The third cycle involves checking posterior teeth for furcation involvement.
The curved explorer is used for this purpose and the doctor gently probes the area where the roots divide to see if there has been any loss of periodontal attachment.
Upper molars have three roots and so there is the possibility of furcation involvement on the Distal-Palatal, Buccal, and Mesial-Palatal surfaces.
The third cycle begins on the upper right molar and is continued around to the last molar on the upper left quadrant.
Furcations are recorded depending on the severity of attachment loss, graded from early to advanced involvement.
A degree of 1 can be charted as an upside down 'V'(^): In this case, the probe just begins to enter the furcation.
A degree of 2 is charted with a closed triangle: In this case, the probe penetrates into the furcation but does not pass through.
A degree of 3 is charted with a solid triangle: In this case, the probe passes through and through the furcation to the other side of the tooth.
The lower molars are also checked for furcation involvement beginning with the lower left quadrant and ending on the lower right quadrant.
Because these teeth have only two roots, the furcations are recorded either on the buccal or lingual aspect.
The fourth cycle is used to check for mucogingival problems.
The doctor will check areas where there is a narrow band of attached gingiva by using the tension test.
The cheeks or lips will be gently pulled to see if any changes occur on the gingival margin. This tension can cause blanching of the gingival tissues due to a narrow or thin gingiva or cause movement of the gingival margin away from the tooth.
In areas where the mucogingival junction is difficult to visualize. We can use the roll technique to find its location. A periodontal probe is placed in the mucosa with its flat surface against the tissue and moved gently in a coronal direction. The mucosa will form a fold of tissue which will end at the junction with the less mobile gingiva.
The doctor will begin checking in the upper right molar region on the buccal surfaces and proceed around the upper arch.
Any areas of inadequate gingiva will be recorded on the tooth diagram by a wavy line over the root of the affected tooth.
The palatal surfaces of the upper arch do not have mucogingival problems because of the dense palatal tissue present.
So after looking at the upper teeth, the doctor checks the lower arch beginning on the buccal surface of the last molar on the lower left quadrant and moving around to the buccal surface of the last tooth on the lower right quadrant. A similar check is made of the lingual tissue beginning on the lower right quadrant and ending on the lower left quadrant.
