Furcation Involved

Teeth
Dr. Maher Kemmona
Postgraguate in Periodontics
28 May 2007
 Diagnostics
Aetiology and
Pathogenesis Classification

Non-Surgical
Anatomy
treatment
Furcation

Long-term Surgical
outcome Treatment

Furcation vs
GTR
Implant
Anatomy
Anatomy II
Anatomy III
Anatomy IV
 Classification of furcation
involvement
• Horizontal as described by Hamp et al.:

- Grade I : horizontal <3mm

- Grade II : horizontal >3mm
- Grade III : through and through
defect
 Classification of furcation
involvement
• Tarnow et al described vertical component
of furcation involvement as:

• Class A : 1-3mm
• Class B : 4-6mm
• Class C : >6mm
 Manual Diagnostic Aid

PQ2N: (Nabers) 3-6-9-12 mm

Radiographic Diagnostics
• OPG
• Periapical X-ray
• Bitewings

• Always check the

endodontic status of
the teeth!!! It may not
be a periodontal
problem you have
encountered.
No furcation involvement
Grade I Furcation
F0 = keine horizontale Sondierungstiefe
F1= Furkation ist mit Sonde bis zu 3mm tief tastbar

Grade II Furcation
Grade III Furcation
Treatment Options
• Non-surgical
• Odontoplastic
• Osteoplastic/-ectomy
• Hemi-/Trisection
• Root Amputation
• GTR
• Extraction
 Periodontal Healing

• New attachment
• Reattachment
• Repair
Non-surgical treatment
• Root Debridement
with Sonic, Ultrasonic
and Manual
Instruments
• Reevaluation
• Supportive
periodontal therapy
• OH- Education
Expectations from non-surgical
therapy (Claffey et al.)
 Expectations from non-surgical
therapy
(Hirschfeld and Wassermann)

• Of 1,464 teeth which originally had furcation

involvements, 460 were lost, 240 of them by
one-sixth of the patients who deteriorated most
• Of 2,139 teeth that originally had been
considered of questionable prognosis, 666 were
lost. Of these, 394 were lost by one sixth of the
patients and only 272 by the other five-sixths.
 Outcome of surgical periodontal
therapy in the literature
• On average surgical treatment has not demonstrated to be superior to root
planning regarding non-surgical treatment, especially in shallow to
moderately deep sites Knowles et al 1979
• This has been shown for various treatment modalities
• For initially deep sites surgical treatment allows for greater pocket depth
reduction over debridement
• The number of teeth that had to be retreated appeared to be lower over 5
years following surgical treatment Ramfjord et al 1987
• Although surgical treatment resulted in less progressive probing attachment
loss over seven years, it must be kept in mind that a higher proportion of
teeth were extracted at baseline in the surgical group in this study.
Kaldahl et al 1996
• Further research needs to establish when and at what time
surgical treatment can offer predictable advantages
OPG 1998
OPG 2004
Post-Implant Therapy
Odontoplastic on Grade I Furcation
Odontoplastic
Osteoplastic
Osteoplastic
Hemisection
 Outcome of surgical periodontal
therapy in the literature
• Hemisection

• The compiled results of studies on hemisection revealed an average failure

rate of 13,1%; the failure rates of implants appeared not sustantially
different Buhler 1994
• 22% of root resected teeth were lost in a 10-year-follow up due to a variety
of reasons, from periodontal to prosthetic failure Blomlöf et al 1997
• 6,9% of teeth were lost over 10-year-follow up, similarly due to varying
reasons Carnivale et al 1998
Trisection
Trisection
Trisection
Trisection
Root Amputation
Premolarisation
Premolarisation
Tunneling (iatrogenic generation
of a Class III furcation)
Tunneling
TEPE Brush after Tunneling
 Guided tissue generation
• New attachment
• In the majority of cases it is a long
junctional epithelium that will establish
after attempted GTR
• Resorbable and non-resorbable
membranes
• Filler (autogenous, xenograft and
alloplastic)
 Outcome of surgical periodontal
therapy in the literature
• GTR

• Improved CAL levels may be achieved after regenerative surgery; osseous

fill combined with some crestal resorption may eliminate most of the depth
of the pocket
• Type of graft material, membrane use, or type of membrane do not seem to
affect the outcome
• Combination of both has in many studies not shown an advantage
• Bone Graft vs. Replaced flap control achieved 65% - 39% vertical bone
defect fill Mellonig et al 1984
• DFDBA vs. Hydroxylapatite achieved 56% - 54% Bowen et al 1989
• Calciumcarbonate vs PTFE achieved 62% - 59% Kim et al 1996
GTR
GTR
Amelogenin