title: Clinical performance of access flap in the treatment of class II furcation defects. A systematic review and meta-analysis of randomized clinical trials.
abstract: OBJECTIVE
  To systematically review the performance of access flap (OFD) in the treatment of class II furcation defects (FD).
  
  
  METHODS
  RCTs evaluating surgical treatment of class II FD with OFD, minimum 6 months follow-up were identified. Screening, data extraction, and quality assessment were conducted independently by three reviewers. The primary outcomes were tooth survival and change in the horizontal clinical attachment level (HCAL). Changes in vertical clinical attachment level (VCAL), reduction of pocket probing depth (PPD), recession increase (REC), horizontal (HBL), and vertical bone level (VBL) were also collected.
  
  
  RESULTS
  The search identified 1571 studies out of which 11 articles met the inclusion criteria. Data analysis was performed on 199 patients and 251 FD. Tooth survival was seldom reported. Altogether with inflammatory amelioration, the weighted mean differences were for HCAL 0.96 mm [CI: (0.60, 1.32), p < 0.001], 0.55 mm [CI: (0.00, 1.10), p = 0.05] for VCAL gain. PPD reduction over 6 months was 1.38 mm [CI: (0.91, 1.85), p < 0.01]. Potential risk of bias was identified.
  
  
  CONCLUSIONS
  Teeth with mandibular class II furcation involvement treated with OFD show significant clinical improvements 6 months after surgery. Nevertheless, in order to better understand the magnitude of these changes and their clinical relevance, prospective long-term trials are needed.
authors.affiliation: Department of surgery, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Graziani
authors.forename: Stefano
authors.initials: S
authors.lastname: Gennai
authors.forename: Dimitra
authors.initials: D
authors.lastname: Karapetsa
authors.forename: Stefano
authors.initials: S
authors.lastname: Rosini
authors.forename: Natalia
authors.initials: N
authors.lastname: Filice
authors.forename: Mario
authors.initials: M
authors.lastname: Gabriele
authors.forename: Maurizio
authors.initials: M
authors.lastname: Tonetti
mesh_terms: D000539:Alveolar Process / Q000473:pathology; D005500:Follow-Up Studies; D017823:Furcation Defects / Q000145:classification / Q000601:surgery*; D005889:Gingival Recession / Q000209:etiology; D006801:Humans; D017622:Periodontal Attachment Loss / Q000601:surgery; D010514:Periodontal Pocket / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D013524:Surgical Flaps / Q000601:surgery*; D016388:Tooth Loss / Q000517:prevention & control
keywords: access flap; conservative surgery; furcation defects; meta-analysis