International Journal of Oral Care and Research

REVIEW ARTICLE
Year
: 2018  |  Volume : 6  |  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

Correspondence Address:
Dr. Sunil Kumar Vaddamanu
Department of Dental Technology, King Khalid University, Abha.
Kingdom of Saudi Arabia

Abstract

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.



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;6:85-88


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 2022 May 18 ];6:85-88
Available from: https://www.ijocr.org/text.asp?2018/6/4/85/253709


Full Text



 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.[1]

The furcation lesion refers to the involvement of the bifurcation or trifurcation of multi-rooted teeth by periodontal disease. Glickman[2] 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.[3],[4],[5] 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.[6] 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.

Furcal anatomy

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].{Table 1}

Defect morphology

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}

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.[22]

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.[23],[24],[25] 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.[26]

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.[27],[28] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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