Management of furcation -involved teeth

1. Management of furcation-involved teeth

2. Intraoperative revision of furcation involvement include • Furcation depth • Width of furcation entrance • Height of furcation entrance • Height of root trunk • Height of interdental bone • Special circumferential bony pockets with indirect furcation involvement • Hamp et al. (1975) classification of the involved furcation: • Degree I: horizontal loss of periodontal support not exceeding one third of the width of the tooth • Degree II: horizontal loss of periodontal support exceeding one third of the width of the tooth, but not encompassing the total width of the furcation area • Degree III: horizontal “through-and-through” destruction of the periodontal tissues in the furcation area

3. Treatment objectives: • The elimination of the microbial plaque from the exposed surfaces of the root complex. • The establishment of an anatomy of the affected surfaces that facilitates proper self-performed plaque control. • Different methods of therapy are recommended: • Degree I: scaling and root planing; furcation plasty. • Degree II: furcation plasty; tunnel preparation; root resection; tooth extraction; guided tissue regeneration at mandibular molars. • Degree III: tunnel preparation; root resection; tooth extraction.

4. Scaling and root planing • degree I involvement in most situations result in the resolution of the inflammatory lesion in the gingiva. • healing will re-establish a normal gingival anatomy with the soft tissue • Extraction • poor prognosis teeth

5. Furcationplasty 1. Reflection of soft tissue flap 2. Removal of the inflammatory soft tissue from the furcation area followed by careful scaling and root planing of the exposed root surfaces. 3. Odontoplasty 4. Recontouring of alveolar bone crest 5.Positioning and suturing mucosal flap at level of alveolar crest

6. Tunnel prepparation • Surgical exposure and management of entire furcation area. • Following the reflection of buccal and lingual mucosal flaps, the granulation tissue in the defect is removed and the root surfaces are scaled and planed. • The furcation area is widened by the removal of some of the inter-radicular bone. • The alveolar bone crest is recontoured;

7. Root separation root resection (RSR) • Root separation involves the sectioning of the root complex and the maintenance of all roots. • Root resection involves the sectioning and the removal of one or two roots of a multi-rooted tooth. • Procedure involved: -endodontic treatment -provisional restoration -RSR

8. Periodontal Risk Assessment