Perio Other – Furcation Defect
A furcation defect occurs due to bone loss, which is typically the result of periodontal disease. The condition affects the base of the root trunk of a tooth where two or more roots meet. The extent and specific details of the defect determine the diagnosis and plan for treatment.
A tooth which contains a furcation defect typically has a reduced prognosis due to the difficulty of rendering the furcation area free from periodontal pathogens. Due to this, surgical periodontal treatment may be considered to either close the furcation defect with a grafting procedure or to allow access to the furcation defect for improved oral hygiene.
Root Trunk Length
The root trunk length is the total distance between the cementoenamel junction (CEJ) and the furcation entrance. This plays an important role in furcation defects as a deeper furcation entrance within the bone means more bone loss is necessary before the furcation will be exposed.
The mean root trunk length is 3 mm on the buccal aspect and 4 mm on the lingual aspect for mandibular first molars. The root trunk length for mandibular second and third molars is either the same or slightly longer compared to the first molars. Though it is possible for the roots to be fused.
For maxillary first molars, the mean root trunk length is 3-4 mm on the buccal aspect. It is 4-5 mm on the mesial aspect and 5-6 mm on the distal aspect. As with the mandibular molars, the root trunk lengths for the maxillary second and third molars is either the same or slightly longer compared to the first molars.
For maxillary first premolars, 40% of the time there is a bifurcation. The mean root trunk length is 8 mm from both the mesial and distal.
Classification of a Furcation Defect
Due to the importance in the assessment of periodontal disease, there are various methods for classification used to measure and record the severity of furcation involvement. Most of the indices are based on horizontal measurements of attachment loss in the furcation.
Diagnosis
In a clinical setting, a nabers probe is commonly used to identify furcation involvement. Cone beam computerized technology (CBCT) has been recently used to detect furcation. Periapical and interproximal intraoral radiographs can also help in the diagnosis and identification of the furcation.
Only multi-rooted teeth can poses a furcation. As a result, upper first premolar, maxillary and mandibular molars may be involved.
Upper premolars have just one palatal and one buccal root. It is important to check the involvement of furcation from the mesial and distal aspects of the tooth.
Maxillary molars have three different roots including a mesio-buccal root, disto-buccal root and a palatal root. The dentist will evaluate for furcation from buccal, mesio-palatal and disto-palatal aspects.
Mandibular molars contain a single mesial and distal root. The involvement should be checked from both buccal and lingual aspects.
Treatment
The goal of treatment for a furcation defect is to eliminate the bacteria from the exposed surface of the root. It also works to establish the anatomy of the tooth, in order for patients to achieve improved control of plaque. The treatment for a patient will vary based on various local and anatomical factors.
- Grade I furcation: scaling and polishing, root surface debridement or furcationplasty may be performed
- Grade II furcation: furcationplasty, open debridement, tunnel preparation, root resection, extraction, guided tissue regeneration (GTR) or enamel matrix derivative may be considered for treatment
- Grade III furcation: open debridement, tunnel preparation, root resection, GTR, or tooth extraction may be performed
Tooth extraction is typically only considered when there is an extensive loss of attachment or when alternative treatments are not effective.