The conservative approach in the treatment of furcation lesions

Molars are the tooth type demonstrating the highest rate of periodontal destruction in untreated disease (50) and suffer the highest frequency of loss for periodontal reasons (3, 72). For the purposes of this chapter, furcation involvement is defined as bone resorption and attachment loss in the interradicular space that results from plaque-associated periodontal disease. Such a condition is reported to considerably increase the risk for tooth loss (24, 32, 57– 59, 80, 99, 102). Therefore, furcation defects represent a formidable problem in the treatment of periodontal disease, principally related to the complex and irregular anatomy of furcations. Moreover, the responsiveness to therapy may be complicated by the presence of a greater radicular surface potentially offered to bacterial toxins and calculus buildup, as compared to defects surrounding single-rooted teeth. Once the lesion has established, the discrepancy in extent between the root surfaces and the periodontal soft tissues facing the bacterial insult may be responsible for a reduced healing response. Finally, the distal location in the arch and the difficult access may conceivably impair both self-performed and professional plaque control procedures in the furcation area, limiting their effectiveness. The principles of therapy of furcation involvement may be discussed under three major headings: conservative, resective and regenerative. It must be borne in mind, however, that the borderline between conservative and resective terms sometimes does not lend itself to a sharp definition, as it is rather difficult in a clinical setting to completely separate conservative and resective treatments. This is especially true for furcation involvements. Resective procedures must sometimes be performed in order to attain a result which can eventually be considered more conservative. For instance, tunnel preparation is an example of conservative therapy carried out to avoid more radical and resective forms of treatment for class II and III furcation involvements. However, tunnel preparation is often accomplished at the ex-