Furcation involvement

Furcation Involvement
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Furcation involvement refers to the loss of alveolar bone and periodontal ligament support in the area where the roots of a multirooted tooth converge, known as the furcation. This condition is a significant complication of periodontal disease and can affect the prognosis of the involved tooth.

Anatomy of Furcation

The furcation area is the anatomical region of a multirooted tooth where the roots divide. In maxillary molars, there are typically three roots, leading to three furcation areas: buccal, mesial, and distal. In mandibular molars, there are usually two roots, resulting in buccal and lingual furcation areas.

Classification of Furcation Involvement

Furcation involvement is classified based on the extent of horizontal and vertical bone loss in the furcation area. The most commonly used classification system is the Glickman classification:

• Grade I: Incipient or early stage involvement with slight bone loss. The furcation can be felt with a probe but cannot be entered.
• Grade II: Partial bone loss with a probe able to enter the furcation but not pass through.
• Grade III: Complete bone loss with a probe able to pass through the furcation from one side to the other.
• Grade IV: Similar to Grade III, but with gingival recession exposing the furcation to view.

Etiology

Furcation involvement is primarily caused by periodontitis, an inflammatory disease affecting the supporting structures of the teeth. Other contributing factors include:

• Occlusal trauma
• Endodontic-periodontal lesions
• Root fractures
• Iatrogenic factors such as improper restorations

Diagnosis

Diagnosis of furcation involvement is achieved through clinical examination and radiographic assessment. Clinically, a periodontal probe is used to detect the presence and extent of furcation involvement. Radiographs, particularly periapical and bitewing radiographs, help visualize the bone loss in the furcation area.

Treatment

The treatment of furcation involvement depends on the severity and classification of the condition. Treatment options include:

• Non-surgical therapy: Scaling and root planing to remove plaque and calculus.
• Surgical therapy:

 * Furcation plasty: Reshaping the furcation area to facilitate cleaning.
 * Root resection: Removal of one or more roots to eliminate the furcation.
 * Guided tissue regeneration: Using barrier membranes to encourage bone regeneration.
 * Bone grafting: Placement of bone grafts to restore bone in the furcation area.

Prognosis

The prognosis of teeth with furcation involvement depends on the degree of involvement, the effectiveness of treatment, and the patient's oral hygiene. Grade I and II involvements have a better prognosis compared to Grade III and IV.

Prevention

Preventive measures include maintaining good oral hygiene, regular dental check-ups, and early treatment of periodontal disease to prevent progression to furcation involvement.

See also

• Periodontal disease
• Periodontal therapy
• Dental anatomy