Abstract
Management of teeth with furcation involvement (FI) is challenging for the clinician. The greater the grade of FI, the more difficult it becomes to treat. Also, the grade of FI affects the prognosis and limits the patient’s ability to maintain. Adequate case selection and analysis of risk factors are fundamental for successful treatment of teeth with FI. In addition, the restorative and endodontic status needs to be considered to avoid future complications. Despite the aforementioned difficulties in the treatment of FI, multiple therapeutic modalities to treat teeth with FI have been utilized over the years in the field of periodontology including resective therapy, open flap debridement (OFD), guided tissue regeneration (GTR), use of biologic agents and plasma concentrates (PCs), endoscope, laser therapy, antimicrobials, and local delivery of statins. Diverse success and survival rates have been reported in the literature with variability among the different techniques.
From the reviewed literature, it can be concluded that treatment of teeth FI can extend the longevity of teeth, even in cases of severe FI, and every effort must be made to retain teeth before electing to extract or possibly place a dental implant. There are novel promising techniques and materials that can be used to successfully treat FI; in spite of that, the regenerative potential needs to be fully elucidated. In addition, further clinical studies with longer follow-up periods are needed in order to design treatment algorithms and clinical guidelines.
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References
Al-Shammari KF, Kazor CE, Wang HL (2001) Molar root anatomy and management of furcation defects. J Clin Periodontol 28(8):730–740
Pontoriero R, Lindhe J, Nyman S, Karring T, Rosenberg E, Sanavi F (1989) Guided tissue regeneration in the treatment of furcation defects in mandibular molars. A clinical study of degree III involvements. J Clin Periodontol 16(3):170–174
Nordland P, Garrett S, Kiger R, Vanooteghem R, Hutchens LH, Egelberg J (1987) The effect of plaque control and root debridement in molar teeth. J Clin Periodontol 14(4):231–236
Wang HL, Burgett FG, Shyr Y, Ramfjord S (1994) The influence of molar furcation involvement and mobility on future clinical periodontal attachment loss. J Periodontol 65(1):25–29
Svardstrom G, Wennstrom JL (2000) Periodontal treatment decisions for molars: an analysis of influencing factors and long-term outcome. J Periodontol 71(4):579–585
Walter C, Schmidt JC, Dula K, Sculean A (2016) Cone beam computed tomography (CBCT) for diagnosis and treatment planning in periodontology: a systematic review. Quintessence Int 47(1):25–37
Nikolic-Jakoba N, Spin-Neto R, Wenzel A (2016) Cone-beam computed tomography for detection of intrabony and furcation defects: a systematic review based on a hierarchical model for diagnostic efficacy. J Periodontol 87(6):630–644
Derks H, Westheide D, Pfefferle T, Eickholz P, Dannewitz B (2018) Retention of molars after root-resective therapy: a retrospective evaluation of up to 30 years. Clin Oral Investig 22(3):1327–1335
Livada R, Fine N, Shiloah J (2014) Root amputation: a new look into an old procedure. N Y State Dent J 80(4):24–28
Schropp L, Wenzel A, Kostopoulos L, Karring T (2003) Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent 23(4):313–323
Melker DJ, Richardson CR (2001) Root reshaping: an integral component of periodontal surgery. Int J Periodontics Restorative Dent 21(3):296–304
Avila-Ortiz G, De Buitrago JG, Reddy MS (2015) Periodontal regeneration - furcation defects: a systematic review from the AAP Regeneration Workshop. J Periodontol 86(2 suppl):S108–S130
Sanz M, Jepsen K, Eickholz P, Jepsen S (2015) Clinical concepts for regenerative therapy in furcations. Periodontol 2000 68(1):308–332
Kinaia BM, Steiger J, Neely AL, Shah M, Bhola M (2011) Treatment of Class II molar furcation involvement: meta-analyses of reentry results. J Periodontol 82(3):413–428
Chen Ts TY, Yen CC, Lu HK (2013) A systematic review and meta-analysis of guided tissue regeneration/osseous grafting for the treatment of Class II furcation defects. J Dent Sci 8:209–224
Reynolds MA, Aichelmann-Reidy ME, Branch-Mays GL, Gunsolley JC (2003) The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A systematic review. Ann Periodontol 8(1):227–265
Murphy KG, Gunsolley JC (2003) Guided tissue regeneration for the treatment of periodontal intrabony and furcation defects. A systematic review. Ann Periodontol 8(1):266–302
Jepsen S, Eberhard J, Herrera D, Needleman I (2002) 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? J Clin Periodontol 29(suppl 3):103–116; discussion 160–162
Huynh-Ba G, Kuonen P, Hofer D, Schmid J, Lang NP, Salvi GE (2009) The effect of periodontal therapy on the survival rate and incidence of complications of multirooted teeth with furcation involvement after an observation period of at least 5 years: a systematic review. J Clin Periodontol 36(2):164–176
Casarin RC, Ribeiro Edel P, Nociti FH Jr et al (2010) Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective 24-month randomized clinical trial. J Clin Periodontol 37(12):1100–1109
Jepsen S, Heinz B, Jepsen K et al (2004) A randomized clinical trial comparing enamel matrix derivative and membrane treatment of buccal Class II furcation involvement in mandibular molars. Part I: Study design and results for primary outcomes. J Periodontol 75(8):1150–1160
Nevins M, Camelo M, Nevins ML, Schenk RK, Lynch SE (2003) Periodontal regeneration in humans using recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and allogenic bone. J Periodontol 74(9):1282–1292
Howell TH, Fiorellini JP, Paquette DW, Offenbacher S, Giannobile WV, Lynch SE (1997) A phase I/II clinical trial to evaluate a combination of recombinant human platelet-derived growth factor-BB and recombinant human insulin-like growth factor-I in patients with periodontal disease. J Periodontol 68(12):1186–1193
Darby IB, Morris KH (2013) A systematic review of the use of growth factors in human periodontal regeneration. J Periodontol 84(4):465–476
Lekovic V, Camargo PM, Weinlaender M, Vasilic N, Aleksic Z, Kenney EB (2003) Effectiveness of a combination of platelet-rich plasma, bovine porous bone mineral and guided tissue regeneration in the treatment of mandibular grade II molar furcations in humans. J Clin Periodontol 30(8):746–751
Pradeep AR, Pai S, Garg G, Devi P, Shetty SK (2009) A randomized clinical trial of autologous platelet-rich plasma in the treatment of mandibular degree II furcation defects. J Clin Periodontol 36(7):581–588
Sharma A, Pradeep AR (2011) Autologous platelet-rich fibrin in the treatment of mandibular degree II furcation defects: a randomized clinical trial. J Periodontol 82(10):1396–1403
Bajaj P, Pradeep AR, Agarwal E et al (2013) Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of mandibular degree II furcation defects: a randomized controlled clinical trial. J Periodontal Res 48(5):573–581
Graziani F, Gennai S, Karapetsa D et al (2015) Clinical performance of access flap in the treatment of class II furcation defects. A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol 42(2):169–181
Reddy MS, Aichelmann-Reidy ME, Avila-Ortiz G et al (2015) Periodontal regeneration - furcation defects: a consensus report from the AAP Regeneration Workshop. J Periodontol 86(2 suppl):S131–S133
Kwan JY (2005) Enhanced periodontal debridement with the use of micro ultrasonic, periodontal endoscopy. J Calif Dent Assoc 33(3):241–248
Michaud RM, Schoolfield J, Mellonig JT, Mealey BL (2007) The efficacy of subgingival calculus removal with endoscopy-aided scaling and root planing: a study on multirooted teeth. J Periodontol 78(12):2238–2245
Stambaugh RV, Meyers GC, Watanabe J, Lass C, Stambaugh KA (2000) Endoscopic instrumentation of the subgingival root surface in periodontal therapy. J Dent Res 79:489
Stambaugh RV, Myers G, Ebling W, Beckman B, Stambaugh K (2002) Endoscopic visualization of the submarginal gingiva dental sulcus and tooth root surfaces. J Periodontol 73(4):374–382
Geisinger ML, Mealey BL, Schoolfield J, Mellonig JT (2007) The effectiveness of subgingival scaling and root planing: an evaluation of therapy with and without the use of the periodontal endoscope. J Periodontol 78(1):22–28
Mills MP, Rosen PS, Chambrone L et al (2018) American Academy of Periodontology best evidence consensus statement on the efficacy of laser therapy used alone or as an adjunct to non-surgical and surgical treatment of periodontitis and peri-implant diseases. J Periodontol 89(7):737–742
de Andrade AK, Feist IS, Pannuti CM, Cai S, Zezell DM, De Micheli G (2008) Nd:YAG laser clinical assisted in class II furcation treatment. Lasers Med Sci 23(4):341–347
Nevins ML, Camelo M, Schupbach P, Kim SW, Kim DM, Nevins M (2012) Human clinical and histologic evaluation of laser-assisted new attachment procedure. Int J Periodontics Restorative Dent 32(5):497–507
Crespi R, Covani U, Margarone JE, Andreana S (1997) Periodontal tissue regeneration in beagle dogs after laser therapy. Lasers Surg Med 21(4):395–402
Mizutani K, Aoki A, Takasaki AA et al (2006) Periodontal tissue healing following flap surgery using an Er:YAG laser in dogs. Lasers Surg Med 38(4):314–324
Pavone C, Perussi LR, de Oliveira GJ et al (2015) Effect of Er,Cr:YSGG laser application in the treatment of experimental periodontitis. Lasers Med Sci 30(3):993–999
Ge L, Zhang Y, Shu R (2017) Er,Cr:YSGG laser application for the treatment of periodontal furcation involvements. Photomed Laser Surg 35(2):92–97
de Almeida JM, Theodoro LH, Bosco AF, Nagata MJ, Oshiiwa M, Garcia VG (2008) In vivo effect of photodynamic therapy on periodontal bone loss in dental furcations. J Periodontol 79(6):1081–1088
Hamblin MR, Hasan T (2004) Photodynamic therapy: a new antimicrobial approach to infectious disease? Photochem Photobiol Sci 3(5):436–450
Luchesi VH, Pimentel SP, Kolbe MF et al (2013) Photodynamic therapy in the treatment of class II furcation: a randomized controlled clinical trial. J Clin Periodontol 40(8):781–788
Matesanz-Perez P, Garcia-Gargallo M, Figuero E, Bascones-Martinez A, Sanz M, Herrera D (2013) A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis. J Clin Periodontol 40(3):227–241
Tonetti MS, Cortellini P, Carnevale G, Cattabriga M, de Sanctis M, Pini Prato GP (1998) A controlled multicenter study of adjunctive use of tetracycline periodontal fibers in mandibular class II furcations with persistent bleeding. J Clin Periodontol 25(9):728–736
Tomasi C, Wennstrom JL (2011) Locally delivered doxycycline as an adjunct to mechanical debridement at retreatment of periodontal pockets: outcome at furcation sites. J Periodontol 82(2):210–218
Dannewitz B, Lippert K, Lang NP, Tonetti MS, Eickholz P (2009) Supportive periodontal therapy of furcation sites: non-surgical instrumentation with or without topical doxycycline. J Clin Periodontol 36(6):514–522
Yilmaz HG, Bayindir H (2012) Clinical evaluation of chlorhexidine and essential oils for adjunctive effects in ultrasonic instrumentation of furcation involvements: a randomized controlled clinical trial. Int J Dent Hyg 10(2):113–117
Del Peloso Ribeiro E, Bittencourt S, Ambrosano GM et al (2006) Povidone-iodine used as an adjunct to non-surgical treatment of furcation involvements. J Periodontol 77(2):211–217
Sgolastra F, Gatto R, Petrucci A, Monaco A (2012) Effectiveness of systemic amoxicillin/metronidazole as adjunctive therapy to scaling and root planing in the treatment of chronic periodontitis: a systematic review and meta-analysis. J Periodontol 83(10):1257–1269
Keestra JA, Grosjean I, Coucke W, Quirynen M, Teughels W (2015) Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis: a systematic review and meta-analysis. J Periodontal Res 50(3):294–314
Eickholz P, Nickles K, Koch R et al (2016) Is furcation involvement affected by adjunctive systemic amoxicillin plus metronidazole? A clinical trials exploratory subanalysis. J Clin Periodontol 43(10):839–848
Bertl K, Parllaku A, Pandis N, Buhlin K, Klinge B, Stavropoulos A (2017) The effect of local and systemic statin use as an adjunct to non-surgical and surgical periodontal therapy-a systematic review and meta-analysis. J Dent 67:18–28
Quist-Paulsen P (2010) Statins and inflammation: an update. Curr Opin Cardiol 25(4):399–405
Ting M, Whitaker EJ, Albandar JM (2016) Systematic review of the in vitro effects of statins on oral and perioral microorganisms. Eur J Oral Sci 124(1):4–10
Adam O, Laufs U (2008) Antioxidative effects of statins. Arch Toxicol 82(12):885–892
Meza-Mauricio J, Soto-Penaloza D, Penarrocha-Oltra D, Montiel-Company JM, Peruzzo DC (2018) Locally applied statins as adjuvants to non-surgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis. Clin Oral Investig 22:2413–2430
Mundy G, Garrett R, Harris S et al (1999) Stimulation of bone formation in vitro and in rodents by statins. Science 286(5446):1946–1949
Grasser WA, Baumann AP, Petras SF et al (2003) Regulation of osteoclast differentiation by statins. J Musculoskelet Neuronal Interact 3(1):53–62
Sinjab K, Zimmo N, Lin GH, Chung MP, Shaikh L, Wang HL (2017) The effect of locally delivered statins on treating periodontal intrabony defects: a systematic review and meta-analysis. J Periodontol 88(4):357–367
Pradeep AR, Karvekar S, Nagpal K, Patnaik K, Raju A, Singh P (2016) Rosuvastatin 1.2 mg in situ gel combined with 1:1 mixture of autologous platelet-rich fibrin and porous hydroxyapatite bone graft in surgical treatment of mandibular Class II furcation defects: a randomized clinical control trial. J Periodontol 87(1):5–13
Garg S, Pradeep AR (2017) 1.2% Rosuvastatin and 1.2% atorvastatin gel local drug delivery and redelivery in the treatment of Class II furcation defects: a randomized controlled clinical trial. J Periodontol 88(3):259–265
Salvi GE, Mischler DC, Schmidlin K et al (2014) Risk factors associated with the longevity of multi-rooted teeth. Long-term outcomes after active and supportive periodontal therapy. J Clin Periodontol 41(7):701–707
Graetz C, Schutzhold S, Plaumann A et al (2015) Prognostic factors for the loss of molars--an 18-years retrospective cohort study. J Clin Periodontol 42(10):943–950
Nibali L, Zavattini A, Nagata K et al (2016) Tooth loss in molars with and without furcation involvement - a systematic review and meta-analysis. J Clin Periodontol 43(2):156–166
Tonetti MS, Christiansen AL, Cortellini P (2017) Vertical subclassification predicts survival of molars with class II furcation involvement during supportive periodontal care. J Clin Periodontol 44(11):1140–1144
Nibali L, Sun C, Akcali A, Yeh YC, Tu YK, Donos N (2018) The effect of horizontal and vertical furcation involvement on molar survival: a retrospective study. J Clin Periodontol 45(3):373–381
Hirschfeld L, Wasserman B (1978) A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol 49(5):225–237
McFall WT Jr (1982) Tooth loss in 100 treated patients with periodontal disease. A long-term study. J Periodontol 53(9):539–549
Schwendicke F, Graetz C, Stolpe M, Dorfer CE (2014) Retaining or replacing molars with furcation involvement: a cost-effectiveness comparison of different strategies. J Clin Periodontol 41(11):1090–1097
Pretzl B, Wiedemann D, Cosgarea R et al (2009) Effort and costs of tooth preservation in supportive periodontal treatment in a German population. J Clin Periodontol 36(8):669–676
Walter C, Dagassan-Berndt DC, Kuhl S, Weiger R, Lang NP, Zitzmann NU (2014) Is furcation involvement in maxillary molars a predictor for subsequent bone augmentation prior to implant placement? A pilot study. Clin Oral Implants Res 25(12):1352–1358
Fardal O, Grytten J (2013) A comparison of teeth and implants during maintenance therapy in terms of the number of disease-free years and costs – an in vivo internal control study. J Clin Periodontol 40(6):645–651
Jung RE, Zembic A, Pjetursson BE, Zwahlen M, Thoma DS (2012) Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clin Oral Implants Res 23(suppl 6):2–21
Schwarz F, Derks J, Monje A, Wang HL (2018) Peri-implantitis. J Periodontol 89(suppl 1):S267–SS90
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Martinez Luna, A.A., Gholami, F. (2020). Management of Furcation Defects. In: Nares, S. (eds) Advances in Periodontal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-12310-9_8
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DOI: https://doi.org/10.1007/978-3-030-12310-9_8
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