The Effectiveness of Regenerative Therapy in Achieving Complete Hard Tissue Closure of Mandibular Class II Furcations

Abstract

Mandibular Class II furcation involvement poses a significant challenge for the treatment and prognosis of mandibular molars. Loss of bone due to advancing periodontal disease in the furcation area with its anatomic configuration leads to continual susceptibility to plaque-related inflammation, breakdown, and attachment loss since adequate debridement and maintenance is difficult. Numerous clinical studies demonstrate regenerative therapies can result in improved overall clinical furation measures with a wide range of clinical success, between 37-91%, for furcation closure. Clinical furcation closure is the most important outcome measurement to ensure proper maintenance by the patient and long-term success of therapy. The purpose of this study was to perform a systematic review of human clinical studies of mandibular Class II furcations treated with regenerative procedures to evaluate hard tissue closure of the furcation, horizontal defect fill (HDF). The search protocol was completed using the OVID database with predetermined inclusion and exclusion criteria, which produced 37 articles for analysis. To be included in this study, surgical re-entry outcome measures for mandibular class II furcations at least 6 months following regenerative therapy in humans had to be reported. Regenerative treatment showed a mean percentage horizontal defect furcation fill ranging from 34.3-46.4%, when adjusted for pre-treatment means. A subset of 17 studies reported the frequency of complete furcation closure yielding a range of 35.5-52.8% closure. Post-hoc comparisons for the effect on open horizontal defect depth revealed a significant difference between open flap debridement and regenerative theapy: bone replacement graft (BRG), guided tissue regeration (GTR) or combination therapy. Guided tissue regeneration (GTR) and combination therapy (GTR/BRG) were superior to open flap debridement in obtaining hard tissue fill. The BRG group produced imtermediate horizontal defect fill relative to open flap debridement and the GTR and GTR/BRG groups with no significant difference between BRG and the other two regenerative treatment groups. Regenerative therapies, according to summary statistics, yield improvements approaching 50% horizontal defect fill. Early diagnosis and treatment may most likely increase the probability of clinical closure. More studies are necessary evaluating the impact of biologic agents on the predictability of improved clinical outcome measures and furcation closure.