ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Periodontal Regeneration In Class II Furcations Is More Effective Than Open Flap Debridement
Clinical Question Is surgical regenerative intervention more effective than open flap debridement in the treatment of class II furcation involved teeth?
Clinical Bottom Line Surgical regenerative intervention, including the use of membranes with or without a bone graft, results in greater improvement in clinical parameters than open flap debridement.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21091347Kinaia/2011Patients with class II furcation involved molarsSystematic Review with Meta-Analysis
Key resultsEfficacy was evaluated by measuring clinical changes and hard tissue changes after surgical re-entry. Data included, vertical probing depths (VPD), vertical CAL, (VCAL), horizontal bone level (HBL), and vertical bone level (VBL).The results demonstrated significantly greater reduction in VPD with the use of resorbable membranes compared to open flap debridement. The mean combined difference was 0.73 – 0.16 mm (95% CI, 0.42 to 1.05). The results demonstrated significantly greater gain in VCAL with the use of resorbable membranes compared to open flap debridement. The mean combined difference was 0.88 –0.16 mm (95% CI, 0.55 to 1.20). The results demonstrated significantly greater increase in HBL with the use of resorbable membranes compared to open flap debridement. The mean combined difference was 0.98 –0.12 mm (95% CI, 0.74 to 1.21). The results demonstrated significantly greater increase in VBL the use of resorbable membranes compared to open flap debridement. The mean combined difference was 0.78 –0.19 mm (95% CI, 0.42 to 1.15).
#2) 14971257Murphy/2003Patients with class II furcation involved molarsSystematic Review with Meta-Analysis
Key resultsA total of 23 studies (22 split-mouth RCTs, 1 Cohort) which involved treatment of furcation defects of all barrier types were reviewed. Compared to open flap debridement (OFD) controls, GTR (guided tissue regeneration) resulted in greater: (1) gain in vertical probing attachment (VPAL) (P<0.0001); (2) reduction in vertical probing depth(VPD) (P<0.0001); and (3) improvements in horizontal probing level attachment upon re-entry (HOPA) (P<0.001). Heterogeneity was significant for each variable. Eleven studies using ePTFE barriers demonstrated a difference between test and control interventions of weighted mean gains in VPAL of 1.39± 0.36mm (P <0.0001). The single study evaluating a polymeric barrier demonstrated a gain in VPAL of 2.5± 0.85 mm. Collagen barriers demonstrated a marginal gain of 0.10±.060 mm.
#3) 12787212Jepsen/2002Patients with class II furcation involved molarsSystematic Review with Meta-Analysis
Key results14 articles were included in the meta-analysis. The primary outcome, reduction in horizontal furcation depth, was assessed during surgical re-entry. The weighted mean difference in the reduction of horizontal probing depth between GTR vs. control (open flap debridement) was: 1.51 mm (95%CI, [0.39-2.62]. The chi-square for heterogeneity 67.6 (df.3), P<0.001) in mandibular class II furcations.
Evidence Search "Furcation Defects"[Mesh] AND "Guided Tissue Regeneration, Periodontal"[Mesh] AND systematic[sb]
Comments on
The Evidence
These studies are systematic reviews with meta-analysis of randomized clinical human trials of treatment modalities for molar furcations. In each study, the authors performed a comprehensive detailed search for relevant trials with specific inclusion & exclusion criteria. Article specific details regarding validity: Kinaia: A total of 13 trials were analyzed, all of which exhibited a test and control-arm.Murphy: Heterogeneity was significant (P<0.001). However, when the 2 most efficacious studies were removed, the heterogeneity was removed and the treatment effect remained significant. Jepsen: The first two summary values should be interpreted with caution as heterogeneity is statistically significant.
Applicability The conclusions above should be considered when developing a surgical treatment plan for periodontal disease patients with class II furcation involved molars. Subject variables including diabetes, smoking status, plaque control and local factors (cervical enamel projections, furcation width/location, enamel pearls, accessory canals, bifurcation ridges, restoration overhangs) should be carefully assessed, as the presence of these factors can prevent effective management of furcation involvement. Modifiable local factors should be corrected or removed prior to surgical intervention. Patients with limited ability to finance regenerative therapy can still benefit clinically from open flap debridement. However, the greatest attachment gain, reduction in probing depth, and horizontal bone level gain is achieved by treatment with periodontal regenerative techniques.
Specialty/Discipline (Periodontics)
Keywords Furcation involvement, regeneration, effectiveness, open flap debridement
ID# 2151
Date of submission: 10/08/2011spacer
E-mail frostn@uthscsa.edu
Author Natalie A. Frost
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Guy Huynh-Ba, DDS
Faculty mentor/Co-author e-mail HuynhBa@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Gina Khong (San Antonio, TX) on 11/28/2017
A PubMed search conducted with Aamna Zaidi in November 2017 found no recent publications that directly compared surgical regeneration to open flap debridement in the treatment of Class II furcation involved teeth. Further research should be done to compare if different biological barriers will affect the regeneration outcome compared to open flap debridement.
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