Furkasi merupakan suatu daerah dengan morfologis anatomi yang kompleks yang sulit bahkan tidak mungkin untuk dilakukan debridemen dengan instrumentasi rutin
Perkembangan inamasi dari penyakit periodontal  kehilangan perlekatan sampai daerah bifurkasi atu trifurkasi gigi berakar ganda
 
• Perluasan kehilangan perlekatan dibutuhkan untuk men"iptakan defek furkasi yang ber#ariasi dan berhubungan dengan faktor anatomis lokal $ root trunk length, morfologi akar% dan anomali perkembangan $cervical enamel projections%
• Faktor lokal  deposisi plak atau mempersulit prosedur oral hygiene
• Karies dan nekrose
(. )efek furkasi Klas **
)iagnosis dan klasi+kasi defek • Probing yang tepat  menentukan keterlibatan
dan perluasan furkasi, posisi perlekatan yang relatif di furkasi, perluasan dan kon+gurasi defek furkasi  prob 'abers
• Sounding transgingi#al untuk menggambarkan anatomi defek furkasi
•  uuan dari pemeriksaan ini adalah untuk mengidentifkasi dan mengklasi+kasikan keterlibatan dan perluasan furkasi dan identi+kasi faktor yang berkontribusi terhadap perkembangan defek furkasi atau berpengaruh terhadap hasil pera-atan.
• Morfologi gigi, posisi gigi terhadap gigi yang
 
Faktor anatomis lokal
• )imensi dari furkasi entrance ber#ariasi /01 furkasi dengan ori+si 2 0mm dan 3/1 2 4.53mm  pertimbangan klinisi untuk memilih instrumen untuk probing $keterlibatan dini dibutuhkan prob dengan dimensi small cross-sectional %
• Pemeriksaan klinis pasien memungkinkan terapis untuk tidak hanya identi+kasi ketrlibatan furkasi tetapi uga anatomi lokal yang dapat mempengaruhi hasil terapi $prognosis%
 
&, Furkasi deraat * gigi molar pertama mandibula dan deraat *** gigi molar kedua mandibula..he root appro7imation on the se"ond molar may be su8"ient to impede a""urate probing of this defe"t
(, )efek furkasi multipel pada molar pertama maksila. )eraat * furkasi bukal dan furkasi deraat ** mesiopalatal dan distopalatal. Deep developmental grooves molar kedua maksila simulate keterlibatan furkasi pada molar ini dengan akar yang fused.
9, Furkasi deraat ** dan * pada molar mandibula
 
• Merupakan hal yang penting dalam perkembangan dan pera-atan keterlibatan furkasi
•  ;arak antara 9!;< furkasi entran"e ber#ariasi. =igi dapat mempunyai root trunks yang sangat pendek, moderate, atau akar yang fused ke uung akar $Figure >?<@%.
• Kombinasi root trunk length dengan umlah dan kon+gurasi akar mempengaruhi keberhasilan pera-atan.
• Lebih pendek root trunk , lebih sedikit perlekatan yang terlibat hingga menebabkan keterlibatan furkasi. Ketika furkasi terekspos, gigi dengan root trunks yang pendek lebih memudahkan akses untuk prosedur pemeliharaan, dan memfasilitasi beberapa prosedur bedah.
• =igi dengan root trunks yang panang atau akar fused bukanlah kandidat yang tepat untuk pera-atan ketika sudah ada keterlibatan furkasi.
• Gambaran berbagai anatomis furkasi yang penting dalam prognosis dan perawatan keterlibatan furkasi
• &, &kar yang terpisah luas. (, &kar terpisah tetapi dekat. 9, &kar yang
fused terpisah hanya pada bagian apikal. ), enamel proe"tion 
keterlibatan furkasi dini
Root Length
• 6oot length is dire"tly related to the Auantity of atta"hment supporting the tooth. eeth -ith long root trunks and short roots may ha#e lost a maority of their support by the time that the fur"ation be"omes aBe"ted.0@,?4 eeth -ith long roots and short<to<moderate root trunk length are more readily treated be"ause su8"ient atta"hment remains to meet fun"tional demands
Root Form
•  he mesial root of most mandibular +rst and se"ond molars and the mesiofa"ial root of the ma7illary +rst molar are typi"ally "ur#ed to the distal side in the api"al third. *n addition, the distal aspe"t of this root is usually hea#ily uted. he "ur#ature and uting may in"rease the potential for root perforation during endodonti" therapy or "ompli"ate post pla"ement during restoration.0,?3 hese anatomi" features may also result in an in"reased in"iden"e of #erti"al root fra"ture. he siCe of the mesial radi"ular pulp may result in remo#al of most of this portion of the tooth during preparation.
Interradicular Dimension
•  he degree of separation of the roots is also an important fa"tor in
treatment planning. 9losely appro7imated or fused roots "an pre"lude adeAuate instrumentation during s"aling, root planing, and surgery. eeth -ith -idely separated roots present more treatment options and are more readily treated.
Anatomy of Furcation
•  he anatomy of the fur"ation is "omple7.  he presen"e of bifur"ational ridges, a "on"a#ity in the dome,00 and possible a""essory "anals0> "ompli"ates not only s"aling, root planing, and surgi"al therapy,?/ but also periodontal maintenan"e. Odontoplasty to redu"e or eliminate these ridges may be reAuired during surgi"al therapy for an optimal result.
Cervical namel !ro"ections
• 9er#i"al enamel proe"tions $9!Ps% are reported to o""ur on /.>1 to ?/.>1 of molars.?>,?5,@3 he pre#alen"e is highest for mandibular and ma7illary se"ond molars. he e7tent of 9!Ps -as "lassi+ed by Masters and Doskins?5 in 0E> $ (o7 >?<0%. Figure >?< pro#ides an e7ample of a grade *** 9!P. hese proe"tions "an aBe"t plaAue remo#al, "an "ompli"ate s"aling and root planing, and may be a lo"al fa"tor in the de#elopment of gingi#itis and periodontitis. 9!Ps should be remo#ed to fa"ilitate maintenan"e.
 
*ndikasi keterlibatan furkasi
 he e7tent and "on+guration of the fur"ation defe"t are fa"tors in both diagnosis and treatment planning. his has led to the de#elopment of a number of indi"es to re"ord fur"ation in#ol#ement. hese indi"es are based on the horiContal measurement of atta"hment loss in the fur"ation,0,05 on a "ombination of horiContal and #erti"al measurements,@5 or a "ombination of these +ndings -ith the lo"aliCed "on+guration of the bony deformity.04 =li"kman 0 "lassi+ed fur"ation in#ol#ement into four grades $Figure >?
• Figure #$%#' Glickman)s classi*cation of furcation involvement(
• &, =rade * fur"ation in#ol#ement. &lthough a spa"e is #isible at the entran"e to the fur"ation, no horiContal "omponent of the fur"ation is e#ident on probing. (, =rade ** fur"ation in a dried skull. 'ote both the horiContal and the #erti"al "omponent of this "ul<de<sa". 9, =rade *** fur"ations on ma7illary molars. Probing "on+rms
that the bu""al fur"ation "onne"ts -ith the distal fur"ation of both these molars, yet the fur"ation is +lled -ith soft tissue. ), =rade * fur"ation. he soft tissues ha#e re"eded su8"iently to allo- dire"t #ision into the
fur"ation of this ma7illary molar
 
• Grade I
• & grade * fur"ation in#ol#ement is the in"ipient or early stage of fur"ation in#ol#ement $see Figure >?<>, A%. he po"ket is suprabony and primarily aBe"ts the soft tissues. !arly bone loss may ha#e o""urred -ith an in"rease in probing depth, but radiographi" "hanges are not usually found.
• Grade II
• & grade ** fur"ation "an aBe"t one or more of the fur"ations of the same tooth. he fur"ation lesion is essentially a "ul<de<sa" $see Figure >?<>, B% -ith a de+nite horiContal "omponent. *f multiple defe"ts are present, they do not "ommuni"ate -ith ea"h other be"ause a portion of the al#eolar bone remains atta"hed to the tooth. he e7tent of the horiContal probing of the fur"ation determines -hether the defe"t is early or ad#an"ed. erti"al bone loss may be present and represents a therapeuti" "ompli"ation. 6adiographs may or may not depi"t the fur"ation in#ol#ement, parti"ularly -ith ma7illary molars be"ause of the radiographi" o#erlap of the roots. *n some #ie-s, ho-e#er, the presen"e of
fur"ation Garro-sH indi"ates possible fur"ation in#ol#ement
• Grade III
• *n grade *** fur"ations, the bone is not atta"hed to the dome of the fur"ation. *n early grade *** in#ol#ement, the opening may be +lled -ith soft tissue and may not be #isible. he "lini"ian may not e#en be able to pass a periodontal probe "ompletely through the fur"ation be"ause of interferen"e -ith the bifur"ational ridges or fa"ialIlingual bony margins. Do-e#er, if the "lini"ian adds the bu""al and lingual probing dimensions and obtains a "umulati#e probing measurement that is eAual to or greater than the bu""alIlingual dimension of the tooth at the fur"ation ori+"e, the "lini"ian must "on"lude that a grade *** fur"ation e7ists $see Figure >?<>, C%. Properly e7posed and angled radiographs of early 9lass *** fur"ations display the defe"t as a radiolu"ent area in the "rot"h of the tooth $see 9hapter @0%.
• Grade I+
• *n grade * fur"ations, the interdental bone is destroyed, and the soft tissues ha#e re"eded api"ally so that the fur"ation opening is "lini"ally #isible. & tunnel therefore e7ists bet-een the roots of su"h an aBe"ted tooth. hus the periodontal probe passes readily from one aspe"t of the tooth to another $see Figure >?<>, D%.
• ,ther Classi*cation Indices
• Damp et al05 modi+ed a three<stage "lassi+"ation system by atta"hing a millimeter measurement to separate the e7tent of horiContal in#ol#ement. !asley and )rennan04 and arno- and Flet"her@5 ha#e des"ribed "lassi+"ation systems that "onsider both horiContal and #erti"al atta"hment loss in "lassifying the e7tent of fur"ation in#ol#ement. he arno- and Flet"her arti"le utiliCes a sub"lassi+"ation that measures the probeable #erti"al depth from the roof of the fur"a api"ally. he sub"lasses being proposed are: &, (, and 9. G&H indi"ates a probeable #erti"al depth of 0 to @ mm, G(H indi"ates to > mm, and G9H indi"ates 5 or more mm of probeable depth from the roof of the fur"a api"ally. Fur"ations -ould thus be "lassi+ed as *&, *(, and *9 **&, **(, and **9 and ***&, ***(, and ***9.
• 9onsideration of defe"t "on+guration and the #erti"al "omponent of the defe"t pro#ides additional information that is useful in planning therapy
Pera-atan
 
• Class I' arly Defects(
• *n"ipient or early fur"ation defe"ts $9lass *% are amenable to "onser#ati#e periodontal therapy.03 (e"ause the po"ket is suprabony and has not entered the fur"ation, oral hygiene, s"aling, and root planing are eBe"ti#e.0> &ny thi"k o#erhanging margins of restorations, fa"ial groo#es, or 9!Ps should be eliminated by odontoplasty, re"ontouring, or repla"ement. he resolution of inammation and subseAuent repair of the periodontal ligament and bone are usually su8"ient to restore periodontal health.
• Class II(
• On"e a horiContal "omponent to the fur"ation has de#eloped $9lass **%, therapy be"omes more "ompli"ated. Shallo- horiContal in#ol#ement -ithout signi+"ant #erti"al bone loss usually responds fa#orably to lo"aliCed ap pro"edures -ith odontoplasty, osteoplasty, and oste"tomy. *solated deep 9lass ** fur"ations may respond to ap pro"edures -ith osteoplasty and odontoplasty $Figure >?<5%. his redu"es the dome of the fur"ation and alters gingi#al "ontours to fa"ilitate the patients plaAue remo#al.
• Figure #$%.' -reatment of a grade II furcation by osteoplasty and odontoplasty(
 
• Classes II to I+' Advanced Defects(
•  he de#elopment of a signi+"ant horiContal "omponent to one or more fur"ations of a multirooted tooth $late 9lass **, 9lass ***, or 9lass * 0@% or the de#elopment of a deep #erti"al "omponent to the fur"a poses additional problems. 'onsurgi"al treatment is usually ineBe"ti#e be"ause the ability to instrument the tooth surfa"es adeAuately is "ompromised.@0,4  Periodontal surgery, endodonti" therapy, and restoration of the tooth may be reAuired to retain the tooth.
 erapi non bedah
 
Obtaining a""ess to the fur"ation reAuires a "ombination of the a-areness of the fur"ation by the patient and an oral hygiene tool that fa"ilitates that a""ess. Many tools, in"luding rubber tips periodontal aids toothbrushes, both spe"i+" and general and other aids ha#e been used o#er time for a""ess to the patient $Figure >?</%.
• Figure #$%/
 
 erapi bedah
,sseous Resection
 
• Regeneration
• *n fur"al lesions, bone regeneration is often thought to be relati#ely futile. he periodontal literature has -ell<do"umented therapeuti" eBorts designed to indu"e ne- atta"hment and re"onstru"tion on molars -ith fur"ation defe"ts. Many surgi"al pro"edures using a #ariety of grafting materials ha#e been tested on teeth -ith diBerent "lasses of fur"ation in#ol#ement. Some in#estigators ha#e reported "lini"al su""ess,? -hereas others ha#e suggested that the use of
these materials in 9lass **, ***, or * fur"ations oBers little ad#antage "ompared -ith surgi"al "ontrols.@,E,@4
• Fur"ation defe"ts -ith deep t-o<-alled or three<-alled "omponents may be suitable for re"onstru"tion pro"edures. hese #erti"al bony deformities respond fa#orably to a #ariety of
surgi"al pro"edures, in"luding debridement -ith or -ithout membranes and bone grafts. 9hapter >0 addresses therapies designed to indu"e ne- atta"hment or reatta"hment.
•  sao et al@E ha#e sho-n that the fur"ation defe"t is a graftable lesion. hey found that lesions that -ere grafted had greater #erti"al +ll than areas treated -ith open ap debridement alone. (o-ers et al5 ha#e sho-n fur"ation bone grafting using #arious membranes "an impro#e the "lini"al status
of these lesions. 'onetheless, bone grafting remains an elusi#e goal -ith #ariable results in fur"ation lesions. &nother area of interest has been barrier membrane te"hnology. &nalysis of published studies demonstrated a great #ariability in the "lini"al out"omes in mandibular grade ** fur"ations treated -ith diBerent types of nonbioabsorbable and bioabsorbable barrier membranes.
• &lthough many barrier membrane studies sho- a slight "lini"al impro#ement after treatment in both ma7illary and mandibular fur"ations, the results are generally in"onsistent.
Prognosis
For many years the presen"e of signi+"ant fur"ation in#ol#ement meant a hopeless long<term prognosis for the tooth. 9lini"al resear"h, ho-e#er, has indi"ated that fur"ation problems are not as se#ere a "ompli"ation as originally suspe"ted if one "an pre#ent the de#elopment of "aries in the fur"ation. 6elati#ely simple periodontal therapy is su8"ient to maintain these teeth in fun"tion for long periods.?0,@@ Other in#estigators ha#e de+ned the reasons for "lini"al failure of root<rese"ted or hemise"ted teeth.?,?3 heir data indi"ate that re"urrent periodontal disease is not a maor "ause of the failure of these teeth. *n#estigations of root<rese"ted or hemise"ted teeth ha#e sho-n that su"h teeth "an fun"tion su""essfully for long periods.?,/,?3 he keys to long< term su""ess appear to be $a% thorough diagnosis, $b% sele"tion of patients -ith good oral hygiene, $"% e7"ellen"e in nonsurgi"al therapy, and $d% "areful surgi"al and restorati#e management.