Treatment Options for Root Furcation Involvement in Molars

Treatment of molar furcation involvement?

Hello, I had a toothache in my upper right molar and visited a nearby dental clinic.
After examination, the dentist said I needed bone grafting and referred me to a periodontist at another clinic, where I scheduled a periodontal flap surgery.
In mid-January, after the periodontist incised the gum, he mentioned that the condition of the alveolar bone around that tooth was worse than he expected and stated that bone grafting would be ineffective.
After suturing, during the follow-up visit, he said that the alveolar bone of the upper right molar had been resorbed for unknown reasons.
Currently, I can only clean the exposed tooth roots using an interproximal brush, and the molar may last for about five more years.
I would like to ask: 1.
Does this molar count as having root furcation involvement? 2.
Can Taoyuan Hospital provide treatment for this type of dental issue? 3.
Do you have any recommendations for periodontists? 4.
Is periodontal regeneration surgery the same as guided bone regeneration? I am also wearing a retainer after orthodontic treatment and would like to preserve my natural teeth as much as possible.
Thank you!

C.L., 40~49 year old female. Ask Date: 2016/03/18

Dr. Huang Zhicheng reply Dentistry

Hello, regarding "Is this molar considered root furcation involvement?" - a clinical examination along with X-ray assistance is necessary for a proper assessment.
Periodontal regeneration surgery: In cases of periodontal disease, destruction of surrounding tissues leads to the formation of pockets; if the destruction is extensive, tooth extraction may be required.
This procedure aims to regenerate lost bone and tissue, and it must be accompanied by proper oral hygiene.
Guided bone surgery: involves the application of bone graft material and a regeneration membrane at the affected site for approximately 3 to 9 months, depending on the size of the defect.
Wishing you peace, health, and well-being.
Sincerely, Dr.
Kuan-Yu Chu, Attending Dentist, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2016/03/18

More Info

Root furcation involvement in molars is a complex dental issue that can significantly affect the prognosis of the affected tooth. When the furcation area, which is the space between the roots of a multi-rooted tooth, becomes compromised due to periodontal disease, it can lead to bone loss and potential tooth mobility. Here’s a comprehensive overview of treatment options and considerations for managing this condition.

Understanding Root Furcation Involvement
1. Diagnosis: The first step in managing root furcation involvement is a thorough diagnosis. This typically involves clinical examination and radiographic evaluation to assess the extent of bone loss and the condition of the periodontal tissues. If the dentist has indicated that the alveolar bone around the tooth is compromised, it is crucial to understand the severity of the furcation involvement, which is classified into three grades:
- Grade I: Mild involvement with less than 1 mm of horizontal bone loss.

- Grade II: Moderate involvement with more than 1 mm but not completely through the furcation.

- Grade III: Severe involvement with complete loss of bone support in the furcation area.

2. Treatment Options:
- Non-Surgical Therapy: This includes scaling and root planing to remove plaque and calculus from the root surfaces. Additionally, the use of antimicrobial agents may help in controlling infection and inflammation.

- Surgical Therapy: If non-surgical methods are insufficient, surgical intervention may be necessary. This can include:
- Flap Surgery: This allows for direct access to the furcation area for thorough cleaning and debridement.

- Bone Grafting: If there is significant bone loss, grafting materials (such as bone powder) can be used to promote bone regeneration in the furcation area.

- Guided Tissue Regeneration (GTR): This technique uses barrier membranes to direct the growth of new bone and periodontal tissues, potentially improving the prognosis of the tooth.

3. Long-Term Management: After initial treatment, regular follow-up appointments are essential to monitor the health of the periodontal tissues and the stability of the tooth. Patients may need to adopt improved oral hygiene practices, including the use of interdental brushes or other aids to maintain cleanliness in the furcation area.

Addressing Your Specific Questions
1. Is this molar considered to have root furcation involvement?: Based on your description, if the alveolar bone loss has affected the area between the roots of the molar, it is likely that you are experiencing root furcation involvement.

2. Can Taoyuan Hospital treat this type of dental issue?: Many hospitals, including Taoyuan Hospital, have dental departments that specialize in periodontal treatments. It is advisable to consult with a periodontist there for a comprehensive evaluation and treatment plan.

3. Recommendations for Periodontists: If you are looking for a specific recommendation, it would be best to consult with your general dentist for referrals to reputable periodontists in your area. They can provide you with options based on your specific needs and the complexity of your case.

4. Is periodontal regeneration surgery the same as guided bone regeneration?: Yes, periodontal regeneration surgery often involves techniques similar to guided bone regeneration (GBR). GBR aims to facilitate the regeneration of lost periodontal structures, including bone and soft tissues, which can be crucial for improving the prognosis of teeth affected by furcation involvement.

Conclusion
In summary, managing root furcation involvement in molars requires a multifaceted approach that includes accurate diagnosis, appropriate treatment options, and ongoing maintenance. The goal is to preserve the natural tooth as long as possible while ensuring the health of the surrounding periodontal tissues. It is essential to maintain open communication with your dental care team to discuss your treatment options and any concerns you may have, especially considering your ongoing orthodontic treatment.

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