Radiographic Evaluation of Regeneration Strategies for the Treatment of Advanced Mandibular Furcation Defects: A Retrospective Study.

Po-Chun Chang,Hsiang-Ling Huang,Yun-Han Ma,Che-Chang Tu

doi:10.3390/membranes12020219

Po-Chun Chang, Hsiang-Ling Huang + Show 2 more

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https://doi.org/10.3390/membranes12020219

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Abstract

Teeth with furcation involvement (FI) present a higher risk of loss and are difficult to maintain. This study evaluated the efficacy of furcation defect regeneration (FDR) as a regeneration strategy. Pre-operative and 6-month postoperative radiographs were collected from patients receiving regeneration therapy for mandibular teeth with degree II and early degree III FI. The linear furcation involvement (LFI), ratio of LFI (RLI), LFI and RLI adjusted bythe alveolar bone crest (ABC), and radiographic intensity were assessed. The effects of demographic characteristics, regeneration treatment strategies, the relationship between furcation and ABC, and adjacent intrabony defect regeneration (AIDR) were evaluated using a generalized linear model and logistic regression. The results demonstrated that 1.5 mm adjusted LFI and 40% adjusted RLI were achieved in both pure furcation defects and combined furcation–angular defects by the combination of bone replacement grafts (BRG) and enamel matrix derivatives (EMD) or collagen membrane (CM); deproteinized bovine bone matrix (DBBM) showed a superior outcome among BRG. In combined furcation–angular defects, EMD appeared more beneficial than CM, and AIDR significantly promoted adjusted LFI and RLI. In conclusion, DBBM with EMD or CM was effective for FDR, and AIDR had a positive effect on FDR in the combined furcation–angular defect.

Highlights

Periodontitis is an infection-induced destructive disease affecting 40–70% of the worldwide population, and the prognosis is worse when the furcation area is involved in multiroot teeth [1]
While collagen membrane (CM), enamel matrix derivatives (EMD), and bone replacement grafts (BRG) were the most commonly used materials for periodontal regeneration, to minimize the variables, this study focused on the regeneration strategies of BRG combined with CM or EMD, and the primary outcome was the radiographic bone gain of the furcation defect after 6 months
Autogenous bone was used in 10 teeth, freeze-dried bone allograft (FDBA) was used in 4 teeth, and deproteinized bovine bone matrix (DBBM) was used in 23 teeth

Summary

Introduction

Periodontitis is an infection-induced destructive disease affecting 40–70% of the worldwide population, and the prognosis is worse when the furcation area is involved in multiroot teeth [1]. A systematic review demonstrated that SRP was only effective in teeth with degree I FI, and surgical approaches provided acceptable tooth survival rates (40–100%) for more than 5 years [5]. A recent systematic review further indicated that in teeth with degree II and III FI, the long-term survival rate of surgical resective procedures and SRP was similar [6]. Both reviews indicated that vertical root fractures, root caries, and endodontic failures could frequently occur in the furcation area following surgical resective procedures

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