Discussion
The patient presented with a probing depth of 8 mm on the buccal furcation area of tooth #19, possibly due to the presence of a CEP that extended deep into the furcation. The presence of the CEP prevented proper soft tissue attachment at the furcal area, leading to the formation of a deep periodontal pocket. Bone loss at the furcal area was most likely due to prolonged plaque accumulation in this periodontal pocket that subsequently led to chronic inflammation and hence attachment loss. By removing the CEP, enamel at the furcation was eliminated to expose the underlying dentin, thereby allowing soft tissue attachment to occur over this area. In so doing, a periodontal pocket was eliminated. Note that a grade II furcation can also be treated with guided tissue regeneration or a bone graft.
It is critical to identify all local etiologic factors because they may accelerate periodontal disease progression and affect the diagnosis, prognosis, and treatment of the disease.
Self-Study Questions
1 What are some anatomic factors that may contribute to periodontal disease?
2 Describe the anatomy of a furcation and define furcation invasion.
3 Name different classification systems of furcation invasion.
4 How should you diagnose a furcation invasion?
Answers located at the end of the chapter.
ACKNOWLEDGMENT
We would like to thank Dr. David Yu for providing Figure 1.7.8.
References
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TAKE‐HOME POINTS
A.
Proximal Contact Relation
Open interproximal contacts or uneven marginal ridge relations may encourage food impaction between the teeth. If proper oral hygiene is absent, food impaction can lead to inflammation, thereby potentially resulting in attachment loss in the interproximal area (Figure 1.7.5).
Root Proximity
Close root proximity between the two adjacent teeth will render oral hygiene difficult to maintain for both the patient and the dental professionals. Hence without good oral hygiene there can be loss of attachment between the two teeth (Figure 1.7.6).
Cervical Enamel Projections and Enamel Pearls
CEPs are extensions of enamel to the furcal area of the root surface. CEPs may potentially predispose a furcation to attachment loss because they prevent connective tissue attachment at furcation. As such, a periodontal pocket may form, leading to plaque accumulation and possibly furcation invasion.
Most clinicians agree there is a correlation between CEPs and the incidence of furcation invasion. Masters and Hoskins reported that 90% of mandibular furcation invasions have CEPs [2]. Bissada and Abdelmalek reported a 50% correlation between CEPs and furcation invasion [3]. Swan and Hurt observed a statistically significant association between