Furcation Defect

- 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 computerised 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.