Periodontal Regeneration – Furcation Defects: A Consensus Report From the AAP Regeneration Workshop

Abstract

Background: Treatment of furcation defects is a core component of periodontal therapy. The goal of this consensus report is to critically appraise the evidence and to subsequently present interpretive conclusions regarding the effectiveness of regenerative therapy for the treatment of furcation defects and recommendations for future research in this area. Methods: A systematic review was conducted before the consensus meeting. This review aims to evaluate and present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy. During the meeting, the outcomes of the systematic review, as well as other pertinent sources of evidence, were discussed by a committee of nine members. The consensus group members submitted additional material for consideration by the group in advance and at the time of the meeting. The group agreed on a comprehensive summary of the evidence and also formulated recommendations for the treatment of furcation defects via regenerative therapies and the conduction of future studies. Results: Histologic proof of periodontal regeneration after the application of a combined regenerative therapy for the treatment of maxillary facial, mesial, distal, and mandibular facial or lingual Class II furcation defects has been demonstrated in several studies. Evidence of histologic periodontal regeneration in mandibular Class III defects is limited to one case report. Favorable outcomes after regenerative therapy for maxillary Class III furcation defects are limited to clinical case reports. In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although generally Class I furcation defects may be treated predictably with non‐regenerative therapies. There is a paucity of data regarding quantifiable patient‐reported outcomes after surgical treatment of furcation defects. Conclusions: Based on the available evidence, it was concluded that regenerative therapy is a viable option to achieve predictable outcomes for the treatment of furcation defects in certain clinical scenarios. Future research should test the efficacy of novel regenerative approaches that have the potential to enhance the effectiveness of therapy in clinical scenarios associated historically with less predictable outcomes. Additionally, future studies should place emphasis on histologic demonstration of periodontal regeneration in humans and also include validated patient‐reported outcomes. Clinical Recommendations: Based on the prevailing evidence, the following clinical recommendations could be offered. 1) Periodontal regeneration has been established as a viable therapeutic option for the treatment of various furcation defects, among which Class II defects represent a highly predictable scenario. Hence, regenerative periodontal therapy should be considered before resective therapy or extraction; 2) The application of a combined therapeutic approach (i.e., ...

Treatment of class II furcation defects with autogenous bone graft associated with Bichat’s fat pad: case report

“…According to a systematic review of Reddy et al [12], is histologically proven by many studies the periodontal regeneration after application of combined regenerative therapy for the treatment of mesial-buccal and distal-buccal class II furcation defects in maxillary molars and buccal or lingual furcation defects in mandibular molars.…”

“…Periodontal regeneration is a viable therapeutic option for the treatment of various furcation defects, including class II defects which have a highly predictable scenario [1,12]. Thus, one should consider this option before indicating the tooth extraction.…”

“…The application of a therapeutic approach using a barrier associated with bone graft aiming at bone neoformation demonstrates greater effectiveness on single therapeutic options [12]. Guided tissue regenerat ion w it h t he use of biocompat ible membranes aim at preventing the immediate migration of the epithelium to the surgical wound, allowing the proliferation of the periodontal ligament cells in the region.…”

“…The rigorous postoperative care associated with subsequent support periodontal therapy is essential to achieve long-term sustainable regenerative results [12]. The patient did not smoke, or have any systemic comorbidities, parafunctional habits; she received periodic hygiene instructions and periodontal control.…”

When Is Cone‐Beam Computed Tomography Imaging Appropriate for Diagnostic Inquiry in the Management of Inflammatory Periodontitis? An American Academy of Periodontology Best Evidence Review

“…Periodontitis can result in clinical signs and symptoms of inflammation that may be reported by patients, but the disease is usually confirmed through clinical and radiographic examinations revealing: 1) deep probing depths (PDs), 2) bleeding on probing (BOP), 3) presence of purulence, 4) clinical attachment loss (AL), 5) alveolar bone resorption, and 6) mobility that can lead to the eventual loss of teeth. Intrabony and furcation defects are clinical findings as a result of the periodontal disease process, and affected teeth are at increased risk for further attachment and bone loss, resulting in a compromised dental prognosis 3‐6 . One of the most difficult clinician challenges is determining whether a compromised tooth can be maintained.…”