A systematic review of guided tissue regeneration for periodontal furcation defects. What is the effect of guided tissue regeneration compared with surgical debridement in the treatment of furcation defects?
OBJECTIVE
To systematically review the evidence of effectiveness of guided tissue regeneration (GTR) for furcation defects.


BACKGROUND
The evidence for the effectiveness of GTR in furcation defects has not yet been systematically appraised.


METHODS
We searched for randomized controlled trials with at least 6 months' follow-up comparing GTR with surgical debridement (open flap debridement, OFD). Data sources included electronic databases, hand-searched journals and contact with experts. Screening, data abstraction and quality assessment were conducted independently by multiple reviewers. The primary outcome measure was reduction in open horizontal furcation depth, secondary outcomes were frequency of furcation closure, gain in horizontal and vertical probing attachment and reduction of vertical probing depth.


RESULTS
For the primary outcome, reduction in horizontal furcation depth assessed during re-entry, the weighted mean difference between GTR and control was 1.51 mm (95% CI [0.39-2.62], chi-square for heterogeneity 67.6 (df = 3), P < 0.001) in mandibular class II furcations, 1.05 mm (95% CI [0.46-1.64, chi-square for heterogeneity 34.9 (df = 3), P < 0.001) in maxillary class II furcations, and 0.87 mm (95% CI [-0.08-1.82], chi-square for heterogeneity 0.1 (df = 4), P = 0.991) in studies that had combined mandibular and maxillary class II furcations. For the secondary outcomes, GTR treatment led to significantly better results than open flap debridement. No meta-analysis could be performed for frequency of furcation closure because of sparse data.


CONCLUSIONS
Overall, GTR was consistently more effective than OFD in reducing open horizontal furcation depths, horizontal and vertical attachment levels and pocket depths for mandibular or maxillary class II furcation defects. However, these improvements were modest, variable and there was only a limited number of studies available to appraise the effects, thus limiting general conclusions about the clinical benefit of GTR. Future studies should aim to identify factors associated with achieving consistent and more pronounced benefits over open flap debridement.
Jepsen
Søren
S
Department of Periodontology, School of Dentistry, University of Kiel, Gemany. jepsen@konspar.uni-keil.de
Eberhard
Jörg
J
Herrera
David
D
Needleman
Ian
I
D017823:Furcation Defects / Q000601:surgery*; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D010512:Periodontal Index; D016032:Randomized Controlled Trials as Topic; D013357:Subgingival Curettage