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Navigating Complexities

Learn about the unique challenges clinicians face in treating periodontally involved furcations and effective strategies for optimal patient outcomes.

The unique and sometimes daunting challenges the conscientious clinician must meet when presented with a periodontally involved furcation have been well elucidated. These include the difficulty, if not impossibility, of achieving complete plaque and calculus removal within the compromised furcation,1–6 the inability of the patient to predictably keep plaque from repopulating the furcation and periodontal pocket,7 and the unique hindrances to plaque removal and control due to the local morphology of the furcation (including fluted roots, cementoenamel projections, or enamel pearls).

These challenges lead many clinicians to attempt to “maintain” teeth with furcation involvement until the only predictable therapy is extraction and replacement. Unfortunately, delaying effective therapy leads to progression of periodontal destruction,8–10 possible compromise of periodontal support of adjacent teeth, and an increased chance of patient discomfort as problem areas become more active.

The relative ineffectiveness of scaling and root planing in the management of furcation-involved teeth, and the increased incidence of multi-rooted tooth loss (as compared to their single-rooted counterparts), have been documented in a number of studies.11–13 Suffice it to say that such attempts at maintenance of the periodontally involved furcation brings clinicians into the realm of actuarial consideration, essentially betting the tooth will outlast the patient.

Fortunately, the predictability of various treatment modalities in given clinical scenarios has stood the test of time.14–18 As important is the fact the profession also has a large body of knowledge regarding which therapies are less effective in specific situations and in specific patient populations.

Any therapy in the area of a tooth with a periodontally involved furcation must be carried out in the context of a thorough, multifactorial examination and diagnosis, shared treatment planning and decision-making, and the multidisciplinary delivery of therapies. Failure to do so is a disservice to the patient.


  1. Waerhaug J. Healing of the dento-epithelial junction following subgingival plaque control. II: As observed on extracted teeth. J Periodontol. 1978;49:119–134.
  2. Stambaugh RV, Dragoo M, Smith DM, Carosali L. The limits of subgingival scaling.Int J Periodontics Restorative Dent. 1981;5:30–42.
  3. Buchanan S, Robertson P. Calculus removal by scaling/​root planing with and without surgical access. J Periodonto 1987;58:163.
  4. Caffesse R, Sweeney PL, Smith BA. Scaling and root planing with and without flap surgery. J Clin Periodontol. 1986;13:205–210.
  5. Rabbani GM, Ash MM, Caffesse RG. The effectiveness of subgingival scaling and root planing in calculus removal.J Periodontol. 1981;52:119–123.
  6. Jones WA, O’Leary TJ. The effectiveness of root planing in removing bacterial endotoxin from the roots of periodontally involved teeth. J Periodontol. 1978;49:337–342.
  7. Tabita PV, Bissada NF, Maybury JE. Effectiveness of supragingival plaque control in the development of subgingival plaque and gingival inflammation in patients with moderate pocket depth. J Periodontol. 1981;52:88–93.
  8. Hirschfeld l, Wassermann B. A long-term study of tooth loss in 600 treated periodontal patients. J Periodontol. 1978;49:225–237.
  9. Goldman MJ, Ross IF, Goteiner D. Effect of periodontal therapy on patients maintained for 15 years or longer. A retrospective study. J Periodontol. 1986;57:347–353.
  10. McFall W Jr. Tooth loss in 100 treated patients with periodontal disease. A long-term study. J Periodontol.1982;53:539–549.
  11. Fleischer HC, Mellonig JT, Brayer WK, Gray JL, Barnett JD. Scaling and root planing efficacy in multirooted teeth. J Periodontol.1989;60:402–409.
  12. Newell D. Current status of the management of teeth with furcation invasion. J Periodontol. 1981;52:559–568.
  13. Waerhaug J. The furcation problem. Etiology, pathogenesis, diagnosis, therapy and prognosis. J Clin Periodontol. 1980;7:73–95.
  14. Rosenberg MM, Kay HB, Keough BE, Holt RL. Periodontol and Prosthetic Management for Advanced Cases. Chicago: Quintessence; 1988:247–298.
  15. Becker W, Becker B, Ochsenbein C, et al. A longitudinal study comparing scaling and osseous surgery and modified Widman procedures. Results after one year. J Periodontol.1988;59:351–365.
  16. Kaldahl WB, Kalkwarf KL, Kashinath DP, Molvar NP, Dyer JK. Long-term evaluation of periodontal therapy: I. Response to 4 therapeutic modalities. J Periodontol. 1996;67:93–102.
  17. Olsen CT, Ammons WF, van Belle G. A longitudinal study comparing apically repositioned flaps, with and without osseous surgery. Int J Periodontics Restorative Dent. 1985;5:10–33.
  18. Fugazzotto PA. Chapter 3 Treating the Periodontally Involved Furcation. In: Periodontal-Restorative Interrelationships: Ensuring Clinical Success. Wiley Blackwell: Ames, Iowa; 2011:89–113.

This information originally appeared in Brodsky A, Fugazzotto PA. Treatment approaches to periodontally furcated mandibular molars. Decisions in Dentistry. 2021;7(6)26–31.

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