1. FURCATION

2. DEFFINITION
The furcation is an area of complex anatomic morphology, that may be difficult or impossible to debride by routine periodontal instrumentation.

3. Etiologic Factors bacterial plaque
local anatomic factors (e.g., root trunk length, root morphology)
local developmental anomalies (e.g., cervical enamel projections)

4. Diagnosis clinical examination Careful probing (Nabors probe)
Transgingival sounding

5. Local Anatomic Factors
Root trunk length
Root length
Root form
Interradicular dimension
Anatomy of furcation
Cervical enamel projections

6. Root Trunk Length
The distance from the cementoenamel junction to the entrance of the furcation can vary extensively

7. Anatomy of the Bony Lesions
Pattern of Attachment Loss
Horizontal bone loss can expose the furcation as thin facial/lingual plates of bone
The treatment response in deep, multiwalled bony defects is different from that in areas of horizontal bone loss.
Other Dental Findings

8. Indices of Furcation Involvement
Glickman's classification

9. Grade I incipient or early stage pocket is suprabony
primarily affects the soft tissues
Early bone loss
radiographic changes

10. Grade II essentially a cul-de-sac definite horizontal component
Radiographs may or may not depict the furcation involvement

11. Grade III bone is not attached to the dome of the furcation
periodontal probe completely through the furcation
display the defect as a radiolucent area

12. Grade IV interdental bone is destroyed
soft tissues have receded apically
furcation opening is clinically visible

13. Other Classification Indices
Hamp et al modified a three-stage classification system
Easley and Drennan and Tarnow and Fletcher
A B C
vertical depth mm mm >7mm
Furcations-IA,IB,IC
IIA,IIB,IIC
IIIA,IIIB,IIIC

14. Treatment objectives of furcation therapy (1) facilitate maintenance
(2) prevent further attachment loss
(3) obliterate the furcation defects as a periodontal maintenance problem

15. Therapeutic Classes of Furcation Defects
Class I: Early Defects
oral hygiene, scaling, and root planing
Class II
Localized flap procedures with odontoplasty, osteoplasty, and ostectomy.
GTR(Guided tissue regeneration)
Classes II to IV: Advanced Defects
Periodontal surgery, endodontic therapy, and restoration of the tooth may be required to retain the tooth.

16. Nonsurgical Therapy
Oral Hygiene Procedures
Scaling and Root Planing

17. Surgical Therapy Osseous Resection Regeneration(GTR) Root Resection
Hemesection
Extraction
Dental Implants

18. Root ResectionProcedure

19. Hemisection Procedure

20. Dental Implants

21. MCQ-1
Which of the following author have described classification system that consider both horizontal and vertical attachment loss in the extent of furcation involvement
(a)Glickman
(b)Hamp
(c) Nyman
(d)Tarnow

22. MCQ-2
The furcation lesion have definite horizontal component,radiographs may or may not depict the furcation involvement
(a)Grade I
(b)Grade II
(c)Grade III
(d)Grade IV

23. MCQ-3
Which is the best treatment modality of isolated deep class II furcations
(a)Scaling and Rootplaning
(b)Odantoplasty and Osteoplasty
(c)Flap debridement with osteoplasty and odantoplasty
(d) Rootresection and Hemisection

24. MCQ-4
Which of the following have good candidates for regeneration procedure
(a)Class I furcation
(b)Class II furcaton
(c)Class III furcation
(d)Class IV furcation

25. MCQ-5
Which of the following probe is used for the diagnosis of furcation defects
(a)U.N.C Probe
(b)WHO Probe
(c)CPITN Probe
(d)Nabers Probe