Tunnel preparation, bicuspidization, root amputation, hemisection

Simple answer yes bicuspidization followed by restorative work but the prognosis will be questionable ,and a more complicated answer and expensive is guided tissue regeneration using guided bone techniques and using freeze drying bone and time to build the amount of bone and x-ray follow up and restorative dentistry work .

Without the comprahansive patient information how could we answer this question?Sometimes I could say extract the tooth and put and implant..much more predictible prognosis..Resective and regeneratif approaches have not been satisfactory for both patient and dentist..plus expences which you have invested (regenerative therapy+Restorative )questionable..sometimes yes resective therapies works but regenerative approaches are not predictible..

I treat patients with instructions to oral hygiene and follow up.

Not enough information. I would say most cost effective and longest lasting is implant, given the patient is a good candidate. Otherwise some of these options could be attempted but the prognosis is poor.

since all patient may not pay the high amount, but still he/she is interested to keep that grade IV furcation involvement tooth. All the treatment option given by you, may be carried out, however I did a simple method, that is "obliteration of furcation with Glass Ionomer cement" after complete debridement .It is given in Carranza's clinical periodontology text book as third objective of furcation involvement management. I prefer Glass Ionomer cement over other materials, since we know that GIC is a human made dentin. I got good result and i followed up to 5 years till now. However i did few cases , which is not sufficient to obtain conclusion for the management of grade IV furcation involvement tooth with GIC.

Thanks to all for their nice answers to the question.

I guess extraction will be the only best possible treatment for this. In case with other modes of treatment, the prognosis will be a big question mark.

Temporary you would benefit patient by saving the tooth but later he will bounce back on you, if you later suggest him for extraction is prognosis is poor.

After extraction advice him to go for implant and that would make patient more happy

yes Dr swapnil, you are right that implant is the best option. However can you tell me how many years you can ensure for post placement implant successful years.will the implant stay for life time in the mouth after placement? A person with Grade IV furcation involvement may not maintain good oral hygiene. Apoor person cannot afford the implant cost.

So i feel the obliteration method with GIC can be practiced.

Thanks for your suggestion.

Yes, for 40+ yrs. we've utilized our calcium materials that heal gingivae & calcify furcations. NOT Calcium HYDROXIDE ? NO, not the hydroxide. It ruins soft tissues. A few treatments of calcium cpds. on furcations work exceptionally well & leave the tissue contour readily cleansable with brushing. Any traditional surgery, extraction, hemisection, etc. are counter-productive myths. Rarely have calcium applications failed and even then the tooth can be saved with root canal therapy employing calcium on the endodontic floor of the furcation. We started with molars. It is simple, direct & still works w/o surgery or anesthesia. Mark DDS www.calciumtherapy.com

Thanks to Dr Mark. Actually in Grade IV furcation involvement (By Glickman) , there is clinically visible furcation area and there is gingival recession too. I know that calcium material is used to repair the perforation of furcation area. However I have not find as such treatment described by you.Thanks for valuable suggestion.

But in my case , obliteration of furcation with Glass ionomer cement is one type of management of furcation involvement.

I agree with Dr. Abhay Das. Apart from tunnelling and bicuspidization, obliteration of furcation with GIC is an equallly effective treatment option that would make maintenance of that tooth more patient-friendly*

(* conditions: grade IV furcation without mobility or root caries, no TFO, that tooth not acting as abutment, patient does have any concerned systemic disease that would accelerate tissue reaction, patient attempts good oral hygiene,...)

I agree with Mr. Gokbulet and Mr. Warner. I think that best way te resolve t6his problem is implant. But age factor is main problen that is considered.

Please remember the question states with "no extraction " .the point is if I ask one of my students this question and he or she says "implant " then he did not read the question carefully. one of the main causes of students failing is the lack of reading the question carefully.

Respectfully

The original Hamp article from the 70's coming from Sweden stated that Cl.III (and thus also Cl.IV) furcations were generally periodontally stable and mostly failed because of rootcaries. Therefore all types of therapy aimed at maintaiing a molar with Cl.IV furcation involvement should emphasize carïesprevention. Excellent oral hygiëne but also professional and home fluoride application can achieve this. Also in the last decade application of Chlorhexidine Varnish developed at the Univ. of Nijmegen has shown benefits in prevention of rootcaries.

Personally I believe that once a molar has Cl.IV furcaton involvement it is has at best a guarded prognosis, nevertheless in individual cases the best option can be to maintain the molar.

Scandinavion literature has shown that periodontal maintenance can be as succesful as implant therapy and we all now that patiënts susceptible to periodontitis also face a higher risk for biologic implant complications.

Let's give teeth a chance