Furcation

Anatomic area of a

multirooted tooth
where the roots diverge.
It an area of complex
anatomic morphology
that may be difficult or
impossible to be
debrided by routine
periodontal
instrumentation

Furcation
Involvement
Invasion of

bifurcation &
trifurcation of a
multi-rooted
teeth by
periodontal
disease

Root Fornix
Roof of the furcation.

Furcational
Entrance
Transitional area

between divided &

undivided part of
root.

 Primary factor is BACTERIAL PLAQUE & the

INFLAMMATORY CONSEQUENCES that result

from its long term presence

Extent of attachment loss on furcation depends on

presence of these factors:
1. Local anatomic factors

3. Miscellaneous

Root trunk length

Root length
Root form
Interradicular dimension
Anatomy of furca
2. Local developmental anomalies:
cervical enamel projections
enamel pearls, bifurcation ridges

Dental caries
Pulpal death
Trauma from occlusion
Root fracture
Pulpo-perio diseases

 Root trunk length

Represents the undivided region of the root.

Short/medium/long

short root trunk=> less attachment need to be lost before

furcation is involved

Once furcation is involved, teeth with shorter root trunk

may be more accessible to maintenance procedure

 Root Length
Root length is indirectly related to the quantity
of attachment supporting the tooth
Teeth with longer root trunk & shorter roots
may have lost a majority of support by the
time that the furcation become affected.
Teeth with long root & short moderate root
trunk length are readily treated because
sufficient attachment remains to meet
functional demands

 Root form
The curvature and

fluting increases the

potential for root
perforation during
endodontic therapy,
complicate post
placement during
restoration & increase
the incidence of
vertical root fracture.

 Interradicular dimension

Teeth with widely separated roots present more

treatment options and are more

readily treated
Teeth with fused, closely approximated roots
preclude adequate instrumentation during SRP
& surgery

Anatomy of furcation

Bifurcational ridges a concavity in the

dome, accessory canals complicates

treatment

 Cervical Enamel Projections

Flat , ectopic extensions of enamel that

extend beyond the normal contour

of the CEJ
Highest prevalence in maxillary &
mandibular 2nd molars.
Grading by Masters & Hoskins
1.
2.
3.

Grade 1- extend from CEJ towards furcation entrance

Grade 2- approaches the furcation entrance. Do not
enter the furcation & therefore no horizontal component
present
Grade 3- extend horizontally in to furcation

 Pattern of attachment loss:

Horizontal bone loss can

expose the furcation

Areas with thick bony
ledges may persist and
predispose to the
development of furcation
with deep vertical
components

 Clinical Probing

Radiographic View

 Nabers probe is used to enter

and measure difficult to access

furcal areas

The goal of examination is to identify and

classify the extent of furcation involvement

and to identify factors that may have
contributed to development of furcation
defect or that could affect the treatment
outcome

 Grade I Incipient Furcation

This is an early lesion. The

pocket is suprabony, involving

the soft tissue. There is slight
bone loss in the furcation area.
Radiographic change is not usual
since bone loss is minimal.
A periodontal probe will detect
root outline or may sink into a
shallow V-shaped notch into the
crestal area

 Grade I Incipient Furcation

The level of bone loss

allows for the insertion of

the periodontal probe into the
concavity of the root trunk

 Grade II Patent Furcation

Cul de sac
In this, bone is destroyed in one

or more aspects of the furcation,

but a portion of the alveolar bone
and periodontal ligament remain
intact, permitting only partial
penetration of the probe into the
furca.
Radiographs may or may not
reveal this type of furcation.

 Grade II Patent Furcation

The level of bone loss allows

for the insertion of a periodontal

probe into the furcation area
between the roots.
Definite horizontal
component
Vertical bone loss

 Grade III Communicating or

Through and Through Furcation

Complete loss of interradicular

bone
But filled with soft tissue and
so not visible
Radiolucent area in the crotch
of the tooth

 Grade IV
Complete loss of interradicular

bone
gingival tissues receded apically
so that furcation is clinically
visible.
Through & through
involvement

 Hamp et al-

Modified a three stage classification system by

attaching a millimeter measurement to separate
extend of horizontal involvement.
Easley & Drennan & Tarnow & Fletcher

Described classification system that consider both

horizontal & vertical attachment loss

 Objectives:
The elimination of the microbial plaque from

the exposed surfaces of the root complex.

Facilitate maintenance
Prevent further attachment loss
Obliterate furcation defects as a periodontal

maintenance problem

Class I : early
defect
Conservative
periodontal
therapy
Oral hygiene
SRP
Odontoplasty
Recontouring
Replacement of
overhanging
restorative
margins,facial
grooves,CEPs

Class II :
Shallow
horizontal
involvement with
out significant
vertical bone loss
Isolated deep class
II defects
Flap procedures
with odontoplasty
& osteoplasty
Facilitate patient
plaque removal

Class II-IV :
Advanced defect
Significant
horizontal /deep
vertical
component to
furca
Periodontal
surgery
Endodontic
therapy
Restoration of
tooth

 Scaling & root planing

Most effective in grade I and shallow grade II.

Deeper sites respond less favorably

Antimicrobials
Adjunct to scaling and root planning
Chlorhexidine
Tetracycline fibers

 Advanced Grade II to grade IV

On vital / endodontically treated teeth
Selection of teeth:
Tooth critically important to overall treatment plan
Tooth with sufficient attachment remaining

For which no other predictable & cost effective therapy available

Tooth in patients with good oral hygiene & low caries activity

 Selection of root:
Removal of one that
eliminate the furcation & produces a maintainable
architecture to remaining roots
One with greatest amount of attachment & bone loss
One with greatest number of anatomic problems
One that least complicate future periodontal
maintenance.
One that best contribute to elimlinte periodontal
problem of adjacent teeth.

 Is the splitting of a two rooted tooth into two separate

portions

called bicuspidation / separation

Commonly done for Mandibular molars

Class II or III furcation

Need widely separated

roots
Containdication:
advanced bone loss in
Interproximal &
Interradicular zone

 After separation one or both

the roots are retained

In mandibular molar the
anatomy always necessitate
removal of mesial root &
retention of distal

Local anaesthesia
2. Elevation of full thickness flap
3. Debridement
4. For hemisection vertically oriented cut is made
faciolingually through the
buccal & lingual root
developmental grooves,
through pulp chamber,
through furcation.
1.

5.
6.
7.
8.
9.

For root resection a horizontal

cut is advisable
Elevation of resected root
Odontoplasty/ bone contouring
Flap is placed back
suture

Guided tissue regeneration

Predictable outcome of GTR

therapy was demonstrated only

in degree II furcation involved
mandibular molars
less favorable results have been
reported in other types of
furcation defects
GTR could be considered in areas
with isolated grade II furcation
defects

 Attachment loss is so extensive that no root can

be maintained
If tooth/gingival anatomy will not allow proper

plaque control
High caries activity
Reluctant patients

For endodontic or restorative reason

Osseointegrated implant is a substitute

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