Back
teeth have two or three roots. This means that at the point
where the roots fuse together near the crown of the tooth
the shape of the roots can be complex, convoluted, and irregular.
“Furcation involvement” is the term used to describe gum disease
when it affects this region.
Uncontrolled gum disease can lead to loss
of attachment of the gum to the tooth. If gum disease progresses,
this pocket of unattached gum eventually deepens until the
furcation area is exposed. Plaque enters the furcation area
where it continues to attack the attachment of the gum to
the tooth and also causes breakdown of the adjacent bone.
Once the disease has progressed to this point, treatment becomes
very complex; so it is clear that prevention at an earlier
stage is the best cure.
Treating and maintaining teeth with furcation
involvement is challenging because of the extreme inaccessibility
of the furcation area for cleaning. Indeed even where access
is possible the complex shape of this region of the tooth
makes thorough plaque removal difficult.
As with any other form of gum disease the
most important single aspect of treatment is improved cleaning
- that is removal of all the plaque from around the neck of
the tooth. Unless the root surfaces are kept plaque-free it
is virtually impossible to ensure the continued survival of
the tooth. There are several types of treatment available:
- Reattachment surgery: This exciting
new technique actually allows tissue to regenerate in
the furcation area and will reverse the disease process
to a great extent. Unfortunately this technique is only
practical in situations where the periodontal disease
has been identified at a very early stage, and where the
shape of the diseased area is favourable.
- Cleaning into the furcation areas is
usually very difficult, as it requires special instruments.
However it is sometimes possible to re-contour the tooth
to allow improved access to the furcation area using an
interdental brush. This useful technique will help us
to preserve the tooth for more years; however it is only
of value when the cleaning is carried out reliably on
at least a daily basis.
- Root sectioning: Sometimes just one
root of a two or three tooth is very much worse affected
by gum disease than others. Removal of this root sometimes
allows greatly improved access for cleaning; however before
the root can be removed the tooth must be root filled.
Such teeth often need to be crowned following treatment.
- Dental Implants: Where disease is advanced
dental implants will usually provided a more predictable
replacement for the tooth. It is important not to wait
too long if an implant is required, as loss of bone around
a hopeless tooth may greatly complicate future implant
treatment.
For further information please see Dental
Implants, Gum
Disease, Preventive
Dentistry and
Maintaining Crowns and Bridges. |
