Furcations Lecture Handout Parts 3 & 4

Question 1

Factors to Consider Before Treatment
 — support
 — of the tooth
 Involvement of —
 Support of —
 — of roots
 Degree of —
 Presence of —
 Access for —
 Patient’s —

Answer 1

Horizontal and vertical osseous
Strategic value
multiple teeth
retained roots
Length
root divergence
sinus or external oblique ridge
oral hygiene
age and type of disease

Question 2

Treatment Alternatives
(7)

Answer 2

 Extraction
 Scale and root plane
 Odontoplasty??
 Flap debridement or osseous surgery
 Tunnel procedure
 Root resection
 Regeneration (Class I and a shallow
Class II)

Question 3

Treatment Alternatives
 Extraction

Answer 3

• In cases of multiple furcated teeth,
  preserving all of the molars may be
  impossible for several reasons. Extractions
  with implants, or another prosthesis may be
  indicated

Question 4

Treatment Alternatives
 Scale and root plane
(2)

Answer 4

• Instrumentation is difficult due to furcation
  entrance diameter and furcation anatomy.
• Ultrasonics may be best modality for
  furcation instrumentation. No difference
  with Grade I furcations but more
  effective in Grade II and Grade III. (Leon
  and Vogel, 87)
  SRM2023

Question 5

Treatment Alternatives
 Odontoplasty

Answer 5

• Removing the roof of the furcation
  may improve patient’s access for
  plaque control. Indicated with Grade
  I and shallow Grade II furcations.
  Must be conservative or root
  sensitivity can result. An option, but
  rarely used.

Question 6

reatment Alternatives
 Flap Debridement/Osseous Surgery
(2)

Answer 6

• Remember, significant reduction in
  effectiveness of non-surgical
  subgingival plaque removal if pocket
  depth is greater than 3 mm.
• Flap debridement would be more
  effective for furcation access

Question 7

Treatment Alternatives
 Tunnel preparation
* Creation of a
* Must have (2)
* Disadvantage of (2)
* Caries seen in –% of 156 tunnels with
rigorous maintenance, fluoride, and CHX
(Hellden et al, 89). (76% success)

Answer 7

furcation tunnel used with
deep Grade II and Grade III furcations.
divergent roots and good
patient home care.
caries, and pulpal
issues.
24

Question 8

Root Resections
 Indications for root resections
(6)

Answer 8

• Severe bone loss
• Close root proximity
• Inability to perform home care
• Strategic tooth
• Root fracture
• Unable to treat involved root with
  endodontics (but able to complete
  endodontics within two weeks if vital root
  amputation)

Question 9

Treatment Alternatives
 Root Resection
* If — cannot be
done in a furcation with severe bone loss
on one of the roots but good support on
the possible remaining roots.
* Study of 100 teeth (50 max. and 50
mand. molars) after ten years found that
—% were still in function. Failures mainly
caused by —*

Answer 9

access for plaque control
62
root fracture

Question 10

Root Resections
 Contraindications for root resection
(9)

Answer 10

• Severe bone loss on retained roots
• Unable to do endodontics on retained roots
• Fused roots apical to furcation
• Poor plaque control
• Mobile teeth
• Long root trunk length
• Poor medical health
• Economics
• Age and type of periodontitis

Question 11

Treatment Alternatives
 Regeneration
* —success depends
on morphology of the defect.
Furcations are poor candidates for
grafting due to lack of —.
* Guided Tissue Regeneration
(GTR) can be effective with —

Answer 11

Osseous grafting
vascularity
bone
replacement grafts

Question 12

Evaluation of FurcationTherapy
 Hirschfeld and Wasserman (1978) found an
overall loss of teeth in a study of –% , but
–% of molars lost. (600 patients treated
and maintained for 15 years or longer.)
 McFall (1982) found an overall tooth loss of
–% in their study, but –% of molars were
lost. (100 patients treated and maintained
for 15 years or longer.)
 Ross and Thompson (1978) treated 100 pts
with –% of molars functioning for 5-24 yrs

Answer 12

7
31
10
57
88

Question 13

Furcation Treatment
 Grade I furcation
(3)

Answer 13

• Control of inflammation through
  plaque control and root
  preparation
• Adjustment of occlusion if
  indicated at reevaluation
• Odontoplasty if indicated (??)

Question 14

Furcation Treatment
 Grade II furcation (shallow)
* Control of inflammation through
(2)
* Adjustment of — if
indicated at reevaluation
* — if indicated (??)
* —

Answer 14

plaque control and root
preparation
occlusion
odontoplasty
Flap debridement/osseous
surgery or potential regeneration

Question 15

Furcation Treatment
 Grade II (deep) furcation
(7)

Answer 15

 Control of inflammation (difficult)
 Adjustment of occlusion if indicated
at reevaluation
 Flap debridement/osseous surgery
 Root resection
 Osseous regeneration
 Tunnel preparation
 Extraction

Question 16

Furcation Treatment
 Grade III furcation
(6)

Answer 16

 Control of inflammation (difficult)
 Adjustment of occlusion if indicated
at reevaluation
 Flap debridement (difficult)
 Root resection
 Tunnel preparation
 Extraction

Question 17

Root Resection vs. Implants
 Fugazzotto, J Perio, 2001
 Comparison of success of root-resected molars and
molar implants in use up to 15 yrs.
 Success of implants was –% for 1472 implants at
13 yrs.
 Success of 701 root resections (various
combinations) was –% at 15 yrs.

Answer 17

97
96.8