Root Resection and Hemisection

Treatment for Advanced Furcation Involvement

In general, flap curettage is the first treatment choice to save a tooth with ad­
vanced furcation involvement (Class 11 deep, Class III). It is a desirable first
choice for diagnosis when considering root resection or hemisection. Also, in
Class II furcation involvement, regenerative procedures with barrier mem­
branes are frequently used (Fig 1-23).
Root resection or hemisection may sometimes be done without flap curet­
tage if a definitive diagnosis can be made by probing or by radiographic exam­
ination after initial therapy. However, even in such cases, surgical therapy is re
quired to eliminate the craterlike osseous defect around the root and to restore
the physiologic gingiva-alveolar bone morphology as the secondary treatment.
Flap curettage as a first treatment
Flap curettage should be done as a first treatment if the periodontal support is
extremely minimal, the root is short, and there is mobility (Fig 1-24). Flap
curettage can also be used to alleviate inflammation, as a regenerative proce­
dure, and as pretreatment for root resection or hemisection.
Conducting flap curettage makes direct visual examination possible, and
root resection or root amputation may be avoided depending on postoperative
improvement. Without flap curettage, it is meaningless to evaluate the reaction
of advanced furcation involvement to debridement.

Fig 1-23 Management for advanced furcation involvement.

Advanced furcation involvement (Degree II deep, Degree III)

Flap curettage Strategic extraction

1
Root resection, hemisection Strategic extraction
I
Flap curettage with
Reevaluation after about 1 year
barrier membrane (GTR)

Root resection, hemisection

Apically positioned flap Apically positioned flap

with osseous resection with osseous resection

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 Methods and Indications of Mucogingival Surgery

Fig 2-1 Indications for mucogingival surgery (MGS).

Yes (presence)

Fig 12-2 Lack of attached gingiva and selection of mucogingival surgery.

No (absence) Yes (presence)

Osseous dehiscence
Protrusion of root
Thickness of gingiva

FGG (free autogenous SCTG (subepithelial

gingival grafts) connective tissue grafts)
Increase of attached
FCTG (free connective PGG (pedicle gingiva by FGG, FCTG
tissue grafts) gingival grafts)

PAPF (partial-thickness
apically positioned flaps)

FAPF (full-thickness Flap curettage with

apically positioned bone graft with barrier
flaps) membrane

83