Clinical Evaluation of Guided Tissue Regeneration in the Treatment of Maxillary Class II Molar Furcation Invasions

Abstract

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.

Effect of Early Membrane Removal on Regeneration of Class II Furcation Defects in Dogs

“…The present study evaluated the effect of early ePTFE membrane removal (2 weeks after placement) in the periodontal regeneration of Class II furcation defects in dogs. The results demonstrated that this procedure promoted the formation of new bone, cementum, and periodontal ligament similar to the control group, and the regenerative results of the control group (4 weeks after placement) were in agreement with previous studies 27,41,42 …”

“…The period of membrane removal varies from 4 to 6 weeks after placement; 18‐22 previous studies have shown the benefit of ePTFE membrane retrieval at this time period, 23‐25 and longer time periods do not provide additional benefit 26 . The exposure of the membrane in the early healing phase has been negatively correlated with the amount of newly formed tissue under the barrier, 27 which occurs due to the bacterial contamination of the membrane. Also, as the length of exposure time increases, the risk of contamination and infection increases 28‐32 .…”

Treatment of grade II furcation involvement using resorbable guided tissue regeneration membrane: A six-month study

“…In a study conducted by Metzler et al,[12] the GTR procedure showed limited application as a therapeutic modality for Class II furcations of the maxillary molars. 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.…”

Treatment Strategy for Guided Tissue Regeneration in Combined Endodontic-Periodontal Lesions: Case Report and Review

“…In this case, a 2-to-3 wall combination defect was present, with mesial grade II furcation involvement. Because of difficult surgical access from the complicated intrinsic trifurcation morphology, some clinical studies have found that the outcome of GTR on mesial and distal maxillary molar furcation was not predictable (38)(39)(40). However, the involved furcation in this case was sufficiently wide for good access to a mechanical instrumentation.…”