Transcript Document 7590943

Clinical Parameters
Furcation
Mobility
Recession
Learning Outcomes
Furcations: Clinical
Considerations
 May or may not be clinically exposed
 Bifurcation: 2 rooted tooth
 Trifurcation: 3 rooted tooth
 Radiographs may aid diagnosis
 Suspect 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, Treatment
Furcation
Characteristics
Treatment Options
Grade I
Initial involvement, may
Perio debridement
penetrate area up to 3 mm Odontoplasty
Slight bone loss
Suprabony pockets
No radiographic changes
Grade II
Bone lost on one or
more aspects, > 3 mm but
not through & through
Horizontal depth varies
Vertical bone loss
possible
Possible radiographic
visibility
Perio debridement
Flap with odontoplasty &
osteoplasty
Guided tissue
regeneration (more success
with mand. Molars)
Root resection
Furcations: Classification,
Characteristics, Treatment
Furcation
Characteristics
Treatment Options
Grade III
Interradicular bone
absent
Access on fa/li
blocked by gingiva
“Through & through “
Radiographically
visible
Perio debridement
Flap procedure
Odontoplasty
Root resection
hemisection
Grade IV
Interradicular bone
absent
Clinically visible
“Through & through”
Radiographically
visible
Debridement
Flap 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 PD
Measure extent, determine cause
Normal physiologic movement not
graded
Degree 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 maintained
 Increasing 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 cause
Nonsurgical treatment includes:
– Debridement
– Oral self-care instruction
– Local medicaments for sensitivity
Treatment Options
Surgical treatment:
– Laterally positioned flap
– Connective tissue graft