Dr.

Bryan Michalowicz
Periodontology III
Spring Semester, 2012
School of Dentistry
University of Minnesota

Tooth Loss Following Periodontal Therapy

Hirschfeld & Wasserman, 1978

Periodontal Surgery: Treatment

of Multi-Rooted Teeth

600 patients followed for at least 15 years

Overall, 7.1% of teeth were lost because of
periodontitis
31.4% of molars with initial furcation
involvements were lost
Only 7.2% of molars with furcation
involvements were lost in the wellmaintained group

Bryan Michalowicz, DDS

Department of Developmental and
Surgical Sciences

Implications of furcation
involvements
In most long-term studies (e.g., McFall,
1982), the teeth most commonly lost due to
periodontitis are:
Maxillary molars > mandibular molars >
maxillary first premolars

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Dr. Bryan Michalowicz

Periodontology III
Spring Semester, 2012
School of Dentistry
University of Minnesota

Treatment options for multi-rooted teeth

with furcation involvements

Odontoplasty
Scaling and Root Planing
Open Debridement
Apically positioned flaps
Root Amputation/Hemisection
Regenerative therapy (e.g., GTR)

Treatment options for multi-rooted teeth

with furcation involvements

Odontoplasty
Scaling and Root Planing
Open Debridement
Apically positioned flaps
Root Amputation/Hemisection
Regenerative therapy (e.g., GTR)

Effect of SCRP and OHI on Molar Teeth

(Norland et al., 1987)
19 subjects treated and monitored for 24
months
Furcations with PD > 4 mm responded less
favorably than non molar teeth or molar flat
surfaces
Among sites with initial PDs > 7 mm, 21%
of furcations, 7% of molar flat surfaces and
11% of non-molar sites lost attachment

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Dr. Bryan Michalowicz

Periodontology III
Spring Semester, 2012
School of Dentistry
University of Minnesota

Important Points

Treatment options for multi-rooted teeth

with furcation involvements

Use of both hand instruments and powered

scalers in furcations removes more calculus
than either method alone.
Whether using hand instruments, powered
scalers or both, more residual calculus is left
in furcations than on non-furcation tooth
surfaces. This is true for both closed and
open curettage.

Odontoplasty
Scaling and Root Planing
Open Debridement
Apically positioned flaps
Root Amputation/Hemisection
Regenerative therapy (e.g., GTR)

Prognosis of Tunnel Preparations for

Class III Furcations (Hellden et al, 1989)

Treatment options for multi-rooted teeth

with furcation involvements

156 teeth in 107 subjects treated by tunnel

preparations
Mean observation time = 3 years
6.7% were extracted and 4.7% hemisected,
primarily because of caries
Overall, 23.5% of teeth developed caries

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Odontoplasty
Scaling and Root Planing
Open Debridement
Apically positioned flaps
Root Amputation/Hemisection
Regenerative therapy (e.g., GTR)

Dr. Bryan Michalowicz

Periodontology III
Spring Semester, 2012
School of Dentistry
University of Minnesota

Hemisected Molars (Erpenstein, 1983)

24 hemisected molars followed for 1 7
years (mean = 2.9 years)
22 served as distal bridge abutments (mostly
mandibular molars)
7 failed for endodontic reasons, only 1
because of periodontitis
Prognosis for hemisected teeth is favorable

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Dr. Bryan Michalowicz

Periodontology III
Spring Semester, 2012
School of Dentistry
University of Minnesota

10 Year Evaluation of Root Resections

(Langer et al, 1981)

Treatment options for multi-rooted teeth

with furcation involvements

100 patients, 50 maxillary and 50 mandibular

molars
Classified failures as due to periodontitis,
endodontic pathology or caries
38/100 failed, 55% of these between 5 7 years
10/38 failures (26%) were because of
periodontitis, most which were maxillary molars
Most mandibular molar failures were because of
root fractures

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Odontoplasty
Scaling and Root Planing
Open Debridement
Apically positioned flaps
Root Amputation/Hemisection
Regenerative therapy (e.g., GTR)

Dr. Bryan Michalowicz

Periodontology III
Spring Semester, 2012
School of Dentistry
University of Minnesota

Guided Tissue Regeneration

Absorbable (polylactic acid or collagen)
Non-absorbable (e.g., ePTFE or Gortex)

Clinical Considerations

Changes From Original

Class II Molar Furcations

Better
No !
Worse

COLL

ePTFE

DEB

26 (44%)
33
0

17 (53%)
15
0

2 (7%)
22
3

Class II furcations can be treated with

regenerative methods if there is some
infrabony component to the lesion.
The clinical and/or radiographic response is
generally similar for allogenic bone grafts,
guided tissue regeneration membranes or
growth factors (e.g., Emdogain)
Class III furcations dont respond well to
surgical treatment and are probably best
maintained non-surgically or extracted.

(Yukna & Yukna, 1996)

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