Management of Furcation Defects
Management of teeth with furcation involvement (FI) is challenging for the clinician. The greater the grade of FI, the more difficult it becomes to treat. Also, the grade of FI affects the prognosis and limits the patient’s ability to maintain. Adequate c
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Management of Furcation Defects Acela A. Martinez Luna and Fatemeh Gholami
8.1
Introduction
Management of teeth with furcation involvement (FI) has always been a challenge for the clinician. Multi-rooted teeth are difficult to treat and maintain due to the complex anatomy that enhances plaque accumulation and limits access for instrumentation and oral hygiene [1]. In addition, tooth-related factors such as enamel projections (Fig. 8.1) and accessory pulpal canals contribute to FI [2]. Unfortunately, furcation lesions respond differently to periodontal treatment than do flat surfaces [3]. Furthermore, longitudinal studies of periodontal therapy have demonstrated that the prognosis for teeth with FI is worse following traditional scaling, and they are at higher risk of future attachment loss [4]. The grade of FI is an effective factor in determination of the course of treatment and prognosis [5]. Diagnosis of FI is based on clinical examination with a Nabers probe, with the use of two-dimensional radiographs serving as an adjunct. According to a recent systematic review, cone beam computed tomography (CBCT) has high accuracy for furcation involvement detection [6]. However, there is limited evidence to support and justify the use of CBCT for the diagnosis and treatment of teeth with FI at this time [7]. Treatment planning of teeth with FI remains a difficult process for the clinician. This chapter will review and discuss the diverse therapeutic modalities for teeth with FI.
A. A. Martinez Luna (*) Division of Periodontology, Department of Surgical Sciences, School of Dental Medicine, East Carolina University, Greenville, NC, USA e-mail: [email protected] F. Gholami Department of Periodontics, College of Dentistry, The University of Illinois at Chicago, Chicago, IL, USA e-mail: [email protected] © Springer Nature Switzerland AG 2020 S. Nares (ed.), Advances in Periodontal Surgery, https://doi.org/10.1007/978-3-030-12310-9_8
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A. A. Martinez Luna and F. Gholami
Fig. 8.1 Clinical view of mandibular first and second molars, showing furcation involvement and cervical enamel projections (arrows)
8.2
Resective Therapy
Root resective therapy is a well-known treatment modality for the management of teeth with advanced FI. The main resective procedures utilized to treat FI include root amputation, hemisection, and bicuspidization. Over the years, the use of these techniques has decreased considerably. Some of the possible reasons of this decrease are the reported complications and failure rates and the fact that more predictable therapies such as periodontal regeneration and dental implants are available. Survival rates of teeth with FI have been published in the literature with heterogenous results. A recent investigation on the retention of molars after root resective therapy over an observational period of 30 years reported a median survival of 20 years and a cumulative survival rate of 90.6% at 10 years that decreased considerably thereafter. The complications that led to tooth extraction include
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