Furcation involvement
Definition:
• furcation is defined as the anatomic area of a multi-rooted tooth where the
roots diverge
• furcation involvement is defined as the invasion of the bifurcation and
trifurcation of multirooted teeth by periodontal disease
Parts of furcation:
• Root complex
• Root trunk
• Root cone
• Furcation entrances
• Root fornix
• Degree of separation
• Divergence
• Coefficient of separation
Furcation defect:
It is the infection invading the furcation of the root
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Etiology of furcation involvement:
• Bacterial plaque:
Plaque-induced inflammation causes the destruction of collagen fiber
attachment of gingiva and alveolar bone
• Local anatomy factors:
Mesial root there is concavities
• Local developmental anomalies:
Enamel peals or enamel projections
• Iatrogenic factors:
Overhanging restoration, result in the accumulation of plaque which causes
inflammation and thus it initiates the development of a furcation lesion
• Trauma from occlusion:
contributing factor in case of furcation involvement with crater-like or angular
deformities in the bone and especially when the bone loss is confined to one of
the two roots
• Combined defects:
Endo-perio or perio-endo lesions which can also cause furcation involvement
Classification of furcation:
Glickman classification:
• Grade I: Incipient lesion. Suprabony pocket and slight bone loss in the furcation
area
• Grade II: Loss of inter radicular bone and pocket formation but a portion of the
alveolar bone and periodontal ligament remain intact
• Grade III: Through-and-through lesion
• Grade IV: Through-and-through lesion with gingival recession, leading to a clearly
visible furcation area
Hamp, Nyman and Lindhe classification:
• Degree I: horizontal attachment loss < 3 mm of the total width of the furcation
area
• Degree II: horizontal attachment loss > 3 mm but not encompassing the total
width of the furcation area
• Degree III: "through and through" destruction of the periodontal tissue in the
furcation area
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Lindhe classification
• Grade I: Loss of inter radicular bone less than or equal to 1/3rd the horizontal
tooth width
• Grade II: Loss of inter radicular bone greater 1/3rd tooth width but not through
and through
• Grade III: Through and through loss of inter radicular bone
Tarnow & Fletcher classification: based on vertical components
• Subgroup A: 1-3mm
• Subgroup B: 4-6mm
• Subgroup C: =7mm
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Clinical features of the furcation:
• Complain of sensitivity to hot and cold
• Throbbing pain in cases of endo- perio lesions
• Tooth may be tender on percussion due to inflammatory changes
Diagnosis:
Probing:
• Instruments used - Naber’s probe
Radiographical findings:
• Both the intraoral periapical radiographs and bitewing radiographs are used to
detect the furcation lesion
Treatment:
The objective of furcation therapy:
• Facilitate maintenance
• Prevent further attachment loss
• Obliterate the furcation defects as a periodontal maintenance problem
Non-surgical treatment:
• Oral hygiene procedures
• Scaling and root planning
Surgical treatment:
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• Osseous Resection
• Regeneration
• Hemi section
• Root Resection/ Hemi section procedure
• Extraction
• Dental implants
Reference:
1. Newman, M. G. (2007). Carranza's clinical periodontology. St. Louis: Saunders.
2. Lang, N. P., Lindhe, J., & John Wiley and Sons. (2015). Clinical Periodontology and
Implant Dentistry.
3. Parihar AS, Katoch V. (2015) Furcation Involvement & Its Treatment: A Review. J
Adv Med Dent Scie Res.
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