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Furcation involvement

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Managing teeth with furcation involvement

Key recomendations

For teeth with Grade I furcation involvement, provide non-surgical treatment with the aim of achieving medium/long term retention of the tooth. 

(Strong recommendation; moderate certainty evidence)


For teeth with Grade II or III furcation involvement, especially those that are holistically assessed as being of ongoing value to the patient and their dentition, provide non-surgical treatment with the aim of achieving medium/long term retention of the tooth.

  • Referral and/or surgical management might be appropriate for some patients.
  • Furcation involvement alone is not an indication for extraction.

(Conditional recommendation; low certainty evidence)

While teeth with furcation involvement are likely to require more complex management, evidence suggests that many will respond to periodontal treatment. The response to treatment varies based on the degree of furcation involvement, with more advanced lesions more likely to lead to tooth loss.

There is consensus in the literature that teeth with class I furcation involvement can be treated successfully with non-surgical periodontal therapy and evidence suggests that the rate of tooth loss for these teeth is similar to that of molar teeth without furcation involvement.91 When comparing the outcomes of teeth with class II or III furcation involvement treated surgically and those treated non-surgically, there is very little difference in survival rates.92 A tooth survival rate of 70% has been observed in the presence of degree III furcations over a follow-up period of 5-15 years in specialist/secondary care.93 The certainty of the evidence is considered low due to the retrospective nature of the included studies.  

The BSP implementation of European S3 - level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice (BSP-S3)6 guideline recommends that molars with residual pockets and associated class II and III furcation involvement receive periodontal therapy. The guideline includes a specific statement that furcation involvement is not an indication for extraction.

Further details on the development of the recommendations in this guidance can be found in Methodology.

Manage teeth with Grade I furcation involvement non-surgically and provide advice regarding home care and maintenance.

For teeth with Grade II or III furcation involvement, provide non-surgical treatment and advice regarding home care and maintenance. If the tooth is holistically assessed as being of ongoing strategic value to the patient and their dentition, consider referral for specialist advice and potential surgical treatment.