Furcation Involvement & Its Treatment: A Review. Article (PDF Available) in Journal of Advanced Medical and Dental Sciences Research. Shikai Tenbo. ;51(3) [Furcation involvement and its management]. [ Article in Japanese]. Hasegawa K, Miyashita H, Kinoshita S. PMID: The management of furcation involvement presents one of the greatest . The membrane was soaked in normal saline solution to improve its adhesion.
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Department of Periodontology and Oral Implantology, I. A total of eight patients, four females and four males, in the age group of 18 to 65 years, with bilateral buccal grade II furcation defects invopvement the mandibular molars, participated in the study. The following clinical measurements were recorded at baseline as well as three and six months post surgery: Pairwise comparisons within the groups were frucation by applying the independent student t test.
Comparisons were also drawn between the test and the control groups by innvolvement the independent student t test. The mean gain in the relative clinical attachment levels in the test and control groups, at the end of six months, were 2. The mean change in the horizontal probing depth values at the end of six months in the test and control groups were 2. The mean reduction janagement the vertical probing depth values in the test and control groups were 1.
The resorbable GTR membrane with bone material was more effective than open debridement alone, in the treatment of furcation defects. The management of furcation involvement presents one of the greatest challenges in periodontal therapy.
Furcation-involved molar teeth respond less favorably to conventional periodontal therapy, and molars are lost more often than any other tooth type.
Among the factors that make molars particularly susceptible to periodontal disease include accumulation of bacterial plaque, as a result of difficult access to oral hygiene procedures. Access to the furcation areas is further complicated by the posterior location of the molars, the disparity between root and furcation anatomies, and the shape and dimension of the debriding instruments.
Roughly over the past 10 years, the outcomes have changed in part because of the furcatuon knowledge about the furcatoon process and wound healing, and in part because of the availability of new materials. These materials have been shown to be osteoconductive, that is, they can promote the growth of bone into areas that they would not normally occupy.
Regeneration by grafting may be further enhanced by the use of barrier membranes that exclude gingival fibroblasts and epithelium from the healing site. It has also been shown that the guided tissue regeneration procedure, using membranes, holds promise for increasing the success of bone grafting. Therefore, it was postulated that combining osseous grafting with guided tissue regeneration may enhance the response to membrane-only therapy, with bone restoration via the conductive effects of the graft, and supporting the membrane to a more optimal position in selective sites.
With the premise of possible synergism of combining osseous grafting and barrier membrane placement, management of grade II furcation defects via a combination therapy was assessed for feasibility and evidence of predictability. A total of eight patients, four females involevment four males, in the age group of 18 – 65 years with bilateral buccal grade II furcation defects in the mandibular molars participated in the study.
The criteria for selection were: The subjects received detailed information regarding their condition and the treatment plan. Oral hygiene instructions were given. After being informed about the aim of the project, a signed consent was taken from the patient. One site in each patient was randomly allocated to the test group and was treated by GTR and Hydroxyapatite bone grafting. The contralateral site was treated using open flap debridement OFD alone. The test and the control sites were chosen with the toss of a coin.
Prior to the anr procedure, thorough scaling and root planing were performed. The subjects were recalled after four to six weeks for surgery. This was carried out at the baseline and at six months postoperatively. Two occlusal stents, one of clear resin and the other of pink auto polymerizing resin were fabricated by the sprinkle-on method for both the test and control sites.
Four to six weeks after scaling and annd planing and just prior to the surgical procedure, each subject was re-examined and baseline data were recorded.
[Furcation involvement and its management].
The granulation tissue was removed in the furcation defect and thorough debridement was carried it with curettes and an ultrasonic scaler, to ensure a clean site for incorporation of the bone graft material and membrane. The appropriate amount of the bone graft was taken managemwnt a container and transferred to a sterilized dappendish, to which a few drops of saline were added. The contents were then mixed with the blunt instrument and transferred to the defect with a plastic filling instrument and condensed.
Before placing the membrane at the test site, a sterile surgical template was applied and approximated for extensions and trimmed accordingly. After the defect was filled with the bone graft [ Figure 9 ], the membrane was removed from the sterile package and was compared with the surgical template and reduced to qnd template dimensions. The membrane was soaked in normal saline solution to improve its adhesion properties as recommended by the manufacturer.
It was subsequently adapted over the defect extending 2 – 3 mm apical to the crest of the existing bone, so as to provide a broad base during the placement. The coronal portion of the membrane was tightly secured to ihs cementoenamel junction CEJ of the tooth, with chromic catgut sutures [ Figure 10 ]. The patients were seen at the end of the first week when the sutures were removed and were instructed to use 10 ml of 0. They were asked not to brush their teeth in the surgical area for a period of three weeks.
All the eight subjects completed the study. No adverse event of any kind occurred during the course of the study. Membrane exposure was not seen in any of the cases. The mean change in the gingival scores for both the test and the control groups were 1. The mean changes in the plaque scores for both the test and the control groups were 2. The mean gain in the relative clinical attachment levels in the test ita control groups at the end of six months were 2. The mean reduction in vertical probing depth values in the test and control groups were 1.
The mean change in horizontal probing depth values at the end of six months in the test and control groups were 2. The introduction of resorbable membrane materials brings clear advantages in the clinical management of guided tissue regeneration procedures: In this study, selection of mandibular grade II defects was done based managemenf the observation by Sanz and Givannoli,[ 11 ] uts stated that, “placement of a barrier membrane should not be indicated in the treatment involvrment maxillary molars with furcation involvement.
Both vertical and horizontal attachment gains were of the magnitude of within 1 mm, and in none of the cases was the furcation closed or any significant difference between the guided tissue regeneration and open flap debridement seen. All measurements were made using the UNC probe, with the help of a custom-made acrylic stent, which served as a fixed reference point.
Irs theoretical advantage of the stent system was demonstrated in the study by Sivertson and Burgett. The bone graft material and the bioabsorbable collagen membrane used in the study appeared to be biocompatible and safe. Membrane exposure was not observed in any of the cases in the study. This may be explained by the biocompatibility of the collagen membrane and its hemostatic and chemotactic functions. This indirectly promotes better flap adaptation, thus resulting in less membrane exposure.
Furthermore, the chemotactic function of the collagen membrane promotes fibroblast migration that ensures primary wound coverage.
The mean gingival and plaque scores were significantly reduced at the end of three months and six months in both the test and the control groups. Comparison between the groups did not show any statistical difference in the mean gingival and plaque scores at the end of three months and at the end of six months. This demonstrates that the oral hygiene compliance of the subjects in both the groups, over the observation period, was statistically significant.
The mean relative clinical attachment values between the managdment and the control groups at the baseline were not statistically significant. The mean gain in the relative clinical attachment level in the test group was statistically significant at the end of three months and also at the end of six months. On the other hand, the mean gain in clinical attachment in the control group was not statistically significant at the end of either three or six months.
The mean gain in the relative attachment levels in test group at the end of six months was 2. Houser et al [ 15 ] showed a mean difference of 2.
However, Lekovic et al [ 16 ] demonstrated that the use of the bone graft did not enhance the effect of the membrane with respect to the level of clinical attachment in furcation defects. The mean vertical probing depth values at the mid furcation area between the test and control groups at the baseline were not statistically significant.
Between the two groups, the mean reduction in the vertical probing depth in the test group was 1.
[Furcation involvement and its management].
This was less favorable than the conclusion from the systematic review reported by Murphy and Gunsolley,[ 17 ] which showed that GTR had more reduction in vertical invokvement depth compared to the Open Flap Debridement OFD controls.
However, the vertical probing depth data obtained in this study was in agreement with the studies of Onvolvement et al ,[ 18 ] Couri et al,[ 19 ] Cury et al [ 20 ] and Tsao et al ,[ 21 ihs which demonstrated that the changes in the vertical probing depth at the furcation sites between the baseline and six months were not statistically significant in all the groups. The primary response variable in the treatment of furcation defects is the attachment level in the horizontal direction.
Both the treatment modalities resulted in the reduction of horizontal probing depth values. These results were in agreement with Lekovic et al [ 16 ] and Anderegg et al. These changes reflect reduction of the horizontal inter-radicular probe penetration.
The reason for this effect can either be the formation of new connective tissue attachment or of a long junctional epithelium between the root surfaces and the newly formed dense soft tissues. A radiographic examination revealed that no complete furcation closure was achieved in any of the defect sites.
However, reduction in the mean horizontal probing depth suggested a considerable change from grade II to grade I in all of the defects studied.
Quantitative radiographic evaluation was not undertaken in the present study; however, comparisons between the initial and six-month postoperative radiographs revealed better radiographic bone level improvement in the GTR group, in which an increased radio-opacity around the furcation area appeared as a pattern, at the six-month postoperative evaluation.
Furcation involvement is probably the most difficult type of defect to standardize. Along with the variables associated with the osseous defect itself, aspects associated with the tooth, and more specifically with furcation morphology,[ 24 ] obviously play a significant role in the outcome of GTR. National Center for Biotechnology InformationU. J Indian Soc Periodontol.
Deepti KhannaSumit Malhotraand D. Author information Article notes Copyright and License information Disclaimer. Received Oct 14; Accepted Apr This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC.
Open in a separate window. Presurgical vertical measurement at the control site with the stent. Presurgical vertical measurements at the test site with the stent. Presurgical horizontal measurement at the control site with the stent.
Presurgical horizontal measurements at the test site with the stent. Presurgical procedure Prior to the surgical procedure, thorough scaling and root planing were performed. Surgical management Four to six weeks after scaling and root planing and just prior to the surgical procedure, each subject was re-examined and baseline data were recorded.
Six months postsurgical vertical measurements at the control site with the stent. Six months postsurgical horizontal measurements at the test site with the stent.