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Perio II > Furcations Part 1 and 2 > Flashcards

Furcations Part 1 and 2 Flashcards

1
Q

what are the goals of furcation therapy

A
  • arrest the active disease
  • prevent further loss of attachment
  • regenerate lost periodontium
  • prevent disease reocurrence
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2
Q

what are the objectives of furcation therapy

A
  • access for home care
  • access for maintenance
  • establish physiologic bone and titssue architecture
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3
Q

what are the ways to classify furcations

A
  • goldman- incipient or glickman - grade 1
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4
Q

what is goldman incipient or glickman grade 1

A

pocket formation into the flute of the furca but the inter radicular bone is intact

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5
Q

what is goldman cul de sac or glickman grade II

A
  • can be shallow or deep
  • loss of inter radicular bone with pocket formation of varying depths into the furca, but not completely through to the other side
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6
Q

what is goldman through and through or glickman grade III

A

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

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7
Q

what is glickman grade IV

A

loss of attachment and gingival recession that has made the furcation clearly visible to clinical exam

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8
Q

what is Hamp (75)

A

classification of the horizontal component of furcation involvement

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9
Q

what is hamp degree 1

A

horizontal loss less than 3mm

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10
Q

what is hamp degree 2

A

horizontal loss greater than 3mm but not the total width of furcation area

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11
Q

what is hamp degree 3

A

through and through

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12
Q

what is tarnow classification

A

classification of the vertical component of furcation involvement

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13
Q

what is subclass A tarnow

A

vertical loss up to 1/3 of furca (1-3mm)

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14
Q

what is subclass B tarnow

A

vertical loss up to 2/3 of furca (4-6mm)

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15
Q

what is subclass C tarnow

A

vertical loss into the apical third (greater than 7mm)

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16
Q

what furcation involvement automatically places patient into stage III or stage IV periodontitis

A

grade/class II or grade/class III furcation

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17
Q

what are the 2 ways to dx by clinically probing the furcations

A
  • standard straight probing with a straight probe only measures the vertical attachment loss and the extent of the horizontal loss will not be detected
  • curved probing (nabers) with a curved probe will determine the horizontal attachment loss
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18
Q

what is the nabers probe used for

A

used to detect furcations

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19
Q

where are the furcation entrances for maxillary molar

A
  • mesial furcation toward palatal 1/3 so probe from palatal
  • distal furcation in mid 1/3 under contact point so probe from palatal or buccal
  • buccal furcation from buccal
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20
Q

what is the probing, radiographic dx for maxillary molars

A

-3% dx by probing alone
- 22% dx by radiographs alone
-65% diagnosed using both clinical and radiographs

21
Q

what is the probing, radiographic dx for mandibular molars

A

-9% dx by probing alone
- 8% dx by radiographs alone
-18% dx by both radiographic and clinical exam

22
Q

what are the grades of CEPs

A

grade I, II, or III depending on extension towards and into the furcation

23
Q

what is the incidence of CEPs

A

ranges from 17-33%
- mandibular second molar has the highest incidence
- asian populations have far higher incidence

24
Q

what are the implications of CEPs

A

epithelial attachment

25
what is the percentage of CEPs on mandibular molars, max molars
- 28.6% of mandibular molars - 1% of maxillary molars - associated with 90% of isolated furcation involvements
26
what percentage of CEPs in molars
32.6%
27
is there a relationship between CEPs and furcations
no
28
what is the root trunk length of maxillary first molars
- mesial: 3mm - facial: 4mm - distal: 5mm
29
what is the root trunk length of mandibular first molars
- buccal: 3mm - lingual: 4mm - also note the inclination of the mandibular molars is to the midline
30
what is the surface area percentage of maxillary first molar
- root trunk ( part of root from CEj to where root divides): 32 - MB root: 25 - palatal root: 24 DB root: 17
31
which root of the maxillary first molar is the most commonly removed
DB root
32
what is the furcation root trunk length for maxillary 1st premolars
mesial: 8mm
33
where are the furcation root concavities
- found 100% of time on mesial surface of mandibular first molar and 99% on distal surface - found 94% on MB, 31% on DB, and 17% on palatal surfaces of maxillary first molars
34
where are furcal concavities on the mandibular molars
100% on the mesial root and 99% on the distal root
35
where are the concavities on the maxillary frist molar furcal root surfaces
- 94% on the MB (0.1-0.7mm) 31% on the DB (0.1mm) and 17% on the palatal root (0.1mm)
36
what are the furcation entrance diameters
- 81% are 1mm or less - 58% are 0.75 or less - width of new curette blade 0.75-1.25mm
37
what percentage of furcations cannot be instrumented with hand instruments
58%
38
describe the limited furcation entrance diameter
- 58% are less than .75mm and 81% are less than 1mm
39
what is the pulp interrelationship
incidence of lateral canals is 28% in furcation area
40
what are bifurcational ridges (interradicular ridges)
73% of mandibular first moalrs have ridges in MD direction and 63% have ridges in BL direction
41
pulpal status can affect:
periodontium by the way of lateral canals and apical foramen
42
where are the bifurcation ridges
73% in MD, 63% in BL direction
43
what is the etiology of furcation bone loss
- plaque (advancing plaque front) - developmental anomalies - iatrogenic - pulpal involvement - occlusal trauma
44
what are the factors to consider before treatment
- horizontal and vertical osseous support - strategic value of the tooth - involvement of multiple teeth - support of retained roots - length of roots - degree of root divergence - presence of sinus or external oblique ridge - access for oral hygiene - patients age and type of disease
45
what are the treatment alternatives
- extraction - scale and root plane - odontoplasty - flap debridement or osseous surgery - tunnel procedure - root resection - regeneration- class I and a shallow class II
46
when would extraction be indicated
in cases of multiple furcated teeth
47
when would you scale and root plane
- 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
48
what is odontoplasty and when is it indicated
- removing the roof of the furcation may improve the patients access for plaque control - indicated with grade I and shallow grade II furcations - must be conservative or root sensitivity can result - rarely used
49

Perio II (13 decks)

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