Week 7- Perio Surgery Furcations, Bone Grafts, GTR Flashcards
(46 cards)
What is the issue with furcation involved teeth?
Tend to respond less favourable to non-surgical perio therapy and have reduced prognosis.
What are surgical tx options for furcation involved teeth?
- Resective surgery
- Furcation plasty
- Hemi-section, root resection, bicuspidization
- Regenerative surgery
What is the classification for furcation involvement?
- Grade I: incipient, catch in furcation
- Grade II: bone loss, not through and through ‘cul-de-sac’
- Grade III: bone loss through and through
What is the perio pocket in a furcation lesion influenced by?
- Anatomy of soft tissue (thick, thin)
- Bone (horizontal and angular loss)
- Inter-radicular anatomy of tooth
What does furcation plasty involve?
- Odontoplasty (reshaping tooth)
- Osteoplasty (reshaping bone)
- Gingivoplasty (reshaping gingiva) to enhance pocket and furcation access following open debridement.
What are the steps of furcation plasty?
- Flap to access inter-radicular area
- Odontoplasty to widen furcation entrance
- Osteoplasty to reduce or eliminate the intra-bony defect and decrease thickness of bone.
- Positioning flap at level of alveolar bone crest.
What is the goal for furcation plasty?
Improved access for self-care and professional supportive care should result
What teeth should aggressive odontoplasty be avoided on and why?
Aggressive odontoplasty should be avoided on vital teeth due to risk of hypersensitivity
What furcation involved teeth can receive tunnel preparation?
Md molars with deep grade II and III furcation defects
What is the rationale for hemi-section, root resection and bicuspidization?
Complete elimination of furcation defect. Involves a multidisciplinary approach and aims to preserve tooth or part of it
When is endo tx completed when hemi-section, root resection and bucuspidization are undertaken?
- Endo done before surgery
- Occasionally, decision to resect root is made during surgery, in which case endo tx is done along with surgery.
What is hemisection?
Sectioning tooth in 2 and removing one half of it (can do cantilever off remaining segment)
What teeth is hemi-section vs root resection done in?
- Hemi-section: lower molar
- Root resection: upper molar
What is this procedure?
Hemi-section
When is hemi-section indicated?
- Severe bone loss around one root
- Perforations during endo
What is root resection?
Removal of one or two roots (with poorest prognosis)
What is this procedure?
Root resection
What is bicuspidization?
Splitting tooth in 2 and retaining both sections
What is this procedure?
Bicuspidization
What are the steps of hemi-section, root resection and bicuspidization?
- Mucoperiosteal flap to expose furcation area
- Sectioning root or tooth with straight line cut
- Careful removal of root (root resection), tooth section (hemisection). Non for bicuspidization.
- Re-positioning of flaps at level of bone crest.
What are failures for hemi-section, root resection and bicuspidization often associated with?
- Usually due to non-periodontal complications so care should be taken to ensure sound endo therapy and a balanced occlusion
- Remaining roots should have adequate bone support
What is regenerative surgery?
Regeneration of periodontal defects involves formation of new cementum, new attachment periodontal fibers and new bone that was destroyed by perio disease.
How can true regeneration be verified?
Only via histologic evaluation by removing tooth and bone. No way to confirm clinically.
What can you confirm by doing re-entry surgery after regenerative surgery?
Can measure bone fill but cannot ascertain if new cementum or periodontal fibers have formed.
