Question

i want the answer for these 3 question

1 -Describe the classification of furcation lesions and relate these to clinical and radiographic findings.

2 -Discuss the differential diagnosis of a radiograph demonstrating a lesion in the inter-radicular space of a multi-rooted tooth.

3-Explain the treatment objectives and the treatment methods for managing furcation lesion

Answer 1

1.

A furcation involvement exists when periodontal disease has caused resorption of bone into the bi- or trifurcation area of a multi-rooted tooth.The proposed classifications are based on the extension of the defect and the degree of horizontal/vertical attachment loss.other classifications have been proposed in an attempt to describe the anatomy of the furcation more completely, describing the number of remaining bony walls, the morphology of the existing bone and the relationship between root trunk and vertical/horizontal attachment loss.

Several systems have been proposed based either on the extent of horizontal probing depth into the furcation defect or on the vertical extent of the loss of alveolar bone within the defect.

• Grade I involvement: it is the incipient or early lesion. The pocket is supra-bony, involving the soft tissue; there is slight bone loss in the furcation area. Radiographic change is not usual, as bone changes are minimal.
• Grade II involvement: the bone is destroyed on one or more aspects of the furcation, but a portion of the alveolar bone and periodontal ligament remain intact, thus allowing only partial penetration of the probe into the furcation area. The radiograph may or may not reveal the grade II furcation involvement.
• Grade III involvement: the inter-radicular bone is completely absent, but the facial and/or lingual orifices of the furcation are occluded by gingival tissue. Therefore, the furcation opening cannot be seen clinically, but it is essentially a through and through tunnel. If the radiograph of the mandibular molars is taken with a proper angle and the roots are divergent, these lesions will appear on the radiograph as a radiolucent area between the roots. The maxillary molars present a diagnostic difficulty owing to roots overlapping each other.
• Grade IV involvement: the inter-radicular bone underneath the roof of furcation is completely destroyed. The gingival tissue is also receded apically so that the furcation opening is clinically visible. The radiographic image is essentially the same as in grade III lesions.

No classification system can be complete but with its continual use both advantages and disadvantages of each system can be evidenced. This classification attempts to refine the existing drawbacks of the current classifications so that the new system can be applied to a wider variety of cases to provide more accurate characterization of the lesions. This would be of significant aid in communication between clinicians and researchers providing a better understanding of furcation involvements and could be important to predict the prognosis and select correct treatment for each case

2.

A program called ORAD was designed using Bayes' theorem to evaluate the radiographic and clinical features of patients with intrabony lesions in order to assist in their identification. Ninety-eight jaw lesions were described by their prevalence and their distribution by age, sex, race, presence of pain, number, size and location of lesions, association with teeth, expansion, locularity, borders, contents and impact on adjacent teeth. The user follows a menu of 16 questions in order to characterize a specific lesion.

The program output is a list of the lesions in order of their estimated probability. In addition, an estimate of the extent of match between the lesion in question and the typical appearance of each lesion in the knowledge base is calculated. Preliminary trials indicate that ORAD is useful in assisting clinicians in formulating a differential diagnosis.

• The unique organization of chapters based on radiologic findings mirrors the situations encountered in daily clinical practice.
• Easy-to-reference tables classifying findings, diagnosis, and differential diagnosis and providing important clinical data are perfect for an at-a-glance review.
• More than 2000 radiographs and schematic diagrams help to guide the reader toward the most likely diagnoses.

Differential Diagnosis in Conventional Radiology will benefit radiologists and specialists seeking to improve their skills in diagnostic imaging and will also be of great interest to residents preparing for their specialist examinations.

In humans, certain genetic mutations have been linked to root development defects. However, the majority of root defects observed in humans are associated with complex genetic disorders that lead to multiple developmental defects.Among the disorders that only affect root development, the premature arrest of root development is common. These disorders are usually associated with trauma that affects the HERS and neighboring neurovascular structures, which disturbs elongation of the root and dentin formation.Dilaceration is another malformation of the tooth root, typically observed as part of an eruption disorder. It is characterized by a sharp curvature in the apex of the tooth that is frequently the consequence of indirect trauma to the primary teeth.

There are also a number of tooth development defects that affect both the crown and root. These include double teeth, regional odontodysplasia, hypophosphatasia, dentin dysplasia type I, dentinogenesis imperfecta types I, II and III, and X-linked hypophosphatemia. Double teeth result from the merging of two adjacent tooth germs during odontogenesis. A related but distinct disorder is concrescence, in which two adjacent teeth are joined by means of only radicular cementum . In regional odontodysplasia, root formation often ends prematurely, leaving a wide-open apex. Hypophosphatasia, which is characterized by defective mineralization and sometimes skeletal abnormalities, is caused by loss-of-function mutations in the ALPL gene, which encodes tissue-nonspecific alkaline phosphatase in humans and mice . Dentin dysplasia type I (DDI) is an infrequent disorder that affects the formation of the dentin in both the crown and root; in the root, dysplastic hard tissue and scattered soft tissue fill the central space. DDI is transmitted as an autosomal dominant trait but its specific genetic cause is unknown. The teeth of dentinogenesis imperfecta type I and II patients exhibit early and complete obliteration of the pulp cavity, which is instead filled with dentin. By contrast, dentinogenesis imperfecta type III patients exhibit excessively large pulp cavities. Again, the genetic causes of these dentinogenesis imperfecta types are unclear, although some studies have linked certain genes to particular types.

3.

Initial furcation involvement can be effectively treated with adequate plaque control and scaling and root planning, while grade II and III furcations require surgical management. Presently available regenerative therapies have demonstrated good prognosis when used in grade II and III furcation involvement.When periodontal disease affects the furcation of a tooth, the chance that it will be lost increases considerably. An increase in the exposed root surface, anatomical peculiarities and irregularities of the furcation surface all favor the growth of bacteria

Several treatment modalities have been made use of to treat furcation involved teeth. Surgical therapy involving regenerative procedures are indicated in class II and III furcation involvements. The regenerative procedures used in these cases include bone grafts and guided tissue regeneration.

The prognosis of teeth with furcation lesions and, especially, the choice of an appropriate treatment would depend on the characteristics of the lesion, whether it is clinically exposed or not exposed, since according to our understanding and based on previously evaluated literature, in the case of a Grade II–III non-exposed furcation lesion the surgical treatment could be the right approach for a better long term survival rate.It is important to consider that the present new system measures the horizontal attachment loss alone. Considering previous articles and, to the base of our knowledge and experience, vertical attachment loss in furcation lesion is more difficult to be clinically determined. On the other hand, the morphology of inter-radicular osseous defects is further complicated by the fact that supra-bony and/or infra-bony defects of different morphology may also be associated with furcation involvements . A further aid to their clinical diagnosis is the use of trans-gingival probing or bone sounding.

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