TREATMENT OF FURCATION INVOLVEMENT Furcation Furcate to divide

TREATMENT OF FURCATION INVOLVEMENT

�Furcation- ‘Furcate’ - to divide into branches. �The Furcation is “an area of complex anatomic morphology that may be difficult or impossible to debride by routine periodontal instrumentation”. �Furcation involvement is defined as bone resorption and attachment loss in the interradicular space that results from plaque-associated periodontal disease.

Significance �Complex anatomic morphology �Difficult to debride by routine periodontal instrumentation �Difficulty in plaque control by routine home care measures �Diagnosis �Of advanced periodontal disease �Prognosis �Becomes less favorable

DIAGNOSIS OF FURCATION INVOLVEMENT �Clinical examination �By probing to determine �The presence and extension of involvement �Position of the attachment relative to the furca �Extent and configuration of the defect �Transgingival probing �Radiographic examination �Has its limitations

TREATMENT OF FURCATION INVOLVEMENT � Objectives � Facilitate maintenance �Opening furcation area for plaque control to the patient and/or to the operator � Obliterate the furcation defect �As a periodontal maintenance problem � Prevent further attachment loss �Control of disease � To increase access to the furcation through gingivectomy, apically positioned flap, odontoplasty, ostectomy/osteoplasty and tunnel preparation. � To regenerate the lost attachment through GTR procedures and bone grafting

TREATMENT OF FURCATION INVOLVEMENT �Grade I �Scaling and root planing �Odontoplasty �Osteoplasty Furcationplasty �Gingivectomy/Apical positioned flap

� Odontoplasty : � Reshaping of a tooth coronal to the furcation. It widens and shallow the furcation by raising the roof of furcation. � The rationale behind this technique is to create improved access for plaque control and maintenance. If CEP is found then it is removed and the area is recontoured. � Odontoplasty must be approached with caution due to the potential complications of hypersensitivity, pulpal exposure and increased risk of root caries. � Osteoplasty: � It is done to provide better gingival form by grooving the bone between the roots and then, festooning and beveling the bone over the roots.

�Gingivectomy/Apical positioned flap: �Can be used in reducing or eliminating the soft tissue pockets over the furcation region to increase access for plaque control and allows resolution of periodontal inflammation.

TREATMENT OF FURCATION INVOLVEMENT � Grade II �Horizontal components complicates treatment �Shallow defects respond favorably to �Flap surgery o Osteoplasty o Odontoplasty �This reduces the dome of the furcation and alters the gingival contour for maintenance �Vertical defects �Narrow and deep defects �Regenerative surgery(Bone grafting, GTR etc. ) �Shallow and wide defects �Root resection

Treatment of Grade II Furcation Involvement

TREATMENT OF FURCATION INVOLVEMENT �Grade III and Grade IV �Complicated by horizontal and vertical defects as well as advanced attachment loss �Non -surgical treatment does not succeed �Inability to instrument the root surfaces �Surgical treatment necessary �Procedures �Root resection �Hemisection �Bicuspidization �Tunnel preparation �Associated treatment �Endodontic and restorative

INDICATIONS FOR SURGICAL APPROACH � A significant horizontal involvement of one or more furcations of a multi-rooted teeth. � Inability to adequately instrument the furcation by routine scaling & root planing. � Persistence of inflammation or exudate after adequate phase I therapy & good oral hygiene.

SURGICAL PROCEDURES � Root resection �Removal of one of the roots of a multirooted tooth �Generally done in maxillary molars �One of the buccal roots removed �Two types of root resection �Non vital root resection � Done after endodontic treatment � No possibility of endodontic failure � Planed procedure �Vital root resection � Emergency procedure � Done prior to endodontic treatment � Possibility of endodontic complications

INDICATIONS OF ROOT RESECTION �Teeth of critical importance �Teeth serving as abutments and the loss of which would change the type of prosthesis �Distal most tooth of the arch �Teeth with sufficient attachment for function �Teeth with advanced bone and attachment loss are not candidates for resection �Teeth for which there is no other predictable or cost effective treatment �Endodontically treated teeth with vertical fracture, advanced bone loss or root caries �Teeth in patients with good oral hygiene and low caries rate

INDICATIONS OF ROOT RESECTION �Which root to remove? �Root that will eliminate furcation �And create a maintainable condition of remaining roots �Root with greatest amount of bone/attachment loss �Enabling tooth to withstand functional demands �Root removal that eliminates periodontal problems of adjacent teeth �Like two/three walled defects adjacent to involved furca �Root with more anatomic problems �Root curvature, development grooves, root flutings etc. �Root that will least complicate future periodontal maintenance

ROOT RESECTION

SURGICAL PROCEDURES �Hemisection �Removal of half of the multirooted tooth �Done in mandibular molars �Either of the roots with part of the crown removed �Indicated in Grade III and Grade IV furcation involvements �Retained root used as abutment �Types �Vital and non vital hemisection �Further treatment �Occlusal evaluation � Reduce masticatory load on resected teeth �Fixed partial denture � To replace removed part of the tooth

HEMISECTION

SURGICAL PROCEDURES �Bicuspidization �Splitting of the multirooted tooth into two halves �Done in mandibular molars � Converted into two premolars �Indicated in Grade III and Grade IV furcation involvements �Furcation converted into interdental area � Increases possibility for maintenance �Types �Vital and non vital bisection �Further treatment �Separate full crowns � With space for interdental cleaning

BICUSPIDIZATION

TUNNEL PREPARATION A radiograph showing Grade III furcation After tunnel preparation presence of wide interdental space that enables plaque control by an interproximal brush

Advanced Class IV Furcation Defects Tooth Extraction Indications for removal of a tooth with a Grade III and IV furcal defects are: i. Individuals who do not maintain oral hygiene ii. Patients with high level of caries activity iii. The existence of an unopposed molar which is the terminal tooth in the arch. iv. Financial consideration preclude acceptance of treatment. v. If an otherwise heroic effort for a tooth with a questionable prognosis would be better handled by an implant.

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