Furcation defect

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Bone loss from aggressive periodontitis that led to an exposed furcation on an upper molar. In health, the bone exists about a millimeter and a half away from the cementoenamel junction, which is the line that separates the crown from the root trunk (the line can be seen clearly in the photo). MolarFurcation.jpg
Bone loss from aggressive periodontitis that led to an exposed furcation on an upper molar. In health, the bone exists about a millimeter and a half away from the cementoenamel junction, which is the line that separates the crown from the root trunk (the line can be seen clearly in the photo).
Evidence of furcal bone loss on #18 (lower left permanent second molar), along with a mesial vertical defect on the same tooth. The bent "stick" on the left of the tooth is a piece of gutta percha being used to trace the defect. -18 furcation.jpg
Evidence of furcal bone loss on #18 (lower left permanent second molar), along with a mesial vertical defect on the same tooth. The bent "stick" on the left of the tooth is a piece of gutta percha being used to trace the defect.

In dentistry, a furcation defect is bone loss, usually a result of periodontal disease, affecting the base of the root trunk of a tooth where two or more roots meet (bifurcation or trifurcation). The extent and configuration of the defect are factors in both diagnosis and treatment planning. [1]

Contents

A tooth with a furcation defect typically possessed a more diminished prognosis owing to the difficulty of rendering the furcation area free from periodontal pathogens. For this reason, surgical periodontal treatment may be considered to either close the furcation defect with grafting procedures or allow greater access to the furcation defect for improved oral hygiene.

Root trunk length

The distance between the cementoenamel junction (CEJ) and the furcation entrance is called the root trunk length. This distance plays an important role in furcation defects because the deeper the furcation entrance is within the bone, the more bone loss necessary before the furcation becomes exposed.

For mandibular first molars, the mean root trunk length is 3 mm on the buccal aspect and 4 mm on the lingual aspect. [2] The root trunk lengths for mandibular second and third molars are either the same or slightly greater than for first molars, although the roots may be fused.

For maxillary first molars, the mean root trunk length is 3-4 mm on the buccal aspect, and 4-5 mm on the mesial aspect and 5-6 mm on the distal aspect. [2] As with mandibular molars, the root trunk lengths for maxillary second and third molars are either the same or slightly greater than for first molars, although the roots may be fused.

For maxillary first premolars, there is a bifurcation 40% of the time and the mean root trunk length is 8 mm from both mesial and distal. [2]

Furcation defect classification

Because of its importance in the assessment of periodontal disease, a number of methods of classification have evolved to measure and record the severity of furcation involvement; most of the indices are based on horizontal measurements of attachment loss in the furcation.

In 1953, Irving Glickman graded furcation involvement into the following four classes: [3]

In 2000, Fedi, et al. modified Glickman's classification to include two degrees of a grade II furcation defect: [4]

In 1975, Sven-Erik Hamp, together with Lindhe and Sture Nyman, classified furcation defects by their probeable depth.

Diagnosis

Nabers probe is used to check for furcation involvement clinically.[ citation needed ] Recently, cone beam computerised technology (CBCT) has also be used to detect furcation. [5] Periapical and interproximal intraoral radiographs can help diagnosing and locating the furcation.[ citation needed ]

Only multirooted teeth have furcation. Therefore, upper first premolar, maxillary and mandibular molars may be involved. Upper premolars have one buccal and one palatal root. Maxillary molars have three roots, a mesio-buccal root, disto-buccal root and a palatal root. Mandibular molars have one mesial and one distal root, and so.

Treatment

The treatment aims are to eliminate the bacteria from the exposed surface of the root(s) and to establish the anatomy of the tooth, so that better plaque control can be achieved. Treatment plans for patients differ depending on the local and anatomical factors.

For Grade I furcation, scaling and polishing, [5] [6] root surface debridement or furcationplasty could be done if suitable.

For Grade II furcation, furcationplasty, open debridement, [5] [7] tunnel preparation, [5] root resection, [5] extraction, [5] guided tissue regeneration (GTR) [7] [5] [6] or enamel matrix derivative could be considered.

As for Grade III furcation, open debridement, [5] [7] tunnel preparation, [5] root resection, [5] [6] GTR, [7] [5] or tooth extraction [5] could be performed if appropriate.

Tooth extraction is usually considered if there is extensive loss of attachment or if other treatments will not obtain good result (i.e. achieving a nice gingival contour to allow good plaque control).

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Canine tooth</span> Long pointed tooth in mammals

In mammalian oral anatomy, the canine teeth, also called cuspids, dog teeth, or fangs, eye teeth, vampire teeth, or vampire fangs, are the relatively long, pointed teeth. They can appear more flattened however, causing them to resemble incisors and leading them to be called incisiform. They developed and are used primarily for firmly holding food in order to tear it apart, and occasionally as weapons. They are often the largest teeth in a mammal's mouth. Individuals of most species that develop them normally have four, two in the upper jaw and two in the lower, separated within each jaw by incisors; humans and dogs are examples. In most species, canines are the anterior-most teeth in the maxillary bone.

<span class="mw-page-title-main">Premolar</span> Transitional teeth located between the canine and molar teeth

The premolars, also called premolar teeth, or bicuspids, are transitional teeth located between the canine and molar teeth. In humans, there are two premolars per quadrant in the permanent set of teeth, making eight premolars total in the mouth. They have at least two cusps. Premolars can be considered transitional teeth during chewing, or mastication. They have properties of both the canines, that lie anterior and molars that lie posterior, and so food can be transferred from the canines to the premolars and finally to the molars for grinding, instead of directly from the canines to the molars.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

<span class="mw-page-title-main">Maxillary first molar</span>

The maxillary first molar is the human tooth located laterally from both the maxillary second premolars of the mouth but mesial from both maxillary second molars.

<span class="mw-page-title-main">Mandibular second premolar</span>

The mandibular second premolar is the tooth located distally from both the mandibular first premolars of the mouth but mesial from both mandibular first molars. The function of this premolar is assist the mandibular first molar during mastication, commonly known as chewing. Mandibular second premolars have three cusps. There is one large cusp on the buccal side of the tooth. The lingual cusps are well developed and functional. Therefore, whereas the mandibular first premolar resembles a small canine, the mandibular second premolar is more alike to the first molar. There are no deciduous (baby) mandibular premolars. Instead, the teeth that precede the permanent mandibular premolars are the deciduous mandibular molars.

<span class="mw-page-title-main">Mandibular first molar</span>

The mandibular first molar or six-year molar is the tooth located distally from both the mandibular second premolars of the mouth but mesial from both mandibular second molars. It is located on the mandibular (lower) arch of the mouth, and generally opposes the maxillary (upper) first molars and the maxillary 2nd premolar in normal class I occlusion. The function of this molar is similar to that of all molars in regard to grinding being the principal action during mastication, commonly known as chewing. There are usually five well-developed cusps on mandibular first molars: two on the buccal, two lingual, and one distal. The shape of the developmental and supplementary grooves, on the occlusal surface, are described as being 'M' shaped. There are great differences between the deciduous (baby) mandibular molars and those of the permanent mandibular molars, even though their function are similar. The permanent mandibular molars are not considered to have any teeth that precede it. Despite being named molars, the deciduous molars are followed by permanent premolars.

<span class="mw-page-title-main">Veterinary dentistry</span> Branch of veterinary medicine

Veterinary dentistry is the field of dentistry applied to the care of animals. It is the art and science of prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and its associated structures as it relates to animals.

<span class="mw-page-title-main">Buccal exostosis</span> Medical condition

A buccal exostosis is an exostosis on the buccal surface of the alveolar ridge of the maxilla or mandible. More commonly seen in the maxilla than the mandible, buccal exostoses are considered to be site specific. Existing as asymptomatic bony nodules, buccal exostoses don’t usually present until adult life, and some consider buccal exostoses to be a variation of normal anatomy rather than disease. Bone is thought to become hyperplastic, consisting of mature cortical and trabecular bone with a smooth outer surface. They are less common when compared with mandibular tori.

Dental anatomy is a field of anatomy dedicated to the study of human tooth structures. The development, appearance, and classification of teeth fall within its purview. Tooth formation begins before birth, and the teeth's eventual morphology is dictated during this time. Dental anatomy is also a taxonomical science: it is concerned with the naming of teeth and the structures of which they are made, this information serving a practical purpose in dental treatment.

Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.

<span class="mw-page-title-main">Scaling and root planing</span> Dental procedure

Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

Guided bone regeneration (GBR) and guided tissue regeneration (GTR) are dental surgical procedures that use barrier membranes to direct the growth of new bone and gingival tissue at sites with insufficient volumes or dimensions of bone or gingiva for proper function, esthetics or prosthetic restoration. Guided bone regeneration typically refers to ridge augmentation or bone regenerative procedures; guided tissue regeneration typically refers to regeneration of periodontal attachment.

<span class="mw-page-title-main">Debridement (dental)</span> Removal of plaque and calculus from teeth

In dentistry, debridement refers to the removal by dental cleaning of accumulations of plaque and calculus (tartar) in order to maintain dental health. Debridement may be performed using ultrasonic instruments, which fracture the calculus, thereby facilitating its removal, as well as hand tools, including periodontal scaler and curettes, or through the use of chemicals such as hydrogen peroxide.

Chronic periodontitis is one of the seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system. Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by the accumulation of profuse amounts of dental plaque. Periodontitis initially begins as gingivitis and can progress onto chronic and subsequent aggressive periodontitis according to the 1999 classification.

Aggressive periodontitis describes a type of periodontal disease and includes two of the seven classifications of periodontitis as defined by the 1999 classification system:

  1. Localized aggressive periodontitis (LAP)
  2. Generalized aggressive periodontitis (GAP)

Serial extraction is the planned extraction of certain deciduous teeth and specific permanent teeth in an orderly sequence and predetermined pattern to guide the erupting permanent teeth into a more favorable position.

A periodontal examination is a clinical examination of the periodontium (gums). It is routinely carried out in dentistry and allied specialties. Many different techniques are used around the world.

Periodontal surgery is a form of dental surgery that prevents or corrects anatomical, traumatic, developmental, or plaque-induced defects in the bone, gingiva, or alveolar mucosa. The objectives of this surgery include accessibility of instruments to root surface, elimination of inflammation, creation of an oral environment for plaque control, periodontal diseases control, oral hygiene maintenance, maintain proper embrasure space, address gingiva-alveolar mucosa problems, and esthetic improvement. The surgical procedures include crown lengthening, frenectomy, and mucogingival flap surgery.

References

  1. Ammons WF, Harrington GW: Furcation, The Problem and Its Management. In Newman, Takei, Carranza, editors: Carranza's Clinical Periodontology, 9th Edition. Philadelphia: W.B. Saunders Co. 2002. page 826-7.
  2. 1 2 3 Carnavale F, Pontoriero R, Lindhe, J: Treatment of Furcation-Involved Teeth. In Lindhe, Karring, Lang, editors: Clinical Periodontology and Implant Dentistry, 4th Edition. London: Blackwell Munksgaard. 2003. pages 707-8.
  3. Knowles J, Burgett F, Nissle R: Results of periodontal treatment related to pocket depth and attachment level, Eight years. J Perio 1979; 50:225.
  4. 1 2 Vandersall DC: Concise Encyclopedia of Periodontology Blackwell Munksgaard 2007
  5. 1 2 3 4 5 6 7 8 9 10 11 12 Umetsubo, Otavio Shoiti; Gaia, Bruno Felipe; Costa, Felipe Ferreira; Cavalcanti, Marcelo Gusmão Paraiso (2012-08-01). "Detection of simulated incipient furcation involvement by CBCT: an in vitro study using pig mandibles". Brazilian Oral Research. 26 (4): 341–347. doi: 10.1590/S1806-83242012000400010 . ISSN   1806-8324. PMID   22790499.
  6. 1 2 3 "Treatment of Furcation Defects". www.drbui.com. Retrieved 2017-03-25.
  7. 1 2 3 4 Aichelmann-Reidy, Mary E.; Avila-Ortiz, Gustavo; Klokkevold, Perry R.; Murphy, Kevin G.; Rosen, Paul S.; Schallhorn, Robert G.; Sculean, Anton; Wang, Hom-Lay; Reddy, Michael S. (2015). "Periodontal Regeneration — Furcation Defects: Practical Applications From the AAP Regeneration Workshop" (PDF). Clinical Advances in Periodontics. 5 (1): 30–39. doi:10.1902/cap.2015.140068. hdl: 2027.42/141344 . PMID   32689737.