|Year : 2018 | Volume
| Issue : 4 | Page : 85-88
Assessment of determinants in successful regeneration of class II furcation involvement by guided tissue regeneration: An overview
Sunil Kumar Vaddamanu1, Ravi Kadur Sundar Raj2, Shankar T Gokhale3, Mukhatar A Javali3, Mohasin A Khader3, N Raghavendra Reddy3
1 Department of Dental Technology, King Khalid University, Abha, Kingdom of Saudi Arabia
2 Department of Pediatric Dentistry and Orthodontics Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
3 Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
|Date of Web Publication||14-May-2019|
Dr. Sunil Kumar Vaddamanu
Department of Dental Technology, King Khalid University, Abha.
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
The ultimate goal of periodontal therapy is to regenerate lost periodontal tissues caused by periodontal diseases. Furcation involvement in multi-rooted teeth caused by chronic periodontitis is a difficult task in achieving the periodontal regeneration. Various treatment modalities are available, among them, guided tissue regeneration (GTR) placement has shown promising results. Various prognostic factors such as anatomical and systemic factors have to be considered for the final outcome of periodontal therapy while placing membrane. The aim of the paper was to evaluate various determinants in class II furcation defect by GTR procedure.
Keywords: Anatomical factors, furcation defect, guided tissue regeneration, regeneration
|How to cite this article:|
Vaddamanu SK, Sundar Raj RK, Gokhale ST, Javali MA, Khader MA, Reddy N R. Assessment of determinants in successful regeneration of class II furcation involvement by guided tissue regeneration: An overview. Int J Oral Care Res 2018;6:85-8
|How to cite this URL:|
Vaddamanu SK, Sundar Raj RK, Gokhale ST, Javali MA, Khader MA, Reddy N R. Assessment of determinants in successful regeneration of class II furcation involvement by guided tissue regeneration: An overview. Int J Oral Care Res [serial online] 2018 [cited 2019 May 21];6:85-8. Available from: http://www.ijocr.org/text.asp?2018/6/4/85/253709
| Introduction|| |
Regeneration of tissues damaged as a result of periodontal disease is the definitive goal of periodontal treatment. Furcation involvement in multi-rooted teeth by chronic periodontitis is a common condition resulting from attachment loss, and management of these defects in multi-rooted teeth is the most difficult task as extension of the periodontal disease between the roots of multi-rooted teeth is considered to be influencing the prognosis of the teeth involved.
The furcation lesion refers to the involvement of the bifurcation or trifurcation of multi-rooted teeth by periodontal disease. Glickman classified furcation invasion into four classes. Class I shows supra-bony incipient defect with no radiographic variations. Class II lesion shows cul-de-sac and a definite horizontal bone loss. Most of the times, radiographic variations may or may not be visible as there may be overlapping of roots. Class III furcation shows through and through involvement of the furcation area with bone loss and radiographic changes. Class IV furcation is clinically visible due to soft tissue recession and also shows through and through involvement of the furcation area, with bone loss and radiographic changes. Periodontal tissues around multi-rooted teeth that have been damaged by periodontal disease can be regenerated. Many treatment options, such as scaling and root planing, osteoplasty, odontoplasty, ostectomy, surgery to increase the access to furcation area, bicuspidization, root resection, tunnel procedure, guided tissue regeneration (GTR), and a combination of membranes and graft materials, are available to treat the furcation.,, Clinical studies have proved that GTR improves the outcome of regenerative therapy in class II furcation by decrease in pocket depth, new attachment, and bone fill. These features make GTR the treatment of choice in furcation defect. GTR showed better results than open-flap debridement or bone grafts alone. In spite of attaining significant results in new attachment by GTR, successful regeneration of class II furcation involvement with membrane still remains a challenge. Various factors such as anatomical factors, systemic factors, and postoperative period play a critical role in successful regenerative outcome of periodontal therapy. The aim of this paper was to assess the determinants in regeneration of class II furcation by GTR.
| Anatomical Factors|| |
Periodontal regeneration in class II furcation by GTR procedure is strongly influenced by furcal anatomy, morphology of defect, gingival biotype, and tooth mobility.
In multi-rooted or bifurcated teeth, the anatomical variations in the furcation play a significant role in the final outcome of periodontal regeneration by GTR procedure. The various factors that are responsible under the furcal anatomy are described in [Table 1].
The clinical outcome of furcation treatment also appears to be strongly related to defect morphology. The various factors that are responsible under defect morphology are described in [Table 2].
|Table 2: Various factors that are responsible under the defect morphology|
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Wound-healing factors influencing the success of regeneration
The patient-related factors such as smoking, stress, and diabetes mellitus influence the healing of furcation lesions and thus have direct effect on the outcome of regeneration of these defects. But, at the same time, age and gender of the patient and the type of periodontal disease do not appear to have a major role in the outcome of regeneration.
Smoking: It has been related with a reduced healing following GTR therapy. Various studies put forwarded the theory that the effect of smoking on furcation regeneration is much significant in tissue maturation phase. When GTR is performed in smokers, an anti-infective therapy should be integrated into the treatment plan to augment the outcome of regenerative procedure in class II furcation defects. As subgingival pathogens are much difficult to remove in smokers by just scaling and root planning, an adjunctive antimicrobial therapy (systemic or local) should be recommended in smokers.,, Moreover, tobacco cessation should be considered as it results in better prognosis and better response in the regeneration of furcation defects, and evidence indicates that former smokers respond to periodontal therapy in a similar way as nonsmokers.
Diabetes mellitus: The progression of diabetes mellitus and the response to periodontal treatment such as GTR get affected by the patients’ susceptibility to periodontal disease and impaired wound healing. Various mechanisms were accountable for delayed wound healing, such as microvascular complications, impaired cell function, decreased tissue oxygenation, increased collagenase production, deregulation of cytokines at the wound site, decreased migration of periodontal ligament cells, and deficiency in the activity of growth factors, which may affect the regeneration., GTR procedure to treat furcation defect can be an option in controlled diabetes mellitus, although postsurgical complications are expected with less successful treatment results. Therefore, patients with diabetes need close monitoring and frequent follow-ups of the GTR site to attain long-term success.
| Conclusion|| |
The final outcome of periodontal regeneration depends on the local and systemic factor that has to be evaluated, before placement of GTR membrane in the class II furcation defects. The clinician should consider the local factors and eliminate them before placing the membrane. These factors may impair the long-term prognosis. Further clinical trials standardizing the various features that affect the outcome of regeneration (patient selection, large sample size, assessment of furcation characteristics, and standardized methods of evaluation) would lead to better comparison of studies and would help to indicate the exact impact of each feature on the final outcome of the regenerative therapy.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Reddy MS, Aichelmann-Reidy ME, Avila-Ortiz G, Klokkevold PR, Murphy KG, Rosen PS, et al
. Periodontal regeneration—Furcation defects: A consensus report from the aap regeneration workshop. J Periodontol 2015;86:S131-3.
Fermin A. Carranza, Paulo M. Camargo, Henry H. Takei Carranza’s clinical periodontology. 12th ed. Elsevier, USA, 2014. P. 298.
Luepke PG, Mellonig JT, Brunsvold MA. A clinical evaluation of a bioresorbable barrier with and without decalcified freeze-dried bone allograft in the treatment of molar furcations. J Clin Periodontol 1997;24:440-6.
De Leonardis D, Garg AK, Pedrazzoli V, Pecora GE. Clinical evaluation of the treatment of class II furcation involvements with bioabsorbable barriers alone or associated with demineralized freeze-dried bone allografts. J Periodontol 1999;70:8-12.
Sahoo S, Sethi K, Kumar P, Bansal A. Management of periodontal furcation defects employing molar bisection: A case report with review of the literature. Dent Hypotheses 2013;4:97-101. [Full text]
Pontoriero R, Lindhe J. Guided tissue regeneration in the treatment of degree II furcations in maxillary molars. J Clin Periodontol 1995;22:756-63.
Mardam-Bey W, Majzoub Z, Kon S. Anatomic considerations in the etiology and management of maxillary and mandibular molars with furcation involvement. Int J Periodontics Restorative Dent 1991;11:398-409.
Novaes AB Jr, Tamani JP, Oliveira PT, Palioto DB, Almeida AL. Root trunk concavities as a risk factor for regenerative procedures of class II furcation lesions in dogs. J Periodontol 2001;72:612-9.
Villaça JH, Rodrigues DC, Novaes AB Jr, Taba M Jr, Souza SL, Grisi MF. Root trunk concavities as a risk factor for regenerative procedures of class II furcation lesions in humans. J Periodontol 2004;75:1493-9.
Nowzari H, MacDonald ES, Flynn J, London RM, Morrison JL, Slots J. The dynamics of microbial colonization of barrier membranes for guided tissue regeneration. J Periodontol 1996;67:694-702.
Kon S. Rios CM, Carvalho JCM, Pustiglione FE, Tristao GC. Tooth morphology: Dimension and concavity depth of the 2nd lower molar trunk. J Dent Res 1992;71(Special Issue): 282 (abstract 134).
Dunlap RM, Gher ME. Root surface measurements of the mandibular first molar. J Periodontol 1985;56:234-8.
Bower RC. Furcation morphology relative to periodontal treatment. Furcation entrance architecture. J Periodontol 1979;50:23-7.
Pustiglione FE, Brazil CAB, Carvalho JCM, Kon S, Tristao GC. Root trunk dimension and concavity of the first lower molar. J Dent Res 1993;72:245.
Bowers GM, Schallhorn RG, McClain PK, Morrison GM, Morgan R, Reynolds MA. Factors influencing the outcome of regenerative therapy in mandibular class II furcations: Part I. J Periodontol 2003;74:1255-68.
Machtei EE, Schallhorn RG. Successful regeneration of mandibular class ii furcation defects: An evidence-based treatment approach. Int J Periodontics Restorative Dent 1995;15:146-67.
Cortellini P, Pini Prato G, Tonetti MS. Periodontal regeneration of human infrabony defects. ii. Re-entry procedures and bone measures. J Periodontol 1993;64:261-8.
Anderegg CR, Metzler DG, Nicoll BK. Gingiva thickness in guided tissue regeneration and associated recession at facial furcation defects. J Periodontol 1995;66:397-402.
Horwitz J, Machtei EE, Reitmeir P, Holle R, Kim TS, Eickholz P. Radiographic parameters as prognostic indicators for healing of class II furcation defects. J Clin Periodontol 2004;31: 105-11.
Avila-Ortiz G, De Buitrago JG, Reddy MS. Periodontal regeneration—Furcation defects: A systematic review from the aap regeneration workshop. J Periodontol 2015;86:S108-30.
Trejo PM, Weltman RL. Favorable periodontal regenerative outcomes from teeth with presurgical mobility: A retrospective study. J Periodontol 2004;75:1532-8.
Melcher AH. On the repair potential of periodontal tissues. J Periodontol 1976;47:256-60.
Patel RA, Wilson RF, Palmer RM. The effect of smoking on periodontal bone regeneration: A systematic review and meta-analysis. J Periodontol 2012;83:143-55.
Johnson GK, Hill M. Cigarette smoking and the periodontal patient. J Periodontol 2004;75:196-209.
Machtei EE, Oettinger-Barak O, Peled M. Guided tissue regeneration in smokers: Effect of aggressive anti-infective therapy in class II furcation defects. J Periodontol 2003;74:579-84.
Kaldahl WB, Johnson GK, Patil KD, Kalkwarf KL. Levels of cigarette consumption and response to periodontal therapy. J Periodontol 1996;67:675-81.
Mattson JS, Gallagher SJ, Jabro MH, McLey LL. Complications associated with diabetes mellitus after guided tissue regeneration: Case report. Compend Contin Educ Dent 1998;19:923-6, 928, 930 passim; quiz 938.
Grossi SG, Skrepcinski FB, DeCaro T, Zambon JJ, Cummins D, Genco RJ. Response to periodontal therapy in diabetics and smokers. J Periodontol 1996;67:1094-102.
[Table 1], [Table 2]