title: Efficacy of combination therapy using anorganic bovine bone graft with resorbable GTR membrane vs. open flap debridement alone in the management of grade II furcation defects in mandibular molars - A comparative study.
abstract: BACKGROUND
  Invasion of the bifurcation and trifurcation of the multi-rooted teeth resulting in furcation involvement is one of the serious complications of periodontitis.
  
  
  OBJECTIVE
  The purpose of the study was to evaluate the efficacy of combination therapy using anorganic bovine bone graft and resorbable guided tissue regeneration (GTR) membrane versus open flap debridement alone in the management of Grade II furcation defects in mandibular molars.
  
  
  METHODS
  The study included a total number of 20 sites in 10 patients with bilateral mandibular furcation defects, out of which 10 sites were treated as test group and 10 as control group. The test group was treated with combination therapy and the control group with open flap debridement alone. The parameters were recorded on 0 day (baseline), 90th day, and 180th day, which included vertical probing depth and horizontal probing depth of the furcation defect, clinical attachment level, and defect fill.
  
  
  METHODS
  Mean and standard deviation were calculated for different variables in each study group at different time points. Mean values were compared by using Wilcoxon signed ranks test, after adjusting the P values for multiple comparison by using Bonferroni correction method.
  
  
  RESULTS
  Both the test and control groups showed a definitive improvement in clinical parameters, which was statistically significant. On comparison, the vertical probing depth showed significant reduction in the test group with a mean reduction of 3.1 ± 0.7 mm, when compared to the control group which showed a mean reduction of 1.5 ± 0.5 mm. The horizontal probing depth of furcation defects was also significantly reduced in the test group with a mean reduction of 2.2 ± 0.6 mm, when compared to the control group in which the mean reduction was 0.9 ± 0.3 mm. There was also significant gain in attachment level in the test group which showed a mean gain of 3.2 ± 0.6 mm, when compared to the control group which showed a gain of 1.2 ± 0.6 mm. Radiographic defect fill was found to be more in the test group with a mean gain of 2.0 ± 0.1 mm, when compared to the control group which showed a defect fill of 0.2 ± 0.1 mm.
  
  
  CONCLUSIONS
  The results of this study demonstrated that the combined use of anorganic bovine bone graft and resorbable GTR membrane is effective than open flap debridement alone in the treatment of mandibular grade II furcation defects.
authors.affiliation: Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India.
authors.forename: Anitha Logaranjani
authors.initials: AL
authors.lastname: Kannan
authors.affiliation: Department of Periodontics, Tagore Dental College, Chennai, Tamil Nadu, India.
authors.forename: Buvaneshwari Birla
authors.initials: BB
authors.lastname: Bose
authors.affiliation: Department of Periodontology and Implantology, Indira Gandhi Institute of Dental Sciences, Pondicherry, India.
authors.forename: Jananni
authors.initials: J
authors.lastname: Muthu
authors.affiliation: Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India.
authors.forename: Rajapriya
authors.initials: R
authors.lastname: Perumalsamy
authors.affiliation: Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Saravanan
authors.initials: S
authors.lastname: Pushparajan
authors.affiliation: Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India.
authors.forename: Ambalavanan
authors.initials: A
authors.lastname: Namasivayam
keywords: Bone grafts; GTR membranes; combination therapy; furcation defects