The effect of operator experience level and root surface access on instrumentation of multirooted teeth was investigated. Fifty molars designated for extraction were randomly distributed among four operators of two different experience levels for scaling and root planing with or without surgical access. Following treatment the teeth were extracted and scored in a blind manner for residual calculus. Teeth were sectioned to allow assessment of the furcal aspects. Results show that operators of both experience levels obtained calculus-free root surfaces significantly more often with flap access than with a non-surgical approach. Additionally, operators with more experience achieved calculus-free root surfaces significantly more often than operators of lesser experience with both an open and closed procedure. However, when furcation aspects alone were assessed, it was found that the more experienced operators obtained a calculus-free surface only 68% of the time with an open approach. Results suggest that, although both surgical access and a more experienced operator significantly enhance calculus removal in molars with furcation invasion, total calculus removal in furcations utilizing conventional instrumentation may be limited.

Studies have shown partial to complete root coverage of denuded root surfaces with the use of thick free gingival autografts (FGGs) or subepithelial connective tissue autografts (CTGs). The purpose of this study was to determine which technique would result in more predictable root coverage of Miller Class I and II marginal tissue recession defects. Paired defects in 10 patients were randomly selected for treatment with either the FGG or the CTG. With stents as reference points, soft tissue recession was measured with a calibrated probe presurgically and 3 and 6 months postsurgically. No significant differences between paired sites in presurgical defect dimensions were found. One patient was dropped from the study for noncompliance with postoperative instructions. The mean percentage of root coverage for the CTG 3 and 6 months postsurgery for the remaining 9 patients was 78% and 80%, respectively. The mean percentage of root coverage for the FGG was 43% at both periods. The difference in root coverage between the 2 techniques was significant (P < 0.03). Complete root coverage was gained in 5 of 9 CTGs but only in one of 9 FGGs. Both techniques resulted in a significant improvement in keratinized tissue and probing attachment level, with most of the changes having occurred during the first three months postoperatively. Results suggest that the CTG may provide a greater percentage of root coverage than the FGG and that both techniques will effectively increase the width of keratinized tissue.

The purpose of this study is to evaluate the potential of decalcified freeze-dried bone allograft (DFDBA) combined with a barrier material in the treatment of human molar furcation defects (experimental) as compared to the barrier technique alone (control). Fifteen pairs of Class II or III furcation invasion defects comprised the study group. Measurements with calibrated periodontal probes were made to determine soft tissue recession, probing depth, and attachment levels. Defects from each pair were randomly selected to be treated with an expanded polytetrafluoroethylene membrane (e-PTFE) and DFDBA or the membrane alone. Additional measurements were made during surgery to determine crestal resorption, and vertical and horizontal open probing attachment. The membrane was removed 4 to 6 weeks post-insertion. Six months post-treatment, each site was surgically reentered and measurements repeated. Following either treatment, recession was minimal with statistically significant improvement in probing depth reduction and clinical attachment level gain favoring the combined technique. Hard tissue changes were comparable for alveolar crestal resorption, however, there was a distinct difference, statistically, for both horizontal and vertical bone repair favoring the use of the demineralized bone graft in combination with the e-PTFE membrane.

This investigation assessed and compared the clinical efficacy of combined open flap debridement/occlusive membrane therapy versus open flap debridement therapy alone, in the treatment of maxillary periodontal furcation defects. Seventeen patients presenting with advanced adult periodontitis, including at least one pair of Class II maxillary furcal defects, comprised the study group. Following completion of a hygienic phase of treatment, measurements were made with calibrated periodontal probes to determine soft tissue recession, probing pocket depths, and attachment levels. Each pair of furcation defects was surgically exposed and hard tissue measurements obtained. Defects were treated with either open flap debridement and a polytetrafluoroethylene periodontal membrane or open flap debridement alone. Membranes were removed at 4 to 6 weeks. Six months postsurgery, soft tissue measurements were repeated and all sites were surgically re-entered to obtain hard tissue measurements. No statistically significant differences were found in recession, probing depth reductions, clinical attachment gains, or resorption of alveolar crest height between test and control groups. Results for these parameters were inconsistent and unpredictable. Statistically significant improvements were found, however, in horizontal open probing attachment (HOPA) and vertical open probing attachment (VOPA) between experimental and control sites. The GTR procedure as used in this study likely has limited application as a therapeutic modality for Class II furcations of maxillary molars. Modifications or improvements in the procedure may result in more predictable healing of these lesions.

This study was conducted to clinically compare freeze-dried bone allograft (FDBA) and demineralized freeze-dried bone allograft (DFDBA). Twenty-two defects (11 intrapatient pairs) in 9 patients were grafted with either DFDBA or FDBA. Evaluations were based on standardized radiographs, presurgical and postsurgical soft tissue measurements using the cemento-enamel junction as a fixed reference point, and osseous measurements at the time of surgery. Grafted sites were re-entered at a minimum of 6 months following placement. A mean osseous repair of 1.7 mm (59%) occurred with DFDBA and 2.4 mm (66%) with FDBA. A mean clinical attachment gain of 1.7 mm was obtained with DFDBA and 2.0 mm with FDBA. Probing depths decreased a mean of 2.00 mm with both DFDBA and FDBA. These findings reveal no significant differences between the two materials in primarily intraosseous defects when evaluated at a minimum 6 months postsurgery.