- Bone loss from aggressive periodontitis can lead to an exposed furcation on a tooth.
- Furcation defect is bone loss affecting the base of the root trunk where two or more roots meet.
- The extent and configuration of the defect are factors in diagnosis and treatment planning.
- Surgical periodontal treatment may be considered to close the furcation defect or improve oral hygiene.
- Furcation defects have a diminished prognosis due to the difficulty of removing periodontal pathogens.
Root Trunk Length
- The distance between the cementoenamel junction (CEJ) and the furcation entrance is called root trunk length.
- Deeper furcation entrances require more bone loss for the furcation to become exposed.
- Mandibular first molars have a mean root trunk length of 3 mm on the buccal aspect and 4 mm on the lingual aspect.
- Maxillary first molars have a mean root trunk length of 3-4 mm on the buccal aspect, 4-5 mm on the mesial aspect, and 5-6 mm on the distal aspect.
- Maxillary first premolars have a mean root trunk length of 8 mm from both mesial and distal.
Furcation Defect Classification
- Furcation involvement can be classified using various methods based on horizontal measurements of attachment loss.
- Glickman's classification includes Grade I (incipient involvement), Grade II (horizontal bone loss), Grade III (through-and-through tunnel), and Grade IV (completely probeable).
- Fedi et al. modified Glickman's classification to include two degrees of a Grade II defect based on vertical bone loss.
- Hamp, Lindhe, and Nyman classified furcation defects by probeable depth, including Class I (less than 3mm), Class II (at least 3mm but not through-and-through), and Class III (entire width of the tooth).
Diagnosis
- Furcation involvement can be checked clinically using a Nabers probe.
- Cone beam computerized technology (CBCT) can also be used to detect furcation.
- Periapical and interproximal intraoral radiographs can help diagnose and locate the furcation.
- Only multirooted teeth have furcation, such as upper first premolars and maxillary and mandibular molars.
- Upper premolars have one buccal and one palatal root, while maxillary molars have three roots and mandibular molars have one mesial and one distal root.
Treatment
- Treatment aims to eliminate bacteria from the exposed root surface and establish proper tooth anatomy for better plaque control.
- Grade I furcation may be treated with scaling, polishing, root surface debridement, or furcationplasty.
- Grade II furcation may require furcationplasty, open debridement, tunnel preparation, root resection, extraction, GTR, or enamel matrix derivative.
- Grade III furcation may be treated with open debridement, tunnel preparation, root resection, GTR, or tooth extraction.
- Tooth extraction is considered if there is extensive loss of attachment or if other treatments will not achieve good results.
In dentistry, a furcation defect is bone loss, usually a result of periodontal disease, affecting the base of the root trunk of a tooth where two or more roots meet (bifurcation or trifurcation). The extent and configuration of the defect are factors in both diagnosis and treatment planning.
A tooth with a furcation defect typically possessed a more diminished prognosis owing to the difficulty of rendering the furcation area free from periodontal pathogens. For this reason, surgical periodontal treatment may be considered to either close the furcation defect with grafting procedures or allow greater access to the furcation defect for improved oral hygiene.
