A clinical comparison of the new attachment obtained by guided tissue regeneration and coronally positioned flap techniques in the management of human molar furcation defects

Abstract

The present clinical trial was designed to evaluate the regenerative potential of the periodontal tissue in Class II furcation defects in mandibular molars using reconstructive surgery based on the guided tissue regeneration (GTR) technique versus the coronally positioned flap (CPF) technique. After the completion of the initial phase of therapy and four to six weeks healing period, 20 furcation-involved molars were examined for baseline data which included plaque index, gingival condition, probing depth (PD), probing attachment level (PA L -V, PAL-H) and radiographs. All parameters were reexamined after three, six and twelve months of healing, except PD, PAL-V and PAL-H which were not measured at three and six months. A nonparametric analysis was used. The study showed that there were no significant differences in the mean baseline measurements between the treatment groups. After 12 months following surgical treatment, both GTR and CPF procedures showed gains in new clinical attachment levels. When comparing parameters between the two surgical procedures, GTR molars showed significantly more improvement in probing depth as well as vertical and horizontal attachment level of the interradicular osseous defect than did the CPF molars (p<0.05). About 80 per cent of the sites treated with the GTR technique showed complete clinical resolution of the furcation problem. CPF therapy reached the same treatment goal in about 50 per cent of the cases which were treated. Guided tissue regeneration appeared to be more effective in promoting regeneration than the coronally positioned flap.Key words: Guided tissue regeneration, coronally positioned flap, periodontal disease/therapy, furcation therapy.(Received for publication December 1996. Revised April, May 1997. Accepted July 1997 A clinical comparison of the new attachment obtained by guided tissue regeneration and coronally positioned flap techniques in the management of human molar f u r c a tion defects

Periodontal Regeneration – Furcation Defects: A Systematic Review From the AAP Regeneration Workshop

“…Thirty‐four articles were excluded after full‐text review (Table 3). 10‐12,16,30‐59 A final selection of 150 articles was made, of which six were systematic reviews, 2,60‐64 109 were clinical trials, 53,65‐172 27 were case series, 173‐199 and eight were case reports 200‐207 . No cohort studies were identified.…”

“…A total of 24 clinical trials 149‐172 and 13 case series 185‐197 were non‐classifiable, as defined in Materials and Methods (Tables 4 and 5). Of the 85 remaining clinical trials, 53,65‐148 eight reported outcomes after applying regenerative therapy on maxillary facial/interproximal Class II furcation defects, 76,87,92,100,105,140,148,208 68 on mandibular facial/lingual Class II furcation defects, 65‐68,70‐72,75,77,78,80‐85,87‐90,93‐99,101‐104,106,107,110‐112,114‐122,124‐139,141‐147 one on maxillary Class III furcation defects, 91 nine on mandibular Class III furcation defects, 69,73,74,77,86,108,109,113,123 and one on maxillary premolars presenting Class I and Class II furcation defects 79 . Of the 14 selected case series, two reported on the treatment of maxillary facial/interproximal Class II furcation defects, 177,180 11 on mandibular facial/lingual Class II furcation defects, 173‐176,178‐184 and two on mandibular Class III furcation defects 198,199 .…”

“…A total of 68 articles reporting clinical trials aimed at assessing the effectiveness of regenerative therapies in the treatment of mandibular facial or lingual Class II furcation defects were identified (see http://www.joponline.org/doi/suppl/10.1902/jop.2015.130677/suppl_file/130677_suptab4.pdf in online Journal of Periodontology ) 65‐68,70‐72,75,77,78,79‐85,87‐90,93‐99,101‐104,106,107,110‐112,114‐122,124‐139,141‐147 . Thirty‐seven studies compared a non‐regenerative surgical intervention consisting of OFD or CPF (control) with at least one regenerative approach (test) 65‐68,70,71,75,77,78,83,85,87,89,93,94,102,103,107,112,118,120‐122,126,128,129,132‐134,137,138,141‐143,145‐147 .…”

“…A total of 68 articles reporting clinical trials aimed at assessing the effectiveness of regenerative therapies in the treatment of mandibular facial or lingual Class II furcation defects were identified (see http://www.joponline.org/doi/suppl/10.1902/jop.2015.130677/suppl_file/130677_suptab4.pdf in online Journal of Periodontology ) 65‐68,70‐72,75,77,78,79‐85,87‐90,93‐99,101‐104,106,107,110‐112,114‐122,124‐139,141‐147 . Thirty‐seven studies compared a non‐regenerative surgical intervention consisting of OFD or CPF (control) with at least one regenerative approach (test) 65‐68,70,71,75,77,78,83,85,87,89,93,94,102,103,107,112,118,120‐122,126,128,129,132‐134,137,138,141‐143,145‐147 . Of these 37 studies, 17 included at least one test group consisting of OFD or CPF plus a barrier membrane alone, 67,68,70,71,78,85,87,89,93,94,107,118,120,122,129,142,145 eight had at least one test group consisting of OFD or CPF + bone graft alone, 65,66,77,103,126,132,133,147 six included at least one test group consisting of OFD or CPF + bone graft in combination with a membrane, 112,129,132,138,143,147 four included at least one test group consisting of OFD or CPF in combination with a bioactive agent alone, 133,135,141,146 and six had at least one test group consisting of OFD or CPF + other regenerative therapies encompassing a variety of grafting materials and chemotherapeutics 75,94,102,121,128,129 .…”

Healing response of apicomarginal defects to two guided tissue regeneration techniques in periradicular surgery: a double‐blind, randomized‐clinical trial

“…(1998), who used free autogenous periosteal grafts for the treatment of furcation involvements and intrabony defects, and observed significant gains in clinical attachment and osseous defect fill. In all these situations the placement of the periosteum in direct contact with the root surface may modify the cellular dynamics of wound healing (Kerdvongbundit et al. 1999).…”