exam 2 (L10) - furcation management Flashcards Preview

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Flashcards in exam 2 (L10) - furcation management Deck (22)
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1
Q

what anatomical structures must be considered when managing furcations?

A
  • root trunk
  • furcation entrance
  • root surface anatomy
  • enamel projections
  • accessory canals
2
Q

what compromises the root trunk, and how does the root trunk affect periodontal tx?

A
  • root trunk = undivided portion of root
  • long root trunks make CCL easier
  • problematic if pt has periodontitis b/c more area to treat
3
Q

what are the fornix and furcation entrance?

A
  • fornix = roof of furcation
  • furcation entrance = transitional area between undivided and divided portion of root
  • need slim ultrasonic devices to clean
4
Q

how does the furation entrance diameter relate to the blade width of a new curette?

A
  • blade width of new Gracey curette = 0.75 mm, and 60% of molar furcation entrances are smaller than that (so use slim ultrasonic)
  • in mandibular molars, FE wider B than L
  • in maxillary molars, FE wider M > D > B
5
Q

what is the prevalence of root concavities in mandibular and maxillary teeth, and what is their significance to tx?

A
  • mandibular: 100% mesial roots, 99% distal roots
  • maxillary: 94% MB roots, 31% DB roots, 17% palatal roots
  • root concavities complicate cleaning
6
Q

what is the significance of cervical enamel projections (CEP), and what is a term for a very large CEP?

A
  • PDL/CT can’t attach to enamel, so CEP areas apical to CEJ have intrinsic AL, leading to pathogen susceptibility
  • large CEP = enamel pearl (most often max 2nd molar)
  • if you see a CEP/enamel pearl, do odontoplasty!
7
Q

what are the 4 classifications of furcations using the Glickman system?

A
  • class I = catch with probe, no radiolucency
  • class II = varies from catch to deep penetration
  • class III = through and through
  • class IV = clinically visible
8
Q

differential diagnosis: what 3 factors discussed can cause furcation radiolucency?

A
  • periodontitis/inflammation
  • trauma from occlusion (TFO) (BL, but not AL)
  • pulp pathology or poorly treated RCT
  • end tx (RCT) > perio tx
9
Q

which mentioned antimicrobials are used in combination with SRP, and what is their effectiveness on furcation areas?

A
  • chlorhexidine
  • tretracycline fibers
  • antimicrobials NOT effective for furcation areas
10
Q

what is the most effective method of furcation management via cleaning?

A
  • open debridement
    + much more effective than closed debridement
  • use ultrasonic cleaners for narrow furcations
11
Q

which treatment option is most effective for grade II furcations? technique?

A
  • osseous surgery (OS)
  • technique:
    +reduce horizontal depth of lip partially blocking furcation
    + make bone ramps into the furcation to help plaque control
    + reduce probing depths
12
Q

in MAXILLARY molars, what technique might be done to help manage furcation problems when cleaning is ineffective?

A
  • root resection
13
Q

when is root resection indicated and contraindicated?

A
  • indicated: class II and III furcations with poor cleaning
  • contraindicated:
    + inadequate bone support
    + fused roots
    + inoperable endodontically (need RCT for root resection)
14
Q

what is the treatment sequence for root resectioning (RSR)?

A
  • endo RCT
  • provisional restoration
  • RSR
  • perio surgery
  • final prosthetic restoration (crown?)
15
Q

what factors must be considered for root resection (RSR)?

A
  • length of root trunk
  • divergence between root cones
  • length and shape of root cones
  • fusion between root cones
  • amount of remaining support around individual roots
  • stability of individual roots
  • access for oral hygiene devices
16
Q

in MANDIBULAR molars, what technique might be done to help manage furcation problems when cleaning is ineffective?

A
  • hemisection
  • used for class III furcations
  • need widely separated roots
  • soft tissue must be positioned below level of pulp chamber
  • “create 2 premolars from a molar”
17
Q

what is a root separation technique?

A

historical technique that sections root complex to maintain all roots (similar to maxillary root sectioning and mandibular hemisection)

18
Q

what is “tunneling,” and when is it performed?

A
  • creating a class III furcation from a class II furcation
  • done to aid patient in removing plaque in furcations
  • moderate failure rate, recurrent periodontitis, and root caries are common, esp if patient is on antihypertensives or other medications that cause xerostomia
19
Q

when and how are furcation defects regenerated?

A
  • when class II furcations are present
  • use GTR to regenerate
  • most predictable in mandibular molars
  • sometimes used in class III furcations, but it is unpredictable
20
Q

regarding furcation defects, when might extraction be a suitable form of tx?

A
  • AL so extensive roots can’t be maintained
  • tooth/gingival anatomy complicates plaque control
  • endo or restorative reasons
  • implant placement (osseointegrated)
21
Q

how good is the longevity of properly treated teeth with class III or less furcation involvement?

A

very good; 70% pt. retained teeth after 22 years in one study

22
Q

what local, behavioral, and systemic factors affect treatment of patients with furcation problems?

A
  • oral hygiene
  • compliance
  • stress
  • intraoral accessability
  • uncontrolled diabetes
  • smoking
  • healing response to previous therapy