Aim and objective: This article aims to emphasize the use of a new classification system with a review of the classification systems devised in the past along with their limitations.
Background: There is a lack of universal acceptance of single classification system for furcation involvement due to certain limitations and drawbacks. So, there is a need for a new approach to address the lacuna in the present classification systems. A thorough literature search was done in Medline/PubMed and Google Scholar to incorporate all the classification systems which have been proposed previously.
Review results: Different classifications have been proposed over different eras, the classification given by Glickman being the most common one. The proposed system is based on the site-specific clinical presentation of the furcation defects and takes into consideration the horizontal and vertical components of furcation as well as its exposure.
Conclusion: The present classification has been underscored which is entirely clinical in nature, avoiding the need for anaesthesia, radiographs and open surgeries. This simple and convenient system will assist the clinical practitioners to record the furcation invasion and aid to visualize the clinical picture of the involved tooth.
Clinical significance: This simple and convenient system will assist the clinical practitioners to record the furcation invasion and aid to visualize the clinical picture of the involved tooth.
Papapanou PN, Sanz M, Buduneli N, et al. Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Periodontol 2018;89:S173–S182. DOI: 10.1111/jcpe.12946
Rasperini G, Majzoub J, Limiroli E, et al. Management of furcation-involved molars: recommendation for treatment and regeneration. Int J Periodont Rest 2020;40(4):e137–e146. DOI: 10.11607/prd.4341
American Academy of Periodontology. Glossary of periodontal terms, 4th ed. Chicago, LA, USA: American Academy of Periodontology 2001. Available online: https://members.perio.org/libraries/glossary [Accessed 13 July 2020].
Darby I, Sanelli M, Shan S, et al. Comparison of clinical and cone beam computed tomography measurements to diagnose furcation involvement. Int J Dent Hyg 2015;13(4):241–245. DOI: 10.1111/idh.12116
McGuire MK, Nunn ME. Prognosis versus actual outcome. III. The effectiveness of clinical parameters in accurately predicting tooth survival. J Periodontol 1996;67:666–674. DOI: 10.1902/jop.19220.127.116.116
Nibali L, Zavattini A, Nagata K, et al. Tooth loss in molars with and without furcation involvement - a systematic review and meta-analysis. J Clin Periodontol 2016;43:156–166. DOI: 10.1111/jcpe.12497
Wang HL, Burgett FG, Shyr Y, et al. The influence of molar furcation involvement and mobility on future clinical periodontal attachment loss. J Periodontol 1994;65(1):25–29. DOI: 10.1902/jop.1918.104.22.168
Svärdström G, Wennström JL. Prevalence of furcation involvements in patients referred for periodontal treatment. J Clin Periodontol 1996;23(12):1093–1099. DOI: 10.1111/j.1600-051X.1996.tb01809.x
Hörr T, Klein F, Kim TS, et al. Digital radiography for assessment of bony defects. Int Poster J Dent Oral Med 2004;6(1):208.
Goldman MJ, Ross IF, Goteiner D. Effect of periodontal therapy onpatients maintained for 15 years or longer. A retrospective study. J Periodontol 1986;57:347–353. DOI: 10.1902/jop.1922.214.171.1247
Hirschfeld L, Wasserman B. A long term survey of tooth loss in 600 treated periodontal patients. J Periodontol 1978;49:225–237. DOI: 10.1902/jop.19126.96.36.199
McFall WT Jr. Tooth loss in 100 treated patients with periodontal disease: a long-term study. J Periodontol 1982;53(9):539–549. DOI: 10.1902/jop.19188.8.131.529
Wood WR, Greco GW, McFall WT Jr. Tooth loss in patients with moderate periodontitis after treatment and long–term maintenance care. J Periodontol 1989;60(9):516–520. DOI: 10.1902/jop.19184.108.40.2066
Tal H, Lemmer J. Furcal defects in dry mandibles. Part II: severity of furcal defects. J Periodontol 1982;53(6):364–367. DOI: 10.1902/jop.19220.127.116.114
Hamp SE, Nyman S, Lindhe J. Periodontal treatment of multirooted teeth. Results after 5 years. J Clin Periodontol 1975;2:126–135. DOI: 10.1111/j.1600-051X.1975.tb01734.x
Mealey BL, Neubauer MF, Butzin CA, et al. Use of furcalbone sounding to improve accuracy of furcation diagnosis. J Periodontol 1994;65:649–657. DOI: 10.1902/jop.1918.104.22.1689
Muller HP, Eger T. The overall significance of regenerative procedures in the treatment of furcations. Quintessence Int 1997;28:321–328.
Karthikeyan BV, Sujatha V, Prabhuji ML. Furcation measurements: realities and limitations. J Int Acad Periodontol 2015;17(4):103–115.
Eickholz P, Kim TS. Reproducibility and validity of the assessment of clinical furcation parameters as related to different probes. J Periodontol 1998;69(3):328–336. DOI: 10.1902/jop.1922.214.171.1248
Becker W, Becker BE, Berg L, et al. New attachment after treatment with root isolation procedures: report for treatedclass III and class II furcations and vertical osseous defects. Int J Periodontics Restorative Dent 1988;8:9–23.
Pontoriero R, Lindhe J, Nyman S, et al. Guided tissue regeneration in degree II furcation-involved mandibular molars. J Clin Periodontol 1988;15:247–254. DOI: 10.1111/j.1600-051x.1988.tb01578.x
Pontoriero R, Lindhe J. Guided tissue regeneration in the treatment of degree II furcations in maxillary molars. J Clin Periodontol 1995;22(10):756–763. DOI: 10.1111/j.1600-051x.1995.tb00258.x
Langer B, Stein S, Wagenberg B. An evaluation of root resections. A tenyears study. J Periodontol 1981;52:719–722. DOI: 10.1902/jop.19126.96.36.1999
Topoll HH, Lange DE. Die Tunnelierung mehrwurzliger Zähne. Ergebnisse 8 Jahre post operationem. Dtsch Zahnärztl Z 1987;42:445–449.
Hellden LB, Elliot A, Steffensen B, et al. The prognosis of tunnel preparations in treatment of class III furcations: a follow-up study. J Periodontol 1989;60(4):182–187. DOI: 10.1902/jop.19188.8.131.52
Glickman I. Clinical periodontology. 2nd ed. Philadelphia: W. B. Saunders; 1958.694–696.
Goldman H. Therapy of the incipient bifurcation involvement. J Periodontol 1958;29:112–116. DOI: 10.1902/jop.19184.108.40.206
Staffileno HJ. Surgical management of the furca invasion. Dent Clin N Am 1969;13(1):103–119.
Easley JR, Drennan GA. Morphological classification of the furca. J Can Dent Assoc 1969;35:104–107.
Goldman H, Cohen D. Periodontal therapy. 6th ed. St. Louis, IL: C.V. Mosby; 1988:921.
Gran D, Stern I, Listgarten M. Periodontics, 6th ed. St. Louis, IL: C.V. Mosby; 1988:931.
Nevins M, Cappetta EG. Treatment of maxillary furcations. In: Nevins M., Mellonig JT, editors. Periodontal therapy - clinical approaches and evidence of success 1st ed. Chicago: Quintessence; 1998.
Ramfjord SP, Ash MM. Periodontology and periodontics, Philadelphia: Saunders; 1979:247–309.
Rateitschak KH, Rateitschak EM, Wolf HF. Parodontologie. In: Rateitschak KH, editors. Farbatlanten der zahnmedizin Stuttgart: Georg Thieme Verlag; 1984:50.
Carnevale G, Pontoriero R, Lindhe J. Treatment of furcation-involved teeth. In: Lindhe J, Lang NP, Karring T, editors. Clinical periodontology and implant dentistry 2nd ed. Copenhagen: Munksgaard; 1997: 823–847.
Walter C, Kaner D, Berndt DC, et al. Three-dimensional imaging as a pre-operative tool in decision making for furcation surgery. J Clin Periodontol 2009;36(3):250–257. DOI: 10.1111/j.1600-051x.2008.01367.x
Eskow RN, Kapin SH. Furcation invasions: correlating a classification system with therapeutic considerations. Part I. Examination, diagnosis and classification. Compend Contin Educ Dent 1984;5:527–532.
Tarnow D, Fletcher P. Classification of the vertical component of furcation involvement. J Periodontol 1984;55(5):283–284. DOI: 10.1902/jop.19220.127.116.113
Tonetti MS, Christiansen AL, Cortellini P. Vertical subclassification predicts survival of molars with class II furcation involvement during supportive periodontal care. J Clin Periodontol 2017;44(11):1140–1144. DOI: 10.1111/jcpe.12789
Fedi PF Jr. The periodontal syllabus. 2nd ed. Philadelphia: Lea & Febinger; 1985:169–170.
Ricchetti PA. A furcation classification based on pulp chamber-furcation relationships and vertical radiographic bone loss. Int J Periodontics Restorative Dent 1998;2:50–59.
Hou GL, Chen YM, Tsai CC, et al. A new classification of molar furcation involvement based on the root trunk and horizontal and vertical bone loss. Int J Periodontics Restorative Dent 1998;18(3):257–265.
Fugazzotto PA. Periodontal-restorative interrelationships: ensuring clinical success. 1st ed. New Jersey: John Wiley & Sons; 2011:89–115.
Rosenberg MM. Management of osseous defects, furcation involvements, and periodontal-pulpal lesions. In: Clinical Dentistry, Periodontal and Oral Surgery, editors. Philadelphia: Harper and Row; 1986.
Heins PJ, Canter SR. Furca involvement: a classification of bony deformities. Periodontics 1968;6:84–88.
Pilloni A, Rojas MA. Furcation involvement classification: a comprehensive review and a new system proposal. Dent J 2018;6(3):34. DOI: 10.3390/dj6030034
Suh YI, Lundgren T, Sigurdsson T, et al. Probing bone level measurements for determination of the depths of class II furcation defects. J Periodontol 2002;73(6):637–642. DOI: 10.1902/jop.2002.73.6.637
Smith RG. Gingival recession reappraisal of an enigmatic condition and a new index for monitoring. J Clin Periodontol 1997;24(3):201–205. DOI: 10.1111/j.1600-051x.1997.tb00492.x
Ramachandra SS, Mehta DS, Nagarajappa Sandesh M, et al. Periodontal probing systems: a review of available equipment. Periodontics 2009;3(3).