Furcation Research Articles

Enhancing furcation involvement classification on panoramic radiographs with vision transformers

BackgroundThe severity of furcation involvement (FI) directly affected tooth prognosis and influenced treatment approaches. However, assessing, diagnosing, and treating molars with FI was complicated by anatomical and morphological variations. Cone-beam computed tomography (CBCT) enhanced diagnostic accuracy for detecting FI and measuring furcation defects. Despite its advantages, the high cost and radiation dose associated with CBCT equipment limited its widespread use. The aim of this study was to evaluate the performance of the Vision Transformer (ViT) in comparison with several commonly used traditional deep learning (DL) models for classifying molars with or without FI on panoramic radiographs.MethodsA total of 1,568 tooth images obtained from 506 panoramic radiographs were used to construct the database and evaluate the models. This study developed and assessed a ViT model for classifying FI from panoramic radiographs, and compared its performance with traditional models, including Multi-Layer Perceptron (MLP), Visual Geometry Group (VGG)Net, and GoogLeNet.ResultsAmong the evaluated models, the ViT model outperformed all others, achieving the highest precision (0.98), recall (0.92), and F1 score (0.95), along with the lowest cross-entropy loss (0.27) and the highest accuracy (92%). ViT also recorded the highest area under the curve (AUC) (98%), outperforming the other models with statistically significant differences (p < 0.05), confirming its enhanced classification capability. The gradient-weighted class activation mapping (Grad-CAM) analysis on the ViT model revealed the key areas of the images that the model focused on during predictions.ConclusionDL algorithms can automatically classify FI using readily accessible panoramic images. These findings demonstrate that ViT outperforms the tested traditional models, highlighting the potential of transformer-based approaches to significantly advance image classification. This approach is also expected to reduce both the radiation dose and the financial burden on patients while simultaneously improving diagnostic precision.

Effect of initial bone morphology on alveolar bone remodeling following molar extraction: A retrospective study.

The clinical evidence about alveolar ridge changes following molar extraction and how the alveolar bone morphology influences the ridge dimensional changes remains limited. A total of 192 patients with 199 molar extractions were included in this retrospective study. Cone-beam computed tomography (CBCT) images of patients were obtained 0-3 months pre extraction and 6-12 months post extraction. Outcome variables included the change rate in ridge height and width. The effect of morphology on the outcomes was explored by single-factor analysis, correlation analysis, and a multiple linear regression model. Significant resorption of alveolar bone occurred vertically and horizontally after molar extraction. Jaw, furcation involvement, number of roots, number of bone wall defects, extraction reasons, overall relative bone loss (RBL), bone height of the furcation region, thickness of the lingual/palatal wall, and height difference between buccal and lingual/palatal walls (|HB-HL|) were significantly correlated with the change in the height of the central alveolar bone (HC). The number of bone wall defects, overall RBL, and |HB-HL| were significantly correlated with horizontal width change. HC resorption was higher in sockets with |HB-HL|>2.5mm and overall RBL>50%. The alveolar bone presented significant resorption after extraction. Anatomical characteristics affected the dimensions of the alveolar bone after molar extraction. When the initial overall RBL was severe or |HB-HL| was larger, the loss of alveolar bone dimensions was even more. In recent years, it has been demonstrated that the local anatomical morphology of extraction sites may influence the process of alveolar bone remodeling. However, most studies have focused on the anterior teeth, with fewer investigations addressing molar extraction sites. Therefore, we aimed to describe ridge changes following molar extraction and investigate how alveolar bone morphology influences ridge dimensional changes. In this retrospective study, we included a total of 199 alveolar sockets from 192 patients with molar extractions and obtained the corresponding cone-beam computed tomography (CBCT) images 0-3 months pre extraction and 6-12 months post extraction. The results showed significant resorption of the alveolar bone following molar extraction. We found that anatomical characteristics significantly affect the dimensions of the alveolar bone after molar extraction. Specifically, the loss of alveolar bone dimensions was greater when the initial overall relative bone loss (RBL) was severe or when the difference between buccal and lingual/palatal walls was greater.

Regeneration of Class III Furcation Defects Using Porous Carbonate Apatite with Basic Fibroblast Growth Factor

Regeneration of Class III Furcation Defects Using Porous Carbonate Apatite with Basic Fibroblast Growth Factor

Evaluating periodontal probing depth and furcation involvement on the endodontic treatment of maxillary fourth premolar complicated crown-root fractures in 122 teeth.

This study aimed to evaluate the prognosis of root canal treatment (RCT) in dogs with complicated crown-root fractures (CCRFs) of the maxillary fourth premolar (PM4), focusing on the impact of periodontal probing depth (PPD) and furcation involvement on treatment outcomes. The study analyzed 122 PM4 teeth affected by CCRF in dogs. The primary outcomes were the success rates of RCT, measured against PPD, and the degree of furcation involvement (stages F0, F1, and F2). The PPD was measured preoperatively to assess its correlation with treatment prognosis. The analysis revealed that RCT outcomes were poor when PPD reached or exceeded 5.43 mm at the F0 stage of furcation involvement. Similarly, poor prognoses were associated with a PPD of 4.60 mm or more at the F1 stage and 3.76 mm or more at the F2 stage. These findings indicate a significant relationship between PPD, furcation involvement, and the success of RCT in CCRF-affected PM4 teeth. Both PPD and furcation involvement are critical factors influencing the success rate of RCT in dogs with CCRF-affected PM4 teeth. When considering RCT for such cases, these parameters should be carefully evaluated to optimize treatment outcomes. This study highlights the importance of assessing PPD and furcation involvement in the decision-making process for RCT in dogs with CCRF of the PM4 teeth, providing valuable insights for veterinary dental practitioners.

Application of artificial intelligence-based detection of furcation involvement in mandibular first molar using cone beam tomography images- a preliminary study

BackgroundRadiographs play a key role in diagnosis of periodontal diseases. Deep learning models have been explored for image analysis in periodontal diseases. However, there is lacuna of research in the deep learning model-based detection of furcation involvements [FI]. The objective of this study was to determine the accuracy of deep learning model in the detection of FI in axial CBCT images.MethodologyWe obtained initial dataset 285 axial CBCT images among which 143 were normal (without FI) and 142 were abnormal (with FI). Data augmentation technique was used to create 600(300 normal and 300 abnormal) images by using 200 images from the training dataset. Remaining 85(43 normal and 42 abnormal) images were kept for testing of model. ResNet101V2 with transfer learning was used employed for the analysis of images.ResultsTraining accuracy of model is 98%, valid accuracy is 97% and test accuracy is 91%. The precision and F1 score were 0.98 and 0.98 respectively. The Area under curve (AUC) was reported at 0.98. The test loss was reported at 0.2170.ConclusionThe deep learning model (ResNet101V2) can accurately detect the FI in axial CBCT images. However, since our study was preliminary in nature and carried out with relatively smaller dataset, a study with larger dataset will further confirm the accuracy of deep learning models.

The Efficacy of Decalcified Freeze-Dried Bone Allograft With or Without Advanced-PRF (Platelet-Rich Fibrin) for Furcation Deficiencies

ABSTRACT Objective: To estimate the efficiency of advanced platelet-rich fibrin (A-PRF) with or without the combination of decalcified freeze-dried bone allograft (DFDBA) in furcation defects. Material and Methods: Twenty individuals with chronic periodontitis, with grade II furcation abnormalities, were included in this cross-sectional research. They were divided arbitrarily into Group I: DFDBA with A-PRF and Group II: DFDBA with 10 samples in each group. These grafts were applied to the defective sites. Radiographic measurements for average alveolar bone defect and clinical parameters, such as gingival index (GI), plaque index (PI), horizontal clinical attachment level (HCAL), and vertical clinical attachment level (VCAL), into the furcation defect were checked at baseline to six-month intervals. Results: Recession, relative vertical attachment level (RVCAL), and percentage of bone fill were observed to be improved in the test sites relative to the control, although these differences were not statistically significant. Conclusion: The combination of DFDBA with A-PRF is effective in comparison with DFDBA alone in the treatment of furcation defects.

Evaluation of Alveolar Bone Destruction Patterns in the Posterior Region of the Maxilla Through Cone Beam Computer Tomography on 361 Consecutive Patients: Effect of Age and Gender.

The aim of this retrospective study is to evaluate the effect of age and gender on the alveolar bone destruction pattern with cone beam computed tomography (CBCT) in the posterior region of the maxilla. The study group included CBCT image records of 361 consecutive patients (180 males and 181 females) aged 20 years and older. Alveolar crest morphology in the maxillary right and left first and second molar teeth on retrospective images was classified as a horizontal or vertical defect (one-walled, two-walled, three-walled, and combined bone defect) on four surfaces (mesial, distal, buccal, and palatinal). Bone crater defects were defined, and furcation involvements and combined periodontal-endodontic lesions (CPELs) were placed in another category. In 361 patients, 1444 teeth were evaluated from adults between 20 and 63 years of age; 49.9% of the patients were male and 50.1% were female. Female patients had a considerably greater rate of one-walled horizontal damage in the right molar teeth than male patients (p = 0.002; p < 0.05). Patients with combined horizontal destruction in the right and left molar teeth, horizontal destruction in the palatinal, and horizontal three-walled destruction had a significantly higher mean age than patients without these periodontal destructions (p = 0.000; p < 0.05). Males were shown to have statistically higher frequencies of horizontal defects when defects were combined or distally and palatally located. Age and gender affect the alveolar bone loss pattern. Except for single-walled destructions, it has been found that the frequency of horizontal destruction increases with age. Horizontal destruction in the palatinal along with horizontal three-walled destruction increased with age.

Case-control Study: Comparative Evaluation of Bio active Glass (Novabone Putty) and Demineralized Freeze-dried Bone Allograft in the Treatment of Mandibular Furcation Defects.

The aim of this study was to compare a second-generation bioactive glass putty biomaterial (Novabone putty) against demineralized freeze-dried bone allograft (DFDBA) in mandibular grade II furcation defects. Fifteen systematically healthy individuals in the age range of 38-50 years were selected for this split-mouth study. Group I consisting of 15 sites, was treated with DFDBA and group II consisting of 15 sites was treated with Novabone putty (NB putty). The clinical parameters recorded at 0, 3 and 6 months included plaque index (PI), gingival index (GI), probing pocket depth (PPD), relative vertical attachment level (RVAL) and relative horizontal attachment level (RHAL). Standardized intraoral periapical radiographs were taken at all 30 sites pre-and 6 months post-operatively. Probing pocket depth reduced significantly (p = 0.001) when baseline values were compared to 3 and 6 months postoperatively. In group II mean RVAL changed from 6.56 ± 1.44 at baseline to 4.80 ± 1.14 at 3 months and 4.80 ± 1.33 at 6 months which was found to be highly significant (HS) (p = 0.001). The mean RHAL also showed a significant difference when baseline values were compared to 6 months post-operatively in both the groups. With respect to defect depth and bone density, no significant difference was found between the two groups. Significant improvement of the clinical parameters were seen in both the groups. As both the groups showed increase in defect fill and bone density, it can be summarized that NB putty seems to have comparable regeneration property to that of DFDBA when used for mandibular grade II furcation defects. The ease of use and higher level of biological performance of second-generation bioactive glass putty make it an ideal graft material. How to cite this article: Sen A, Rajan P, Kumar V, et al. Case-control Study: Comparative Evaluation of Bio active Glass (Novabone Putty) and Demineralized Freeze-dried Bone Allograft in the Treatment of Mandibular Furcation Defects. J Contemp Dent Pract 2024;25(7):696-702.

The 2018 Classification of Periodontal Diseases: An Observational Study on Inter-examiner Agreement among Undergraduate Students.

The objective of the present observational study was to assess the inter-examiner agreement for the diagnosis of periodontitis using the 2018 CPD among fourth and fifth year undergraduate students. It is hypothesised that there is no difference in the inter-examiner relaibility between fourth- and fifth-year undergraduate students regarding staging and grading periodontal disease using the 2018 Classification of Periodontal Diseases (CPD). All participants received training on the 2018 CPD scheme through a mandatory periodontics course conducted by a periodontist. Documentation for seven deidentified periodontitis patients, comprising medical history, dental history including tooth loss, intra-oral photographs and radiographs, periodontal charts reporting probing depth, plaque and bleeding on probing scores, furcation involvement and clinical attachment loss, was sent via e-mail to undergraduate students. The cases consisted of one sextant, and the participants were instructed to assume the sextant to be a true representation of the entire dentition. Power analysis was done on pilot data, and the level of significance was set at p0.05. The percentage of undergraduate students in the fourth and fifth year that correctly identified the stage of periodontitis according to the 2018 CPD ranged between 28% and 72% and 18.5% and 77.8%, respectively. The percentage of undergraduate students in the fourth and fifth year that correctly identified the grade of periodontitis ranged between 40% and 88% and 51.8% and 92.5%, respectively. The overall staging and grading ranged between 22.8% and 74.1%, and 45.66% and 87.4%, respectively. There was no statistically significant difference between fourth- and fifth-year undergraduate students with regards to assigning the correct diagnoses to case documentation in terms of either stage or grade. Fourth- and fifth-year undergraduate students demonstrated high inter-examiner agreement using the 2018 CPD.

Tooth loss during long-term periodontal therapy in specialized practices – a retrospective cohort study from a periodontal practice-based research network (Perio-PBRN)

ObjectivesTo investigate tooth-specific, clinical tooth-, and patient-related factors associated with tooth loss (TL) in patients with mild to severe periodontitis treated in a periodontal practice-based research network (Perio-PBRN) over at least 5 years.Materials and methodsThe Perio-PBRN consists of five German periodontal practices where clinical data were collected regarding patient age, tooth type, bleeding on probing (BOP), pocket probing depth (PPD), furcation involvement (FI), number of attended appointments, and other variables of interest. The data were evaluated regarding factors influencing TL.ResultsData from 687 patients (aged 54.5 ± 11.1 years) with mild (N = 23, 3.35%), moderate (N = 247, 35.95%) or severe (N = 417, 60.70%) periodontitis and 15,931 teeth over a mean observation period of 6.83 ± 1.40 years per patient were gathered via the Perio-PBRN. In this period, a total of 657 teeth were lost (4.12%, overall TL: 0.14 ± 0.22 teeth/patient/y). The risk of TL was significantly increased for teeth with persistent PPD ≥ 6 mm (hazard ratio: 6.81 [95% confidence interval: 5.07–9.15] in comparison to PPD < 4 mm. Additionally, BOP (3.90 [2.46–6.19]), furcation involvement, jaw, age and tooth type showed a significant influence on TL, while number of visits were not significantly associated with TL.ConclusionsPeriodontal care of patients with moderate to severe disease in specialized practices was associated with a low rate of TL. Known tooth-related prognostic factors were confirmed. However, the results must be interpreted cautiously without knowledge of risk factors such as smoking and diabetes.Clinical relevancePBRNs can help gather large amounts of periodontal practice-level data.Trial registrationThe study was registered in the German Clinical Trials Register (DRKS 00011448).

Effectiveness of nonsurgical re-instrumentation: Tooth-related factors.

To investigate tooth-related factors that influence pocket closure (PC) and the reduction of pocket probing depths (PPD) after nonsurgical re-instrumentation (NSRI) as part of step 3 therapy. A total of 480 patients (10,807 teeth) presenting with residual pockets 6.33±3.79 months after steps 1 and 2 of periodontal therapy were included and retrospectively analyzed before and 5.93±4.31 months after NSRI. Reduction of PPD and PC rates following NSRI were associated with tooth-related factors, namely tooth type, arch, number of roots, furcation involvement (FI), pulp vitality, mobility, type of restoration, presence of plaque, and bleeding on probing (BOP), using mixed-effects regression models. NSRI reduced periodontal pockets persisting after initial cause-related therapy by (mean±SD) 1.32±1.79mm in PPD, and PC rate was 40%. Moderate pockets (4-5mm) responded better to NSRI than deep pockets (≥6mm) in terms of PC (51% vs. 16%). Both PPD reduction and PC rates of deep residual pockets were significantly influenced by tooth type, arch, number of roots, and presence of BOP. Tooth type, arch, number of roots, and presence of BOP at re-evaluation (before NSRI) had a significant and clinically relevant influence on NSRI as part of step 3 therapy. Considering these factors, particularly for deep residual pockets, may allow more tailored re-intervention. The present study aimed to investigate the influence of tooth-related factors on the outcome of repeated nonsurgical therapy of periodontitis. Therefore, 480 patients (10,807 teeth) presenting with clinical symptoms of persistent periodontitis after initial therapy were administered repeated nonsurgical therapy and retrospectively analyzed. Therapy outcomes were associated with tooth-related factors, namely tooth type, tooth location (maxilla/mandible), number of roots, involvement of the root furcation area in multi-rooted teeth, pulp vitality, mobility, restoration, presence of plaque and bleeding upon periodontal probing, using mixed-effects models. The results revealed that repeated nonsurgical therapy was effective in reducing inflammation and clinical signs of disease, with moderate residual periodontal defects responding better than deep defects. Healing of deep defects after repeated nonsurgical therapy; however, was significantly influenced by the factors: tooth type, location, number of roots, and bleeding on probing. Considering these factors, particularly in deep residual defects which are commonly suggested to be treated surgically, may allow less invasiveness and thus a more tailored re-intervention.

Evaluation of concentrated growth factors with and without metformin gel in the treatment of mandibular class II furcation defect

Abstract Background Untreated periodontal diseases in the molar region often result in loss of periodontal support. This results in the development of furcation defects. These defects have been associated with a deteriorating prognosis and without treatment may result in ultimate loss of the involved tooth. Furcation involvement therefore presents both diagnostic and therapeutic challenges. Objective The present study aimed to evaluate and compare the effects of 1% metformin gel (MF) plus concentrated growth factors (CGF) versus CGF alone in the treatment of Grade II mandibular furcation defects, clinically, and radiographically. Patients and methods Nine patients with 20 Grade II mandibular furcation defect sites were selected and divided into two groups. Group I included 10 defects was treated with 1% MF gel plus CGF while group II included 10 defects was treated with CGF alone. The clinical outcome parameters were probing pocket depth (PD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing. The radiographic study included furcation defect depth, width, and height assessed by cone beam computed tomography. The clinical parameters were evaluated at baseline, 3 and 6 months while the radiographic parameters were evaluated at baseline and 6 months. Results Both the study groups showed statistically significant improvement in all clinical parameters (PI, bleeding on probing, PPD, CAL) after 3 and 6-month postsurgical compared to baseline. A significantly greater mean reduction of PD and CAL were observed in group I compared with group II at 3 and 6 months. The radiographic assessment showed significant improvement in bone gain in both groups after 6 months postsurgery. Comparing the two groups, significant reductions of depth, width, and height were exhibited in group I as compared with group II at 6 months post-treatment. Conclusion Based on the results of the current study, CGF with and without 1% MF can be successfully used for the treatment of mandibular furcation involvement, however, the addition of 1% MF gel to CGF was found to have potentiating effect as it resulted in more favorable clinical and radiographic outcomes.

Periodontal regeneration using platelet-rich fibrin. Furcation defects: A systematic review with meta-analysis.

The objective of the study was to compare the treatment outcomes of periodontal furcation defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with those of other modalities for the treatment of furcation defects. Studies were classified into 11 categories in 3 different groups as follows: Group I (addition of PRF): (1) open flap debridement (OFD) alone versus OFD/PRF, (2) OFD/bone graft (OFD/BG) versus OFD/BG/PRF; Group II (comparative studies to PRF): (3) OFD/BG versus OFD/PRF, (4) OFD/collagen membrane versus OFD/PRF, (5) OFD/PRP versus OFD/PRF, (6) OFD/rhBMP2 versus OFD/PRF; and Group III (addition of biomaterial/biomolecule to PRF): OFD/PRF versus … (7) OFD/PRF/BG, (8) OFD/PRF/amniotic membrane (AM), (9) OFD/PRF/metformin, (10) OFD/PRF/bisphosphonates, (11) OFD/PRF/statins. Weighted means and forest plots were calculated for the reduction of probing pocket depth (PPD), gain of vertical and horizontal clinical attachment levels (VCAL and HCAL), gain in vertical and horizontal bone levels (VBL, HBL), and radiographic bone fill (RBF). From 45 articles identified, 21 RCTs reporting on class II furcations were included. The use of OFD/PRF and OFD/BG/PRF statistically significantly reduced PPD and improved VCAL and HCAL when compared to OFD or OFD/BG, respectively. The comparison between OFD/PRF alone versus OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2 led to similar outcomes for all investigated parameters, including a reduction in PPD, VCAL/HCAL gain, and RBF. The additional incorporation of a BG to OFD/PRF only mildly improved outcomes, whereas the addition of AM improved clinical outcomes. The addition of small biomolecules such as metformin, bisphosphonates, or statins all led to significant improvements in PPD, VCAL, and HCAL when compared to OFD/PRF alone. Noteworthy, a very high heterogeneity was found in the investigated studies. The use of PRF significantly improved clinical outcomes in class II furcation defects when compared to OFD alone, with similar levels being observed between OFD/PRF and/or OFD/BG, OFD/CM, OFD/PRP, or OFD/rhBMP2. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future histological research investigating PRF in human furcation defects is largely needed. The use of PRF in conjunction with OFD statistically significantly improved PPD, VCAL, and HCAL values, yielding comparable outcomes to commonly used biomaterials. The combination of PRF to bone grafts or the addition of small biomolecules may offer additional clinical benefits, thus warranting future investigation.

Nutrition and Periodontitis: A Cross-Sectional Study from a Practice-Based Research Network.

Despite clinical interventional studies on the influence of diet on periodontal inflammatory parameters, there has been no practice-based cross-sectional study from a German population to date that has conducted both a comprehensive dental and periodontal examination and a thorough validated assessment of dietary behavior. Therefore, the aim of this pilot study was to evaluate, in a proof of concept, whether there is a correlation between the overall periodontal inflammatory surface area (PISA), periodontal clinical parameters (pocket probing depths (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), furcation involvement (FI), tooth mobility (TM)), and the dietary behavior of patients with periodontal disease when utilizing a practice-based research network. The primary outcome was the correlation between the periodontal inflammatory surface (PISA) and the dietary assessment data. The practice-based research network, consisting of eight Master's graduates, recruited patients who met the inclusion and exclusion criteria and performed a periodontal examination together with the assessment of dietary behavior using a digital version of the validated retrospective dietary recall (DEGS/RKI). Statistical analyses included linear regression models adjusted for age and smoking and unpaired t-tests, conducted using STATA 17.0 with a significance level of 5%. In addition, the data obtained were classified according to the currently recommended amounts of daily intake. A total of 1283 teeth were analyzed, with 60.25% (773 teeth) requiring treatment. The average PISA was 753.16 mm2 (SD ± 535.75 mm). Based on dietary guidelines, the studied population consumed excessive amounts of extrinsic sugars and fats, while their fiber and legume intake was insufficient. The intake of certain nutrients, including water-soluble fibers, specific fatty acids, vitamins (D, B1, B2, B6, and B12), iron, and zinc, was associated with reduced PISA, PPD, CAL, and BOP. Within the limits of the current study, including its cross-sectional design and cohort size, the outcomes demonstrated the influence of nutrition on periodontal health.

Efficacy of Platelet-rich Fibrin for the Treatment of Grade II Furcation Defects in Mandibular Molars

Aim: To evaluate the efficacy of platelet-rich fibrin (PRF) in the treatment of grade II furcation mandibular molars. Materials and Methods: We enrolled 12 patients with 24 mandibular class II furcation defects in this randomized clinical trial with a split-mouth design. These defects were treated with either open flap debridement (OFD) in conjunction with PRF (test group) or only OFD (control group). We recorded and assessed clinical parameters (probing pocket depth [PPD], gingival recession [GR], and vertical and horizontal clinical attachment level [VCAL and HCAL, respectively]), radiographic parameters (bone defect fill [%BF]), and microbiological parameters at baseline and 6 months after treatment. Results: After treatment, PPD, VCAL, HCAL, BF, and microbiological parameters were significantly reduced in both groups. All clinical and radiographic parameters showed significant improvement at the sites that had been treated with PRF and OFD compared with those that had been treated with OFD alone. Among 24 furcation defects in both groups, 10 showed a significantly improved clinical condition and 14 remained at the initial grade. There were no more severe conditions recorded after treatment. Conclusion: Within the limitation of this article, we have demonstrated the effectiveness of PRF in the regenerative treatment of grade II furcation defects.

A Comparative Analysis of Open Flap Debridement with and without Autogenous Periosteal Graft as a Barrier Membrane for the Treatment of Class II Furcation Involvement in Mandibular Molars: A Case-control Study

A Comparative Analysis of Open Flap Debridement with and without Autogenous Periosteal Graft as a Barrier Membrane for the Treatment of Class II Furcation Involvement in Mandibular Molars: A Case-control Study

Patient-reported outcome measures and health economics in regenerative periodontal therapy: A systematic review and meta-analysis.

Understanding patient responses to periodontal regeneration is crucial. This systematic review and meta-analysis addressed two key questions: (a) the impact of periodontal regeneration on patient-reported outcome measures (PROMs) for intrabony and furcation involvement and (b) the cost-effectiveness of periodontal regeneration for treating periodontal defects. Twenty-four studies were included, with 20 randomized clinical trials (RCTs) reporting patient-reported outcomes and five (three RCTs and two economic model-based studies) reporting cost-effectiveness outcomes. Results favored regeneration therapy over conventional flap surgery for intrabony defects, showing improvements in qualitative (i.e., amount of regenerated attachment apparatus) and quantitative parameters (i.e., probing and radiographic parameters). In terms of PROMs, regenerative treatments involving barrier membranes resulted in longer chair times and higher rates of complications (such as membrane exposure or edema) compared to flap with biologic agents or access flap alone. Despite this, oral health-related quality of life improved after both regenerative and extraction procedures. Economically, regeneration remained favorable compared to extraction and replacement or open flap debridement alone for periodontal defects. Single-flap variants in open flap debridement yielded similar outcomes to regenerative treatment, offering a potentially cost-effective option. Nevertheless, further discussion on the benefits of less-invasive flap designs is needed due to the lack of histological evaluation.

Microbiological and molecular profile of furcation defects in a population with untreated periodontitis.

To describe the microbiological composition of subgingival dental plaque and molecular profile of gingival crevicular fluid (GCF) of periodontal furcation-involved defects. Fifty-seven participants with periodontitis contributed with a degree II-III furcation involvement (FI), a non-furcation (NF) periodontal defect and a periodontally healthy site (HS). Subgingival plaque was analysed by sequencing the V3-V4 region of the 16S rRNA gene, and a multiplex bead immunoassay was carried out to estimate the GCF levels of 18 GCF biomarkers. Aiming to explore inherent patterns and the intrinsic structure of data, an AI-clustering method was also applied. In total, 171 subgingival plaque and 84 GCF samples were analysed. Four microbiome clusters were identified and associated with FI, NF and HS. A reduced aerobic microbiota (p = .01) was detected in FI compared with NF; IL-6, MMP-3, MMP-8, BMP-2, SOST, EGF and TIMP-1 levels were increased in the GCF of FI compared with NF. This is the first study to profile periodontal furcation defects from a microbiological and inflammatory standpoint using conventional and AI-based analyses. A reduced aerobic microbial biofilm and an increase of several inflammatory, connective tissue degradation and repair markers were detected compared with other periodontal defects.

Root surface biomodification in periodontal therapy: Biological rationale and clinical applications.

Regenerative periodontal therapy aims to form new cementum, periodontal ligament, and alveolar bone, all sealed by gingival tissue. The root surface acts as the wound margin during this regeneration process. Root surface biomodification (root conditioning/root decontamination), therefore, seems instrumental in promoting surface decontamination and enhancing tissue attachment by removing the smear layer, exposing collagen fibrils, and facilitating blood clot formation and stabilization. This review attempted to provide an all-encompassing, evidence-based assessment of the role of root surface biomodification in regenerative periodontal therapy, particularly in intrabony defects, furcation defects, and root coverage procedures. The reviewed evidence suggested that root conditioning agents, whether used independently or in conjunction with bone graft materials, biological agents, membranes, or connective tissue grafts, do not offer any clinical advantage regarding clinical attachment gain. Thus, integrating chemical methods with the mechanical root instrumentation process does not necessarily contribute to superior clinical outcomes.

Role of Sticky Bone in the Management of Various Alveolar Bone Defects: A Systematic Review.

This systematic review aimed to evaluate the effectiveness of sticky bone in managing various alveolar bone defects, examining both its benefits and drawbacks. The review adhered to PRISMA guidelines and employed a thorough search strategy using major databases, medical subject headings (MeSH) keywords, and Boolean operators. As a result, the systematic review identified 12 studies focusing on the efficacy of sticky bone in treating alveolar bone defects. Inclusion criteria consisted of randomized controlled trials and case series reporting on the outcomes of sticky bone use for bone defect treatment. Two examiners meticulously performed screening, data extraction, and bias assessment, with the risk of bias evaluated using the Cochrane tool. The findings indicated significant improvements in bone quality, width, height, and volume, with enhanced predictability in socket preservation and implant placement. Sticky bone was particularly effective in ridge augmentation, guided bone regeneration, and filling periodontal defects, often outperforming alternatives like concentrated growth factors (CGFs) and autologous fibrin glue (AFG). It simplified procedures and reduced resorption during healing, underscoring its value as a versatile adjunct in bone reconstruction surgery. Sticky bone demonstrated exceptional results in various oral surgeries, effectively addressing issues such as furcation defects, bone loss, and ridge augmentation, with significant clinical and radiographic improvements. Further research is needed to explore its full potential and refine protocols for broader oral surgery and periodontics applications.