Horizontal Probing Depth Research Articles

Clinicoradiographic comparative evaluation of 1% melatonin gel plus platelet-rich fibrin over platelet-rich fibrin alone in treatment of Grade II furcation defects: A randomized controlled double-blind clinical trial.

The present study aims to evaluate and compare the effects of 1% melatonin gel plus platelet-rich fibrin (PRF) and PRF alone in treatment of furcation defects, clinically and radiographically using cone-beam computed tomography. This split-mouth clinical trial included 23 patients with 46 bilateral Grade II furcation defects in first or second maxillary or mandibular molars. Control group was treated with PRF alone while the test group was treated with 1% melatonin gel and PRF. Clinical attachment level (CAL) and horizontal probing depth (HPD) were primary outcome parameters while secondary outcome parameters were pocket probing depth (PPD) and defect volume (DV) assessed at 3 and 6 months postoperatively. Significantly greater mean reduction of PPD, HPD, and CAL gain was observed in test group (2.23±0.41, 2.36±0.68, and 2.97±0.62mm, respectively) in comparison with control group (2.83±0.78, 2.85±0.67, and 3.21±0.86mm, respectively) at 6 months. A significant reduction in the mean DV was exhibited radiographically in test group (1.06±0.5 mm3) as compared with control group (3.94±1.32 mm3) at the end of 6 months. Both the groups showed improvements in assessed parameters. In Grade II furcation defects the combination therapy of 1% melatonin + PRF shows a statistically significant degree of bone fill within the periodontal tissues and also better results in terms of decrease in PPD, HPD, and a greater CAL gain.

Comparative clinical evaluation of xenograft (Cerabone) versus allograft combined with platelet-rich fibrin for treatment of grade II mandibular furcation defects

Abstract Aim: The present study aims to evaluate the efficacy of naturally-derived bovine hydroxyapatite (Cerabone) versus demineralized freeze-dried bone allograft both combined with platelet-rich fibrin for treatment of grade II mandibular furcation defects. Method: This clinical study included 20 systemically healthy patients, with grade II mandibular furcation defects, performed over 6 months. Control group comprised of open flap debridement + demineralized freeze-dried bone allograft + platelet-rich fibrin and test group comprised of open flap debridement + Cerabone + platelet-rich fibrin. Clinical parameters included: Plaque index, Modified Sulcular bleeding index, Vertical probing pocket depth, Horizontal probing depth, Probing clinical attachment level, Radiographic furcation depth, and radiographic bone fill percentage. Results: Both groups showed satisfactory bone regeneration and improvement in clinical parameters. The test group exhibited greater reduction in vertical probing pocket depth, horizontal probing depth, and higher radiographic bone fill percentage when compared to control group, although these findings were not statistically significant. Conclusion: Both bone grafts were equally effective in treatment of grade II furcation defects. Further long-term studies are required to explore their maximum regenerative potential.

Treatment of mandibular Grade II furcation defects using demineralized freeze-dried bone allograft alone or in combination with guided tissue regeneration membrane – A randomized controlled clinical trial.

Background– Periodontal disease, if not interfered, will headway further with attachment loss involving the bifurcation or trifurcation of multirooted teeth. Furcation involved molar teeth respond less favorably to conventional periodontal therapy alone resulting into tooth loss. Combining osseous grafting with guided tissue regeneration membrane may enhance the response to treatment as compared to graft – only therapy by achieving mechanical stabilization and preventing micromovement of the bone graft material.
 
 Aim & Objective – To compare the efficacy of demineralized freeze-dried bone allograft alone or in combination with guided tissue regeneration membrane in the treatment of mandibular Grade II furcation defects.
 
 Materials & method - In this study a total number of 20 patients with 20 mandibular sites (buccal grade II furcation involvement) were evaluated. They were divided into two groups: Control group (bone graft only) and test group (bone graft + GTR). The clinical parameters assessed were vertical probing depth, horizontal probing depth and relative clinical attachment level.
 
 Results – In this study the statistical analyses comparing test and control sites at baseline revealed no significant differences between the two groups for any of the clinical parameters considered. At 6 month evaluation, significant difference was found between two groups regarding VPD, HPD and rCAL.
 
 Conclusion – It was concluded that there is a significant enhanced effect of using DFDBA bone graft in combination with GTR membrane over bone graft alone for the treatment of mandibular Grade II furcation defects.

Effect of Injectable Platelet-Rich Fibrin with a Nano-Hydroxyapatite Bone Graft on the Treatment of a Grade II Furcation Defect.

Background: Periodontal diseases lead to bone loss, crestal defects and even loss of the tooth, which also further makes it difficult to replace the tooth. Autogenous bone grafts are considered the gold standard in bone regenerative procedures. This study aimed to compare and evaluate the bone regenerative effects of i-PRF (Injectable- Platelet-rich fibrin) with a bone graft and a bone graft alone in mandibular grade II furcation defects over a period of 9 months. Method: This was a comparative study of 12 participants, who were randomly selected and grouped into two groups: test and control. Following phase I therapy, both groups were subjected to open flap debridement. In the test group, after debridement, a nano-hydroxyapatite bone graft mixed with i-PRF was inserted, whereas in the control group only a nano-hydroxyapatite bone graft was inserted. The clinical parameters such as plaque index (PI), gingival index (GI), pocket probing depth (PPD), clinical attachment level (CAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were recorded at baseline, 3 months, 6 months and 9 months following the surgery. The bone area fill (BAF) was assessed using intraoral periapical radiographs (IOPARs) taken at baseline and 9 months after surgery. Results: At the baseline, there was no statistically significant difference between the tested parameters. After 9 months all the clinical parameters, PI, GI, PPD, CAL, HPD and VPD as well as radiographic bone fill showed a significant increase in both the groups (p < 0.05) (PI-TGr; CGr-VPD-3.5 ± 0.54 to 0.66 ± 0.51; 3.3 ± 0.81 to 2 ± 0.63/BAF-2.9 ± 0.88 to 5.6 ± 1.10; 3.4 ± 1.39 to 3.9 ± 1.4). On comparison the test group showed better results for each clinical parameter. Conclusion: The results showed increased improvement in clinical conditions in both groups, although better results were seen in the group where i-PRF with a nano-HA bone graft was used in the furcation defect.

Clinical and Radiographic Evaluation of Applying Atorvastatin 1.2% Bio Adhesive with Plasma Rich in Growth Factor (PRGF) for Treatment of Mandibular Class II Furcation Defects: a Randomized Clinical Trial.

Statement of the Problem: Molar teeth with furcation involvement are one of the most common problems in patients with periodontal disease. Regeneration methods are of the most controversial treatment strategies for these lesions.Purpose: The purpose of this study was to determine the effect of plasma rich in growth factors (PRGF) with 1.2% Atorvastatin (ATV) in the treatment of furcation involvement of mandibular molars.Materials and Method: The present randomized clinical trial was conducted on 15 patients with moderate periodontitis and class II furcation involvements; 24 defects were located in four groups of six, including debridement, ATV1.2%, PRGF, PRGF with ATV1.2%. The parameters of vertical probing depth (VPD), vertical clinical attachment level (VCAL), gingival index (GI), horizontal probing depth (HPD) and gingival recession (GR) were measured at baseline (T0), immediately before surgery (T1), 3 (T2), and 6 (T3) months after surgery. Moreover, the bone conditions were evaluated by digital subtraction radiography before and six months after surgery. Data were analyzed using SPSS23 software.Results: No significant difference in radiographic parameters was observed among the groups (p= 0.08). There was no significant difference in the mean levels of VPD, VCAL and HPD among the groups at different times (p<0.05). Comparison of clinical parameters of VPD, VCAL and GI in the treatment groups compared to the baseline showed a significant improvement in each group (p< 0.05) but there was no significant difference among different groups (p< 0.05).Conclusion: The use of PRGF with ATV 1.2% in grade II furcation involvement in mandi-bular molars was effective in the improvement of clinical and radiographic parameters six months after treatment, but this effect revealed no difference in comparison with the other groups.

Overview of the Effect of Different Regenerative Materials in Class II Furcation Defects in Periodontal Patients.

The aim of this review was to give an overview of the outcomes of the use of different regenerative materials to treat molars with class II furcation defects in patients with periodontitis in comparison with open flap debridement (OFD). A search of five databases (PubMed-Medline, Embase, Cochrane, Scopus and Web of Science) was conducted up to and including January 2022. According to the PICOS guidelines, only randomized control trials (S) considering periodontal patients with at least one molar with a class II furcation involvement (P) treated with regenerative materials (I) in comparison to OFD as control treatment (C) and a minimum follow-up period of 6 months were included. Vertical clinical attachment level (VCAL) was considered as the primary outcome (O), while horizontal clinical attachment level (HCAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were considered as secondary outcomes. The search through the databases initially identified 1315 articles. Only 25 of them met the eligibility criteria and were included. The studies were grouped in four macro-categories according to the material used: absorbable and non-absorbable membranes, blood derivatives and a combination of different materials. The greater part of the included studies reported a statistically significant difference in using regenerative materials when compared to OFD. The blood derivatives groups reported a range of mean changes in VCAL of 0.86–4.6 mm, absorbable membrane groups reported −0.6–3.75 mm, non-absorbable membranes groups reported −2.47–4.1 mm, multiple materials groups reported −1.5–4.87 mm and enamel matrix derivatives reported a mean change in VCAL of 1.45 mm. OFD showed a range of mean VCAL changes of −1.86–2.81 mm. Although no statistical analysis was performed, the use of regenerative materials may be considered moderately beneficial in the treatment of molars with grade II furcation involvement. However, the substantial heterogeneity in the protocols’ design does not allow us to draw definitive conclusions. In addition, low levels of evidence for morbidity and patient-centered outcomes were reported.

Evaluation of the efficacy of concentrated growth factor along with bovine-derived xenograft and collagen membrane in the treatment of Degree II mandibular molar furcation defect - A clinicoradiographic study.

Background:The ultimate goal of furcation defect therapy is furcation closure via periodontal regeneration. However, the process of periodontal regeneration is affected by the regenerative environment of signaling molecules and growth factors due to which consistent findings of complete furcation closure could not be attained. In this study, we have evaluated the use of concentrated growth factor (CGF) which provides sustained release growth factors in conjunction with bovine-derived xenograft anorganic bovine bone (ABB) in guided tissue regeneration (GTR) of Degree II mandibular molar furcation defect.Materials and Methods:Twenty patients with Degree II mandibular molar furcation defects were selected for the study. Each group consisted of 10 patients and a total of 10 sites were treated in each group. The control sites were treated with GTR and ABB, while the experimental sites received CGF mixed with ABB along with GTR. Clinical parameters recorded were Plaque Index, Gingival Index, vertical probing depth, and horizontal probing depth measured at baseline and 6 months. Radiographic parameters such as the vertical height of defect, horizontal depth of defect, and percentage of vertical and horizontal bone fill were recorded at baseline and 6 months.Results:All the parameters recorded showed a significant reduction from baseline to 6 months in both the groups. Significantly higher vertical and horizontal bone fill was observed in the experimental group as compared to the control group.Conclusion:The use of CGF showed a positive additive efficacy in enhancing the events of periodontal regeneration in the treatment of Degree II mandibular molar furcation defect.

Clinico-radiographic comparative evaluation of 1% metformin gel plus platelet-rich fibrin over platelet-rich fibrin alone in the treatment of Grade II furcation defects: A randomized controlled double-blind clinical trial.

The present study was aimed to evaluate and compare the effects of 1% MF plus PRF over PRF alone in treatment of Grade II furcation defects, clinically and radiographically by using cone-beam computed tomography. This split-mouth clinical trial randomly allotted 21 patients with 42 bilateral Grade II furcation defects into two groups. Group I was treated with PRF alone while Group II with 1% MF gel and PRF. The primary outcome parameters were clinical attachment level (CAL) and horizontal probing depth (HPD) while the secondary outcome parameters were probing depth (PD) and defect volume (DV). The clinical parameters were evaluated at 3, 6, and 12 months and the radiographic parameters at 12 months. Both the study groups yielded improvements in assessed parameters; however, significantly greater mean reduction of PD, HPD, and CAL gain was observed in Group II (3.90 ± 0.78mm, 2.94 ± 0.80mm, and 3.42 ± 0.93mm) in comparison with Group I (3.23 ± 0.90mm, 1.96 ± 0.80mm, and 2.67 ± 0.88mm) at 12 months, respectively. A significant reduction of DV was exhibited radiographically in Group II (12.61 ± 4.01 mm3 ) as compared with Group I (9.14 ± 4.31mm3 ) at the end of 12 months. Better clinical and radiographic findings in terms of reduction in PD, HPD, CAL gain, and significant reduction in DV in Group II patients indicated that the combination therapy of 1% MF + PRF promotes regenerative ability within the periodontal tissues in Grade II furcation defects to a greater extent.

Clinical effect of simvastatin gel with bone graft in grade II furcation defects: A randomized controlled clinical trial

Aim: To evaluate the effectiveness of 1.2 mg/mL simvastatin (SMV) gel with hydroxyapatite (HA) bone graft in the surgical treatment of mandibular Grade II furcation defects compared with HA bone graft, SMV, and placebo after open-flap debridement (OFD). Materials and Methods: The present study was a single-center, triple-blind randomized controlled clinical trial wherein 23 mandibular grade II furcation defects from 15 chronic periodontitis patients were randomly assigned for treatment with either placebo gel (group 1; n = 5), HA (group 2; n = 6), SMV (group 3; n = 6), and SMV + HA (group 4; n = 6). Clinical parameters at the furcation defect site, such as horizontal and vertical probing depth (HPD and VPD), vertical clinical attachment level (VCAL), radiologic parameters, such as vertical defect depth in intraoral periapical radiograph (IOPA), vertical and horizontal defect depth, and volume of defect in cone-beam computed tomography (CBCT) were recorded at baseline, 3, and 6 months postoperatively and analyzed using SPSS software. For intragroup comparison, paired t test and Wilcoxon test were used, and for intergroup comparison, ANOVA and Kruskal-Wallis test were used. Results: SMV + HA group had improvement in all the clinical parameters when compared to baseline but were not significantly different when compared to other groups. However, statistically significant improvement in HPD was evident in SMV + HA group at 3 months (1.8 ± 1.3; P = 0.019; P < 0.05) when compared to HA group. In CBCT, SMV + HA group had significant improvement in VDD, HDD, and volume of the defect whereas in IOPA, there was no significant findings. Conclusion: Simvastatin with HA is more effective in reducing the horizontal component of grade II furcation defects.

COMPARATIVE STUDY OF BIOACTIVE GLASS AND FREEZE DRIED BONE ALLOGRAFT IN CLASS II FURCATION DEFECTS

Background: In periodontal therapy, furcation defects are one of the most therapeutically challenging periodontal therapies. Till now various treatment methods have been tried which have shown different success rates. The present study was undertaken to compare the efficacy of bioactive glass (alloplast) with Freeze dried bone allograft (FDBA) in the treatment of Class II furcation defects.&#x0D; Materials and Methods: Twenty patients were selected for the study which had bilateral Class II furcation defects in molars from which ten patients were male and ten patients sere female in the age group of 45-55 years. Various clinical measurements were recorded at three times i.e. at baseline, at one month and at six months post surgery which included the Turesky-Glimore-Glickman modification of the Quigley Hein plaque index, the Loe and silness gingival index, relative clinical attachment level vertical probing depth in the mid-furcation area, and horizontal probing depth in the furcation area. The statistical analysis was done using SPSS version 23.0.&#x0D; Results: In the relative clinical attachment levels, the mean gain in the test and control groups was 2.45 and 1.58 mm, respectively at the end of six months. In the horizontal probing depth values, the mean change in the bioactive glass graft and freeze dried bone allograft was 1.45 and 1.33 mm, respectively.&#x0D; Conclusion: From our study it was concluded that efficacy of Bioactive glass is much better as compared to Freeze dried bone allograft in the treatment of Class II furcation defects.&#x0D; Keywords: Bioactive glass, Freeze dried bone allograft, furcation defects

Furcation: the truth behind the roots!!!

Background: Complex anatomic morphology of bifurcations and trifurcations predisposes multirooted teeth to plaque accumulation leading to periodontal infection. This poses a great difficulty in treatment planning and management of these furcation defects.Assessing the degree of furcation involvement depending on external tooth surface points may lead to the underestimation of positive treatment outcomes. Aim: To determine the buccolingual width of the furcation of mandibular molar and compare it with buccolingual width of mesial and distal roots at the level of root separation. Materials and Methods: 40 randomly selected mandibular molars were analyzed in which 20 first molars and 20 second molars were included. Four horizontal buccolingual distances were evaluated: CEJ, Furcation entrance/ roof width (FE), Mesial root width (MRW), andDistal root width (DRW).Discrepancies between FE measurements and MRW, DRW, and CEJ were determined in each tooth by subtracting the FE measurements respectively from MRW, DRW, and CEJ. Results: The width of the furcation entrance has a mean of 5.41 ± 0.67 mm varying from 4 to 7 mm in first molars and a mean of 5.18 ± 0.64 mm varying from 4 to 6 mm in second molars. In this study, the FE is measured more internally than the mesial and distal root surfaces and therefore, the FE is smaller than MRW and DRW.From this, it is evident that the actual furcation width is much less than the CEJ width, MRW and DRW measured buccolingually. Conclusion: Clinical measurements of horizontal probing depth that use the external surfaces of roots as reference points overestimate the true anatomical component of furcation involvement in mandibular molars. Conversely, positive treatment outcomes in these teeth may be underestimated.Thus, estimation of actual furcation entrance width before a surgical intervention is necessary and can influence the prognosis of involved teeth after different regenerative therapies for furcation defects. Key words : Furcation therapy, molar anatomy, periodontal attachment loss/diagnosis, outcome assessment of regenerative therapies.

Platelet-rich fibrin in combination with decalcified freeze-dried bone allograft for the management of mandibular degree II furcation defect: A randomised controlled clinical trial.

Background: Treatment of furcation involvement of molars with periodontal disease remains challenging and unpredictable. Platelet-rich fibrin (PRF) has received the attention of researchers due to its pleiotropic properties essential for periodontal wound healing. The osteoinductive property of demineralized freeze-dried bone allograft (DFDBA) has been successfully used in periodontal regeneration. Aim: The present study aimed to explore the effectiveness of PRF alone and with DFDBA in the treatment of mandibular degree II furcation defects in subjects with chronic periodontitis. Material and Methods: Patients treated were from the Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly. A total of 60 mandibular molars were treated with either open flap debridement (OFD) alone, [Formula: see text] combination or [Formula: see text] combination. The soft and hard tissue parameters such as vertical probing depth (VPD), vertical clinical attachment level (VCAL), gingival marginal level (GML), horizontal probing depth (HPD), vertical bone fill (VBF), horizontal bone fill (HBF) and furcation width (FW) were determined at baseline and 9 months postoperatively. A paired [Formula: see text]-test was conducted to assess the statistical significance between time period within each group for clinical and radiographic parameters. ANOVA and post-hoc Tukey's tests were also conducted for intergroup comparison of soft and hard tissue parameters. Statistical significance was set at [Formula: see text]. Results and Discussion: After 9 months, all treatment groups showed significant ([Formula: see text]) improvement in soft and hard tissue parameters, except GML in all the three groups and HBF and FW in the OFD group as compared to baseline. The mean VBF change was highest in the [Formula: see text] group ([Formula: see text]) mm, followed by that in the [Formula: see text] and OFD groups ([Formula: see text] and [Formula: see text][Formula: see text]mm, respectively). Conclusions: It was shown that both [Formula: see text] and [Formula: see text] combinations were significantly advantageous for the management of mandibular degree II furcation defects. However, the [Formula: see text] combination has significantly greater benefits than [Formula: see text] combination in terms of VBF.

Evaluation of Demineralized Freeze-Dried Bone Allograft in Combination with Chorion Membrane in the Treatment of Grade II Furcation Defects: A Randomized Controlled Trial.

The aim of present study was to evaluate the efficacy of demineralized freeze-dried bone allograft (DFDBA) alone and in combination with chorion membrane (CM) in the treatment of Grade II furcation defects using cone beam computed tomography (CBCT). Sites were randomly assigned to Group I (DFDBA) and Group II (DFDBA + CM). Probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), and horizontal probing depth (HPD) were evaluated at 3 and 6 months and defect volume at 6 months. DFDBA + CM led to significant improvement in all parameters, indicating additional benefits of combination therapy.

Clinico‐radiographic evaluation of 1% alendronate gel as an adjunct and smart blood derivative platelet rich fibrin in grade II furcation defects

The treatment of molar furcation involvement is unpredictable due to the complex anatomy and poor access for instrumentation. Previous studies have reported successful regeneration with endogenous regenerative material such as platelet rich fibrin (PRF) and bisphosphonates as alendronate (ALN). Hence, the present study was aimed to evaluate clinically and radiographically the efficacy of 1% ALN gel in combination with PRF (PRF+ALN) and PRF alone in the treatment of grade II furcation defects. A split mouth study with 40 bilateral furcation defects was randomly divided into PRF group and PRF+ALN group. Bone defect volume was the primary outcome evaluated at the end of 6 months with CBCT while the secondary outcomes being changes in clinical parameters including Probing pocket depth (PPD), Clinical attachment level (CAL) and Horizontal probing depth (HPD) recorded at baseline, 3 and 6 months. The mean reduction in PPD, CAL and HPD was 1.85 ± 0.59 mm, 1.9 ± 0.64 mm and 1.7 ± 0.73 mm respectively for PRF group and 2.85 ± 0.88 mm, 3.05 ± 0.98 mm and 2.3 ± 0.73 mm respectively for PRF+ ALN group (p<0.05). At the end of 6 months, mean reduction in bone defect volume for PRF and PRF+ ALN group was 8.65 ± 3.84 mm3 and 11.98 ± 4.13 mm3 respectively. PRF+ ALN treated defects exhibited better clinical and radiographic outcomes suggestive of enhanced periodontal regeneration when compared to PRF alone treated sites.

Volumetric Assessment of Regenerative Efficacy of Demineralized Freeze-Dried Bone Allograft With or Without Amnion Membrane in Grade II Furcation Defects: A Cone Beam Computed Tomography Study.

Volumetric changes were evaluated to assess the regenerative efficacy of demineralized freeze-dried bone allograft (DFDBA) with and without amnion membrane (AM) in Grade II furcation defects both clinically and radiographically using cone beam computed tomography (CBCT). Sites were randomly assigned to Group I (DFDBA) and Group II (DFDBA + AM). Clinical parameters such as probing pocket depth, clinical attachment level, gingival recession, and horizontal probing depth were assessed at baseline, 3 months, and 6 months. Radiographic dimensions of the defect height, width, depth, and volume were assessed at baseline and 6 months postoperatively. DFDBA used with AM resulted in significant improvement in clinical and radiographic parameters when compared with DFDBA alone. The mean reductions in radiographic volume of the defect were 11.15 ± 6.39 mL for Group I and 17.02 ± 10.86 mL for Group II. Greater reduction in volume indicated a greater amount of healed regenerated tissue in Group II patients.

Guided tissue regeneration and platelet rich growth factor for the treatment of Grade II furcation defects: A randomized double-blinded clinical trial - A pilot study.

The treatment of furcation area defects remained as a challenging issue in periodontal treatments. Regeneration treatment of furcation defects is the most discussed periodontal treatment. Although not completely hopeless in prognosis, the presence of the furcation involvement significantly increases the chance of tooth loss. The current research was conductedeto compare theeadditive effect of combined guided tissue regeneration (GTR) and platelet-rich growth factor (PRGF) on the treatment of furcation bony defects. A randomized, triple-blinded, split-mouth study was designed. It included patients with a moderate to severe chronic periodontitis with bilateral Grade II furcation involvement of first or second mandibular molars. Each side of mouth was randomly allocated for the treatment with either Bio-Gide American Society of Anesthesiologists GTR or a PRGF or PRGF by itself. Plaque index, gingival index, vertical clinical attachment level, vertical probing depth, recession depth (REC), horizontal probing depth, fornix to alveolar crest (FAC), fornix to base of defect (FBD), furcation vertical component and furcation horizontal component (FHC) were recorded. The current research was conducted to compare the additive effect of combined GTR and PRGF on treatment of furcation bony defects. Altman's nomogram, Kolmogorov-Smirnov test, Friedman test, general linear model, repeated measures, and paired t-test were used as statistical analysis in this research. P < 0.05 was considered statistically significant. Eight patients were finally enrolled for this study. Overly, general and specific clinical and furcation parameters were improved except REC that was deteriorated insignificantly and FAC improved not significantly. Intergroup comparison revealed better improvement of FHC in GTR/PRGF group (P = 0.02). A significant improvement in the Grade II furcation defects treated with either GTR or PRGF/GTR was noticed. Further large-scale trials are needed to reveal differences of mentioned treatment in more details.

Comparative Evaluation of Bioactive Glass (Putty) and Platelet Rich Fibrin in Treating Furcation Defects.

The aim of this study was to compare a second-generation bioactive glass putty biomaterial against platelet rich fibrin in treating grade II furcation defects. Subjects were 15 systemically healthy patients (10 males and 5 females, ages 20-50 with a mean age of 38.33) with 20 mandibular molar class II furcation defects according to Glickman's classification. The 20 mandibular molar furcation defects were randomly allocated as follows: Group I, 10 furcation defects were treated using bioactive glass (NovaBone) bone graft putty material; Group II, 10 furcation defects were treated using platelet rich fibrin (PRF). Customized acrylic stents were fabricated on study casts and trimmed to the height contour of the teeth to serve as a fixed reference point for measurements. The following measurements were collected: gingival index, plaque index, vertical probing depth (from gingival margin to base of the pocket), clinical attachment level (CEJ to the base of the pocket), and horizontal probing depth of furcation involvement (using stent). Results showed that both groups had improvement in gingival index (GI) and plaque index (PI) at the recall intervals. There was an overall reduction in both vertical and horizontal probing depth in both groups; however, the Putty group (Group I) showed consistently more vertical probing depth reduction than the PRF group (Group II) at the end of third month (P-value = 0.0004), sixth month (P-value = 0.00001), and ninth month (P-value = 0.0004). Our conclusion was that use of bioactive glass osteostimulative biomaterial yields superior clinical results, including increased pocket depth reduction of class II furcation defects as compared to an autologous platelet concentrate. The clinical significance of our findings include the ease of use and superior biologic performance of second-generation putty bioglass biomaterials in furcation defects.

The efficacy of transgingival probing in class II buccal furcation defects treated by guided tissue regeneration.

Background:The objectives of the present study were to establish transgingival probing as an evaluating method in the clinical studies of periodontal regenerative techniques and to compare the effectiveness of transgingival probing to the surgical entry.Materials and Methods:Ten systemically healthy persons (20–50 years) with moderate to severe chronic periodontitis participated in this study. These cases were recruited into the study only when they fulfilled the eligibility criteria. Vertical probing depth (VPD) and horizontal probing depth (HPD) of furcation defects were measured with and without opening the flap, following local anesthesia during initial surgery and at 6 months after collagen membrane placement. The defect fill (DF) was also noted. The mean measurements of clinical parameters were compared by two-tailed paired t-test at 5% level of significance.Results:The difference between the measurements of VPD and HPD taken during transgingival probing and after opening the flap was lie in the range of 0.10–0.30 mm at the time of initial surgery and 6 months after surgery that was not statistically significant. Persons experienced slight discomfort or pain during opening the flap as compared to transgingival probing, and this method was also appreciated by the patients as it is easy, simple and does not involve the surgical procedure.Conclusion:The results of the study suggest that measurements recorded during transgingival probing and after opening the flap do not influence the required outcome of regenerative therapies, i.e., DF that was not statistically significant difference from surgical reentry. Therefore, it was concluded that transgingival probing could be used as evaluating parameters to see the outcome of regenerative surgeries and the surgical reentry procedure may be avoided because it is a second surgical procedure, time-consuming and interrupts the healing process.

A comparative evaluation of freeze-dried bone allograft with and without bioabsorbable guided tissue regeneration membrane Healiguide(®) in the treatment of Grade II furcation defects: A clinical study.

Background:Furcation defects represent one of the most demanding therapeutic challenges for periodontal therapy. Various treatment modalities have been tried with different success rates. The present study was undertaken to evaluate the efficacy of freeze-dried bone allograft (FDBA) with and without bioabsorbable guided tissue regeneration (GTR) membrane Healiguide® in the treatment of Grade II furcation defects.Materials and Methods:Ten patients with bilateral Grade II furcation defects were selected for the study. After phase I therapy, subjects were divided into two arms and treated in a split-mouth design. Ten defects were treated with FDBA alone in the control arm. Ten defects were treated with FDBA in conjunction with bioabsorbable GTR membrane Healiguide® in test arm. Clinical parameters like plaque index, gingival index, vertical probing depth, horizontal probing depth, and relative attachment level (RAL) were assessed at baseline, 3 months, and 6 months postoperatively.Results:At 6 months, clinical improvement was seen in both the arms with mean pocket depth reduction of 1.2 ± 1.032 mm and 1.7 ± 0.948 mm and mean horizontal probing depth reduction being 2.1 ± 1.969 mm and 1.6 ± 1.264 mm in control and test arm, respectively. Both surgical procedures resulted in a statistically significant reduction in vertical and horizontal probing depths.Conclusion:Both the arms demonstrated a significant improvement in the probing depth, horizontal furcation depth, and RAL at 6 months postsurgery in the treatment of Grade II furcation defects. However, on the intergroup comparison, there was no statistically significant difference in the results achieved between two arms.

Efficacy of combination therapy using anorganic bovine bone graft with resorbable GTR membrane vs. open flap debridement alone in the management of grade II furcation defects in mandibular molars - A comparative study.

Context:Invasion of the bifurcation and trifurcation of the multi-rooted teeth resulting in furcation involvement is one of the serious complications of periodontitis.Aim:The purpose of the study was to evaluate the efficacy of combination therapy using anorganic bovine bone graft and resorbable guided tissue regeneration (GTR) membrane versus open flap debridement alone in the management of Grade II furcation defects in mandibular molars.Materials and Methods:The study included a total number of 20 sites in 10 patients with bilateral mandibular furcation defects, out of which 10 sites were treated as test group and 10 as control group. The test group was treated with combination therapy and the control group with open flap debridement alone. The parameters were recorded on 0 day (baseline), 90th day, and 180th day, which included vertical probing depth and horizontal probing depth of the furcation defect, clinical attachment level, and defect fill.Statistical Analysis Used:Mean and standard deviation were calculated for different variables in each study group at different time points. Mean values were compared by using Wilcoxon signed ranks test, after adjusting the P values for multiple comparison by using Bonferroni correction method.Results:Both the test and control groups showed a definitive improvement in clinical parameters, which was statistically significant. On comparison, the vertical probing depth showed significant reduction in the test group with a mean reduction of 3.1 ± 0.7 mm, when compared to the control group which showed a mean reduction of 1.5 ± 0.5 mm. The horizontal probing depth of furcation defects was also significantly reduced in the test group with a mean reduction of 2.2 ± 0.6 mm, when compared to the control group in which the mean reduction was 0.9 ± 0.3 mm. There was also significant gain in attachment level in the test group which showed a mean gain of 3.2 ± 0.6 mm, when compared to the control group which showed a gain of 1.2 ± 0.6 mm. Radiographic defect fill was found to be more in the test group with a mean gain of 2.0 ± 0.1 mm, when compared to the control group which showed a defect fill of 0.2 ± 0.1 mm.Conclusions:The results of this study demonstrated that the combined use of anorganic bovine bone graft and resorbable GTR membrane is effective than open flap debridement alone in the treatment of mandibular grade II furcation defects.