Impaired healing response of periodontal furcation defects following flap debridement surgery in smokers. A controlled clinical trial.
OBJECTIVE
The purpose of the present parallel-design, controlled clinical trial was to evaluate the treatment outcome of periodontal furcation defects following flap debridement surgery (FDS) procedure in cigarette smokers compared to non-smokers.


METHODS
After initial therapy, 31 systemically healthy subjects with moderate to advanced periodontitis, who presented at least one Class I or II molar furcation defect, were selected. Nineteen patients (mean age: 40.3 years, 15 males) were smokers (>or=10 cigarettes/day) and 12 patients (mean age: 44.8 years, 3 males) were non-smokers. Full-mouth plaque score (FMPS) and full-mouth bleeding score (FMBS), probing pocket depth (PPD), vertical clinical attachment level (v-CAL), and horizontal clinical attachment level (h-CAL) were assessed immediately before and 6 months following surgery.


RESULTS
Overall, statistically significant v-CAL gain was observed in smokers (1.0 +/- 1.3 mm) and non-smokers (1.3+/-1.1 mm), the difference between groups being statistically significant (p=0.0003). In proximal furcation defects, v-CAL gain amounted to 2.3+/-0.7 mm in non-smokers as compared to 1.0+/-1.1 mm in smokers (p=0.0013). At 6 months postsurgery, non-smokers presented a greater h-CAL gain (1.3+/-1.1 mm) than smokers (0.6+/-1.0 mm), with a statistically significant difference between groups (p=0.0089). This trend was confirmed in both facial/lingual (1.4+/-1.0 versus 0.8+/-0.8 mm) and proximal furcation defects (1.2+/-1.3 versus 0.5+/-1.2 mm). The proportion of Class II furcations showing improvement to postsurgery Class I was 27.6% in smokers and 38.5% in non-smokers. After 6 months, 3.4% of presurgery Class I furcation defects in smokers showed complete closure, as compared to 27.8% in non-smokers.


CONCLUSIONS
The results of the present study indicated that (1) FDS produced clinically and statistically significant PPD reduction, v-CAL gain, and h-CAL gain in Class I/II molar furcation defects, and (2) cigarette smokers exhibited a less favorable healing outcome following surgery in terms of both v-CAL and h-CAL gain.
Trombelli
Leonardo
L
Research Center for Study of Periodontal Diseases, University of Ferrara, Ferrara, Italy. ltr@dns.unife.it
Cho
Kyoo-Sung
KS
Kim
Chong-Kwan
CK
Scapoli
Chiara
C
Scabbia
Alessandro
A
D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003646:Debridement; D003774:Dental Plaque Index; D005260:Female; D005500:Follow-Up Studies; D017823:Furcation Defects / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000503:physiopathology / Q000601:surgery; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000503:physiopathology / Q000601:surgery; D010518:Periodontitis / Q000503:physiopathology / Q000601:surgery; D016037:Single-Blind Method; D012907:Smoking / Q000503:physiopathology*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology