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