Furcation

A furcation involvement, also called a furcation invasion, is defined as an area of bone loss at this branching point of a tooth root. The bone loss results from periodontal (gum) disease.

Etiology

1. Extension of inflammatory periodontal disease.
2. Trauma from occlusion.
3. Cervical enamel projections
4. Pulpoperiodontal diseases
5. Iatrogenic cofactors
6. Anatomical factors

Diagnosis

Furcation involvement can be diagnosed by two methods:

• Clinical examination

A thorough clinical examination is the key to diagnosis and treatment planning. Careful probing is performed by using a Naber’s probe. Transgingival probing further helps to define the anatomy of the furcation defect.

Clinical classification of Furcation Involvement

According to Glickman (1953)

1. Grade I: Pocket formation into the flute of the furcation but inter-radicular bone is intact
2. Grade II: Loss of inter-radicular bone and pocket formation of various depths into the furcation but not completely probable to the opposite side of the tooth.
3. Grade III: Complete loss of inter-radicular bone with pocket formation that is completely probable to the opposite side of the tooth.
4. Grade IV: Loss of attachment and recession that has made the entire furcation clinically visible.

According to Goldman and Cohen

1. Grade I: Incipient lesion
2. Grade II: It is a cul de sac lesion
3. Grade III: Through and through furcation involvement

According to Hamp et al.

1. Degree I: Horizontal loss of periodontal tissue support less than 3 mm.
2. Degree II: Horizontal loss of support exceeding 3 mm but not encompassing the total width of the furcation area.
3. Degree III: Horizontal through and through destruction of the periodontal tissues in the furcation.

According to Tarnow and Fletcher

1. Subclass A: Vertical destruction to one-third of the total interradicular height (1-3 mm).
2. Subclass B: Vertical destruction reaching two-thirds of the inter-radicular height. (4 to 6 mm).
3. Subclass C: Inter-radicular osseous destruction into or beyond the apical third (more than 7 mm).

• Radiographic examination

Radiographs can also be used as diagnostic aids in diagnosing furcation involvement

Radiographic classification of Furcation Involvement

1. Grade I: Radiographic changes are not usually found
2. Grade II: Radiographs may or may not depict the furcation involvement
3. Grade III: Show a radiolucent area in the crotch of the tooth
4. Grade IV: Seen as a radiolucent area.

-18 furcation

Treatment

• Grade I: Scaling, root planing, curettage, gingivectomy, odontoplasty.
• Grade II: Scaling, root planing, curettage, odontoplasty, osteoplasty with limited ostectomy, in shallow grade II invasions. In more severe furcation involvements, root resection/hemisection is done.
• Grade III: Tunneling, root sectioning, hemisection, extraction
• Grade IV: Maintenance

Regenerative procedures: Autogenous and autologous osseous grafting, synthetic grafting, GTR, root conditioning, coronally displaced flap and combination procedures. GTR and combination procedures.

Furcation Resources
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