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Fast Facts: Perio Edition - Furcations

Fast Facts

Fast Facts: Perio Edition Episode 81
 
[Andrew Johnston, RDH]
 
Welcome back everyone! You are listening to another episode of Fast Facts- Perio Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Katrina Sanders.
 
[Katrina Sanders, RDH]
 
Hello and welcome to Fast Facts: Perio Edition. This week, we are going to shrink down and magic school bus into a furcation. For all my millennials out there, we all learned science with Ms. Frizzle, and today we're going to learn about the science of furcations by shrinking down and really exploring what we know about furcations. Remember, assessing furcations is a critical clinical parameter for evaluating the health, wellness, and vitality of our patients periodontium. And unfortunately, many times identifying furcations is missed until the furcation is so involved that it is detected radiologically. Let's take a look at what we know about furcations.
 
Yes, we do know that our maxillary and mandibular molars will present with furcations. In the maxillary, our maxillary first molars will experience, on occasion, a buccal furcation, and it should be noted on the maxillary first molars that that buckle furcation is typically about 4mm from the CEJ. The mezio lingual furcation of a maxillary first molar is about 3mm from the CEJ. That is important. We look at the distal furcation being located about 5mm from the CEJ and this can give us a lot of information about our patient's attachment loss.
 
For example, if our patient is a typical 3-2-3 patient and there's even 1 recession on the buckle aspect, we could start to slowly creep into that furcation. By the time we have 2mm of buckle recession on maxillary first molar, that patient likely could be experiencing a grade one furcation. If we take a look at the mandible, the furcation is actually located even a bit higher on the mandible. For example, on the buckle aspect of a mandibular first molar, that entrance to the furcation is about 3mm from the CEJ. So if you're probing a patient and on tooth number 19, you're probing along and that patient is a 3-2-3, and they have even 1mm recession, you are likely entering into an early grade one furcation for this patient.
 
On a mandibular first molar, the lingual furcation is located 4mm from the CEJ. And so again, when we start to take a look at some of these early attachment loss modalities, we're not only evaluating the distance from the CEJ, but also the anatomy of the concavity leading into the furcation. Speaking of concavities, fun fact - the maxillary first premolar, 61% of the time will also be bi-furcated. You heard that right, 61% of the time, the maxillary first premolar will present with a buccal and lingual root, meaning we could actually articulate into a furcation on either the mesial or the distal aspect.
 
Now, the root trunk on a maxillary first premolar is pretty long, about 7mm from that CEJ. However, when we do see bifurcated maxillary first premolars with a really deep mesial concavity, this absolutely could elevate this patient's risk of experiencing, advancing, and furthering periodontal disease in these areas. As we all know that furcations are relatively challenging for our patients to manage at home. Furcation involvement may be measured and classified utilizing a Nabers probe. And in some cases we know we can also see advanced furcation involvements detected radiologically. Nevertheless, furcations are critical for us to be assessing as clinicians because we understand that the advancement of furcations can change the patient's prognosis long term. It can absolutely change the cleanse ability for our patients and ultimately they can impact the success of our care.
 
This has been another episode of Fast Facts - Perio Edition with Katrina Sanders, RDH. Please feel free to reach me on Instagram @thedentalwinegenist or on my website www.KatrinaSanders.com Cheers.
 
[Andrew Johnston, RDH]
 
Thank you for listening to another episode of Fast Facts - Perio Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at www.dentistrx.com. We'll see you next week for another Fast Fact!
 
 
Resource: ​​
Nield-Gehrig J. Advanced instrumentation techniques for root surfacedebridement.Journal of Practical Hygiene. 2004;13(3):19-22.http://www.perio.org/resources-products/pdf/management.pdf. Accessed August 25,2009.Scheid, RC.Woelfel’s Dental Anatomy Its Relevance to Dentistry. 7th ed.Philadelphia, PA: Lippincott Williams & Wilkins, 2007:205.


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