Furcation involved teeth :-(furcation
involvement)
The term furcation involvement
:refers to the involvement of bifurcation or
trifurcation of the multirooted teeth by the
periodontal diseases. The bacterial plaque is the
causative agent of the gingivitis and destructive
periodontal disease causes destruction of the
periodontal tissues.
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Objectives of these procedures:1-to obtain visibility and access such areas of
the roots to proper professional
debridement.
2-To eliminate the pathologically depend on
p.d pockets.
3-To establish the morphology of dentogingival region which facilitate the proper
self performed tooth cleaning.
Anatomical characteristics:General information regarding the anatomy of
the function areas may be gained an
autopsymaterial the buccal
or labial plate of the alveolar bone may be
thin or sometimes exposing the root surface
so we may have dehiscene which is a dipping
in the crestal bone margin in or fenestration
which is circumscribed window like in the
cortical plate over the root surface .
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Diagnosis of furcation involved teeth:The examination of the teeth should include
both probing and radiographic analysis .
clinical examination done by using graduated
perio-dontal probe,curred explorer or small
curettes, because the involved teeth may have
only a pin point area to be detected.
Factors play a role in the etiology of
the furcation involvement:1-plaque from progressive periodontal
diseases.
2-Trauma from occlusion (injury from trauma).
3-Enamel .projections.
Morphological variation:1-incisors and canines has tow roots for each
and so we have tow furcas.
2-mand premolars----3 roots.
3-max premolars----3 roots.
4- mandibular molar ----4 roots .
5-fusion of divergent roots.
6- cervical E projection or E pearls in the
furcation area.
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7- Accessory pulp canals which communicates
with the furcation areas.
Classification of furcation
involvement:Degree1(grade 1):- is the incipient or early
lesion ,in which there is suprabony pocket
involving the periodontal tissues surrounding
the area
Or:-horizontal loss of the periodontal tissue
support not exceeding 1/3 of the width of the
tooth .
Degree2(grade 2):- bone destruction on one or
more aspects of the furaction ,but a portion of
the alveolar bone and periodontal ligament
remains intact.
or :-horizontal loss of the periodontal tissue
support not exceeding 1/3 of the width of the
tooth .
Grade3(degree 3):- the interradicular bone is
completely absent, but the facial and /or
lingual orifices of the furcation are occluded by
the gingival tissue ,these fore the furcation
opening cannot be seen clinically ,it a through
and through tunnel .
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Or :-horizontal through and through
destruction of periodontal tissues of furcation
areas.
Some times we have also:Degree4(grade4):- as in the grade 3, we have
destruction of the interradicular bone ,but also
we have recede of gingival tissue apically ,so
that the furcation opening is clinically visible
with out coverage by the gingival.
Rational therapy of furcation
involvement:Therapeutic alternatives for different degrees
of the involvement
Degree1 :- scaling and root planning ,
furcation plasty.
Degree2:-furcation plasty
Tunnel preparation
Root resection
Tooth extraction
Degree3:-tunnel preparation
Root resection
Tooth extraction
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Furcation plasty:Include the following procedures:1-Reflection of mucoperiosteal flap to get
better access to the interradicular area.
2-Removal of soft and hard bacterial deposits
and inflammatory soft tissue from furcation
area.
3-Odontoplasty i.e removal of tooth substance
in the furcation area in order to widen an
arrow entrance of the furcas.
4-Osteoplasty :i.e recontouring of bony defect
in the furcation area.
5-Repositioning and suturing of the flap . there
for furcation plasty is done in advanced
degree1 and initial degree2 involvement and
to over come the difficulties of large contact
area of max molar and premolars.
Objectives of furcation plasty :6
1-removel of plaque and calculus.
2-establish a condition in the dento gingival
region which facilitate the self performed
plaque control.
Tunnel preparation:It means surgical exposure of the furcation
area , it is remained either open or close by
flap . the flap is alterated ei buccally and
lingually , then the roots surfaces are scaled
and planned and irregular alveolar bone crests
are recontoued. Surgical packs may be
applied to prevent granulation tissue formation
in the tunnel space during healing .mandibular
malars are more suited for this mode of
therapy . risks for caries lesion developed in
the denuded root surfaces within and adjacent
to such tunnels. The tunnels area should
cleaned by interdental tooth brush which
should immersed in fluoride sol . as a
desensetizing agent . such method should be
used with restriction and only in situation
where there is enough space between the
roots.
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Root resection:This is the procedure of choice in the cases of
deep grade 2 and grade 3 involvement . it
means the removal of one or more roots from
the multirooted teeth ,the risks of having an
overhang of the tooth substance during tooth
hemi section or root resection is important to
carry out these procedures after flap
alteration.
Failures of furcation therapy:1-in adequate plaque control and
maintenance.
2-Poor root resection technique.
3-Root caries.
4-Cracked roots.
5-Improper restoration.
Molar furcation are complicated due to
the presence of :1-fused roots.
2-Cervical enamel projections.
3-Enamel pearls.
4-Furcation ridges.
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NEW ATTACHMENT AND GUIDED
TISSUES
REGENERATION-GTR.
Aspects of periodontal healing:1-Regeneration
2-Repair
3-Attachment
1-Regeneration:-is the growth and
differentiation of new cells and intercellular
substance to form new tissue. It occurs by
growth from the same type of the tissue that
has been destroyed or from its precursor.
2-Repair:-Restoration of continuity of diseased
marginal gingiva and reestablishment of by
scar. Bone loss is arrested with mobilization of
epithelial and connective tissue cells into the
damaged area with increase mitotic division to
provide the sufficient no. of cells.
3-New attachment:-Is the embedding of new
periodontal ligament. Fibers into new
cementum and attachment of epithelium to the
tooth surface previously denuded by
diseaas.The term re-attachment were used in
the past to refer to the restoration of the
marginal periodontium.
Re-attachment:-refer to repair in the areas of
root not previously opposed to the pockets but
after surgical detachment of the tissues or
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after traumatic tears in the cementum, tooth
fractures, treatment of periapical lesion.
Regeneration of periodontal ligament is the
basis for new attachment because:1-periodontal ligament provides continuity
between alveolar bone and cementum.
2-periodental ligament contain cells that can
synthesize and remodel the 3 connective
tissue of the alveolar part of periodontium.
Evaluation of new attachment and bone
regeneration:1-clinical methods:A- Pocket probing.
B- Attachment level.
C- Gingival indices.
D- Bone level.
2- Radiographic methods.
3- Surgical re-entry.
4- Histologic methods.
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