Treatment Of Furcation Defects Research Articles

Evaluation of Regenerative Efficacy of Amnion and Chorion Membrane in Treatment of Mandibular Molar Furcation Defects: A Clinico-radiographic Study.

Amnion and chorion membranes possess unique inherited biological properties that enhance wound healing and may accelerate periodontal regeneration. The present study aims to evaluate and compare the efficacy of amnion and chorion membranes in the treatment of furcation defects. A total of 20 patients were selected and were randomly allocated to group I and group II with 10 subjects in each group. Amnion and chorion membranes are placental-derived membranes that accelerate regeneration by having natural growth factors with their antimicrobial and inflammation reduction properties. Group I was treated using bone grafting with decalcified freeze-dried bone allograft (DFDBA) and placement of amnion as a membrane for guided tissue regeneration (GTR) whereas group II was treated using bone grafting with DFDBA and placement of chorion as a membrane for GTR. The patients were followed for clinical and radiographic parameters and were evaluated between 3 and 6 months after surgery. In intragroup comparison, a significant difference was evident in both the groups for all the clinical and radiographic parameters within the groups. (p = 0.01) This means both amnion and chorion membranes showed statistically significant regenerative efficacy. In intergroup comparison, the results show that all the clinical parameters and radiographic parameters show no significant difference between the groups. The amnion and chorion membranes had similar regenerative efficacy in combination with DFDBA in patients with buccal degree II furcation defects in mandibular molars. The amnion and chorion membranes have shown significant improvement in clinical and radiographic parameters when used for the treatment of buccal degree II furcation defects in mandibular molars. How to cite this article: Mallapragda S, Gupta R, Gupta S, et al. Evaluation of Regenerative Efficacy of Amnion and Chorion Membrane in Treatment of Mandibular Molar Furcation Defects: A Clinico-radiographic Study. J Contemp Dent Pract 2024;25(2):160-167.

Clinico-radiographic 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 (CBCT). This split-mouth clinical trial included 23 patients with 46 bilateral Grade II furcation defects in 1st or 2nd maxillary or mandibular molars. Control group was treated with PRF alone while Test group with 1% melatonin gel and PRF. Clinical attachment level (CAL) and Horizontal probing depth (HPD) were primary outcome parameters while secondary outcome parameters were probing depth (PD) and defect volume (DV) assessed at 3 and 6 months postoperatively. Significantly greater mean reduction of PD, HPD and CAL gain was observed in Test group (2.23 ± 0.41 mm, 2.36 ± 0.68 mm and 2.97 ± 0.62 mm respectively) in comparison with Control group (2.83 ± 0.78mm, 2.85 ± 0.67 mm and 3.21 ± 0.86 mm 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 PD, HPD and a greater CAL gain. This article is protected by copyright. All rights reserved.

Treatment of furcation defects using various bone grafts and guided tissue regeneration membranes: A review on single-center institutional studies

Abstract Bone formation in class II furcation is least due to the morphology of the root in case of multirooted teeth performed by conventional procedure. Hence, various bone grafts with membranes have been tried in the current study to evaluate its efficacy by comparing test and control groups. This collection of research from a single center presents a bone graft and guided tissue regeneration (GTR) membrane-based furcation therapy. Bio-Oss and Bio-Gide, PerioGlas and Atrisorb, Periobone G and Resolut XT, as well as PepGen P-15 and Atrisorb, were among the bone graft materials used, both with and without the GTR barrier. Patients were divided into four groups based on the periodontal regenerative materials used. A periodontal flap procedure was performed where periodontal intraosseous defect along with furcation defects were present. The results show that the bone formation in the furcation area was more with Group C (Periobone G and Resolut XT) as compared to the least amount of bone formation in Group A (Bio-Oss and Bio-Gide) in the test group, and this same group shows least bone formation in control. To conclude, clinical outcomes observed with the combined use of Atrisorb as a GTR barrier and PerioGlas as a bone graft material improved the clinical measurements of furcation defect depth compared to the use of PerioGlas alone.

Porcine-derived soft block bone substitutes for the treatment of severe class II furcation-involved mandibular molars: a prospective controlled follow-up study.

No evidence exists regarding the advantages of periodontal regeneration treatment for furcation defects using soft block bone substitutes. Therefore, this randomized controlled trial aimed to assess the clinical and radiographic outcomes of regenerative therapy using porcine-derived soft block bone substitutes (DPBM-C, test group) compared with porcine-derived particulate bone substitutes (DPBM, control group) for the treatment of severe class II furcation defects in the mandibular molar regions. Thirty-five enrolled patients (test group, n=17; control group, n=18) were available for a 12-month follow-up assessment. Clinical (probing pocket depth [PPD] and clinical attachment level [CAL]) and radiographic (vertical furcation defect; VFD) parameters were evaluated at baseline and 6 and 12 months after regenerative treatment. Early postoperative discomfort (severity and duration of pain and swelling) and wound healing outcomes (dehiscence, suppuration, abscess formation, and swelling) were also assessed 2 weeks after surgery. For both treatment modalities, significant improvements in PPD, CAL, and VFD were found in the test group (PPD reduction of 4.1±3.0 mm, CAL gain of 4.4±2.9 mm, and VFD reduction of 4.1±2.5 mm) and control group (PPD reduction of 2.7±2.0 mm, CAL gain of 2.0±2.8 mm, and VFD reduction of 2.4±2.5 mm) 12 months after the regenerative treatment of furcation defects (P<0.05). However, no statistically significant differences were found in any of the measured clinical and radiographic parameters, and no significant differences were observed in any early postoperative discomfort and wound healing outcomes between the 2 groups. Similar to DPBM, DPBM-C showed favorable clinical and radiographic outcomes for periodontal regeneration of severe class II furcation defects in a 12-month follow-up period. Clinical Research Information Service Identifier: KCT0007305.

Functional and structural aspects in periodontal furcation treatment: a novel approach.

The outcome in the treatment of furcation defects is often unsatisfactory. The reasons are morphologic and pathologic peculiarities as well as extensive changes in shape caused by resective treatment of periodontal lesions in multi-rooted teeth. Therefore, augmentative strategies are suggested to improve the prognosis. However, the success rate decreases with increasing severity of the disease. In contrast, if the affected roots are not extracted but are extruded after hemi- or trisection, this leads to a coronal displacement of the disease process and a significantly improved situation for hygiene. At the same time, the resection of inflammatory tissue of the periodontal pockets is accompanied by vertical and horizontal bone apposition. The results are predictable and stable in the long term. The burden for the patient is low. ((Quintessence Int 2022;53: 884-891; Originally published (in German) in Quintessenz Zahnmedizin 2020; 71(9): 1024-1032; doi: 10.3290/j.qi.b3418205).

The use of enamel matrix derivative in the treatment of class II furcation defects: systematic review and meta-analysis.

To evaluate the effect of enamel matrix derivative (EMD) in the regeneration of class II furcation defects, used alone or in conjunction with biomaterials. Electronic database searches and hand searches were carried out and double-blind randomized controlled trials evaluating the use of EMD in class II furcation therapy were included, and a meta-analysis comparing the effect of open flap debridement (OFD)+βTCP/HA with and without EMD was carried out. The initial search resulted in a total of 298 articles, after removing the duplicates and exclusions after analysing the titles, abstracts and full text, five studies were included for the qualitative synthesis and two for the quantitative analysis. The meta-analysis showed no statistical difference when comparing OFD+βTCP/ HA with or without EMD in the treatment of furcation defects in any of the evaluated parameters. According to GRADE, the certainty of the evidence for the variables evaluated was moderate. The therapeutic modalities studied improved the periodontal clinical parameters of class II furcations, but the use of EMD in the treatment of these defects did not contribute to a clinical improvement that justified its use associated with the therapies/biomaterials. It is important to emphasize the need for more studies with larger samples to increase the certainty of the evidence reported in this review.

Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta-analysis of randomized clinical trials.

To investigate the clinical performance of regenerative periodontal surgery in the treatment of furcation defects versus open flap debridement (OFD) and to compare different regenerative modalities. A systematic search was conducted to identify RCTs evaluating regenerative surgical treatment of furcations with a minimum of 12-month follow-up. Three authors independently reviewed, selected and extracted data from the search conducted and assessed risk of bias. Primary outcomes were tooth loss, furcation improvement (closure/conversion) (FImp), gain of horizontal bone level (HBL) and attachment level (HCAL). Secondary outcomes were gain in vertical attachment level (VCAL), probing pocket depth (PPD) reduction, PROMs and adverse events. Data were summarized into Bayesian standard and network meta-analysis in order to estimate direct and indirect treatment effects and to establish a ranking of treatments. The search identified 19 articles, reporting on 20 RCTs (19 on class II, 1 on class III furcations) with a total of 575 patients/787 defects. Tooth loss was not reported. Furcation closure ranged between 0% and 60% (10 trials), and class I conversion from 29% to 100% (six trials). Regenerative techniques were superior to OFD for FImp (OR=20.9; 90% CrI=5.81, 69.41), HCAL gain (1.6mm), VCAL gain (1.3mm) and PPD reduction (1.3mm). Bone replacement grafts (BRG) resulted in the highest probability (Pr=61%) of being the best treatment for HBL gain. Non-resorbable membranes+BRG ranked as the best treatment for VCAL gain (Pr=75%) and PPD reduction (Pr=56%). Regenerative surgery of class II furcations is superior to OFD. FImp (furcation closure or class I conversion) can be expected for the majority of defects. Treatment modalities involving BRG are associated with higher performance.

HISTOMORPHEMITC EVALUATION OF THE EFFICACY OF AMNIOTIC CHORION MEMBRANE IN MANAGEMENT OF GRADE II FURCATION DEFECTS (IN VITRO STUDY)

Introduction: Treatment of furcation defects especially critical size defects remains a considerable challenge in clinical practice. Treatment modalities vary according to the type and location of the defects. Regenerative procedures are one of the treatment modalities in furcation involvement. Objectives: The aim of this study was to evaluate histomorphometrically the regenerative potential of amnion chorion membrane (ACM) on the management of induced grade II furcation defects and compare it to collagen membrane. Material and methods: This study was conducted on eight adult male Mongrel dogs, about 18-24 months old, weighing approximately 18-24 Kgs. On the left sides; the created defects were filled with β-tricalcium phosphate + hydroxy apatite and covered by amnion chorion membrane (study group). While on the right sides; the created defects were filled with the β-tricalcium phosphate + hydroxyapatite then covered by collagen membranes (control group). Results: ACM has shown superior results in bone formation when compared to control group treated with resorbable collagen membrane. Conclusion: ACM is an effective, easy to handle, safe, and time saving membrane that can be used in periodontal regeneration and management of grade II furcation defects.

Autologous Platelet Concentrates in Treatment of Furcation Defects-A Systematic Review and Meta-Analysis.

Background: The aim of this review was to evaluate the adjunctive effect of autologous platelet concentrates (APCs) for the treatment of furcation defects, in terms of scientific quality of the clinical trials and regeneration parameters assessment. Methods: A systematic search was carried out in the electronic databases MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trials), and EMBASE, together with hand searching of relevant journals. Two independent reviewers screened the articles yielded in the initial search and retrieved the full-text version of potentially eligible studies. Relevant data and outcomes were extracted from the included studies. Risk of bias assessment was also carried out. The outcome variables, relative to baseline and post-operative defect characteristics (probing pocket depth (PPD), horizontal and vertical clinical attachment loss (HCAL, VCAL), horizontal and vertical furcation depth (HFD, VFD) were considered for meta-analysis. Results: Ten randomized trials were included in this review. Only one study was judged at high risk of bias, while seven had a low risk, testifying to the good level of the evidence of this review. The meta-analysis showed a favorable effect regarding all outcome variables, for APCs used in adjunct to open flap debridement (p < 0.001). Regarding APCs in adjunct to bone grafting, a significant advantage was found only for HCAL (p < 0.001, mean difference 0.74, 95% CI 0.54, 0.94). The sub-group analysis showed that both platelet-rich fibrin and platelet-rich plasma in adjunct with open flap debridement, yielded significantly favorable results. No meta-analysis was performed for APCs in combination with guided tissue regeneration (GTR) as only one study was found. Conclusion: For the treatment of furcation defects APCs may be beneficial as an adjunct to open flap debridement alone and bone grafting, while limited evidence of an effect of APCs when used in combination with GTR was found.

Evaluation and comparison of hydroxyapatite crystals with collagen fibrils bone graft alone and in combination with guided tissue regeneration membrane.

Background:The combination of collagen in bone grafts is being used because of its properties that accentuate the degree of regeneration. Furcation involvement poses challenge to the prognosis of a tooth, the use of bone grafts and a combination of grafts and membranes have proved to be beneficial in the treatment of furcation defects. Thus, the aim of the present study was to clinically evaluate and compare the effectiveness of collagen fiber bone graft with and without a membrane in the treatment of mandibular Grade II furcation defects.Materials and Methods:A clinical split-mouth randomized control trial, which included ten patients having bilateral mandibular Grade II furcation defects, was randomly assigned to Group I, treated with bone graft of hydroxyapatite with collagen fibers, and Group II, treated with bone graft of hydroxyapatite with collagen fibers and guided tissue regeneration membrane of polyglycolide and polylactide copolymer, respectively. The clinical measurements were recorded at baseline and 6 months after surgery; and plaque and gingival index were recorded at baseline and at 3 and 6 months after surgery. The data obtained was statistically evaluated.Results:The overall results showed that the treatment procedures demonstrated statistically significant reduction in probing pocket depth, vertical defect fill, and horizontal depth of furcation, with a gain in clinical attachment level. On comparison of both the groups, Group II showed superior results with a statistically significant difference in all parameters except in gingival recession.Conclusion:The findings of the study demonstrated superior clinical results obtained with hydroxyapatite with collagen fibers, used in combination with polyglycolide and polylactide copolymer as compared to used alone in the treatment of Grade II furcation defects.

Demineralized freeze-dried bone allograft with or without platelet-rich fibrin in the treatment of mandibular Degree II furcation defects: A clinical and cone beam computed tomography study.

Background:Currently, there is no gold-standard regenerative material for the treatment of furcation defects. The use of bone grafts in combination with guided tissue regeneration membrane is a predictable treatment option but is expensive. Platelet concentrates are increasingly being used owing to their ease of use and cost-effectiveness.Aims:The aim of this study is to evaluate the ability of platelet-rich fibrin (PRF) to augment the regenerative effects exerted by demineralized freeze-dried bone allograft (DFDBA) in the treatment of mandibular degree II furcation defects.Materials and Methods:Twenty-eight defects in 14 patients with bilateral Degree II mandibular furcation defects were included in the study. The test group was treated with a combination of DFDBA and PRF, while in the control group DFDBA was used alone. Clinical parameters such as probing depth, relative vertical clinical attachment level, relative horizontal clinical attachment level (RHCAL), gingival margin level (GML), plaque index, and sulcus bleeding index were measured at baseline and 6 months. Radiographic parameters, such as vertical defect depth, horizontal defect depth and defect fill, were measured using cone beam computed tomography, taken at baseline and 6 months.Statistical Analysis Used:The intragroup and intergroup comparisons were done using the paired t-test.Results:The intergroup comparison of mean change in the parameters showed, statistically significant difference in RHCAL (<0.001) and GML (0.014), and no significant difference in other parameters.Conclusions:Within the limitations of the present study, PRF seems to favor soft-tissue healing but has no additional benefit in bone regeneration when used in combination with DFDBA.

A Randomized Controlled Clinical Study of Autologous Platelet Rich Fibrin (PRF) in Combination with HA and Beta-TCP or HA and Beta-TCP Alone for Treatment of Furcation Defects

A Randomized Controlled Clinical Study of Autologous Platelet Rich Fibrin (PRF) in Combination with HA and Beta-TCP or HA and Beta-TCP Alone for Treatment of Furcation Defects

Immunohistopathologic evaluation of Drynaria fortunei rhizome extract in the management of Class II furcation defects in a canine model.

Management of furcation defects is still a challenging subject in periodontal therapy. Drynaria fortunei (Df) is a common type of traditional Chinese herb in the area of orthopedics and traumatology. In vitro and tissue engineering studies have shown that Df induces osteoblastic proliferation and promotes the differentiation of human periodontal ligament cells. This study investigated the management of Class II furcation defects in dogs using guided tissue regeneration (GTR) and Df granules mixed with β-tricalcium phosphate (β- TCP) alloplast. Sixteen Class II critical-sized furcation defects were surgically created in four mongrel dogs: Eight defects were treated with GTR and Df granules mixed with (β-TCP) alloplast served as the experimental group, while the other eight were managed with GTR and alloplast, served as control. Dogs were sacrificed at 4 and 8weeks and the premolars were processed for the evaluation of treatment outcome including; osteoblastic count (OC), cementum layer thickness (CLT), percentage of collagen in bone matrix (CBM), and alkaline phosphatase (ALP) immunoreaction. Experimental group treated with Df showed a significant increase (P<0.001) in the values of OC, CLT, CBM, and ALP immunoreactivity when compared with control at 4 and 8weeks after treatment. Drynaria fortunei demonstrated increased regeneration and bone formation when used in the treatment of furcation defects in a canine model.

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.

Rosuvastatin 1.2 mg In Situ Gel Combined With 1:1 Mixture of Autologous Platelet-Rich Fibrin and Porous Hydroxyapatite Bone Graft in Surgical Treatment of Mandibular Class II Furcation Defects: A Randomized Clinical Control Trial.

A wide range of regenerative materials have been tried and tested in the treatment of furcation defects. Rosuvastatin (RSV) is a new synthetic, second-generation, sulfur-containing, hydrophilic statin with potent anti-inflammatory and osseodifferentiation mechanisms of action. Platelet-rich fibrin (PRF) is a platelet concentrate having sustained release of various growth factors with regenerative potential to treat periodontal defects. Porous hydroxyapatite (HA) bone grafting material has a clinically satisfactory response when used to fill periodontal intrabony defects. This double-masked randomized study is designed to evaluate the potency of a combination of 1.2 mg RSV in situ gel with a 1:1 mixture of autologous PRF and HA bone graft in the surgical treatment of mandibular Class II furcation defects compared with autologous PRF and HA bone graft placed after open-flap debridement (OFD). One hundred five mandibular furcation defects were treated with OFD + placebo gel (group 1), PRF + HA with OFD (group 2), or 1.2 mg RSV gel + PRF + HA with OFD (group 3). Clinical and radiologic parameters (i.e., probing depth [PD], relative vertical and relative horizontal clinical attachment level [rvCAL and rhCAL], intrabony defect depth, and percentage of defect fill) were recorded at baseline and 9 months postoperatively. Mean PD reduction was greater in group 2 (3.68 ± 1.07 mm) and group 3 (4.62 ± 1.03 mm) than group 1 (2.11 ± 1.25 mm), and mean rvCAL and rhCAL gain were greater in group 2 (3.31 ± 0.52 and 2.97 ± 0.56 mm, respectively) and group 3 (4.17 ± 0.70 and 4.05 ± 0.76 mm) compared with group 1 (1.82 ± 0.78 and 1.62 ± 0.64 mm). A significantly greater percentage of mean bone fill was found in group 2 (54.69% ± 1.93%) and group 3 (61.94% ± 3.54%) compared with group 1 (10.09% ± 4.28%). Treatment of furcation defects with 1.2 mg RSV in situ gel combined with autologous PRF and porous HA bone graft results in significant improvements of clinical and radiographic parameters compared with OFD alone. These results imply that the combination of RSV, PRF, and HA has synergistic effects, explaining their role as a regenerative material in the treatment of furcation defects.

Hemisection: A conservative approach of tooth preservation

Progressive inflammatory periodontal disease, if left untreated, it will ultimately result in attachment loss. This can affect the bifurcation or trifurcation of multirooted teeth. Dentists are challenged to save those teeth that earlier would have been extracted without a second thought to save it. Hence, resective therapy has been utilized in the treatment of furcation defects. Hemisection is a removal of compromised root and the associated crown portion. It is one of the treatment options for preserving remaining part of molar having sound periodontium. This case report presents a patient in whom distal half of the carious and periodontally compromised tooth was resected, and after healing, fixed dental prosthesis was given to restore proper form and function.

Regenerative Approaches in the Treatment of Furcation Lesions are Predictable in Class II Maxillary Facial or Interproximal and Mandibular Facial or Lingual Class II Furcation Defects

Article Title and Bibliographic Information Periodontal regeneration – furcation defects: a systematic review from the AAP regeneration workshop. Avila-Ortiz G, De Buitrago JG, Reddy MS.J Periodontol. 2015;86(2 Suppl):S108-30. Reviewers Fernanda Vieira Ribeiro, DDS, MS, PhD, Professor, Marcio Zaffalon Casati, DDS, MS, PhD, Professor Purpose/Question The authors conducted a systematic review of clinical studies on the effectiveness of various regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy. Source of Funding As described by the authors, Dr. Avila-Ortiz has received research funding from Osteogenics Biomedical (Lubbock, Texas), Geistlich Pharma (Wolhusen, Switzerland), DENTSPLY (York, Pennsylvania), and BioHorizons (Birmingham, Alabama) and lecture honoraria from Laboratorios INIBSA (Barcelona, Spain). Dr. Reddy has received grant support and other funding through his institution, the University of Alabama at Birmingham; from BioDLogics (Memphis, Tennessee), Biomet 3i (Palm Beach Gardens, Florida), Procter & Gamble (Cincinnati, Ohio), Institute Straumann (Basel, Switzerland), Sunstar Americas (Chicago, Illinois), Zimmer Dental (Carlsbad, California), BioHorizons, National Institutes of Health, and National Institute of Dental and Craniofacial Research. Dr. De Buitrago reports no conflicts of interest related to this review. The 2014 Regeneration Workshop was hosted by the American Academy of Periodontology (AAP) and supported in part by the AAP Foundation, Geistlich Pharma North America, Colgate-Palmolive, and the Osteology Foundation. Type of Study/Design Systematic review Level of Evidence Level 2: Limited quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent or limited quality patient-oriented evidence

Periodontal Regeneration — Furcation Defects: Practical Applications From the AAP Regeneration Workshop

Focused Clinical Question: How should periodontal furcation defects be managed via periodontal regenerative therapy, and what parameters should be used for treatment selection? Summary: The treatment of furcation defects can vary based on the type and location of the furcation involvement. Attaining predictable regenerative outcomes is dependent on the control of local and systemic factors. A combined treatment approach (barrier and bone replacement graft with or without biologic) generally offers the better therapeutic outcome over monotherapy. Class I furcation defects can be managed via conventional periodontal non-surgical and/or surgical therapy, whereas Class II furcation defects generally attain better outcomes with regenerative therapy. There is weak evidence, limited to case reports, that Class III furcation defects can be treated successfully with regenerative therapy. Conclusions: In Class I furcation defects, regenerative therapy might be beneficial in certain clinical scenarios, although most Class I furcation defects can be treated successfully with non-regenerative therapy. For successful treatment of maxillary and mandibular molars with Class II furcation defects, systemic and local factors should be controlled, and surgical debridement and postoperative maintenance should be performed adequately. Although there is limited evidence for regeneration of Class III furcation defects, there may be a modest improvement allowing for tooth retention. Ultimately, the benefit of tooth retention and cost should be considered in the indication of therapy for teeth with severe furcation involvement.

Periodontal regeneration - furcation defects: a systematic review from the AAP Regeneration Workshop.

The aim of this review is to present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy to provide clinical guidelines for the therapeutic management of furcation defects and to identify priorities for future research that may advance the understanding of periodontal regenerative medicine. A comprehensive search based on predetermined eligibility criteria was conducted to identify human original studies and systematic reviews on the topic of periodontal regeneration of furcation defects. Two reviewers independently screened the title and abstract of the entries yielded from the initial search. Subsequently, both reviewers read the full-text version of potentially eligible studies, made a final article selection, and extracted the data of the selected studies considering specific clinical scenarios. The clinical scenarios contemplated in this review included the following: 1) facial and interproximal Class I defects in maxillary molars; 2) facial and lingual Class I defects in mandibular molars; 3) facial and interproximal Class II furcation defects in maxillary molars; 4) facial and lingual Class II furcation defects in mandibular molars; 5) Class III furcation defects in maxillary molars; 6) Class III furcation defects in mandibular molars; and 7) Class I, II, or III furcation defects in maxillary premolars. Endpoints of interest included different clinical, radiographic, microbiologic, histologic, and patient-reported outcomes. The initial search yielded a total of 1,500 entries. The final selection consisted of 150 articles, of which six were systematic reviews, 109 were clinical trials, 27 were case series, and eight were case reports. A summary of the main findings of previously published systematic reviews and the available evidence relative to the indication of regenerative approaches for the treatment of furcation defects compared with conventional surgical therapy are presented. Given the marked methodologic heterogeneity and the wide variety of materials and techniques applied in the selected clinical trials, the conduction of a meta-analysis was not viable. On the basis of the reviewed evidence, the following conclusions can be drawn. 1) Periodontal regeneration has been demonstrated histologically and clinically for the treatment of maxillary facial or interproximal and mandibular facial or lingual Class II furcation defects. 2) Although periodontal regeneration has been demonstrated histologically for the treatment of mandibular Class III defects, the evidence is limited to one case report. 3) Evidence supporting regenerative therapy in maxillary Class III furcation defects in maxillary molars is limited to clinical case reports. 4) In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although most Class I furcation defects may be successfully treated with non-regenerative therapy. 5) Future research efforts should be primarily directed toward the conduction of clinical trials to test novel regenerative approaches that place emphasis primarily on patient-reported outcomes and also on histologic demonstration of periodontal regeneration. Investigators should also focus on understanding the influence that local, systemic, and technical factors may have on the outcomes of regenerative therapy in furcation defects.

Clinical and radiographic evaluation of Bio-Gen with biocollagen compared with Bio-Gen with connective tissue in the treatment of class II furcation defects: a randomized clinical trial

ObjectiveTreatment of furcation defects are thought to be challenging. The purpose of this study was to evaluate the clinical and radiographic parameters of Bio-Gen with Biocollagen compared with Bio-Gen with connective tissue in the treatment of Class II furcation defects.Material and MethodsIn this clinical trial, 24 patients with Class II furcation defect on a buccal or lingual mandibular molar were recruited. After oral hygiene instruction, scaling and root planing and achievement of acceptable plaque control, the patients were randomly chosen to receive either connective tissue and Bio-Gen (case group) or Biocollagen and Bio-Gen (control group). The following parameters were recorded before the first and re-entry surgery (six months later): vertical clinical attachment level (VCAL), gingival index (GI), plaque index (PI), horizontal probing depth (HPD), vertical probing depth (VPD), gingival recession (GR), furcation vertical component (FVC), furcation to alveolar crest (FAC), fornix to base of defect (FBD), and furcation horizontal component (FHC) were calculated at the time of first surgery and during re-entry. A digital periapical radiograph was taken in parallel before first surgery and re-entry. The radiographs were then analyzed by digital subtraction. The differences with p value <0.05 were considered significant.ResultsOnly the mean changes of FAC, FHC, mean of FHC, FBD in re-entry revealed statistically significant differences between the two groups. HPD, VPD, FBD, FAC, and FHC showed statistically significant differences after 6 months in the case group. However, in the control group, statistically significant differences were found in GR and HPD. We did not observe any significant difference in radiographic changes among the two groups. ConclusionThe results of this trial indicate that better clinical outcomes can be obtained with connective tissue grafts in combination with bone material compared with a resorbable barrier with bone material. The differences in radiographic changes between the two groups, however, were not statistically significant.