8/28/2015
Furcation Involvement
Advanced Clinical Concepts
Presented by Judy Mabe, RDH, MEd
Class I
Class II
• Entrance to furcation can be felt with probe
• Probe tip cannot enter the furcation area
• Differentiate between normal root depression and furcation • Probe tip can partially enter furcation
• Extends about one‐third of tooth
• NOT able to pass completely through
Class IV
Class III
• Mandibular molars
• probe passes completely through furcation
• Same as class III except furcation is clinically visible due to tissue recession • Maxillary molars
• probe touches the palatal (lingual) root
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8/28/2015
Sample Periodontal Chart
Maxillary Anteriors
• Central & Lateral Incisors
• Proximal concavities rare
• Palatal groove on maxillary lateral incisor
• Canines
• proximal concavities
Root Morphology
Maxillary Premolars
• Proximal concavities
• First
• Bifurcated
• Deep M concavity
• Distal concavity less pronounced
• Second
• Single root
• M concavity shallower than 1st
premolar
• WHY are these differences important?
Maxillary Molars
• Trifurcated
• Where are the 3 furcation entrances?
Mandibular Anteriors
• Proximal concavities
• Centrals & Laterals
• May be deeper on canines
• Concavities
• Where are the root concavities?
• 1st vs. 2nd molars
• ID key root differences between 1st and 2nd molars
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Mandibular Premolars
Mandibular Molars
• Bifurcated
• First premolar
• Deep D concavity
• Where are the furcation entrances?
• First molar
• Root characteristics?
Why is this important to know?
• Second molar
• Root characteristics? Horizontal Exploration & Instrumentation
Periodontal Files
Area‐Specific Curettes
Lower cutting edge
Self‐angulated
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Debridement
Root trunk
Distal
Root branches
B/L and Mesial
G11/12
G 13/14
G 17/18
Instrument Variations
G15/16
• Standard
• Extended • Miniature
• Combinations
• Access to furcations
• Deeper, narrower pockets
Miniatures
Comparison of Standard & Extended Shanks
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Advanced Fulcrums
Basic Extraoral
Advantages
Disadvantages
 Easier access to maxillary 2nd & 3rd molars
 Easier access to deep pockets
 Improved parallelism of lower shank to molar teeth
 Facilitates neutral wrist position for molar teeth
 Requires greater degree of muscle coordination and instrumentation skill
 Greater risk of instrument stick
 Reduce tactile information to the fingers
 May cause muscle strain
Modified Intraoral Fulcrum
Dominant hand rests against patient’s cheek or chin
Cross Arch
• Intraoral • Altered point of contact between middle & ring fingers
• Opposite side of arch from treatment area
• point of contact lower against middle finger
• NOT same as split fulcrum
• ring finger does not touch middle
Opposite Arch
Finger‐on‐Finger
• Intraoral • Intraoral • Opposite arch from treatment area
• Index finger of nondominant
hand serves as resting point for dominant hand
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Finger Assist
References
• Index finger of nondominant
hand used • Nield, Gehrig, J.S., (2013). Fundamentals of Periodontal Instrumentation and Advanced Root Instrumentation, 7th Ed.
• Wilkins, E., (2013). Clinical Practice of the Dental Hygienist, 11th Ed.
• Concentrate lateral pressure against tooth surface • Help control instrument stroke
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