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clinical parameters

This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • In Slide Show, click on the right mouse button
  • Select “Meeting Minder”
  • Select the “Action Items” tab
  • Type in action items as they come up
  • Click OK to dismiss this box
  • This will automatically create an Action Item slide at the end of your presentation with your points entered.

Clinical Parameters

Furcation Recession

Mobility

furcations clinical considerations
Furcations: Clinical Considerations
  • May or may not be clinically exposed
  • Bifurcation: 2 rooted tooth
  • Trifurcation: 3 rooted tooth
  • Radiographs may aid diagnosis
  • Suspect furcation involvement when pockets measure 5-6 mm+
  • Increased risk for root caries, root resorption, recession sensitivity, pulp involvement, abscess formation
furcations
Furcations
  • Extension of bone loss between roots of teeth
  • Teeth with furcation involvement are high risk for continued attachment loss
  • Detection of furcation faciliated by using a specially designed furcation probe
probing furcations
No. 2 Naber’s furcation probe & a narrow Michigan O periodontal probe

Move probe towards location of the furcation & curve into furcation area

Probing Furcations
probing furcations6
Probing Furcations
  • Access to furcations:
    • Mesial surface max. molars:
      • Best to approach from palatal direction b/c mesial furcation is palatal to midpoint of mesial surface
    • Distal surface of max. molars
      • Located more towards midline
      • Detected from buccal or palatal approach
probing furcations7
Probing Furcations
  • Most common site: mand. First molar
  • Least common site: max. first bicuspid
furcations10
Slimline access

Radiographic assessment

Furcations
root resection hemisection
Root resection:

Performed on vital or endodontically treated teeth

Hemisection:

Splitting of two rooted tooth into two parts

Following sectioning, one or both roots can be retained

Classification

Root Resection & Hemisection
mobility
Mobility
  • Risk factor for PD
  • Measure extent, determine cause
  • Normal physiologic movement not graded
  • Degree of mobility not always correlated to amount of bone loss
causes of mobility
Causes of Mobility
  • Mobility may be related to:
    • Trauma from occlusion
    • Loss of periodontal support
    • Gingival inflammation
    • Pregnancy & hormonal changes
    • Periodontal surgery
  • Minor mobility can usually be maintained
  • Increasing mobility – more frequent PMT and/or referral for surery
classification of mobility
Classification of Mobility
  • Nomenclature used varies across systems:
    • Class I etc.
    • Grade I etc.
    • I mobility etc.
    • Grade 1 etc.
    • 1, 2, 3
classification of mobility15
Classification of Mobility
    • N=normal physiologic mobility
    • Grade I=slight mobility, up to 1 mm of horizontal displacement in a facial-lingual direction
    • Grade II=moderate mobility, > 1 mm of horizontal displacement
    • Grade III=severe mobility, greater than 1 mm of movement in any direction (horizontal & vertical)
      • Nield-Gehrig & Houseman, 1996
  • Mobility can be measured using 2 instrument handles
recession
Recession
  • Disturbance to the gingiva results in an apical shift of the gingiva margin
  • Actual recession:
    • Level of the epithelial attachment on tooth
  • Apparent recession:
    • Level of the crest of the gingival margin
etiology of gingival recession
Causes:

Mechanical trauma: hard brush, vigorous technique

Crown margins

Periodontal disease

Occlusal trauma

Defects in bone

Causes:

Trauma from teeth in opposing jaw

Oral habits, oral piercing

Poorly designed partial dentures

Tooth position

Healing response following periodontal surgery

Etiology of Gingival Recession
gingival recession
Gingival Recession
  • Toothbrush Trauma
gingival recession19
Gingival Recession
  • Trauma from denture
gingival recession20
Gingival Recession
  • Oral Piercing
gingival recession21
Gingival Recession
  • Orthodontics
gingival recession22
Gingival Recession
  • Prominent Roots
gingival recession23
Gingival Recession
  • Frenal Attachment
symptoms signs
Symptoms/signs
  • Client usually complains of:
    • Sensitivity
    • Aesthetics
  • Complications:
    • Increased sensitivity
    • Loss of tissue from root surface (erosion, abrasion) – protective cementum removed
    • Caries
    • Greater risk for PD: greater surface area for plaque retention
treatment options
Treatment Options
  • Depends on cause
  • Nonsurgical treatment includes:
    • Debridement
    • Oral self-care instruction
    • Local medicaments for sensitivity
treatment options26
Treatment Options
  • Surgical treatment:
    • Laterally positioned flap
    • Connective tissue graft
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