Furcations

Question 1

Goals of Therapy
(4)

Answer 1

Arrest the active
disease
Prevent further
loss of attachment
Regenerate lost
periodontium
Prevent disease
reoccurrence

Question 2

Objectives of Furcation Therapy
(3)

Answer 2

Access for home
care
Access for
maintenance
Establish
physiologic bone
and tissue
architecture

Question 3

Overview of Furcation Therapy
(6)

Answer 3

 Classification
 Furcation anatomy
 Diagnosis
 Etiology
 Treatment options
 Long-term studies

Question 4

 Goldman-incipient or Glickman-Grade I

Answer 4

• Pocket formation into the flute of the
  furca, but the inter-radicular bone is
  intact

Question 5

 Goldman-cul-de-sac or Glickman-Grade II
(shallow and deep)
(2)

Answer 5

• Loss of inter-radicular bone with pocket
  formation of varying depths into the furca, but
  not completely through to the other side.
• Can be shallow or deep

Question 6

 Goldman-through and through or
Glickman-Grade III

Answer 6

• Complete loss of inter-radicular bone
  with pocket formation allowing probe to
  pass completely to the other side

Question 7

 Glickman-Grade IV

Answer 7

• Loss of attachment and gingival
  recession that has made the furcation
  clearly visible to clinical examination

Question 8

 Hamp (75)-

Answer 8

classification of the horizontal
component of furcation involvement

Question 9

Hamp
* Degree 1:
* Degree 2:
* Degree 3:

Answer 9

horizontal loss less than 3 mm
horizontal loss >3 mm but not the total
width of furcation area
through and through

Question 10

 Tarnow (84):

Answer 10

classification of the vertical
component of furcation involvement

Question 11

Tarnow
* Subclass A:
* Subclass B:
* Subclass C:

Answer 11

vertical loss up to 1/3 of
furca (1-3 mm)
vertical loss up to 2/3 of
furca (4-6 mm)
vertical loss into the apical
third (>7mm)

Question 12

Grade/Class II or Grade/Class III furcation
involvement automatically places patient into

Answer 12

Stage III or Stage IV Periodontitis.***

Question 13

Clinically probing the furcations
* Standard “straight” probing:
* “Curved” probing (Nabers) with a curved
probe:

Answer 13

with a
straight probe only measures the vertical
attachment loss, and the extent of the
horizontal loss will not be detected

will determine the horizontal
attachment loss

Question 14

Nabers Probe (used to detect
furcations)
Location of furcation entrances for maxillary molar
* Mesial furcation:
* Distal furcation:
* Buccal furcation:

Answer 14

toward palatal 1/3 so probe from
palatal
in mid 1/3 (under contact point) so
probe from palatal (or buccal)
from buccal!

Question 15

Study looked at 72 pts with chronic
periodontitis and 90% of the 303 maxillary
molars had furcation bone loss.
* –% diagnosed by probing alone,
* –% by radiographs alone and
* –% diagnosed using both clinical and
radiographs

Answer 15

3
22
65

Question 16

 Study evaluated 312 mandibular molars
and 35% had furcation involvement.
* –% were diagnosed by probing alone
* –% diagnosed by radiographs alone,
* –% diagnosed by a both of
radiographic and clinical examination

Answer 16

9
8
18

Question 17

 Cervical Enamel Projections
* Grade I, II, III depending on …
 Incidence ranges from —% from
various studies, (mandibular second molar
has highest incidence). Studies of Asian
populations have far higher incidence.
 Implications of CEPs: (1)

Answer 17

extension
towards and into the furcation
17-33
epithelial attachment

Question 18

Cervical Enamel Projections
 Grade I, II, and III
 Masters and Hoskins 64: –% of
mandibular molars, 1% of max molars;
associated with –% isolated furcation
involvements
 Swan and Hurt 76: –% in molars
 Lieb 67: no relationship between CEPs
and isolated furcation involvement

Answer 18

28.6
90
32.6

Question 19

Root Trunk Length
Maxillary first molars
* Mesial: – mm
* Facial: – mm
* Distal: – mm

Answer 19

3
4
5

Question 20

Mand. first molars
* Buccal: – mm
* Lingual: – mm
* (Also, note the
inclination of the
mandibular molars is
to the —)

Answer 20

3
4
midline

Question 21

Surface Area of Maxillary 1st Molar
Component Surface Area %
Root trunk (part of root from CEJ to
where root divides):
Mesio-Buccal Root:
Palatal Root:
Disto-Buccal Root (most commonly
removed):

Answer 21

32
25
24
17

Question 22

Furcation Root Trunk Length
Maxillary
Molars
Mesial:
Facial:
Distal:

Answer 22

3 mm
4 mm
5 mm

Question 23

Furcation Root Trunk Length
Mandibular
Molars
Buccal:
Lingual:

Answer 23

3 mm
4 mm

Question 24

Furcation Root Trunk Length
Maxillary 1st
Bicuspid
Mesial:

Answer 24

8 mm

Question 25

Anatomical Considerations
 Maxillary First Bicuspid furcation location
* — mm (Booker, 85)
 Furcation Root Concavities
* Found 100% of time on mesial surface of
mandibular first molar and –% on distal
surface (Bower 79)
* Found –% on mesial-buccal, –% on
distal-buccal, and –% on palatal
surfaces of maxillary first molars

Answer 25

7.9
99
94, 31, 17

Question 26

Furcal concavities on the mandibular molars
occur —% on the mesial root and —% on the
distal root

Answer 26

100
99

Question 27

Concavities on the
maxillary first molar
furcal root surfaces:
–% on the mesio-
buccal,(0.1 -0.7mm)
–% on the distal-
buccal (0.1 mm) and
–% on the palatal
root (0.1mm) (C).

Answer 27

94
31
17

Question 28

Furcation Entrance Diameter (Bower, 79)
 –% are 1.0 mm or less
 –% are 0.75 mm or less

Answer 28

81
58

Question 29

Width of new curette blade
 — mm

Answer 29

0.75-1.25

Question 30

Therefore, –% of furcations cannot be
instrumented with hand instruments.

Answer 30

58

Question 31

Limited furcation entrance diameter:
–% are less than .75 mm and –%
are less than 1.00 mm

Answer 31

58
81

Question 32

Pulp interrelationship
* Incidence of lateral canals is –%** in
furcation area (Gutman, 78)

Answer 32

28

Question 33

Bifurcational ridges (Interradicular
ridges)
* –% of mandibular first molars have
ridges in mesial-distal direction, and –%
have ridges in buccal-lingual direction
(Everett, 58)

Answer 33

73
63

Question 34

— can affect
periodontium by way of lateral
canals and apical foramen

Answer 34

Pulpal status

Question 35

Bifurcation ridges: –% in
mesial-distal, and –% in
buccal-lingual direction

Answer 35

73
63

Question 36

Etiology of Furcation Bone Loss
(5)

Answer 36

 Plaque (advancing plaque front-
Waerhaug, 80)**
 Developmental Anomalies
 Iatrogenic
 Pulpal Involvement (via lateral
canals, endo-perio lesions)
 Occlusal Trauma (Glickman)