Furcation periodontal lesions are defined as clinical loss of attachment and alveolar bone in the interradicular region. They are very common in clinical practice and usually result from plaque-associated periodontal disease. These defects are of utmost importance as their presence dramatically alters the prognosis of the tooth in question as well as its diagnosis and treatment.
A well-described classification of defects affecting the furcation is important, as it helps to make an accurate diagnosis of the tooth concerned and thus determine its prognosis and the treatment to be planned.
Historically, several classification systems of defects affecting the furcation have been published. The most commonly used today are those of Hamp (1975), Ramfjord and Ash (1979), and Tarnow and Fletcher (1984). However, they have several drawbacks.
The most recent classifications, published by Pilloni and Rojas (2018) and Kolte and Pajnigara (2018), are the first attempts to establish a system that relates the degree of horizontal and vertical attachment loss and bone resorption in the furcation area to the length of the root trunk and the position of the margo gingivalis.
American Academy of Periodontology. Glossary of Periodontal Terms, 4th ed.; Chicago, LA, USA, 2001; Available online: https://members.perio.org/libraries/glossary(accessed on 2 November 2017).
Bali V, Parimoo R, Singh S. Classification of furcation involvement: Aliterature review. International Journal of Health Sciences. 2021; 5(S1), 428–440.
Basaraba N. Furcation invasions. In Periodontal Diseases; Schluger S, Yuodelis R, Page RC, Johnson RH,Eds.; Lea and Febiger: Philadelphia, PA, USA, 1990; ISBN 13-978-0812110845.
Carnevale G, Pontoriero R, Lindhe J. Treatment of furcation—involved teeth. In Clinical Periodontologyand Implant Dentistry, 5th ed.; Lindhe J, Lang NP, Karring T, Eds.; Munksgaard: Copenhagen, Denmark,2012; vol. 2, pp. 823–847. ISBN 978-1-11835561-9.
Easley JR, Drennan GA. Morphological classification of the furca. J Can Dent Assoc (Tor). 1969 Feb;35(2):104-7. PMID: 5250485.
Eskow RN, Kapin SH. Furcation invasions: correlating a classification system with therapeutic considerations.Part I. Examination, diagnosis, and classification. Compend Contin Educ Dent 1984 Jun, 5(6): 477–487.
Fedi PF Jr. The Periodontal Syllabus, 2nd ed.; Lea and Febiger: Philadelphia, PA, USA, 1985; pp. 169170.ISBN 13-978-0781779722.
Gerova T., Miteva M. Application of two-dimensional radiography and CBCT in periodontology. International J Sci Res. 2019, 8.11: 61-5.
Gerova T., Miteva M. The role of CBCT-imaging technique in periodontology. International J Sci Res. 2019, 8.11: 51-4.
Glickman I. Clinical Periodontology: Prevention, Diagnosis, and Treatment of Periodontal Disease in the Practice of General Dentistry, 4th ed.; 1972; pp. 242245. ISBN 0721641377.
Goldman HM, Cohen DW. Periodontal Therapy, 6th ed.; C. V. Mosby:St. Louis, IL, USA, 1988; p. 921.ISBN 13-9780801618741.
Goldman HM. Therapy of the incipient bifurcation involvement. J Periodontol. 1958, 29:112–116.
Grant DA, Stern IB.; Listgarten MA. Periodontics, 6th ed.; C. V. Mosby: St. Louis, IL, USA, 1988; p. 931.
Hamp SE, Nyman S, Lindhe J. Periodontal treatment of multirooted teeth. Results after 5 years. J Clin Periodontol. 1975 Aug;2(3):126-35. doi: 10.1111/j.1600-051x.1975.tb01734.x. PMID: 1058213.
Hou GL, Chen YM, Tsai CC, Weisgold AS. A new classification of molar furcation involvement basedon the root trunk and horizontal and vertical bone loss. Int J Periodontics Restor Dent 1998 Jun, 18(3): 257–65.
Jepsen S, Deschner J, Braun A, Schwarz F, Eberhard J. Calculus removal and the prevention of its formation. Periodontol 2000. 2011 Feb;55(1):167-88. doi: 10.1111/j.1600-0757.2010.00382.x. PMID: 21134234.
Kolte AP, Pajnigara NG et al. Comprehensive Classification System for Furcation Involvement ² Incorporating Additional Variables, JClinDiag Res 2018Aug, 12(8): ZE01-ZE04, page 1-3.
Nevins M, Cappetta EG. Treatment of maxillary furcations. In Periodontal Therapy-Clinical Approachesand Evidence of Success; Nevins M, Mellonig JT, Eds.; Quintessence: Chicago, IL, USA, 1998;ISBN 13-978-0867153095.
Nibali L, Zavattini A, Nagata K, Di Iorio A, Lin GH, Needleman I, Donos N. Tooth loss in molars with and without furcation involvement - a systematic review and meta-analysis. J Clin Periodontol. 2016 Feb;43(2):156-66. doi: 10.1111/jcpe.12497. Epub 2016 Feb 12. PMID: 26932323.
Parihar AS, Katoch V. Furcation Involvement & Its Treatment: A Review. J Adv Med Dent Scie Res 2015;3(1):81-87.
Peeran SW, Ramalingam K, Sethuraman S, Thiruneervannan M. Furcation Involvement in Periodontal Disease: A Narrative Review. Cureus. 2024 Mar 10;16(3):e55924. doi: 10.7759/cureus.55924. PMID: 38601385; PMCID: PMC11004587.
Peeran SW, Ramalingam K. Essentials of Periodontics and Oral Implantology. Chennai,India: JPS Publication; 2021.p.143-148; ISBN: 9788195047543
Pilloni A, Rojas MA. Furcation Involvement Classification: A Comprehensive Review and a New System Proposal. Dent J (Basel). 2018 Jul 23;6(3):34. doi: 10.3390/dj6030034. PMID: 30041399; PMCID: PMC6162379.
Ramfjord SP, Ash MM. Periodontology and Periodontics; Saunders: Philadelphia, PA, USA, 1979; pp. 247–309.ISBN 13-978-0721674605.
Richetti PA. A furcation classification based upon pulpchamber relationships and vertical radiographicbone loss. Int J Periodontics Restorative Dent. 1982, 2(5): 509.
Rosenberg MM. Management of osseous defects, furcation involvements, and periodontal-pulpal lesions.In Clinical Dentistry, Periodontal and Oral Surgery; Philadelphia, PA, USA, 1986.
Staffileno HJ. Surgical management of the furca invasion. Dent Clin North Am. 1969 Jan;13(1):103-19. PMID: 5249424.
Tal H, Lemmer J. Furcal defects in dry mandibles.Part II: Severity of furcaldefects. J Periodontol 1982 Jun, 53(6):364-7.
Tarnow D, Fletcher P. Classification of the vertical component of furcation involvement. J Periodontol 1984 May,55(5): 283-4.
Walter C, Kaner D, Berndt DC, Weiger R, Zitzmann NU. Three-dimensional imaging as a pre-operativetool in decision making for furcation surgery. J Clin Periodontol 2009 Mar, 36(3): 250–7.
