Furcation Involvement & Its Treatment: A Review. Article (PDF Available) in Journal of Advanced Medical and Dental Sciences Research. Shikai Tenbo. ;51(3) [Furcation involvement and its management]. [ Article in Japanese]. Hasegawa K, Miyashita H, Kinoshita S. PMID: The management of furcation involvement presents one of the greatest . The membrane was soaked in normal saline solution to improve its adhesion.

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Register Lost your password? A furcation or furca is frcation area of a tooth where the root divides from the common root trunk into a bifurcation or trifurcation.

Furcation involvement in posterior teeth is the result of progressive periodontal breakdown due to inflammation. It is important to determine the extent of furcation involvement to a make an appropriate diagnosis and developing a treatment plan. Furcation involvement worsens the prognosis of the tooth because long-term studies indicate that teeth with furcation involvement are the teeth that tend to be lost over time. In a study Hirschfeld and Wasserman 1reported that percentage of tooth loss in furcation-involved molars was The access to the furcation area is difficult both for the dentist and ivolvement, and their treatment constitutes an enormous challenge.

The treatment of teeth with furcation involvement ranges from thorough debridement to regenerative procedures and, if the lesion progresses, to extraction. In the following discussion, we shall discuss in detail the etiology of furcation involvement and its potential treatments.

Furcations present very unusual challenges for instrumentation due to their anatomical features. It is important to understand…………………. The root trunk height may vary from surface to surface on a molar or premolar Table The root cones start at the furcation point from where they may take various shapes diverging from the root trunk.

The furcation fornix is referred to as the roof of furcation area and furcation entrance is the transitional area between the divided and undivided roots.

Root divergence furcxtion the degree of separation of roots and coefficient of separation is the length of root cones in relation to the length of root complex. The shapes of roots may have different shapes and may be completely or incompletely fused.

The incompletely fused roots may be fused in the area of CEJ but are separated in the apical region. The degree of root divergence also varies from tooth to tooth. Let us now discuss the anatomy of various bifurcated and trifurcated teeth managemment detail. The root of the maxillary first premolar is usually bifurcated in the apical or middle third making facial and palatal roots.

When viewed from the mesial aspect, a furction groove extends from the contact area to the bifurcation. The mean distance of the furcation from CEJ for maxillary first premolar is 8 mm with a furcation width of approximately 0. The maxillary first molar is the largest tooth in the maxillary dental arch.

It has three roots, mesiobuccal, distobuccal and a palatal root. The lingual root is the longest, the mesiobuccal root is not as long, but it is broader buccolingually, the distobuccal root is the smallest of all the three roots.

The average root trunk length from the cervical line to the furcation area is infolvement 4 mm. Usually, there is a deep developmental groove which extends on the buccal surface of the root trunk from the furcation area toward the cervical line, where it terminates in a shallow depression or it may extend slightly on the enamel surface at the cervix.

The buccal furcation entrance unvolvement narrower than the distal and mesial furcation entrances. The distobuccal root is narrower than the other two roots. When seen from the mesial surface, the mesiobuccal root occupies two-thirds of the buccolingual measurement of the tooth and it hides the distobuccal root.


There are three furcation entrances on a maxillary first molar and these are located at varying distances from the CEJ. The distance of the mesial furcation entrance from CEJ is around 3 mm, while that of buccal and distal furcations from CEJ is 3.

It indicates that the furcation fornix is inclined in the mesiodistal plane and the mesial furcation entrance is closer to CEJ as compared to the distal entrance. In general, the overall size of maxillary second molar is smaller than the first molar and larger than the third molar. The root trunk length of second maxillary molar is more than the first molar and hence the respective furcation entrances are farther from CEJ as compared to the first molar.

The degree of root separation of the second molar is less than the first molar and that of the third molar is less than the second molar.

All involgement depressions found on the root surface of the second molar are usually shallower than the first molar. As the degree of root separation of the second molar is less that the first molar, the furcation entrances are narrower.

The mandibular first molar has two roots, a mesiodistally flattened mesial root and a mostly straight and more rounded distal root curcation. The mesial root is curved mesially from managemeny third to middle third portion. Distal root is less curved and its axis is in the distal direction from the root trunk to the apex. Both mesial and distal roots are wider mesiodistally on the buccal aspect as compared to the lingual aspect.

The point of bifurcation is present approximately 3 mm below the CEJ on the buccal aspect and 4 mm below the CEJ on lingual aspect. Thus, the furcation fornix is inclined in buccolingual direction. The alveolar bone thickness on the buccal aspect of the first molar is less as compared to the second molar and thus chances of fenestration and dehiscence are more on the buccal aspect of the first mandibular molar. The root trunk length of mandibular second molar is more than the first molar.

Root divergence of mandibular second molar is less than the first molar. The root trunk of both first and second molar has a depression between the bifurcation and cervical line. The shape of mandibular third molar varies considerably from individual to individual. The mesial and distal roots may have a definite bifurcation point or they may be fused for all or part of their length.

The most common etiology of furcation involvement is bacterial plaque causing inflammation in periodontal tissues. Extension of inflammation leads to progressive loss of anr and hard tissue in the bifurcation and trifurcation of posterior teeth.

Other predisposing and contributing factors which facilitate furcation involvement include tooth brush trauma causing recession and loss of attachment, trauma from occlusion, endodontic lesions that get an access to furcation area, the thickness of investing alveolar process, root fracture and iatrogenic factors. A tooth may also be predisposed to furcation involvement due to anatomical factors and root fracture involving furcations 6. Following is the detailed description of these factors.

The plaque-induced inflammation causes the destruction of collagen fiber attachment of gingiva and alveolar bone.

Furcation involvement and its treatment –

Furcation involvement is primarily due to the rootward extension of the periodontal pocket in the region of furcation. The resolution of inflammation prevents further attachment loss and is the primary requirement of all types of furcation treatments. If the patient is not able to keep the furcation areas free from plaque further hard and soft tissue loss results.

TFO is a predisposing factor for a more rapid involvement of furcation in inflammatory periodontal diseases. It has been well established that in the absence of inflammation, TFO causes……………. Buy Now For International Users: Masters and Hoskins 7 manavement the incidence of CEPs in extracted human teeth and suggested their possible implication in isolated furcation involvement.


They can be classified on the basis of their proximity to furcation entrance as. Grade II — The enamel projection approaches the manavement to the furcation. It does not enter the furcation, and therefore, no horizontal component is present.

[Furcation involvement and its management].

Grade III — The enamel projection extends horizontally into the furcation. A higher prevalence of CEPs has been found in the mandibular molars than in the maxillary molars. Further, the prevalence is highest for mandibular and maxillary second molars.

The clinical significance of CEP is that while attempting regeneration in involved furcation, CEP should be removed because connective tissue does not attach to enamel and a long junctional epithelium shall be formed which is easily susceptible to breakdown.

There is a high percentage of molars with patent accessory canals that open in their furcation area It is one of the co-factors contributing to the development of furcation lesion. The presence of accessory canals in the furcation area may easily extend the endodontic infection in the furcation area and may result in bone loss in furcation.

In one study, the prevalence of assessor canals in the furcation region of molars has been found to be Out of total samples, accessory canals in the furcation area were demonstrated in With no apparent periodontal involvement, the endodontic lesion gets access to the furcation by accessory canals.

The endodontic treatment of tooth resolves the periodontal problem also. Regeneration of new intrafurcal bone and attachment can be expected in such cases. If there is an accumulation of plaque in the furcation area adjacent to endodontic sinus tract the lesion becomes endo-perio lesion. If the furcation lesion is detected in a non-vital tooth, the endodontic treatment should be initiated and re-evaluation of furcation should be done after weeks.

The resolution of clinical inflammation in furcation area can be observed after this time period.

However, complete hard and soft tissue formation may take as long as 6 months or more. During the inflammatory process, the thick alveolar process may predispose to the formation of deep horizontal and vertical defects without soft tissue involvemeny, whereas think bone is commonly associated with recession which may result in easier access to the furcation.

A rapid localized bone loss is often seen in association with vertical root fracture. In the case of vertical root fracture involving trunk of the root, frequently its extension to furcation area is found. It may result in rapid formation of isolated furcation lesion. The prognosis of such teeth is poor and frequently, tooth loss results. The development of furcation lesions has also been demonstrated due to inappropriate treatments. Overhanging restorations result in harboring of plaque resulting in inflammation and thus initiating the development of a furcation lesion.

It has been observed that molars with restorations have a higher prevalence of furcation involvement than the non-restored molars. The furcation lesions are most commonly seen in maxillary and managemejt first molars This is because their………………………. The prognosis of the tooth is established only after the exact condition of furcation is known.

There are various factors which are considered while making a diagnosis of furcation involvement and establishing the prognosis of the involved tooth.

These include 21. Out of horizontal and vertical bone loss parameters, the managemfnt bone loss is more commonly used parameter. Following are some of these proposed classifications for furcation involvement. Glickman 22 proposed classification for furcation involvement were four grades of furcation involvement were described.

Incipient or early lesion.