Furcation Treatment Research Articles

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).

Data on the effect of sub-epithelial connective tissue graft with hydroxyl-apatite for furcation treatment in Indians.

Grade II furcation defect has a great potential for regeneration. Attempts have been made to regenerate lost periodontium in furcation defects through variety of approaches. A total of 22 patients with Grade II furcation defect were examined. The patients were sequentially grouped into three groups namely, (Group A) subepithelial connective tissue graft as a barrier membrane, (Group B) bovine bone graft material Bio-OssTM and (Group C) with the combination of the two. The treatment modalities show that there was a strong improvement in the resolution of the grade II furcation defects. The reduction in horizontal furcation defect measurement was 20.63% for group A. The change was found to be moderate (p=0.023*). The % change is 20.97% for group B and it is statistically significance (p = 0.001**). The % change was 20.78% in Group C with a good statistical significance (p=0.003**). Complete obliteration of the defect clinically and radio-graphically was observed for grade II furcation defect. Thus, the effect of sub-epithelial connective tissue graft with hydroxyl-apatite for furcation treatment in Indians is documented in this report.

The efficiency of using enamel matrix derivative in therapeutic approach of periodontal furcation defects of maxillary and mandibular molars.

Periodontal disease is an inflammatory condition which affects the covering and support structures of the teeth and, if left untreated, leads to tooth loss. Resorption of the alveolar bone from bi- and trifurcation regions of a multirooted tooth due to the progression of a periodontal disease bears involvement furcation. The degree of furcation involvement is clinically assessed by changes in the vertical and horizontal plane at the root separation area. In the approach of the furcation treatment, the morphological and functional particularities of pluriradicular teeth must be considered and the current techniques look for solutions for the regeneration of the destroyed periodontal tissues. Enamel matrix derivative (EMD) has the role of stimulating healing processes through effects on various growth factors, cement formation, angiogenesis and are used single or in combination with bone graft substitute (BGS) or guided tissue regeneration (GTR) in the complex treatment of periodontal disease. The present study follows PubMed publications on the efficiency of EMD in the treatment of pluriradicular tooth furcations. The findings are that there are not many studies in the usage of EMD associated with the treatment of furcations, but it is an important choice in the complex treatment of destructive periodontal disease, and further studies are needed to be done in periodontal regeneration.

The Application of an Enamel Matrix Protein Derivative (Emdogain) in Furcations: A Review of Literature

Periodontal disease results in the loss of the attachment apparatus. The search for techniques and products to encourage the regeneration of this tissue has received more attention over the past three decades. The results from basic research have shown that although there are not many studies on the use of EMD in the treatment of furcations, it is an essential option in the difficult management of furcations, and more research in periodontal regeneration is required. This paper aims to evaluate the effect of enamel matrix derivative (EMD) in the treatment of furcations.

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.

Autologous PRF in Degree II Furcation Treatment: A Clinicoradiographic Study Using Dentascan

Autologous PRF in Degree II Furcation Treatment: A Clinicoradiographic Study Using Dentascan

Effect of Autologous Platelet Rich Fibrin in Human Mandibular Molar Grade II Furcation Defects- A Randomized Clinical Trial.

The Furcation of multirooted teeth is difficult region to gain access for treatment due to their complex anatomy. Modifications have been made in the periodontal instrument armamentarium to facilitate treatment of furcations. Moreover, many new materials have been introduced to attempt regeneration in the furcation defects. This study evaluated the role of Platelet Rich Fibrin (PRF) in comparison with allograft and Guided Tissue Regeneration (GTR) in the treatment of Grade II mandibular molar furcations. This was a parallel arm prospective randomized, interventional trial (NCT 02430519) conducted on 22 patients, with Grade II mandibular furcation defects. Patients were divided into two equal groups. Group A, were treated by the placement of PRF as a graft and as a membrane while in Group B, the defects were treated by the placement of allograft and Healiguide collagen membrane. Clinical parameters {Plaque Index (PI), Probing Depth (PD), Relative Vertical Clinical Attachment Level (RVCAL), Relative Horizontal Clinical Attachment Level (RHCAL), Gingival Marginal Level(GML), and amount of Bonefill using Radio-Visiography (RVGBF)}, were estimated at baseline and nine months postoperatively. Comparison between the groups was analysed by using independent sample t-test, whereas, paired t-test was used to assess the mean values within the groups. The intergroup comparison for PI, PD, RHCAL, GML, was statistically not significant. Pertaining to RVCAL, there was a statistically significant difference at nine months (p-value=0.04) in Group A. Also, there was a statistically significant difference related to RVGBF (p-value=0.006) in Group A at nine months. The efficacy of PRF should be ascertained by conducting more studies with a larger sample size, on a long term basis, in patients with molar Grade II furcation defects.

Clinical Efficacy of Growth Factors to Enhance Tissue Repair in Oral and Maxillofacial Reconstruction: A Systematic Review

Provide a comprehensive overview on the clinical use and the efficacy of growth factors in different reconstructive procedures in the oral maxillofacial area. A systematic review of the literature on the clinical use of human and human recombinant growth factors in oral maxillofacial reconstruction has been performed. The use of autogenous growth factors in platelet concentrates (PCs) has shown to be beneficial in the treatment of intrabony pockets at a reasonable level of evidence by improving probing depth and clinical attachment levels as well as linear bone fill within the limits of the observation periods. The application in conjunction with non-autogenous graft materials has been superior to the use of PCs only or grafting materials alone. No benefits have been shown for the use of PCs in recession treatment. When used in furcation treatment, probing depth, clinical attachment level and linear bone fill have been reported to improve significantly, however, without clinical benefit. No benefit for the final outcome could be shown for the use of PCs neither in sinus lift procedures nor in lateral / vertical crest augmentations. The use of human recombinant growth factors has been so far limited almost exclusively to rhPDGF-BB and rhBMPs (BMP-2, BMP-7 and GDF-5). The use of rhPDGF in the treatment of intrabony pockets has shown a reliable increase in linear bone fill but weaker evidence for permanent improvements of clinical attachment level. So far there is no evidence to support the use in recession treatment, sinus lift procedures and socket healing as well as lateral / vertical augmentations of the alveolar crest. rhBMPs have shown to be effective in enhancing bone formation in socket healing (rhBMP-2) and sinus lift procedures (rhBMP-2 and GDF-5). No controlled studies are available for the use in mandibular segmental repair. Successful reports on this application appear to be limited to primary reconstruction after ablative surgery for benign pathology with preservation of the periosteum. Evidence of clinical efficacy of growth factors in reconstructive procedures in the oral and maxillofacial area is limited.

The perio-esthetic-restorative approach for anterior rehabilitation

Ensuring clinical success begins with a careful discussion of treatment planning, comprehensively covering all variables in simple to complex cases. Procedures including the crown lengthening surgery, furcation treatment and mucogingival therapy and tooth restoration are essential treatment regimens requiring multifaceted expertise. The interplay of periodontics and restorative dentistry is present at many fronts including the response of the gingival tissue to the restorative preparations. Dental restorations and periodontal health are inseparably interrelated. The adaptation of the margins, the contours of the restoration, the proximal relationships and the surface smoothness have a critical biological impact on the gingiva and the supporting periodontal tissues. The different surgical procedures used for crown lengthening are gingivectomy/gingivoplasty, apically positioned flap with or without osseous resection and orthodontic extrusion. The paper presents crown lengthening of severely mutilated teeth to increase the clinical crown height for adequate restoration.

Management of periodontal furcation defects employing molar bisection; a case report with review of the literature

Introduction: The management and long-term retention of molars exhibiting furcation invasion have always been a challenge in dentistry. Latest innovations in dental sciences and higher patient's expectations have led to more conservative treatment approaches in saving the teeth with hopeless periodontal prognosis. When periodontal disease affects the furcation area of tooth, the chance of its exfoliation increase considerably. Here, authors have sought to discuss a comprehensive review of literature with case report for the management of decayed mandibular first molars (with furcation invasion) using bicuspidization procedure. Case Report: The furcation defect (in mandibular first molars) was clinically detected in a middle aged male, which was converted into two bicuspids by intentional bisection procedures. The definitive treatment included restoration with double crowns. Bicuspidization procedure with double metal crowns truly yielded a satisfactory result. Discussion: The treatment of furcations affected by periodontal disease is one of the most difficult problems for the general dentist and periodontist. An increase in the exposed root surface, anatomical peculiarities and irregularities of the furcation surface all favor the growth of bacteria. These problems make it harder for the patient to maintain hygiene, and impede adequate treatment. Bisection/bicuspidization of the decayed molars can be a practicable treatment option when there is vertical bone loss involving root/roots with furcation defect. In real terms, it is the separation of mesial and distal roots of mandibular molars along with its crown portion, where both segments are then retained individually.

Is Platelet Concentrate Advantageous for the Surgical Treatment of Periodontal Diseases? A Systematic Review and Meta‐Analysis

The aim of the present review is to systematically evaluate the effects of autogenous platelet concentrates on clinical outcomes of the surgical treatment of periodontal diseases. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched using a combination of specific search terms. Furthermore, a hand search of relevant journals and bibliographies of reviews was performed. Only randomized clinical trials were included. For periodontal intrabony defects, the primary outcome variable was the clinical attachment level. For gingival recession, outcome variables were root coverage and keratinized tissue increase. Data were adjusted for baseline values. The methodologic quality of the included studies was assessed. The results of studies in which the only difference between test and control groups was the adjunct of platelet concentrates were aggregated using a meta-analysis. For intrabony defects, the influences of guided tissue regeneration (GTR) and study type (split-mouth versus parallel studies) were also evaluated. The initial search yielded 424 studies. Of the 29 eligible studies, 24 studies were included. There were 16 studies on the treatment of periodontal intrabony defects, all of which used platelet-rich plasma (PRP); six studies on gingival recession treatment; and two studies on the treatment of furcation defects. A significant positive effect of the adjunct of PRP was found for intrabony defects. Such an effect was magnified in studies in which GTR was not used, whereas in studies using GTR, the use of PRP had no adjunctive effect. No effect of the study type was found. No significant effect of platelet concentrates was found for gingival recession treatment in which only studies with a follow-up ≤6 months displayed positive results. No significant benefit of PRP could be demonstrated for furcation treatment. PRP may exert a positive adjunctive effect when used in combination with graft materials, but not with GTR, for the treatment of intrabony defects. No significant benefit of platelet concentrates was found for the treatment of gingival recession.

Periodontal disease affecting tooth furcations. A review of the treatments available

The molars are the teeth that suffer the greatest periodontal destruction in untreated patients. When periodontal disease affects the furcation of a tooth, the chance that it will be lost increases considerably. An increase in the exposed root surface, anatomical peculiarities and irregularities of the furcation surface all favor the growth of bacteria. These problems make it harder for the patient to maintain hygiene, and impede adequate treatment. The treatment of furcations affected by periodontal disease is one of the most difficult problems for the general dentist and periodontist. The motivation of both the attending professional and of the patient are therefore of great importance. No ideal procedure for treating such lesions exists. The present paper reviews those options that are currently available. Long-term research will be needed, along with the development of new techniques, to solve the problem of furcations affected by periodontal disease, possibly including substitution of the affected tooth by an implant.

Nd:YAG laser clinical assisted in class II furcation treatment

The Nd:YAG laser efficacy associated with conventional treatment for bacterial reduction has been investigated throughout literature. The purpose of this study was to evaluate the bacterial reduction after Nd:YAG laser irradiation associated with scaling and root planning in class II furcation defects in patients with chronic periodontitis. Thirty-four furcation lesions were selected from 17 subjects. The control group received conventional treatment, and the experimental group received the same treatment followed by Nd:YAG laser irradiation (100 mJ/pulse; 15 Hz; 1.5 W, 60 s, 141.5 J/cm(2)). Both treatments resulted in improvements of most clinical parameters. A significant reduction of colony forming unit (CFU) of total bacteria number was observed in both groups. The highest reduction was noted in the experimental group immediately after the treatment. The number of dark pigmented bacteria and the percentage of patients with Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans reduced immediately after the treatment and returned to values close to the initial ones 6 weeks after the baseline for both groups. The Nd:YAG laser associated with conventional treatment promoted significant bacterial reduction in class II furcation immediately after irradiation, although this reduction was not observed 6 weeks after the baseline.

Considerations for furcation treatment. Part III: Restorative therapy

Considerations for furcation treatment. Part III: Restorative therapy

Considerations for furcation treatment. Part II: Periodontal therapy

Considerations for furcation treatment. Part II: Periodontal therapy

Considerations for furcation treatment Part I: Diagnosis and treatment planning

Considerations for furcation treatment Part I: Diagnosis and treatment planning