Periodontal Surgery: Treatment

of Multi-Rooted Teeth

Bryan Michalowicz, DDS

Department of Developmental and

Surgical Sciences

Tooth Loss Following Periodontal Therapy

Hirschfeld & Wasserman, 1978

600 patients followed for at least 15 years

Overall, 7.1% of teeth were lost because ofperiodontitis

31.4% of molars with initial furcationinvolvements were lost

Only 7.2% of molars with furcationinvolvements were lost in the well-maintained group

Implications of furcation

involvements

In most long-term studies (e.g., McFall,

1982), the teeth most commonly lost due to

periodontitis are:

Maxillary molars > mandibular molars >

maxillary first premolars

Dr. Bryan Michalowicz Periodontology III

Spring Semester, 2012School of Dentistry

University of Minnesota

1 of 6

Treatment options for multi-rooted teeth

with furcation involvements

Odontoplasty

Scaling and Root Planing

Open Debridement

Apically positioned flaps

Root Amputation/Hemisection

Regenerative therapy (e.g., GTR)

Treatment options for multi-rooted teeth

with furcation involvements

Odontoplasty

Scaling and Root Planing

Open Debridement

Apically positioned flaps

Root Amputation/Hemisection

Regenerative therapy (e.g., GTR)

Effect of SCRP and OHI on Molar Teeth

(Norland et al., 1987)

19 subjects treated and monitored for 24months

Furcations with PD > 4 mm responded lessfavorably than non molar teeth or molar flatsurfaces

Among sites with initial PDs > 7 mm, 21%of furcations, 7% of molar flat surfaces and11% of non-molar sites lost attachment

Dr. Bryan Michalowicz Periodontology III

Spring Semester, 2012School of Dentistry

University of Minnesota

2 of 6

Important Points

Use of both hand instruments and powered

scalers in furcations removes more calculus

than either method alone.

Whether using hand instruments, powered

scalers or both, more residual calculus is left

in furcations than on non-furcation tooth

surfaces. This is true for both closed and

open curettage.

Treatment options for multi-rooted teeth

with furcation involvements

Odontoplasty

Scaling and Root Planing

Open Debridement

Apically positioned flaps

Root Amputation/Hemisection

Regenerative therapy (e.g., GTR)

Prognosis of Tunnel Preparations for

Class III Furcations (Hellden et al, 1989)

156 teeth in 107 subjects treated by tunnel

preparations

Mean observation time = 3 years

6.7% were extracted and 4.7% hemisected,

primarily because of caries

Overall, 23.5% of teeth developed caries

Treatment options for multi-rooted teeth

with furcation involvements

Odontoplasty

Scaling and Root Planing

Open Debridement

Apically positioned flaps

Root Amputation/Hemisection

Regenerative therapy (e.g., GTR)

Dr. Bryan Michalowicz Periodontology III

Spring Semester, 2012School of Dentistry

University of Minnesota

3 of 6

Hemisected Molars (Erpenstein, 1983)

24 hemisected molars followed for 1 7

years (mean = 2.9 years)

22 served as distal bridge abutments (mostly

mandibular molars)

7 failed for endodontic reasons, only 1

because of periodontitis

Prognosis for hemisected teeth is favorable

Dr. Bryan Michalowicz Periodontology III

Spring Semester, 2012School of Dentistry

University of Minnesota

4 of 6

10 Year Evaluation of Root Resections

(Langer et al, 1981)

100 patients, 50 maxillary and 50 mandibularmolars

Classified failures as due to periodontitis,endodontic pathology or caries

38/100 failed, 55% of these between 5 7 years

10/38 failures (26%) were because ofperiodontitis, most which were maxillary molars

Most mandibular molar failures were because ofroot fractures

Treatment options for multi-rooted teeth

with furcation involvements

Odontoplasty

Scaling and Root Planing

Open Debridement

Apically positioned flaps

Root Amputation/Hemisection

Regenerative therapy (e.g., GTR)

Dr. Bryan Michalowicz Periodontology III

Spring Semester, 2012School of Dentistry

University of Minnesota

5 of 6

Guided Tissue Regeneration

Absorbable (polylactic acid or collagen)

Non-absorbable (e.g., ePTFE or Gortex)

Changes From Original

Class II Molar Furcations

COLL ePTFE DEB

Better 26 (44%) 17 (53%) 2 (7%)

No ! 33 15 22

Worse 0 0 3

(Yukna & Yukna, 1996)

Clinical Considerations

Class II furcations can be treated withregenerative methods if there is someinfrabony component to the lesion.

The clinical and/or radiographic response isgenerally similar for allogenic bone grafts,guided tissue regeneration membranes orgrowth factors (e.g., Emdogain)

Class III furcations dont respond well tosurgical treatment and are probably bestmaintained non-surgically or extracted.

Dr. Bryan Michalowicz Periodontology III

Spring Semester, 2012School of Dentistry

University of Minnesota

6 of 6