Clinical Human Comparison of Expanded Polytetrafluoroethylene Barrier Membrane and Freeze‐Dried Dura Mater Allografts for Guided Tissue Regeneration of Lost Periodontal Support. I. Mandibular Molar Class II Furcations

Abstract

The response of mandibular Class II facial furcations to guided tissue regeneration treatment with expanded polytetrafluoroethylene barrier membrane (e-PTFE) or freeze-dried dura mater allograft (FDDMA) barriers was evaluated in 11 pairs of molars in 11 patients. Following initial preparation, full thickness flaps were raised in the area being treated, the bone and furcation defects debrided of granulomatous tissue, and the involved root surfaces mechanically and chemically prepared. By random allocation, e-PTFE or FDDMA barriers were fitted over the furcations, secured in place, and the host flap repositioned or coronally positioned. Postsurgical deplaquing was performed every 10 days leading up to e-PTFE removal at about 6 weeks (the resorbable FDDMA did not require removal). Continuing supportive periodontal therapy was provided until surgical re-entry at one year for documentation and any further necessary treatment. Direct clinical measurements demonstrated essentially similar clinical results with both barrier materials for bone and soft tissue changes (few statistically or clinically significant differences). Exceptions were the amount of horizontal furcation fill and the change in the width of the keratinized gingiva, both of which were better with FDDMA (P less than 0.05). Improvements in open probing attachment levels observed at the time of e-PTFE removal were lost over the intervening months, more so for the vertical than the horizontal component of the furcation lesion. Intrapatient comparisons suggested better horizontal furcation responses with FDDMA. The findings of this study suggest equal clinical results with e-PTFE and FDDMA barriers utilizing the GTR technique. These results in Class II mandibular furcations are less favorable than those reported by others. Barrier techniques to handicap the race between different tissues of the periodontal complex appear to be of some clinical benefit and deserve further evaluation.

An evaluation of bovine derived xenograft with and without a bioabsorbable collagen membrane in the treatment of mandibular Class II furcation defects

“…Some other studies have reported a similar result while using the GTR technique for the treatment of furcation defects. 36,37 Reduction in probing depth was in agreement with studies by Garret et al and Wang et al 38,39 However, the result was somewhat less than Lekovic and Anderegg 34,35 and more than Yukna and Bowers. 10,26 But generally, both treatments were successful in reducing pocket depth in furcation areas.…”

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

“…The position of measurement may influence the results. Some studies 27 were measured at the middle of the mesiofacial and distofacial roots and in the middle of the furcation, while others recorded probing depth and clinical attachment in the furcation, using two locations on the furcation aspects on mesial of the distal root and on the distal of the mesial root. M a c h t e i 2 8 presented ve rtical probing at t a c h m e n t levels (PAL-V) by using true vertical rather than oblique-vertical measurement of the distance from the stent to the most coronal extension of the attachment apparatus at the orifice of the furcation defect.…”