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根分叉病变是牙周炎病变波及多根牙根分叉区,导致根分叉处的牙周附着丧失和牙槽骨破坏。由于多根牙根分叉区解剖结构复杂,彻底清创难度较大,一旦伴有根分叉病变,病情进展较单根牙更快且附着丧失更明显。因此,伴有根分叉病变牙齿的失牙率也更高。根据根分叉病变的严重程度,临床医生可以选用相应的治疗方法,牙周非手术治疗是最基本的治疗,其他治疗手段包括牙周手术治疗(根据根分叉病变程度选择不同的术式)、牙周-牙体联合治疗、牙周-正畸联合治疗等,各种治疗方法的预后不尽相同。文章就根分叉病变的发生、发展、临床诊断、治疗及预后等相关问题做一综述。     

根分叉病变发生、发展与治疗研究进展

根分叉病变是牙周炎病变波及多根牙根分叉区,导致根分叉处的牙周附着丧失和牙槽骨破坏。由于多根牙根分叉区解剖结构复杂,彻底清创难度较大,一旦伴有根分叉病变,病情进展较单根牙更快且附着丧失更明显。因此,伴有根分叉病变牙齿的失牙率也更高。根据根分叉病变的严重程度,临床医生可以选用相应的治疗方法,牙周非手术治疗是最基本的治疗,其他治疗手段包括牙周手术治疗（根据根分叉病变程度选择不同的术式）、牙周-牙体联合治疗、牙周-正畸联合治疗等,各种治疗方法的预后不尽相同。文章就根分叉病变的发生、发展、临床诊断、治疗及预后等相关问题做一综述。     

再生胶原膜治疗牙周根分叉病变的临床观察

目的　观察国产BME - 10X型医用胶原膜引导组织再生 (GTR)治疗根分叉病变的临床效果。方法选择 40例牙周炎患者、46颗牙Ⅱ 根分叉病变 ,随机分组 ,实验组用GTR术 ,对照组用翻瓣术。分别记录术前、术后1年的牙周临床指数和摄X线牙片。结果与结论　再生胶原膜治疗Ⅱ 根分叉病变优于常规牙周翻瓣术     

超声骨刀与植骨联合治疗根分叉病变的研究

目的：研究不同植骨材料和超声骨刀联合治疗第一磨牙根分叉病变骨下袋的治疗效果。方法：选择第一磨牙根分又病变骨下袋病例102例,随机分为4组：A组实施翻瓣术,应用超声骨刀,B、C组在此基础上分别植入羟基磷灰石骨粉和Bio—Oss骨粉,D组实施翻瓣术,植入Bio—Oss骨粉,在基线及术后1、6、12月检测牙周临床指标和根分又区骨密度。结果：四组病例术后临床指标均有所改善,与基线比较有显著性差异俨〈0．05）,但组间比较无显著性差异（P〉0．05）。C组在骨密度增加方面较A、B、D组明显,而B、D组又较A组增加明显,均有统计学意义（P〈0．05）。结论：超声骨刀联合Bio—OS8骨粉植入治疗根分叉病变能获得更多的牙周再生和牙槽骨的重建。     

“简易断根术”治疗牙周病临床观察

断根术是治疗多根牙某一牙根牙周组织严重破坏,从根分叉处切除患根,以达到消除深牙周袋和牙周炎症的一种方法。常规的断根方法需经翻瓣后切断取出患根。临床中需要施行断根术的患牙,多数患根牙周袋很深且为骨上袋型,围绕患根的牙周组织几乎全部破坏,有时牙周袋可直达根尖,甚至个别出现根尖外     

骨形态蛋白复合物联合引导组织再生技术治疗根分叉病变的研究

目的 评价骨形态蛋白复合物联合引导组织再生技术治疗根分叉病变的临床效果。方法 选择30颗Ⅱ～Ⅲ度根分叉病变患牙，其中骨形态蛋白复合物联合引导组织再生技术治疗10颗（BMP组），引导组织再生技术治疗10颗（GTR组），常规牙周翻瓣术治疗10颗（OFD组），作为对照组。术后12周、24周分别观察各组的牙周探诊深度（PPD）、根分叉水平探入深度（HPD）、临床牙周附着丧失（CAL）和龈沟出血指数（SBI）等临床指标变化。用SPSS10．0软件包对相关数据统计学分析。结果 三组术后PPD、HPD、CAL和SBI均有明显减少，BMP组、GTR组与OFD组相比较，减少更为明显，有显著性差异（P〈0．05），BMP组与GTR组相比，PPD和CAL减少更为明显，有显著性差异（P〈0．01），而SBI无显著性差异（P〉0．05）。术前与术后X线比较，BMP组可见阴影变小，牙槽骨密度增加更为明显。结论 骨形态蛋白复合物联合GTR技术与传统的GTR术和牙周翻瓣术相比，更能有效减轻牙周炎症、减少牙周袋深度、增加临床牙周附着水平和促进牙周骨组织再生修复的能力。骨形态蛋白复合物联合GTR技术治疗Ⅱ～Ⅲ度根分叉病变可以获得满意的临床效果。     

引导组织再生术治疗根分叉病变15例临床报道

目的：对引导组织再生术（GTR）治疗Ⅱ-Ⅲ度根分叉病变的临床疗效进行评价。方法：选取Ⅱ-Ⅲ度根分叉病变的患牙30颗,翻瓣术＋胶原膜治疗15颗,单纯翻瓣术治疗15颗,术后半年通过观察牙龈指数（GI）、附着水平（AL）、根分叉垂直探诊深度（PD）与根分叉水平探诊深度（PFD）的变化,对两种手术方法的临床疗效进行比较。结果：术后半年,两组病例所有临床指标比术前明显改善,且有显著性差异（P〈0.05）。GTR组与翻瓣组比较,各项指标均有显著性差异（P〈0.05）。结论：GTR组治疗Ⅱ-Ⅲ度根分叉病变,比单纯翻瓣术有更好的临床疗效。     

倍骼生在Ⅱ度根分叉病变治疗中的临床应用

目的探讨倍骼生在Ⅱ度根分叉病变治疗中的疗效。方法 28例经过牙周基础治疗患者的36颗Ⅱ度根分叉病变患牙,随机分为：试验组18颗,行翻瓣术联合倍骼生植入术;对照组18颗,单纯行翻瓣术。术前及术后3、6、12个月检查牙周临床指标并进行定位根尖片检查。结果试验组牙周袋探诊深度（probing depth,PD）、附着丧失（attachment loss,AL）、根分叉水平探诊深度（horizontal probing depth,HPD）与基线比较,术后3个月（P〈0.05）及术后6、12个月差异均有统计学意义（P〈0.001）;对照组PD、AL与基线比较,术后3、6、12个月差异均有统计学意义（P〈0.05）,HPD术后虽有改善但无统计学意义（P〉0.05）。2组术后各时间点比较,PD（P〈0.05）、AL（P〈0.05）和HPD（P〈0.001）差异均有统计学意义。结论应用倍骼生治疗Ⅱ度根分叉病变可获得比单纯翻瓣刮治更好的治疗效果。     

青少年双根型下颌第一恒磨牙牙根外形解剖数据的CBCT测量分析

目的:利用CBCT测量青少年双根型下颌第一恒磨牙(PMFMs)牙根外形解剖数据,为根分叉病变的预防、牙周炎的预后判断及治疗提供解剖学依据和临床指导。方法:选取359颗双根型PMFMs的CBCT影像学资料,测量根柱长度、CEJ根方2 mm处的根柱凹陷程度、根分叉穹窿顶点下2 mm处的根分叉宽度和根面凹陷程度。结果:颊侧根柱短(P<0.05);在根分叉穹窿顶点下2 mm处颊侧根分叉大,近中根根面凹陷更深更显著(P<0.05);在CEJ根方2 mm处颊侧的根柱凹陷宽而深(P<0.05)。结论:在牙周检查和治疗双根型PMFMs时要关注牙根的表面凹陷,发生早期根分叉病变可从颊侧分叉进入治疗。     

植入羟基磷灰石治疗根分叉病变

作者采用局部翻瓣术植入颗粒型羟基磷灰石治疗根分叉病变３２例。经观察，术后１个月填塞物呈散在分布，３个月时部分融合，根分叉病变缩小，６个月时填塞物明显融合，周围有骨组织形成，１０个月时填塞物颗粒基本消失，根分叉病变明显缩小。     

Prevalence and severity of periodontal disease at mandibular molar teeth in smokers with regular oral hygiene habits

BACKGROUND: Smoking appears to be detrimental to health because it has been associated with several diseases including cancer and cardiovascular diseases. Smoking also appears to be a major environmental factor associated with periodontal disease progression. The objective of this study was to evaluate the prevalence and severity of periodontal destruction as influenced by smoking in a Thai population. METHODS: Gingival health and periodontal conditions at mandibular molar furcation sites in 120 Thai dental patients (60 smokers and 60 never-smokers, age range 31 to 60 years) with generally high oral hygiene standards and regular dental care habits were evaluated. RESULTS: Smokers exhibited more frequent and severe mandibular molar periodontal destruction than never-smokers. The prevalence and severity of gingival recession, periodontal pocket formation, clinical attachment loss, furcation involvement, and tooth mobility were significantly increased in smokers compared to never-smokers. Seventy-three percent of the smokers exhibited furcation involvement in contrast to only 20% of the never-smokers. CONCLUSIONS: The results of this study suggest that smoking appears to be a major environmental factor associated with accelerated periodontal destruction in adult smokers with generally high oral hygiene standards and regular dental care habits in a Thai population.     

Furcation lesion in a mandibular canine

Morphological changes can complicate dental treatment. This report presents a rare case of a furcation lesion in a mandibular canine with two roots. A 39-year-old man in general good health sought dental care for severe pain in his maxillary anterior teeth. The clinical examination showed localized swelling in the vestibular mucosa close to the mandibular left canine. Radiographic examination revealed two distinct roots and vertical bone resorption in the canine's mesial surface. Periodontal evaluation led to a diagnosis of periodontal abscess associated with furcation lesion. Despite the occurrence in an atypical location, the site of periodontal furcation received conventional therapy for initial decontamination, including tissue debridement and a combination of polyvinylpyrrolidone irrigation and antibiotics. To improve access, the decontamination was completed with surgical techniques and scaling and root planing. Early diagnosis of this rare morphological change helped to determine appropriate, timely treatment planning and optimal patient recovery.     

Fixed restoration of sectioned mandibular molar teeth

A mandibular molar tooth may have its furcation area or one of its roots severely affected by periodontal disease or caries. Multiple factors must be favorable to restore health to such a compromised tooth. Adequate bone support for stabilization of the individual roots and coronal segments must be available after periodontal therapy. Root morphology and separation space must allow for ease of preparation and cleaning between the sectioned roots. Endodontic therapy should be uncomplicated and provide an excellent prognosis for long-term success. All caries must be removed and adequate tooth structure must remain after root and crown sectioning. Appropriate resistance and retention form must be achievable after tooth preparation of a sectioned mandibular molar. If these conditions can be met and the patient wants to keep the tooth, fixed restoration of a sectioned molar tooth is a viable treatment alternative to extraction and replacement with a removable partial denture or a dental implant. This article has described factors and procedures that should be considered for successful fixed prosthodontic treatment of sectioned multirooted mandibular molar teeth. The authors recommend an interdisciplinary diagnostic and treatment planning approach before performing endodontics, providing periodontal therapy, and restoring bicuspidized or hemisectioned multirooted teeth.     

Effect of smoking on periodontal health in molar teeth

BACKGROUND: It is generally accepted that the primary cause of periodontitis is bacterial infection of long duration. In addition, there are several risk factors that may increase the probability and severity of periodontitis. For example, an increased breakdown of alveolar bone has been observed in smokers compared to never-smokers. The objective of this study was to investigate the association between cigarette smoking and periodontal health, in particular, furcation involvement in molar teeth. METHODS: One hundred twenty (120) adult regular dental patients, presenting with at least 20 teeth each, third molars excluded, were evaluated. Sixty of the subjects consumed an average (+/- SD) of 16.8 +/- 3.8 cigarettes daily and had smoked for 21.4 +/- 5.7 years. The remaining subjects presented a negative history of smoking. Periodontal conditions for the molar teeth were recorded at the first and second mandibular molar buccal furcation area. RESULTS: Oral hygiene standards and dental care habits did not differ notably between smokers and never-smokers. Smokers exhibited significantly fewer molar teeth than never-smokers (2.2 +/- 1.1 versus 3.0 +/- 0.8; P<0.01). Also, smokers exhibited significantly advanced gingival recession, probing depth, clinical attachment loss, furcation involvement, and tooth mobility compared to never-smokers (P<0.01). CONCLUSIONS: The results of this study suggest that long-term cigarette smoking significantly worsens periodontal health including degree and incidence of furcation involvement in molar teeth.     

Topographic study of root trunk type on Chinese molars with Class III furcation involvements: molar type and furcation site

This study investigated the relationship between root trunk length and prognosis for molars with furcation involvement. Molars with furcation involvement were obtained from 169 patients affected with periodontitis. The test group consisted of 174 hopeless molars screened from a total of 441 molars with Class III involvement; the remaining 267 molars formed the control group. Both arches showed a significantly higher missing rate for teeth with a long root trunk length (type C) in second molars (41.3% and 32.4% in the maxilla and mandible, respectively), with a high degree of Class III furcation involvement for the test group (extracted hopeless or poor prognosis), compared to first molars (9.9% and 0.9% in the maxilla and mandible, respectively). Both arches had a significantly higher prevalence of long root trunk lengths in the second molars compared to first molars, irrespective of furcation site. Although first molars had an early and higher prevalence of Class III furcation involvement than second molars, the latter reached a significantly higher missing rate. Molars with longer root trunk lengths had a higher risk for poor prognosis than shorter root trunks when teeth were affected by Class III furcation involvement. For extracted furcation-involved maxillary second molars that failed to respond to periodontal therapy, long root trunk length (C) accounted for the greatest prevalence at the mesial furcation site (41.8%), followed by the distal (33.0%) and buccal sites (25.2%); the greatest prevalence of root trunk length C was found at the lingual (47.9%) and buccal furcation sites (45.1%) of mandibular second molars. When a molar with root trunk type C has a Class III involvement, the prognosis is poor; for the disease to reach that level, greater amounts of attachment must be destroyed.     

The effect of topical citric acid application on the healing of experimental furcation defects in dogs

In a previous study, citric acid-conditioning of the root surface greatly improved the rate of success of new-attachment procedures in periodontal furcation pockets in mandibular premolars of Labrador retrievers (Crigger et al. 1978). In the present study, this experimental approach was tested in six beagles. The furcations on one side in each dog were reoperated six weeks after the first surgery. In 27 of the 35 treated teeth, mesiodistal sections showed closure of the furcation and new connective tissue attachment including deposition of new cementum. The extension of new attachment in the buccolingual dimension of the furcation, however, was not improved by repeating the surgical procedure.     

Management of Longstanding Furcation Perforation Using a Novel Approach

Introduction

Iatrogenic furcation perforation may occur during the access preparation of the endodontic treatment. This may lead to periodontal defects and subsequent tooth loss. In this case report, we presented a new approach that may help salvage cases with a longstanding furcation involvement and substantial bone loss resulting from perforation.

Methods

A mandibular molar case that had a furcation perforation and longstanding furcation bone loss with a probing depth of 10 mm in the buccal furcation area. We applied a novel approach, which used both nonsurgical and surgical interventions. We first reaccessed the tooth to reseal the perforation site with MTA followed by a newly designed surgical approach including the use of a stent, a reverse submarginal flap, Emdogain (Straumann USA, Andover, MA), guided bone regeneration, and postoperative isolation of the surgical site. The post-treatment follow-ups with up to 19-month recall showed favorable results with significant bone regeneration at the furcation and the probing depth reduced to 4–5 mm.

Conclusions

Longstanding furcation perforations with periodontal involvement may be savable and have a better prognosis. This may require a modified flap design to access the defect, guided bone and periodontal regeneration, and postoperative isolation of the surgical defect.     

Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals

AIM: To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling. DESIGN: Multicentre, prospective study. SETTING: The departments of oral and maxillo-facial surgery in two district general hospitals. METHOD: One thousand and seven molar apicectomy procedures, combined with amalgam root-end filling were expedited during the period 1974-1995. A five-year review of each operated tooth was carried out or attempted between 1979-2000. RESULTS: Of the 790 (78%) operated molars successfully reviewed at 5 years or later 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), and these included 12 which were assumed to be of periodontal origin. Whilst longitudinal root fracture, perforation and/or infection in the furcation, periodontal disease or a non-restorable crown accounted for treatment failure and often the need to remove teeth subsequently, the study probably pointed to the apical ends of the roots rather than the furcation as being the major sites at which 'unsatisfactory healing' occurred. Mandibular first molars attracted the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). 'Good' root canal treatment (RCT) at the outset improved the prognosis of a root-end filling (REF) whilst the absence of RCT compromised it. Cystic change pointed to a better prognosis than apical granulomatous change as did a deep compared with a shallow 'bone cuff'. Disease at the furcation suggested a worse prognosis. Teeth which showed 'complete healing' at 1 year had a 75% probability of maintaining this outcome at 5 years. Sensory disturbance of variable duration occurred in the lower lip following 20-21% of mandibular molar procedures. In the majority of cases (79-80%) this had remitted within 3 months. A permanent deficit occurred in 8 patients (1%) where the apicectomy could definitely be incriminated as causative. Four were associated with first molar apicectomy and four with second molar apicectomy. CONCLUSIONS: Molar apicectomy with amalgam root-end filling attracts an overall 'complete healing' rate at 5 years of 57%, the results being best with mandibular first molars and worst with mandibular second molars. The prognosis is also better where there is 'good' initial orthograde root filling, an associated radicular cyst as compared with granulomatous change and where the buccal sulcus is deep rather than shallow. It is worse when orthograde root filling is absent and when there is disease in the furcation. 'Complete healing' at 1 year can be expected to be maintained at 5 years in 75% of cases. The commonest site of subsequent periradicular rarefaction seems to be 'apical' whilst failure at the furcation is probably comparatively rare. There is a threefold increase in the occurrence of permanent lower lip sensory impairment following second molar surgery in comparison with first molar surgery, the overall incidence being 1%.