361
Treatment of Periodontal Furcation Defects. Mandibular Class III Defects* Bernard G.
Gantés, Blake N. Synowski, Steven Garrett, and Jan H. Egelberg
Class hi furcation defects were treated in 27 subjects that included citric acid root conditioning and coronally using regenerative therapy sutures. In addition to this therapy, 13 of the secured crown-attached positioned flaps by 27 defects received freeze-dried, decalcified allogenic bone grafts. The effect of these therapies was evaluated from soft tissue probing measurements, including furcation probings to determine soft tissue closure of the defects. At 6 months postsurgery, the mean vertical probing depth reduction and the mean probing attachment level gain in the furcation area were 2.6 mm and 2.2 mm for the non-grafted defects and 1.9 mm and 1.5 mm for the grafted defects. One of the 14 non-grafted defects and 3 of 13 grafted defects were judged to show soft tissue clinical closure by a panel of 3 independent examiners. No statistically significant differences were observed between defects treated with or without bone grafts. J Periodontol 1991;62:361-365. Twenty-seven
mandibular
a
Key Words: Furcation defects/therapy; acid etching, dental; citric acid; surgical flaps.
Different regenerative therapies have been described in treating mandibular Class II furcation defects. Kenney et al.1 demonstrated improved furcation fill after use of a porous hydroxyapatite implant material. Pontoriero et al.2 observed soft tissue closure of about 90% of mandibular Class II furcation defects following surgical wound closure that included the use of a non-resorbable membrane. Using the same therapy, Lekovic et al.3 found similar soft tissue improvement, but noted upon 6month reentry that the soft tissue closure was not associated with bony closure of the defects. By combining this therapy with porous hydroxyapatite implant material, Lekovic et al.4 were able to demonstrate an improved furcation fill. Gantes et al.5 and Garrett et al.6 reported complete bone fill in approximately 50% of mandibular Class II furcation defects treated with coronally positioned flaps. In a study involving mandibular Class III furcation defects, Pontoriero et al.7 reported that 8 of 21 treated defects demonstrated soft tissue closure after treatment with nonresorbable membranes. No reentry procedure was utilized to evaluate bone fill. The purpose of this study was to evaluate the outcome of treatment of mandibular Class III furcation defects using a combined therapy of citric acid root conditioning and coronally positioned flaps. In addition, the effect of freezedried, demineralized bone allografts was evaluated.
'Department of Periodontics, sity, Loma Linda, CA.
School of
Dentistry,
Loma Linda Univer-
MATERIAL AND METHODS
Patients and
Experimental Teeth Twenty seven adult patients volunteered for this study. They were selected from patients undergoing therapy at the School of Dentistry, Loma Linda University. Criteria for selection included the following: the patients had to be systemically healthy and had to have 1 molar tooth with a Class III furcation defect probeable "through-and-through"; the involved teeth had to have intact tooth surfaces adjacent to the furcation defect, respond within normal range to pulp testing and have at least 2 mm of keratinized gingiva both buccally and lingually. A total of 27 furcation defects were selected for treatment. Fourteen defects were treated with citric acid root conditioning plus buccal and lingual coronal flap positioning. Thirteen additional defects received the same therapy plus freeze-dried demineralized bone allografts. The 2 treatment modalities were assigned randomly. The distribution of the 2 treatment modalities is presented in Tables 1 and
2.
Treatment Initial treatment consisted of oral
hygiene instructions with attention to the experimental teeth. The surgeries were not carried out until the patients had demonstrated that they could keep the experimental teeth plaque free. The surgical procedure corresponded to the technique described previously for buccal Class II furcation defects,8 special
362
J Periodontol June 1991
TREATMENT OF MANDIBULAR CLASS III LESIONS
Table 1: Soft Tissue Changes in Class III Mandibular Furcation Defects Treated With Citric Acid Conditioning + Coronal Flap Positioning; Means of Buccal and Lingual Measurements (N = 14)
Subject
Probing
Tooth
Probing Depth (mm) Initial
Attachment Level Gain at 6 Months
(mm)
9.00 6.00 7.75 7.50 9.00 6.50 8.00 7.25 4.75 7.25 7.75 9.50 8.50 5.25
6 Months 6.00 4.25 2.50 8.00 4.75 4.00 4.25 3.75 3.00 5.50 3.25 7.50 6.50 4.50
2.00 1.50 4.25 .50 3.00 2.00 3.25 3.75 1.25 2.00 3.50 1.75 1.25 1.25
Mean
7.43^
J.84
2.23*
S.D.
1.41
1.66
1.12
46 37 46 37 36 46 47 46 36 46 47 36 47 36
9 10 11 12 13 14
*p
Treatment of Periodontal Furcation Defects. Mandibular Class III Defects* Bernard G.
Gantés, Blake N. Synowski, Steven Garrett, and Jan H. Egelberg
Class hi furcation defects were treated in 27 subjects that included citric acid root conditioning and coronally using regenerative therapy sutures. In addition to this therapy, 13 of the secured crown-attached positioned flaps by 27 defects received freeze-dried, decalcified allogenic bone grafts. The effect of these therapies was evaluated from soft tissue probing measurements, including furcation probings to determine soft tissue closure of the defects. At 6 months postsurgery, the mean vertical probing depth reduction and the mean probing attachment level gain in the furcation area were 2.6 mm and 2.2 mm for the non-grafted defects and 1.9 mm and 1.5 mm for the grafted defects. One of the 14 non-grafted defects and 3 of 13 grafted defects were judged to show soft tissue clinical closure by a panel of 3 independent examiners. No statistically significant differences were observed between defects treated with or without bone grafts. J Periodontol 1991;62:361-365. Twenty-seven
mandibular
a
Key Words: Furcation defects/therapy; acid etching, dental; citric acid; surgical flaps.
Different regenerative therapies have been described in treating mandibular Class II furcation defects. Kenney et al.1 demonstrated improved furcation fill after use of a porous hydroxyapatite implant material. Pontoriero et al.2 observed soft tissue closure of about 90% of mandibular Class II furcation defects following surgical wound closure that included the use of a non-resorbable membrane. Using the same therapy, Lekovic et al.3 found similar soft tissue improvement, but noted upon 6month reentry that the soft tissue closure was not associated with bony closure of the defects. By combining this therapy with porous hydroxyapatite implant material, Lekovic et al.4 were able to demonstrate an improved furcation fill. Gantes et al.5 and Garrett et al.6 reported complete bone fill in approximately 50% of mandibular Class II furcation defects treated with coronally positioned flaps. In a study involving mandibular Class III furcation defects, Pontoriero et al.7 reported that 8 of 21 treated defects demonstrated soft tissue closure after treatment with nonresorbable membranes. No reentry procedure was utilized to evaluate bone fill. The purpose of this study was to evaluate the outcome of treatment of mandibular Class III furcation defects using a combined therapy of citric acid root conditioning and coronally positioned flaps. In addition, the effect of freezedried, demineralized bone allografts was evaluated.
'Department of Periodontics, sity, Loma Linda, CA.
School of
Dentistry,
Loma Linda Univer-
MATERIAL AND METHODS
Patients and
Experimental Teeth Twenty seven adult patients volunteered for this study. They were selected from patients undergoing therapy at the School of Dentistry, Loma Linda University. Criteria for selection included the following: the patients had to be systemically healthy and had to have 1 molar tooth with a Class III furcation defect probeable "through-and-through"; the involved teeth had to have intact tooth surfaces adjacent to the furcation defect, respond within normal range to pulp testing and have at least 2 mm of keratinized gingiva both buccally and lingually. A total of 27 furcation defects were selected for treatment. Fourteen defects were treated with citric acid root conditioning plus buccal and lingual coronal flap positioning. Thirteen additional defects received the same therapy plus freeze-dried demineralized bone allografts. The 2 treatment modalities were assigned randomly. The distribution of the 2 treatment modalities is presented in Tables 1 and
2.
Treatment Initial treatment consisted of oral
hygiene instructions with attention to the experimental teeth. The surgeries were not carried out until the patients had demonstrated that they could keep the experimental teeth plaque free. The surgical procedure corresponded to the technique described previously for buccal Class II furcation defects,8 special
362
J Periodontol June 1991
TREATMENT OF MANDIBULAR CLASS III LESIONS
Table 1: Soft Tissue Changes in Class III Mandibular Furcation Defects Treated With Citric Acid Conditioning + Coronal Flap Positioning; Means of Buccal and Lingual Measurements (N = 14)
Subject
Probing
Tooth
Probing Depth (mm) Initial
Attachment Level Gain at 6 Months
(mm)
9.00 6.00 7.75 7.50 9.00 6.50 8.00 7.25 4.75 7.25 7.75 9.50 8.50 5.25
6 Months 6.00 4.25 2.50 8.00 4.75 4.00 4.25 3.75 3.00 5.50 3.25 7.50 6.50 4.50
2.00 1.50 4.25 .50 3.00 2.00 3.25 3.75 1.25 2.00 3.50 1.75 1.25 1.25
Mean
7.43^
J.84
2.23*
S.D.
1.41
1.66
1.12
46 37 46 37 36 46 47 46 36 46 47 36 47 36
9 10 11 12 13 14
*p
