The furcation problem. Etiology, pathogenesis, diagnosis, therapy and prognosis.

Abstract

Abstract The furcation problem was studied in a dental autopsy material, i.e. extracted teeth were examined under the stereomicroscope. The folowing conclusions were reached: extraction. Plaque and Gingival Indices, degree of mobility, and other pertinent clinical data were recorded. A landmark was made on the tooth surface at the gingival margin so as to localize the margin during the examination of the extracted tooth. Immediately following the extraction, loosely attached soft tissue between the roots and in the area of the junctional epithelium were removed; any blood was washed away. The tooth was kept in a 1 % solution of Water Blue for 10 min, rinsed in running water, and air‐dried. The teeth were examined under the stereomicroscope. The following conclusions were reached:Subgingival plaque is common, even in the absence of supragingival plaque, among patients who have started efficient supragingival plaque control but after subgingival plaque has been formed.Efficient supragingival plaque control may remove subgingival plaque as far as 2.5 mm below the gingival margin.Subgingival plaque, in the absence of supragingival plaque, is only occasionally associated with a marginal gingivitis. Subgingival plaque, in the absence of supragingival plaque, causes a clinically undetectable submarginal gingivitis which leads to destruction of the attachment apparatus and eventually to furcation involvement. Loss of attachment, whether it takes place on the outer surfaces or in the furcations, is strongly correlated with subgingival plaque and submarginal gingivitis. There is no correlation between visible supragingival plaque and loss of attachment in the furcations, nor is there any association between subingival plaque in the furcations and marginal gingivitis. The conventional Plaque and Gingival Indices do not reflect the actual conditions in advanced destructive periodontal disease, including furcation involvement. Subgingival plaque control is likely to be incomplete on the outer surfaces and is a total failure in the furcations. In established furcation involvement more attachment is likely to be lost between the roots than on the outer surfaces.An early diagnosis is essential for successful management of the furcation problem. But it is extremely difficult to make a correct diagnosis because so many of the clinical criteria are misleading and because pain often precludes the probing which is necessary to establish the extent of the lesion.Root resection can be given a logical place in the overall plaque control rationale; but the indication for this treatment is strongly dependent on the anatomy of the tooth, the age of the patient and his predisposition to destructive periodontal disease.The prognosis of root resection depends on successful endodontic treatment as well as total plaque control.Increased mobility is a very late symptom in the development of the furcation involvement and is not involved in its etiology.