Periodontal Photo Essay
Q: Why do we barrel in furcations?
A: By removing the overhanging lip on the furcation, we usually find bone to be more coronal in the furcation, creating a parabolic architecture and maintainable environment. No further breakdown should occur.
Tooth #30 exhibits a Class II furcation with the old margin approximating the furcation.
After biologic shaping, the overhang of the furcation is removed to allow for a more maintainable furcation area.
Completed restoration with the contours of the new restoration mimicking the shaped root surface.
You have the opportunity to gather more in-depth information in our author's course Advanced periodontology: surgical protocols by Dr. Daniel Melker.
Q:Why do we barrel in a furcation to the occlusal surface when fabricating a new crown?
A:When we contour the crown so the barreling in goes to the occlusal surface, the patient can clean everywhere; there is no plaque buildup. If we can stop short of the occlusal surface, we find plaque accumulates and it is as though the furcation is still present.
When the furcation is removed and the new restoration places the furcation back in that area, it becomes a location for plaque accumulation.
After biologic shaping, the furcation is replaced and the area accumulates plaque.
The furcation was removed but replaced in the final restoration. The tissue has become inflamed from the root being replaced because of plaque accumulation.
Q:How do you contour a new restoration once the tooth has been biologically shaped?
A: The new restoration follows the contours of the shaped tooth and does not have a height contour placed on the buccal.
Occlusal view on the day of impression
Buccal view on the day of impression
Buccal furcation contours carried to the occlusal surface of tooth #30
Q: Should the contours of the new restoration follow the shaped tooth?
A:Yes, to allow for the proper maintenance by the patient and hygienist. As previously discussed, any furcation that is barreled in should be carried to the occlusal surface.
Contours of shaped teeth are shown.
An occlusal view of shaped teeth and, in particular, barreled in furcation of teeth #30 & 31.
Restorations mimic shaped teeth.
Restorations placed on teeth mimic shaped teeth
Q:Does vertical probing in the furcation area tell what periodontal issues may exist?
A:No, as the furcation may approximate the old margin, causing the possibility of future problems for the furcation and new crown. It is important to eliminate any furcation present prior to placement of a new restoration.
Tooth #30 appears to have minimal periodontal issues, based on tissue appearance.
Upon reflection of the flap, the existing margin ends in the furcation. A significant problem exists in terms of the furcation breaking down further over time if left that close to the final margin.
Vertical probing is minimal (2 mm) in the furcation area.
By removing the old margin and smoothing the furcation area, the problem is solved. The operator can now place a new margin anywhere he or she wishes.
The flap is sutured just coronal to the bone so as not to expose it. The concept of suturing is to try to get as much primary closure as possible. Better wound healing occurs and less pain is involved with primary closure.
There are additional details that you can discover in course Perio-restorative protocols: team-based approach.
Author information: Daniel Melker