Diagnosis and Treatment of Furcation-Involved Teeth

Luigi Nibali

• Publisher: Wiley-Blackwell
• Year: 2018
• Print ISBN: 9781119270652
• eBook ISBN: 9781119270676
• Edition: 1
• Topic: Medicine
• Subtopic: Dentistry

Diagnosis and Treatment of Furcation-Involved Teeth offers dental professionals a comprehensive review of the aetiology and diagnosis of furcation defects, including treatment options.

• Provides a practical manual for the successful diagnosis and treatment of a therapeutic challenge for general dentists and periodontists
• Presents illustrative photographs of clinical cases and procedures
• Offers a helpful chapter on patient-reported outcomes
• Includes a companion website with video clips and case studies

Chapter 1
Anatomy of Multi‐rooted Teeth and Aetiopathogenesis of the Furcation Defect

Bernadette Pretzl

Section of Periodontology, Department of Operative Dentistry, University Clinic Heidelberg, Heidelberg, Germany

1.1 Introduction: Why Focus on Molars?

Dentists generally agree on three statements about molars:

• They play an important role in the dentition.
• They are difficult to reach for self‐performed as well as professional cleaning due to their posterior position in the mouth.
• They pose some challenges due to their unique anatomy.

The important role of molar teeth in the dentition mainly consists in their contribution to mastication, because they carry a considerable part of the occlusal load. Hiiemäe (1967) focused on the masticatory function in mammals and molars grinding the food, and in 1975 Bates et al. reviewed the literature on the masticatory cycle in natural and artificial dentitions of men, attributing a fundamental role to our posterior teeth regarding the intake and preparation of nutrition. Thus, a focus on molars and the endeavour to retain our posterior teeth in a healthy functional state seems justified.

This chapter will reveal how the posterior position of molars makes them less accessible for cleaning, whether it may be self‐performed or carried out by a dental professional. This fact, combined with the unique anatomy of molars, poses a challenge for all dentists focusing on molar retention.

1.2 The ‘Special’ Anatomy of Molar Teeth

The essential knowledge of molar root anatomy for every periodontist is stressed in a review by Al‐Shammari et al. (2001). Due to the higher mortality and compromised diagnoses of furcation‐involved molars, and likewise to the reduced efficacy of periodontal therapy in multi‐rooted teeth, the authors suggest a thorough engagement with possibly decisive tooth factors such as furcation entrance area, (bi)furcation ridges, root surface area, root separation, and root trunk length, because they may critically affect the diagnosis and therapy of multi‐rooted teeth (Leknes 1997; Al‐Shammari et al. 2001).

For centuries, scientists have concerned themselves with the human teeth, their anatomy, evolution, function, histology, and histogenesis. Almost 3000 years ago, the Etruscans populating the northern and central part of what is now Italy from 900 to 100 BC recognized the importance of teeth and fabricated quite delicate dental prostheses, which Loevy and Kowitz (1997) compared to prostheses from the mid‐twentieth century.

The formation and genesis of teeth have been studied in more detail during the last three and a half centuries, starting with the works of the so‐called father of microscopic anatomy and histology, Marcello Malpighi (1628–1694) from Italy (Rifkin and Ackerman 2011), who referred to an ‘involucrum externum’ describing the outer part of the tooth, which is today known as enamel. More than a century later the formation of cementum (1798–1801) and dentine (1835–1839) was described (e.g. Blake 1801; Bell 1835). Written in 1935, Meyer’s Normal Histology and Histogenesis of the Human Teeth and Associated Parts (Churchill 1935) builds the foundation of our understanding regarding the anatomy of teeth. Orban and Mueller (1929), who studied the development of furcations in multi‐rooted teeth, set a focus on molars using graphic reconstructions as early as 1929. Their three‐dimensional illustrations allow a detailed impression of the root area comparable to those documented by Svärdström and Wennström (1988). In later years, scientists focused more and more on micro‐anatomical and histological research.

Based on the knowledge thus created, the sequence of molar development can be divided into three phases analogous to the development of all teeth (Thesleff and Hurmerinta 1981): initiation, morphogenesis, and cell differentiation. The evolution of more than one root sets molars apart from the rest of the dentition: in multi‐rooted teeth the enamel organ expands with projections of Hertwig’s root sheath (an epithelial diaphragm). These expansions were described as lobular growing inwards between the lobes. Depending on the number of lobes, two to three (in rarer cases four) roots develop as soon as the projections have fused (Bhussry 1980). In an investigation by Bower (1983) of furcation development, evolving mandibular molars from 13 foetuses between 17 and 38 weeks of gestation were fixed, sectioned, and stained, giving a unique and detailed impression of furcation development. The author measured the base of the dental papilla as well as the buccal and lingual epithelial elements and described the development as follows: The first epithelial elements, which later evolve into the bifurcation, appear at the 24‐week stage of gestational age. At that time, the crown formation of the molar is not complete and Hertwig’s root sheath has not developed yet (Bhussry 1980; Bower 1983). Thus, the author suggests that the epithelial elements form extensions of the epithelium of the developing crown rather than the root (Bower 1983). Additionally, he detected stellate reticulum (which is essential for the formation of ameloblasts) in the furcation area. The author speculated about a possible mechanism of enamel formation due to the presence of stellate reticulum in the region of the furcation, which develops into ameloblasts, for example resulting in cervical projections of enamel.

1.3 Anatomical Factors in Molar Teeth

In 1988, Svärdström and...

Table of contents

• Cover
• Table of Contents
• Foreword
• Preface
• Chapter 1: Anatomy of Multi‐rooted Teeth and Aetiopathogenesis of the Furcation Defect
• Chapter 2: Clinical and Radiographic Diagnosis and Epidemiology of Furcation Involvement
• Chapter 3: How Good are We at Cleaning Furcations? Non‐surgical and Surgical Studies
• Chapter 4: Furcation
• Chapter 5: Why do We Really Care About Furcations? Long‐term Tooth Loss Data
• Chapter 6: Regenerative Therapy of Furcation Involvements in Preclinical Models
• Chapter 7: Regenerative Therapy of Furcations in Human Clinical Studies
• Chapter 8: Furcation Therapy
• Chapter 9: Furcation Tunnelling
• Chapter 10: Innovative and Adjunctive Furcation Therapy:
• Chapter 11: Furcation
• Chapter 12: Is it Worth it? Health Economics of Furcation Involvement
• Chapter 13: Deep Gaps between the Roots of the Molars:
• Chapter 14: Assessment of Two Example Cases Based on a Review of the Literature
• Chapter 15: Furcations
• Index
• End User License Agreement