Analyze The Furcations
We are in a series discussing the key elements of a periodontal evaluation. My last blog touched on the importance of evaluating not only the quantity, but also the quality of calculus. Now, let’s move on to another important finding, furcation involvement.
The degree of furcation involvement is a major factor in determining an accurate prognosis and in the development of an appropriate treatment plan. Furcation exposure, more than anything, complicates instrumentation. It is far more difficult to instrument a six millimeter pocket if it is associated with an exposed furcation than it is if the pocket is adjacent to a flat surface. Further, it is far more difficult to maintain adequate plaque control when there is furcation exposure.
The prognosis for a tooth with furcation exposure is less favorable than it is for one without exposure. This must be taken into consideration when developing a treatment plan. In most cases, it is unwise to use a furcation involved tooth as a key element in a restorative treatment plan.
Furcation exposures also play a key element in the development of a periodontal treatment plan. Surgical access is often needed to provide adequate access for instrumentation.
When exploring for furcation involvement do not forget to check the maxillary first and the mandibular second bicuspids. These teeth, at times, are multi-rooted. It is best to explore the mesial furcations of maxillary molars from the palate side and the distal furcations of maxillary molars from the facial side. I grade furcations from one to three:
Grade one – early exposure
Grade two – able to probe into the central area of the furcation
Grade three – able to probe all the way through to the other side
There are many explorers available for probing furcations. I prefer an 11/12 explorer because it works well not only for exploring the furcations but also for exploring the root surface.