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Clinical Parameters
Furcation Recession
Mobility
Learning Outcomes
Furcations: Clinical ConsiderationsMay or may not be clinically exposedBifurcation: 2 rooted toothTrifurcation: 3 rooted toothRadiographs may aid diagnosisSuspect furcation involvement when
pockets measure 5-6 mm+Increased risk for root caries, root
resorption, recession sensitivity, pulp involvement, abscess formation
Furcations
Extension of bone loss between roots of teeth
Teeth with furcation involvement are high risk for continued attachment loss
Detection of furcation faciliated by using a specially designed furcation probe
Probing Furcations
No. 2 Naber’s furcation probe & a narrow Michigan O periodontal probe
Move probe towards location of the furcation & curve into furcation area
Probing Furcations
Access to furcations:– Mesial surface max. molars:
• Best to approach from palatal direction b/c mesial furcation is palatal to midpoint of mesial surface
– Distal surface of max. molars• Located more towards midline• Detected from buccal or palatal approach
Probing Furcations
Most common site: mand. First molar
Least common site: max. first bicuspid
Furcations: Classification, Characteristics, TreatmentFurcation Characteristics Treatment Options
Grade I Initial involvement, may penetrate area up to 3 mmSlight bone lossSuprabony pocketsNo radiographic changes
Perio debridementOdontoplasty
Grade II Bone lost on one or more aspects, > 3 mm but not through & throughHorizontal depth variesVertical bone loss possiblePossible radiographic visibility
Perio debridementFlap with odontoplasty & osteoplastyGuided tissue regeneration (more success with mand. Molars)Root resection
Furcations: Classification, Characteristics, TreatmentFurcation Characteristics Treatment Options
Grade III Interradicular bone absentAccess on fa/li blocked by gingiva“Through & through “Radiographically visible
Perio debridementFlap procedureOdontoplastyRoot resectionhemisection
Grade IV Interradicular bone absentClinically visible“Through & through”Radiographically visible
DebridementFlap surgery
Furcations
Slimline access Radiographic assessment
Root Resection & Hemisection Root resection:
– Performed on vital or endodontically treated teeth
Hemisection:– Splitting of two rooted
tooth into two parts
– Following sectioning, one or both roots can be retained
Classification
Mobility
Risk factor for PDMeasure extent, determine causeNormal physiologic movement not
gradedDegree of mobility not always
correlated to amount of bone loss
Causes of Mobility
Mobility may be related to:– Trauma from occlusion– Loss of periodontal support– Gingival inflammation– Pregnancy & hormonal changes– Periodontal surgery
Minor mobility can usually be maintainedIncreasing mobility – more frequent PMT
and/or referral for surery
Classification of Mobility
Nomenclature used varies across systems:– Class I etc.– Grade I etc.– I mobility etc.– Grade 1 etc.– 1, 2, 3
Classification of Mobility
– N=normal physiologic mobility– Grade I=slight mobility, up to 1 mm of
horizontal displacement in a facial-lingual direction
– Grade II=moderate mobility, > 1 mm of horizontal displacement
– Grade III=severe mobility, greater than 1 mm of movement in any direction (horizontal & vertical)
• Nield-Gehrig & Houseman, 1996
Mobility can be measured using 2 instrument handles
Recession
Disturbance to the gingiva results in an apical shift of the gingiva margin
Actual recession:– Level of the epithelial attachment on
tooth
Apparent recession:– Level of the crest of the gingival
margin
Etiology of Gingival Recession
Causes:– Mechanical
trauma: hard brush, vigorous technique
– Crown margins– Periodontal
disease– Occlusal trauma– Defects in bone
Causes:– Trauma from teeth
in opposing jaw– Oral habits, oral
piercing– Poorly designed
partial dentures– Tooth position– Healing response
following periodontal surgery
Gingival Recession
Toothbrush Trauma
Gingival Recession
Trauma from denture
Gingival Recession
Oral Piercing
Gingival Recession
Orthodontics
Gingival Recession
Prominent Roots
Gingival Recession
Frenal Attachment
Symptoms/signs
Client usually complains of:– Sensitivity– Aesthetics
Complications:– Increased sensitivity– Loss of tissue from root surface (erosion,
abrasion) – protective cementum removed– Caries– Greater risk for PD: greater surface area for
plaque retention
Treatment Options
Depends on causeNonsurgical treatment includes:
– Debridement– Oral self-care instruction– Local medicaments for sensitivity
Treatment Options
Surgical treatment:– Laterally positioned flap– Connective tissue graft