Recession and furcation

Question 1

What is recession?

Answer 1

Non inflammatory condition characterised by apical retreat of the periodontium (where ID papilla normally stays normal level)

Question 2

Aetiology of recession?

Answer 2

Primary factor being presence of alv bone loss on facial tooth aspect
Fenestration- window of bone loss
Dehiscence- lack of bone
Can be due to trauma (Improper tbing)

Question 3

What does recession look like clinically?

Answer 3

Look for ‘Stillman’s cleft: (V shape in gum)

‘McCalls festoons’ (gum has rolled margin)

Question 4

What does McCalls festoon look like?

Answer 4

Gum has a rolled margin

Question 5

What is generalised recession associated with?

Answer 5

Dentine hypersensitivity, root caries, toothbrush abrasion

Question 6

What is localised recession?

Answer 6

usually on lower anteriors due to frenum pull

Question 7

How do you monitor recession?

Answer 7

Clinical measurements (LOA and pocket depths) Use double perio chart

Question 8

What treatment is there for recession?

Answer 8

Eliminate the causative factors: modify the toothbrush technique
Eliminate areas of mild chronic inflammation
Frenectomy (removal of frenum)
Treat any hypersensitivity (Fluoride, desensitising agents)
Prevent caries (good OH)

Question 9

What is furcation involvement?

Answer 9

The horizontal loss of support in areas where roots of multi-rooted teeth converge.

Question 10

How do you diagnose a furcation?

Answer 10

Radiographs and clinical exam
Radiographs- periapical/bitewing
Clinically- Soft tissue may be filling defect

Question 11

What teeth are affected by furcation?

Answer 11

Maxillary 1st premolars (2 roots- mesial & distal)
Maxillary Molars- 3 roots (Mesial, distal, buccal)
Mandibular molars- 2 roots (buccal & lingual)

Question 12

What are the grades of furcation?

Answer 12

1- horizontal loss of support1/3 width of tooth

3- through-through defect

Question 13

What is the prognosis of a furcation?

Answer 13

A furcation reduces the prognosis for a tooth for 2 reasons: Furcation involvement is difficult to clean (so more difficult to control disease)
Loss of vitality of the tooth may occur due to accessory canals running from pulp into furc area (these act as a conduct tube for bacteria).

Question 14

What is the vitality testing?

Answer 14

Using Ethyl Chloride or elective pulp tester

Question 15

How often should you do a vitality test with a furcation present?

Answer 15

Every year

Question 16

How often should you re-grade a furcation?

Answer 16

Every 6 months

Question 17

What treatment for a furcation?

Answer 17

To either expose the furcation for access of cleaning

or Induce regeneration of new bone

Question 18

What treatment do you use for a grade 1 furcation?

Answer 18

OHI, Scale, polish, RSD

Furcation plasty

Question 19

What treatment do you use for a grade 2 furcation?

Answer 19

OHI, Furcation plasty, tunnel prep, GTR, root resection, extraction

Question 20

What treatment do you use for a grade 3 furcation?

Answer 20

OHI, Exraction, tunnel prep, root resection.

Question 21

What is furcation plasty?

Answer 21

It is for patients access for cleaning
Involves reflection of flap
Removal of deposits and soft tissue from furc
Remove tooth substance to widen the entrance
+/- recontour bone
Replace flap

Question 22

What problems can arise with furcation plasty?

Answer 22

Hypersensitivity, damage to pulp, root caries.