The response of human buccal maxillary furcation defects to combined regenerative techniques--two controlled clinical studies.
Treatment of maxillary furcation lesions presents important clinical challenges. The aim of this study was to evaluate the response of buccal class II furcation defects in systemically healthy, non-smoking, Adult Periodontitis patients undergoing supportive periodontal therapy and surgical periodontal regenerative techniques. The treatment protocol emphasised infection control, careful soft tissue management and wound stability. Two experiments were performed. In the first experiment, a coronally positioned flap (CPF) technique was compared with surgical debridement. In the second experiment, an experimental technique (ET) was also compared with surgical debridement. The ET was a combination of a composite graft consisting of microparticulate (40-70 microns) hydroxyapatite and tetracycline (3:1), a guided tissue regeneration barrier (GTR) and CPF. Sixty patients were divided into the four (n = 15) treatment groups. The clinical variables evaluated were plaque, bleeding-on-probing scores, gingival recession, probing pocket depth (PD), vertical (VAL) and horizontal attachment levels (HAL). Reevaluation was performed 12 months after the surgical procedures and revealed that the three techniques resulted in improvements in all the clinical variables evaluated. Post-operative measurements from controls, CPF and ET showed (respectively) 1.53 +/- 1.12 mm, 1.40 +/- 0.75 mm, 2.43 +/- 1.36 mm reduction in PD; 0.63 +/- 0.1 mm, 1.17 +/- 1.12 mm and 1.57 +/- 1.32 mm VAL gains and 1.03 +/- 0.30 mm, 1.40 +/- 0.96 mm and 2.13 +/- 1.52 mm HAL gains. Five out of fifteen furcations in the ET group were closed after treatment. It was concluded that satisfactory clinical results--measured by PD reduction, VAL and HAL gains--can be obtained in advanced defects formerly considered as being non-responsive to regenerative periodontal therapy. The proposed ET showed significantly better results, with more PD reduction, HAL and VAL gains and a higher frequency of furcation closure compared with the other techniques tested, and shows promise as a new regenerative treatment technique.
de Santana
R B
RB
Department of Periodontology and Oral Biology, Boston University, Goldman School of Dental Medicine, Massachusetts, USA.
Gusman
H C
HC
Van Dyke
T E
TE
D000328:Adult; D018786:Bone Substitutes; D017886:Durapatite; D005260:Female; D017823:Furcation Defects / Q000601:surgery*; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures; D017622:Periodontal Attachment Loss / Q000601:surgery; D010512:Periodontal Index; D011182:Postoperative Care; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000517:prevention & control; D013754:Tetracyclines / Q000627:therapeutic use; D016896:Treatment Outcome
D018786:Bone Substitutes; D013754:Tetracyclines; D017886:Durapatite