40. Treatment of furcation involvement Flashcards by Sam A

Treatment of furcation involvement

Root complex

Portion of root located apical to CEJ
Divided into two parts: Root trunk and root cone

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Treatment of furcation involvement

Root trunk

Undivided region of the root
Distance between CEJ and the furcation

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Treatment of furcation involvement

Root cone

Divided region of root complex

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Treatment of furcation involvement

Furcation entrance

Transition between undivided and divided part of root

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Treatment of furcation involvement

Furcation fornix

Roof of furcation

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Treatment of furcation involvement

Degree of seperation

Angle of seperation between the two roots

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Treatment of furcation involvement

Divergence

Distance between two roots(increases in apical direction)

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Treatment of furcation involvement

Coefficient of seperation

Length of root cones in relation to length of root complex

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Treatment of furcation involvement

Maxillary first molar size compared to second

Larger

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Treatment of furcation involvement

Maxillary second molar size compared to third molar

Larger

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Treatment of furcation involvement

Maxillary molar roots

3 roots
MB(Vertically positioned)
Buccal
Palatal(inclined, circular cross section)

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Treatment of furcation involvement

Maxillary molar furcation entrances

3 furcation entrances
Mesial(3mm from CEJ)
Buccal(3.5mm from CEJ)
Distal(5mm from CEJ)

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Treatment of furcation involvement

Furcation fornix inclination in maxillary molars

Inclined

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Treatment of furcation involvement

Degree of seperation and divergence from first to third maxillary molar

Decreases

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Treatment of furcation involvement

Maxillary premolar roots

2 roots
Buccal and palatal

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Treatment of furcation involvement

Distance between CEJ and furcation entrance in maxillary premolars

8mm

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Treatment of furcation involvement

Width of furcation entrance in maxillary molars

0.7mm

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Treatment of furcation involvement

Roots of mandibular molars

2 roots
Mesial and distal

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Treatment of furcation involvement

Root trunk of mandibular first molar compared with second

Shorter root trunk

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Treatment of furcation involvement

Mandibular molar lingual entrance compared with buccal

More apical to CEJ(>4mm) than buccal entrance(3mm)

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Furcation classifications

Class 0
Class 1
Class 2
Class 3

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Class 0 furcation

Study These Flashcards

No furcation involvement

Class 1 furcation

Study These Flashcards

Horizontal direction, probe travels less than 3mm

through one or two entrances

Class 2 furcation

Study These Flashcards

Horizontal direction, probe travels more than 3mm

-Probe doesnt go through whole furcation
-Only in one entrane

Class 3 furcation

Horizontal, probe travels more than 3mm making through and through lesion ## Footnote two or more entrances

Subclasses of furcation in class 3

1. Less than 3mm in vertical direction 2. 3-6mm in vertical direction 3. More than 6mm in vertical direction

# Treatment of furcation involvement Probe used for assessment of furcations

* Nabers probe * 1 for upper * 2 for upper and lower

# Treatment of furcation involvement Nabers probe design

* Curved working end * Circular cross section * Blunt atraumatic tip

# Treatment of furcation involvement Nabers probe markings

2 black bands between 3-6 and 9-12mm

# Treatment of furcation involvement Areas of mandibular molars checked with nabers probe

Buccal and lingual entrances

# Treatment of furcation involvement Areas of maxillary molars checked with nabers probe

* Buccal * DP(Located midway) * MP(much closer to palatal)

# Treatment of furcation involvement Areas of maxillary premolars checked with nabers probe

Mesial and distal entrances

# Treatment of furcation involvement Radiographs used for assessment/comfirmation of furcation involvement

* Periapical * Vertical bitewing

# Treatment of furcation involvement Differential diagnosis of furcation involvement

* Pulpal pathoses-originating from root canal * Occlusal overload

# Treatment of furcation involvement Factors to consider to confirm pulpal pathosis

* Vitality of tooth tested * If tooth vital=>plaque associated lesion supected * If tooth non vital=>furcation involvement w/ endodontic origin

# Treatment of furcation involvement Factors to consider to confirm occlusal overload

* Increased mobility * Probing fails to detect furcation

# Treatment of furcation involvement Treatment of F1

* Scaling and root planing=> * Furcation plasty

# Treatment of furcation involvement Treatment of F2

* Furcation plasty * Tunnel preparation * Root resection * Tooth extraction * GTR for mandibular molars

# Treatment of furcation involvement Furcation plasty

* Elimination of interradicular defect * Tooth substance removed(odontoplasty) * Alveolar crest remodelled at level of furcation entrance(osteoplasty) * Mainly at buccal and lingual furcations

# Treatment of furcation involvement Furcation plasty procedure

* Incision and flap retraction to access interradicular area and surrounding bone * Removal of inflammatory soft tissue=>scaling and root planning exposed root surfaces * Removal of crown and root substance in furcation area * Recontouring of alveolar bone crest * Positioning and suturing of mucosal flaps at level of alveolar crest=>cover fucation entrance w/ soft tissue

# Treatment of furcation involvement Reason for Removal of crown and root substance in furcation area

* Reduces horizontal component of defect * Widens furcation entrance

# Treatment of furcation involvement Reason for recontouring of alveolar bone crest during furcation plasty

Reduces BL dimension of bone defect in furcation area

# Treatment of furcation involvement Tunnel preparation

* Resective therapy * F2 and F3 in mandibular molars(short root trunk, wide seperation angle, long divergence between mesial and distal roots)

# Treatment of furcation involvement Tunnel preperation procedure

* Incision and flap * Granulation tissue removed * Root scaling and planing * Furcation area widened-removal of interradicular bone * Alveolar bone crest recontoured * Flaps sutured apically * Topical CHX

# Treatment of furcation involvement Reason for widening of furcation area by removal of interradicular bone in tunnel preparation

Allows access for cleaning devices to be inserted during plaque control

# Treatment of furcation involvement Root seperation

Sectioning of root complex and maintenaince of all roots

# Treatment of furcation involvement Root resection

Sectioning and removal of one or two roots of multi-rooted tooth

# Treatment of furcation involvement Factors to consider for root seperation and resection

* Length of the root trunk(shorter the better) * Divergence * Fusion between root cones * Remaining support around individual roots * Length and shape of root cones * stability of indivudual roots * Access for oral hygiene devices

# Treatment of furcation involvement Maxillary molar treatment with RSR

* DB root often removed * MB root preferred for retention

# Treatment of furcation involvement Treatment of F2 and F3 in maxillary first premolar

Extraction

# Treatment of furcation involvement Treatment options of mandibular molars with RSR

* Seperate the two roots but maintain them both(premolarisation) * Seprate and extract mesial root * Seperate and extract distal root

# Treatment of furcation involvement Reason for seperation and extraction of mesial root of mandibular molars during RSR

* Greater surface area but ourglass shaped cross section=> * Difficult to clean

# Treatment of furcation involvement Treatment sequence in RSR

* Endo treatment * Provisional restoration * RSR * Periodontal surgery * Final prosthetic restoration

# Treatment of furcation involvement Criteria for extraction

* Root cant be maintained=>extensive attachment loss * Anatomy wont allow proper self performed plaque control * Poor prognosis=>endo or caries lesions

40. Treatment of furcation involvement Flashcards

(54 cards)