Papilla preservation flaps for periodontal regeneration of molars severely compromised by combined furcation and intrabony defects: Retrospective analysis of a registry‐based cohort

Abstract

Background Furcation involvement and attachment loss are major predictors of tooth loss. The aim of this study was to describe specific designs for papilla preservation flaps (PPFs) and minimally invasive surgery to be used in compromised molars and report proof‐of‐principle data with 3 to 16‐year follow‐up in severely compromised molars due to the presence of combined furcation and intrabony defects. Methods Forty‐nine subjects with furcated molars and deep intrabony defects were treated with PPFs, application of periodontal regenerative devices. Improvement as a consequence of therapy was defined as tooth retention, reduction in horizontal and vertical furcation involvement, decrease in probing depths, and increases in clinical attachment level. Subjects were maintained with regular supportive periodontal care. Results At 1 year, 100% of maxillary and 92% of mandibular molars showed improvements. Improvements were not observed in molars with baseline hypermobility: two mandibular molars with hypermobility were extracted at the 1‐year follow‐up. Improvement in vertical sub‐classification was observed in 87.5% of maxillary and in 84.6% of mandibular molars. One‐year improvements could be maintained over the 3 to 16‐year follow‐up. Conclusions PPFs and periodontal regeneration can be applied and provide clinical benefits to severely compromised molars due to the combined presence of furcation involvement and deep intrabony defects. These results were obtained in cases with an interdental peak of bone and gingival margin coronal to the furcation entrance in well‐maintained and compliant subjects. Randomized controlled clinical trials with medium‐ to long‐term follow‐up are needed to confirm these findings.

Periodontal regeneration versus extraction and dental implant or prosthetic replacement of teeth severely compromised by attachment loss to the apex: A randomized controlled clinical trial reporting 10‐year outcomes, survival analysis and mean cumulative cost of recurrence

“…Case selection is also critical: all cases were characterized by the presence of good peaks of bone/attachment on the adjacent teeth, essentially providing good coronal anchorage to ensure stability of the flap and the clot as well as limiting soft‐tissue recession. Such characteristic is critical for both the test and the control treatments, and it is important not to generalize the results to cases without such specific morphology (Cortellini et al., 2019).…”

“…These included patient comfort, masticatory function and improvement of clinical parameters contributing to the assessment of tooth prognosis according to McGuire and Nunn (1996a, 1996b) and Kwok and Caton (2007). Secondary outcomes included the following: (a) the assessment of periodontal parameters including full‐mouth plaque score (FMPS), full‐mouth bleeding on probing (FMBS), probing pocket depths (PPDs), recession of the gingival margin (Rec), tooth mobility and assessment of tooth vitality (cold test and electric pulp testing; Cortellini, Cortellini, & Tonetti, 2019; Cortellini et al., 2011); (b) biological or technical complications at the experimentally treated teeth or at the abutments of tooth‐ or implant‐supported bridges; and (c) health economic measures. Outcomes were evaluated yearly over the 10‐year follow‐up period by a single examiner (MST) not involved in the delivery of treatment.…”

Treatment effect of guided tissue regeneration on the horizontal and vertical components of furcation defects: A retrospective study

“…34 Briefly, the vertical component was calculated based on the amount of bone loss in the furcation defect, subclass A was designated when bone loss reached the coronal third (≤33%) of the furcation region, subclass B was when the bone loss reached the middle third (33%-67%) of the furcation region and subclass C was assigned when the bone loss reached the apical third (≥67%) of the furcation region. 4,7,21,34 When multiple root areas of a single tooth were involved, the area with the greatest vertical component was used to determine the subclass of the tooth. 34 The values obtained at baseline were then compared to the values obtained from radiographs taken at the 1-year post-op follow-up ( Figure 1).…”

“…13,[17][18][19][20] Studies looking at the predictability and prevalence of complications following GTR treatment in furcation defects are limited. [21][22][23][24] Although factors affecting the success of GTR in furcation defects have been examined previously, 25,26 indepth assessment of factors that may influence and predict the long-term treatment outcomes are still lacking. 17,[27][28][29][30][31] Further, most studies have evaluated the effect of regeneration in furcations only on the horizontal component and not on the vertical aspect of the furcation defect.…”

Feasibility and needs for simultaneous or staged bone augmentation to place prosthetically guided dental implants after extraction or exfoliation of first molars due to severe periodontitis

“…The residual amount of bone, rather than the horizontal component of the furcation involvement, as reflected in the vertical subclassification (Tarnow & Fletcher, 1984), has been recently associated with tooth survival (Nibali et al., 2018; Tonetti, Christiansen, & Cortellini, 2017). Advanced treatment options are able to extend retention of these compromised molars (Cortellini, Cortellini, & Tonetti, 2020; Dommisch, Walter, Dannewitz, & Eickholz, 2020; Jepsen et al., 2019), and the recent European S3 clinical guidelines suggest periodontal therapy as the treatment of choice to maintain masticatory function (Sanz et al, 2020). In such cases, however, eventual progression of periodontitis may lead to large amounts of resorption of the alveolar bone and complicate replacement with implant retained fixed partial dentures.…”