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Clinical Parameters

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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


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
  • 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
Slimline access

Radiographic assessment

root resection hemisection
Root resection:

Performed on vital or endodontically treated teeth


Splitting of two rooted tooth into two parts

Following sectioning, one or both roots can be retained


Root Resection & Hemisection
  • 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
  • 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

Mechanical trauma: hard brush, vigorous technique

Crown margins

Periodontal disease

Occlusal trauma

Defects in bone


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
  • 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