Zacher Amalia, Marretta Sandra Manfra
Best Friends Animal Dentistry, San Jose, CA, USA.
14589Professor Emerita University of Illinois College of Veterinary Medicine, Champaign-Urbana, IL, USA.
J Vet Dent. 2022 Jun;39(2):151-172. doi: 10.1177/08987564221076908. Epub 2022 Mar 2.
The furcation is the anatomic area where the roots divide on a multirooted tooth. Periodontal disease causing alveolar bone loss can lead to furcation lesions of various stages. Once furcation involvement has occurred, the area can be more difficult to clean or treat due to the complex anatomy and morphology of furcations. Teeth with short root trunks, longer tooth roots, and roots with wide furcation entrance areas/degrees of separation and wide root divergence are considered better candidates for long term maintenance. Dog teeth possess many of these advantageous anatomic features compared to human teeth. Treatment options for teeth with furcation lesions include: closed debridement, open debridement, furcation plasty, tunneling, partial tooth or root resection, root separation (hemisection or trisection), regenerative therapies, or exodontia. There are many factors to consider in determining treatment options. The favorable and unfavorable characteristics for maintenance of teeth with furcation lesions are summarized. Home care and ongoing professional care are important aspects of periodontal disease control for any patient. Studies of systemic and local antibiotic therapies in human patients have not demonstrated reduction of furcation stages, and probiotic effects at furcation sites have not been specifically examined. Human review studies show that most molar teeth once deemed "hopeless" due to stage 3 furcation lesions can be maintained for at least 5 to 15 years with supportive periodontal therapy. Similar long term studies in dogs are needed to improve the evidence-based management of canine patients with furcation lesions.
根分叉是多根牙牙根分开的解剖区域。导致牙槽骨丧失的牙周病可引发不同阶段的根分叉病变。一旦发生根分叉病变，由于根分叉复杂的解剖结构和形态，该区域会更难清洁或治疗。具有短根干、较长牙根以及根分叉入口区域/分开程度宽和牙根分歧大的牙齿被认为更适合长期维持。与人类牙齿相比，犬齿具备许多这些有利的解剖特征。根分叉病变牙齿的治疗选择包括：封闭清创术、开放清创术、根分叉成形术、隧道成形术、部分牙或牙根切除术、牙根分离（半切术或三分术）、再生治疗或拔牙。在确定治疗方案时需考虑许多因素。总结了根分叉病变牙齿维持的有利和不利特征。家庭护理和持续的专业护理是任何患者牙周病控制的重要方面。对人类患者进行的全身和局部抗生素治疗研究未显示根分叉阶段有所减少，且未专门研究根分叉部位的益生菌作用。人类综述研究表明，大多数因3期根分叉病变一度被视为“无保留价值”的磨牙，通过支持性牙周治疗可维持至少5至15年。需要在犬类中进行类似的长期研究，以改善基于证据的犬类根分叉病变患者管理。
