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Periodontics

Why are furcation areas important and how can they be treated?

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This question was submitted by a general dentist: Why are furcation areas important and how can they be treated?

Dr. Sayed Mirbod, representing the Canadian Academy of Periodontology (CAP), provided this initial quick response:

The primary etiologic factor in periodontal disease is plaque. The outcome of periodontal therapy is in general good and predictable, if the clinician and the patient can adequately access root surfaces to remove the bacterial plaque. Access to the molars furcation areas is especially difficult for the patient and clinician alike due to the posterior location of molars, the dimension and position of furcation entrances, and the internal furcation surfaces that are frequently concave or irregularly contoured. The disparity between the size of commonly used scaling instruments and the size of the furcation entrance further complicates the situation.

Traditional therapy aimed at alleviating the inflammatory lesion by eliminating soft and hard tissue deposits in the furcation area using scaling and root planing should be the starting point in treating furcation defects. The efficacy of scaling and root planing at the furcation area can be improved using Cavitron inserts (1). With proper postoperative maintenance care, this simple treatment may be successful in treating many a molar defects in particular in the maxillary area. Conservative surgical therapy, such as Modified Widman flap or flap with minor osseous resection can improve access to the furcation for better debridement by the clinician and easier home-care for the patient (2,3) Nevertheless, loss of attachment within the furcation area should be expected following such surgical interventions.

Root resective procedures can be used to treat furcation involvement permitting the preservation of part of the root for future prosthodontic applications. Although, the immediate results may be gratifying for the patient and clinician and the long-term failure rates may be as high as 38% over a 10-year period. The high failure rates, in particular in the mandibular cases, can be attributed to endodontic and prosthodontic variables further complicating the treatment (4, 5).

References

  1. Takacs VJ, Lie T, Perala DG, Adams DF. Efficacy of 5 machining instruments in scaling of molar furcations. J Periodontol. 1993;64(3):228-36.
  2. Fleischer HC, Mellonig JT, Brayer WK, Gray JL, Barnett JD. Scaling and root planing efficacy in multirooted teeth. J Periodontol. 1989;60(7):402-9.
  3. Kalkwarf KL, Kaldahl WB, Patil KD. Evaluation of furcation region response to periodontal therapy. J Periodontol. 1988;59(12):794-804.
  4. Langer B, Stein SD, Wagenberg B. An evaluation of root resections. A ten-year study. J Periodontol. 1981;59(12):719-22.
  5. Buhler H. Evaluation of root-resected teeth. Results after 10 years. J Periodontol. 1988;59(12):805-10.

 

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