7.

4 Develop Strategies for Managing Furcation Involvement

Fig. 7.3 Treatment planning for furcation involvement other than maintenance “as is” or extraction. If a tooth presents with furcation in­
volvement, deep pocketing and it is desired to keep tooth and improve it with treatment, the next step is nonsurgical periodontal treatment
including oral hygiene instruction and SRP. If this fails to resolve pocketing, regenerative surgery should be attempted first for deep infrabony
pockets suitable for regeneration as it may improve the condition. If regeneration is not indicated, or did not resolve pocketing, osseous
surgery combined with odontoplasty should reshape tooth and surrounding bone of teeth with shallow Class II or I defects. If the furcation has
a deep horizontal depth on a maxillary molar, root amputation may eliminate the furcation involvement. For mandibular molars, tunneling can
provide oral hygiene access on teeth with shallow root trunks and divergent roots. Otherwise, hemisection can remove the furcation roof in
mandibular molars by either removing a root or transforming each half of the tooth into a premolar-like tooth. Hemisection, root amputation,
and odontoplasty require a new full coverage restoration for each retained tooth. Root canal therapy and core build-up typically are required
after hemisection and root amputation, and may be needed after odontoplasty.

it is a useful approach for simplifying periodontal treatment
in arches containing second and third molars with furcation
involvement.
The major disadvantage with this approach is the loss of
occlusal function and bone that comes with tooth extrac­
tion. Tooth replacement is most likely necessary for any teeth
other than 2nd or 3rd molars. Tooth replacement is costly with
implant therapy the most expensive dental treatment. More­
over, restorations replacing missing teeth most likely need
periodic replacement, and pose a risk for recurrent disease.
Therefore, for most patients, the goal of dental therapy should
be to maintain natural teeth as long as possible.
7.4.3 Combined Pocket Reduction and
Tooth Shaping Approach
The goal should be to preserve most teeth with furcation
involvement with periodontal and restorative therapy. Indica­
tions for the tooth in question are as follows:
• Tooth is of importance to the patient and overall treatment
(especially first molars).
• Tooth lacks mobility.
• Restoration is possible.
• Patient is willing to undergo procedures and willing to
maintain teeth long term.
The advantage of this method is that it preserves teeth and
function at a relatively low cost and facilitates long-term peri­
odontal maintenance. There is no real disadvantage to this
approach.
7.4.4 Pocket-reduction Strategy
Initially, pocket reduction should be attempted with nonsurgi­
cal therapy including oral hygiene and SRP, even though this
will likely not resolve the furcation involvement. It will, how­
ever, simplify the remaining treatment through better gingival
health.
For oral hygiene, the following may be effective:
• End-tufted tooth brush for very wide, exposed buccal, and
distalmost furcation entrances.
• Small interproximal brushes for insertion into wide,
exposed furcation entrances.
• Rubber-tipped stimulators (i.e., GUM Stimudent) for narrow
furcation entrances.
• Oral irrigators (with subgingival tip, if available) for any
furcation involvement.

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 7 Treating Teeth with Furcation Involvement

Fig. 7.5 Features of biologic shaping.

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