Furcation involvement
Diagnosis :
Probing into the furcation and Xrays
Pulp pathology ↑ in teeth with furcation involvement → SHOULD DO PST
Classification
Class 1 : Probe can be inserted <3mm between the roots. / furcation can be felt by probing but involvement is <⅓ of tooth width
→ Requires scaling and root planing, possibly with furcation plasty.
Class 2: Horizontal probing depth exceeding 3mm but not extending fully through the width of furcation / >⅓ of tooth width but not the whole width of furcation
→ GTR together with graft materials and EMD
Class 3 : Horizontal through- and- through destruction in the furcation area.
→ May require tunnel preparation, &/ or root resection, &/ or extraction.GTR less predictable in Class 3 defects.
Rx techniques
- Scaling and root debridement
-Unless the post- Rx morphology can be kept clean by pt, it will not be successful.
- Furcation plasty
– An open procedure involving a muco- periosteal flap to allow root debridement and scaling, followed by the removal of tooth structure in the furcation area to achieve a widened entrance to give access for cleaning. Osseous recontouring may be used if indicated. The flap is repositioned and sutured to ↑ access post-op
– risk of pulpal damage and post- operative dentine sensitivity/ caries.
- Tunnel preparation Naber’s probe
-similar to furcation plasty using buccal and lingual flaps. the main difference being that the entire furcation
area is exposed and the flaps are sutured together intra- radicularly to leave a large exposed furcation.
-high risk of post- operative caries, dentine sensitivity, and pulpal exposure
-good in mandi molars in pt with optimal OH
In cases where its considered for furcation plasty and tunnel, might be better to go for root resection instead
- Root resection
-amputation of one (or even two) of the roots of a multirooted tooth, leaving the crown and the root stump.
-make sure that the root to be retained can be treated endodontically, is in sound periodontal state with good bony support, is restorable, and will be a viable tooth in the long term.
-Resection of the root with a high- speed bur is followed by smoothing, recontouring, and restoration of
any residual pulp cavity. It is sometimes not possible to proceed with root resection, despite apparently favourable radiographs, especially in maxillary molars, so warn patient pre- operatively.
- Hemisection
– dividing lower molars in half to give two smaller units each with a single root. One is extracted and the other retained.
– RCT pre- operatively and restoration of the divided crown is required post- operatively.
- Extraction
- Guided tissue regeneration
- Enamel matrix derivatives
Best is still plaque control that can be achieved and maintained by the patient. Mini interproximal brushes are a valuable aid in cleaning furcation defects and are available in a variety of sizes and shapes.