Failure of resin ionomers in the retention of multi-rooted teeth with Class III furcation involvement: a rebuttal case report.
BACKGROUND
Severe periodontal furcation invasion has long been a treatment dilemma for the clinician. Many techniques have been advocated in the treatment of multi-rooted posterior teeth ranging from conventional scaling and root planing (SRP), apically positioned flaps, root amputations, root resections, tunnel procedures, guided tissue regeneration, and restorations. The keys to success depend on the clinician's ability to access the furcation to remove local factors and create an environment that enhances the patient's own hygiene efforts. Long-term success in treating teeth with furcation invasion depends upon tooth retention and arresting the destructive processes within the furcation area.


METHODS
A Class III furcation invasion in a mandibular molar was treated by surgical access for SRP along with obliterating the furcation utilizing a resin ionomer restoration.


RESULTS
Initially, the patient was asymptomatic. Within 3 months of treatment, the patient presented with suppuration that was refractory to local efforts. Radiographs taken only 5 months postsurgery demonstrated advanced bone loss apical to the restoration. The tooth ultimately was extracted because mobility increased and the tooth became symptomatic.


CONCLUSIONS
The clinician must consider the multi-factorial etiology of periodontal breakdown within a furcation. For this patient, the technique of sealing off the exposed furcation with restorative material appeared to have resulted in progressive bone loss and accelerate tooth loss. This single case report is presented as a rebuttal to recently published articles, which have demonstrated excellent results when treating furcations with ionomer restorations.
Fowler
E B
EB
Periodontics Department, Fort Lewis, WA, USA. fowlered@worldnet.att.net
Breault
L G
LG
D000328:Adult; D016301:Alveolar Bone Loss / Q000209:etiology*; D019232:Dental Restoration Failure; D003793:Dental Restoration, Permanent / Q000009:adverse effects* / Q000379:methods; D017823:Furcation Defects / Q000150:complications* / Q000628:therapy*; D005899:Glass Ionomer Cements; D006801:Humans; D008297:Male; D008334:Mandible; D008963:Molar; D012117:Resins, Synthetic; D016388:Tooth Loss / Q000209:etiology
C074933:Geristore; D005899:Glass Ionomer Cements; D012117:Resins, Synthetic