3. Dr. E. Barrie Kenney
Tarrson Family Endowed Chair in Periodontics
Professor & Chairman
Section of Periodontics
Dr. Heddie O. Sedano
Professor Emeritus & Lecturer
Section of Periodontics
Presents
5. In teeth with furcation lesions a tooth
mortality rate for periodontal reasons of
31% - 57% has been observed over
periods averaging about 20 years
compared to an overall tooth mortality
for all teeth of only 7% - 10%.
(Hirschfield 1978, McFall 1982)
Long term follow-up of periodontal
treatment indicates periodontal lesions
in the majority of patients will respond
well. The one exception to this seem to
be lesions in multi-rooted teeth that
have advanced into the furcation area
between the roots. (Hirschfield 1978,
McFall 1982, Goldman 1986)
6. Bone loss can occur at any point on
the buccal surface of molars so
pocket depth must be checked at
several points and the deepest
measurement recorded.
7. Bone loss in furcations can
occur in a horizontal or
vertical plane.
8. Furcation involvements are
classified as grade I, grade II,
grade III or grade IV.
Grade I furcation involvement
shows initial attachment loss with
most of the bone still intact in the
furcation. No radiographic changes
seen.
11. At time of surgery
minimal bone loss in
furcation.
12. The bone defect is a cul de sac
with a definite horizontal bone
loss. Vertical bone loss may also
be present. There is an opening
into the furca with a bony wall at
the deepest portion.
There is some bone present in the
inner part of the defect so that in
part the furcation is filled to the
roof. There may or may not be
radiographic changes depending
on the amount of furcal bone left
unaffected.
GRADE II FURCATION
13. Early grade II furcation.
Both molars have grade
II furcation with 5mm
pockets.
14. Early grade II furcations at
time of surgery,
beginning bone loss in
both molars.
15. Moderate grade II furcation.
More severe horizontal
bone loss on the buccal is
seen at the time of surgery.
16. Moderate grade II furcation.
Radiographic evidence of
bone loss in furcation.
17. Advanced grade II furcation.
Severe bone loss in buccal
furcation while the lingual
furcation has normal bone.
18. Advanced grade II furcation. The
probe can not pass completely
through the furcation as there is
still intact bone in the lingual
half of the furcation.
19. Bone is lost across the whole
width of the furcation so no bone
is attached to the furcation roof.
Radiograph show a radiolucency
in the coronal portion of the
furcation bone.
GRADE III FURCATION
26. At time of surgery there is
advanced bone loss
exposing the mesial furca
with bone loss extending all
the way to the distal
furcation
27. Grade III furcations extending
across both the first and second
molars with bone loss allowing
passage of probes completely
through the furcation.
28. At the time of surgery there
has been bone loss in both a
horizontal and vertical
dimensions.
29. Bone loss across the furcation is
accompanied with gingival
recession at the furcation is
clinically visible.
Radiographically this shows
bone loss similar to Grade III
furcation.
GRADE IV FURCATION
34. Furcation involvements have
anatomical factors that make it
difficult to carry out root planing,
calculus removal and
degranulation.
Calculus can deposit in the roof
of the furcations and in
inaccessible regions where the
space is too small for hand
curettes.
36. In lower molars there is often an
anatomical groove on the lateral
aspect of the roots particularly the
mesial root.
This makes it difficult for
instrumental access. Fine
ultrasonic scalers or ultrafine
diamond burs in a slow speed
handpiece may be the only
accessible instrumentation.
37.
38. Treatment options for furcation
involved teeth.
Grade I furcation with 4 mm or
less pocket depth may be treated
with initial therapy. Most other
furcations require, in addition,
surgical therapy.
39. In this case grade II furcations on
the buccal and lingual were
treated with initial therapy and
then with flap and osseous
surgery.
45. In this Grade two furca the bone defect is less
than 4 mm. Below the roof of the furca and so
resective osseous surgery is indicated.
46. Bone has been removed to eliminate the
defect and to create a positive architecture
47. The flap is apically positioned and
shaped to follow the bone contours
so that minimal post surgical pockets
are developed.
48. In this furca there is deep
pockets and advanced bone
loss.
49. The bone loss is such that the deepest part
of the defect is more than 4 mm. from the
roof of the furca. Regenerative procedures
are needed.
50. Bio oss and Emdogain have been
used to fill the defect to the level of
the bone crest.
51. The flap has been sutured at its
original level and Emdogain applied
to the space under the flap.
52. More advanced bone loss is
treated with regenerative
periodontal surgery.
In this case the advanced bone
loss precludes osseous surgery so
regeneration surgery using a
periosteal graft was used.
53.
54. Periosteal graft from palate Periosteal graft placed over bony
defects and flaps sutured to position
56. Advanced grade III furcation may
be treated with root resections.
In this upper molar the disto-
buccal root was resected,
endodontic therapy done and a
specially contoured crown was
placed.
57.
58. In lower molars hemisection is
used and one or both roots are
retained.
This involves endodontic
treatment and new crowns.
59.
60.
61. In cases with advanced grade III
involvement it may be
necessary to extract the tooth
due to its very poor hopeless
prognosis.
62.
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