Treatment of Furcation Involvement

Diagnosis and treatment of furcation involvement of multirooted teeth is one of the more difficult

Furcation Involvement

Normal

Fig. 5-25. Normal relationship of the CEJ and the osseous crest.

(FromBaimaRF: J Prosthet Dent 56:138, 1986.)

Normal

Fig. 5-25. Normal relationship of the CEJ and the osseous crest.

(FromBaimaRF: J Prosthet Dent 56:138, 1986.)

problems encountered in the periodontal-restora-tive dentistry continuum. Familiarity with the furcation's anatomic and morphologic variations is essential when formulating a treatment plan and prognosis for multirooted teeth.

Classification of Involvements. Furcation involvements can be classified as Class (or Grade) I,II, III, and IV Because these classifications are arbitrary, however, the reader should refer to periodon-tal textbooks and other readings for further detail and clarification.

The normal position of the osseous crest (Fig. 5-25) is approximately 1.5 mm apical to the cementoenamel junction (CEJ) in a young, healthy adult. If vertical loss of periodontal support is less than 3 mm apical to the CEJ, this is considered to be Class I involvement (Fig. 5-26, A). There is no gross or radiographic evidence of bone loss. Clinically the furca can be probed up to 1 mm horizontally. If vertical loss is greater than 3 mm but the total horizontal width of the furcation is not involved, Class II involvement (Fig. 5-26, B) exists. A portion of the bone and periodontium remains intact, but osseous loss is evident on radiographs. The furca is penetrable more than 1 mm horizontally but does not extend through-and-through.

A horizontal through-and-through lesion that is occluded by gingiva but allows passage of an instrument from the buccal, lingual, or palatal surface is defined as a Class III involvement (Fig. 5-26, C. The degree of osseous loss is grossly evident on radiographs. A horizontal through-and-through lesion that is not occluded by gingiva is defined as a Class IV involvement (Fig. 5-26, D).

Review of Root Anatomy. The discussion of root anatomy is logically divided into maxillary and mandibular teeth.

Most maxillary molars have three roots-mesiobuccal, distobuccal, and palatal-although

Classification Furcation DefectsClassification Furcation

Fig. 5-26. Furcation involvements. A, Class 1. B, Class 11.

(From Baima RF: J Prosthet Dent 56:138, 1986.)

Anatomic Variation Furcations

Fig. 5-26. Furcation involvements. A, Class 1. B, Class 11.

(From Baima RF: J Prosthet Dent 56:138, 1986.)

there may be variations, such as fused roots or fewer roots, particularly with second and third molars. The mesiobuccal root of most maxillary molars, especially the first molar, is usually biconcave and curves to the distal. The distobuccal root also is biconcave and somewhat less curved. The palatal root is wide buccolingually and mesiodistally and palatally diverges from the crown of the tooth. This configuration is unique to human dentition and may pose special problems when preparing, restoring, and designing restorations. The distobuccal and palatal roots tend to be in the same plane distally, and the distal furcation is more apical on the tooth than the mesial furcation. In spite of this anatomy, the distal furca is more often involved in periodontal lesions than the mesial furca. From the apical perspective, a groove tends to unite the buccal and mesiopalatal openings of the bifurcation and can be probed when there is furca involvement.

Most mandibular molars have two roots-mesial and distal-although, as with maxillary molars, there may be variations. The mesial root is flattened buccolingually, with concave surfaces on each proximal side. It curves distally, especially in first molars. The distal root is wider buccolingually than the mesial root and is concave on its mesial side. Its apex is often curved distally with a flat or convex distal aspect. Both root surfaces of mandibular molars facing the furca are concave, resulting in an osseous chamber that is wider mesiodistally than either the buccal or the lingual furcation opening. The roof of the furcation is difficult to maintain because of mesiodistal bifurcation ridges.

NOTE: Maxillary and mandibular second and third molars often have more apically placed furcas than first molars and often exhibit fused roots with little or no furcation .

Maxillary premolars, particularly first premolars and (at times) mandibular premolars, also have furcations. However, because they are rarely amenable to treatment by odontoplasty-osteoplasty or root amputation procedures,' they will not be discussed here. Students should refer to oral anatomy and morphology textbooks"', " for further clarification and study of molar root anatomy.

Odontoplasty-osteoplasty. Lesser degrees of furcation involvement can often be controlled by root planing and scaling, adequate oral hygiene, and/or gingivectomy-gingivoplasty However, when the involvement is more extensive, recontouring of the tooth or bone may be necessary.

Class I and incipient Class Il lesions (Fig. 5-27) can be treated by reflecting the soft tissue in the fur-

Dental Furcations

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  • BELLADONNA
    How can furcation involvements affect periodontal treatment?
    7 years ago
  • Paul
    Do not confuse buccal groove with furcation involvement?
    7 years ago
  • Joshua
    What is furcation involvment?
    7 years ago
  • aman rezene
    How to chart furcation involvement?
    7 years ago
  • gemma cremonesi
    What is an apical lesion near furcation and distal root involvement?
    3 years ago
  • tranquilla napolitano
    How to treat furcation?
    1 year ago
  • Keir
    How to fix a forcation involvement in teeth?
    12 months ago
  • glenda
    How to manage furcation involved infection of the tooth?
    10 months ago
  • SOFIA
    How to treat furcation lesions?
    7 months ago
  • Michelle
    How is furcation treated?
    3 months ago
  • David Fuller
    Can bone be placed in a furcation of a molar?
    3 months ago
  • John
    What can be done if furcation is involved during rct of molars?
    3 months ago
  • mimosa twofoot
    Can a person have pain with pressure on a molar with furcation involvement?
    3 months ago
  • ANGELIKA VOGLER
    How to treat if furcation involved?
    2 months ago
  • OLLE
    How to treat furcation involvemetn?
    1 month ago

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