interradicular bone loss less than or equal

Lindhe, 1983 Degree I : Loss of interradicular bone loss less than or equal to one-third Degree II : Loss of interradicular bone greater than one-third but not through-andthrough Degree III : Through-and-through loss of interradicular bone 4

Tarnow and Fletcher, 1984 Subclass A : Vertical loss of 1 to 3 mm

Tarnow and Fletcher, 1984 Subclass A : Vertical loss of 1 to 3 mm Subclass B : Vertical loss of 4 to 6 mm Subclass C : Vertical loss of 7+mm 5

Arrow-like shadow in Furcation Subtle shadow over the mesial root of maxillary first molars

Arrow-like shadow in Furcation Subtle shadow over the mesial root of maxillary first molars that pointed toward the opening of the furcation. Prichard (1972) 6

Furcation Arrow A small triangular radiographic shadow across the mesial or distal roots of

Furcation Arrow A small triangular radiographic shadow across the mesial or distal roots of some maxillary molars. - Diagnostic aid 1 st nominator ; Hardekopf et al. , 1987 7

Etiology of Furcation Involvement 1. Inflammatory periodontal disease 2. Excessive occlusal force 3. Cervical

Etiology of Furcation Involvement 1. Inflammatory periodontal disease 2. Excessive occlusal force 3. Cervical enamel projection 4. Periodontal-Endodontic interrelationship 5. Iatrogenic factor 8

Classification ( Masters and Hoskins, 1964 ) Grade I ; Definite but short projection

Classification ( Masters and Hoskins, 1964 ) Grade I ; Definite but short projection from CEJ Grade II ; Longer and approach area of root division Grade III ; Extended directly into furcation area 9

Incidence of Cervical Enamel Projection Mx. 1 st molar ; 8. 2%, Mn. 2

Incidence of Cervical Enamel Projection Mx. 1 st molar ; 8. 2%, Mn. 2 nd molar ; 38. 5% ( Grewe, 1965 ) Mn. 2 nd molar ; 37. 4% ( Lee et al. , 1975 ) 10

Periodontal-Endodontic Interrelationship • Accessory pulpal canals in furcation area • Origin ; Localized failure

Periodontal-Endodontic Interrelationship • Accessory pulpal canals in furcation area • Origin ; Localized failure in formation of Hertzwig’s epithelial root sheath 11

Incidence of Accessory Canal Mx. & Mn. molar(46) ; 59% Lowman, 1974 Mn. 1

Incidence of Accessory Canal Mx. & Mn. molar(46) ; 59% Lowman, 1974 Mn. 1 st molar (100) ; 46% Vertucci & Williams, 1974 Mx. & Mn. 1 st molar (195) ; 76% Burch & Hulen, 1974 12

Detection of Furcation Involvement 1. Conventional Periodontal Probe 2. Curettes 3. Furcation Probe (Nabers

Detection of Furcation Involvement 1. Conventional Periodontal Probe 2. Curettes 3. Furcation Probe (Nabers 2, CH 3, CP 12) 4. Radiographs 13

Detection of Furcation Involvement 1. Conventional Periodontal Probe Inadequate in three dimensional aspect of

Detection of Furcation Involvement 1. Conventional Periodontal Probe Inadequate in three dimensional aspect of furcation 2. Curettes 14

Detection of Furcation Involvement 3. Furcation Probe (Nabers 2, CH 3, CP 12) Evaluate

Detection of Furcation Involvement 3. Furcation Probe (Nabers 2, CH 3, CP 12) Evaluate the character & extent of furcation involvement 15

Detection of Furcation Involvement 4. Radiographs 1) Evaluation of root morphology and apicocoronal position

Detection of Furcation Involvement 4. Radiographs 1) Evaluation of root morphology and apicocoronal position of furcation 2) Relatively accurate information by multiple beam angulation (Ross and Thomson, 1980) 3) Use the canal filling material 16

Incidence & Distribution of Furcation Involvement Larato, 1970 1. Increase with age Related to

Incidence & Distribution of Furcation Involvement Larato, 1970 1. Increase with age Related to duration of time in position 2. 1 st molar : Most common Mx. bicuspid : Lowest 17

Incidence & Distribution of Furcation Involvement Ross and Thompson, 1980 1. More common than

Incidence & Distribution of Furcation Involvement Ross and Thompson, 1980 1. More common than anticipated 2. 3 times more frequently in Mx. than Mn. : Due to bone quality 18

Indication for Extraction with Grade III Furcation Defect 1. Existence of unopposed molar which

Indication for Extraction with Grade III Furcation Defect 1. Existence of unopposed molar which is terminal tooth in arch 2. 1 st molar with adjacent 2 nd premolar & other molar with adequate bone support 3. Solitary distal abutment tooth which exhibit mobility 4. For periodontal treatment and health of adjacent teeth 1~3: Newell, 1981 ; 4 : Goldman and Cohen, 1980 19

Comfortable and functional tooth should not be extracted just because there is evidence of

Comfortable and functional tooth should not be extracted just because there is evidence of bone resorption, pocket formation, furcal invasion or mobility. Prichard, 1979 20

Additional Examination 1. TFO 2. Tooth mobility 3. Dimension of attached gingiva 4. Pulp

Additional Examination 1. TFO 2. Tooth mobility 3. Dimension of attached gingiva 4. Pulp vitality and need of endodontic therapy 5. Crown and root ratio 21