FURCATION
DEFFINITION
• The furcation is an area of complex
anatomic morphology, that may be difficult
or impossible to debride by routine
periodontal instrumentation.
Etiologic Factors
• bacterial plaque
• local anatomic factors (e.g., root trunk
length, root morphology)
• local developmental anomalies (e.g.,
cervical enamel projections)
Diagnosis
• clinical examination
• Careful probing (Nabors probe)
• Transgingival sounding
Local Anatomic Factors
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Root trunk length
Root length
Root form
Interradicular dimension
Anatomy of furcation
Cervical enamel projections
Root Trunk Length
• The distance from the cementoenamel
junction to the entrance of the furcation
can vary extensively
Anatomy of the Bony Lesions
• Pattern of Attachment Loss
Horizontal bone loss can expose the furcation as thin facial/lingual
plates of bone
The treatment response in deep, multiwalled bony defects is
different from that in areas of horizontal bone loss.
• Other Dental Findings
Indices of Furcation Involvement
• Glickman's classification
Grade I
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incipient or early stage
pocket is suprabony
primarily affects the soft tissues
Early bone loss
radiographic changes
Grade II
• essentially a cul-de-sac
• definite horizontal component
• Radiographs may or may not depict the
furcation involvement
Grade III
• bone is not attached to the dome of the
furcation
• periodontal probe completely through the
furcation
• display the defect as a radiolucent area
Grade IV
• interdental bone is destroyed
• soft tissues have receded apically
• furcation opening is clinically visible
Other Classification Indices
• Hamp et al modified a three-stage
classification system
• Easley and Drennan and Tarnow and
Fletcher
A
vertical depth- 1-3mm
Furcations-IA,IB,IC
IIA,IIB,IIC
IIIA,IIIB,IIIC
B
4-6mm
C
>7mm
Treatment
• objectives of furcation therapy
(1) facilitate maintenance
(2) prevent further attachment loss
(3) obliterate the furcation defects as a
periodontal maintenance problem
Therapeutic Classes of
Furcation Defects
• Class I: Early Defects
oral hygiene, scaling, and root planing
• Class II
• Localized flap procedures with odontoplasty, osteoplasty, and
ostectomy.
• GTR(Guided tissue regeneration)
• Classes II to IV: Advanced Defects
• Periodontal surgery, endodontic therapy, and restoration of the tooth
may be required to retain the tooth.
Nonsurgical Therapy
Oral Hygiene Procedures
Scaling and Root Planing
Surgical Therapy
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Osseous Resection
Regeneration(GTR)
Root Resection
Hemesection
Extraction
Dental Implants
Root ResectionProcedure
Hemisection Procedure
Dental Implants
MCQ-1
• Which of the following author have
described classification system that
consider both horizontal and vertical
attachment loss in the extent of furcation
involvement
(a)Glickman
(b)Hamp
(c) Nyman
(d)Tarnow
MCQ-2
• The furcation lesion have definite
horizontal component,radiographs may or
may not depict the furcation involvement
(a)Grade I
(b)Grade II
(c)Grade III
(d)Grade IV
MCQ-3
• Which is the best treatment modality of
isolated deep class II furcations
(a)Scaling and Rootplaning
(b)Odantoplasty and Osteoplasty
(c)Flap debridement with osteoplasty and
odantoplasty
(d) Rootresection and Hemisection
MCQ-4
• Which of the following have good
candidates for regeneration procedure
(a)Class I furcation
(b)Class II furcaton
(c)Class III furcation
(d)Class IV furcation
MCQ-5
• Which of the following probe is used for
the diagnosis of furcation defects
(a)U.N.C Probe
(b)WHO Probe
(c)CPITN Probe
(d)Nabers Probe