The applications of the plasma matrix in the treatments of dental pulp and periapical diseases / 口腔疾病防治

@#The plasma matrix is a kind of autologous blood conduct. It has been widely used in maxillofacial tissue regeneration, skin cosmetology and some other fields. Recently, to preserve the dental pulp as well as the teeth, pulp regeneration therapy and apical surgery have become increasingly important as well as the applications of bioactive materials. As a kind of autologous bioactive material, the plasma matrix has some natural advantages as it is easy to obtain and malleable. The plasma matrix can be used in the following cases: ①pulp revascularization of young permanent teeth with open apical foramina that cannot stimulate apical bleeding; ② apical barrier surgery with bone defects and large area perforation repair with bone defects or root sidewall repair surgery; ③ apical surgeries of teeth with large area of apical lesions, with or without periodontal diseases. The plasma matrix is a product derived from our blood, and there are no obvious contraindications for its use. Several systematic reviews have shown that the plasma matrix can effectively promote the regenerative repair of dental pulp in patients with periapical diseases. However, the applications of plasma matrix are different because its characteristics are affected by different preparation methods. In addition, there is still a lack of long-term clinical researches on the plasma matrix, and the histological evidences are difficult to obtain, so a large number of in vitro and in vivo experimental studies are still needed. This article will describe the applications of different kinds of plasma matrix for dental pulp regeneration and bone tissue regeneration in apical surgeries to provide references for clinicians in indication selection and prognosis evaluation.

Efficacy of treatment of class II furcation lesions using membrane associated with bone grafting in mandibular molars compared to membrane only: a systematic review and meta-analysis / Eficacia del tratamiento de lesiones de furca grado II utilizando membrana asociada con injerto óseo en molares mandibulares en comparación con solamente membrana: revisión sistemática y metanálisis

Objective: The objective of the present systematic review and meta-analysis was to compare treatment with membrane associated with bone grafting and treatment exclusively with membrane in the approach of Class II furcation defects in mandibular molars. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were conducted in five databases (PubMed, Web of Science, Scopus, Ovid, and Lilacs), in Septem-ber 2021, without restriction regarding publication year or language. Studies comparing membranes associated with bone grafting and membranes exclusively in the treatment of Class II furcation lesions were included. Cross-sectional, case-control studies, and reviews were excluded. Study selection, data extraction, and risk of bias assessment (MINORS) were performed by two review authors. The certainty of the evidence (GRADE) was evaluated and meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. Results: Four hundred eighty-six references were iden-tified and four studies were included. Greater reduction in probing depth [MD = 0.32 (CI = 0.09, 0.56)] and greater clinical attachment level gain [MD = 0.41 (CI = 0.24, 0.57)] were observed when membrane and bone grafting were used. The risk of bias of included studies was low. Conclusions: This present systematic review and meta-analysis demonstrated that treatment of Class II furcation defects in mandibular molars using membrane and bone grafing is significantly more efficacious than treatment with the exclusive use of membrane.

Objetivo: El objetivo de la presente revisión sistemática y metanálisis fue comparar el tratamiento con membrana asociado a injerto óseo y el tratamiento exclusivamente con membrana en el abordaje de lesiones de furca grado II en molares mandibulares. Materiales y Métodos: Se siguió la declaración de elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Las búsquedas se realizaron en cinco bases de datos (PubMed, Web of Science, Scopus, Ovid y Lilacs), en septiembre de 2021, sin restricción de año de publicación o idioma. Se incluyeron estudios que compararon membranas asociadas con injertos óseos y membranas exclusivamente en el tratamiento de lesiones de furca de grado II. Se excluyeron los estudios transversales, de casos y controles y las revisiones. Dos revisores realizaron la selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo (MINORS). Se evaluó la certeza de la evidencia (GRADE) y se realizó un metanálisis. Se proporcionaron la diferencia de medias (DM) y el intervalo de confianza (IC) del 95%. Resultados: Se identificaron 486 referencias y se incluyeron cuatro estudios. Se observó una mayor reducción en la profundidad de sondaje [DM = 0,32 (IC = 0,09, 0,56)] y una mayor ganancia en el nivel de inserción clínica [DM = 0,41 (IC= 0,24, 0,57)] cuando se utilizaron injertos de membrana y hueso. El riesgo de sesgo de los estudios incluidos fue bajo. Conclusión: La presente revisión sistemática y metanálisis demostró que el tratamiento de los defectos de furca de grado II en molares mandibulares utilizando membrana e injertos de hueso es significativamente más eficaz que el tratamiento con el uso exclusivo de membrana.

Clinical identification and endodontic management of furcation canals: a case series

Abstract In the case of endodontic infection, the presence of furcation canals can be at the origin of a periodontal lesion located in the furcation. The furcation being very close to the marginal periodontium, this type of lesion can be favorable to the genesis of an endo-periodontal lesion. These furcation canals are lateral canals located on the pulp chamber floor and constitute one of the many physiological communication pathways between endodontic and periodontal tissues. These canals are most often difficult to localize, shape, and to fill because of their small diameter and length. The disinfection of the pulp chamber floor with sodium hypochlorite solution may contribute to the disinfection of furcation canals when they are not identified, shaped, and/or filled. This case series illustrates the endodontic management of visible furcation canals associated with an endo-periodontal lesion. These furcation canals had a large diameter which allowed their identification during the endodontic treatment.

Resumo No caso de infecção endodôntica, a presença de canais cavo inter-radiculares pode estar na origem de uma lesão periodontal localizada na região de furca. Sendo a furca muito próxima do periodonto marginal, esse tipo de lesão pode ser favorável à fomação de uma lesão endo-periodontal. Esses canais estão localizados no assoalho da câmara pulpar e constituem uma das inúmeras vias de comunicação fisiológica entre os tecidos endodônticos e periodontais. Esses canais são na maioria das vezes difíceis de localizar, instrumentar e obturar por causa do diâmetro e comprimento reduzidos. A desinfecção do assoalho da câmara pulpar com solução de hipoclorito de sódio pode contribuir para a desinfecção dos canais cavo inter-radiculares quando eles não são localizados, instrumentamos e/ou obturados. Os casos clínicos descritos ilustram o manejo endodôntico de canais cavo inter-radiculares visíveis associados a uma lesão endo-periodontal. Esses canais cavo inter-radiculares tinham um grande diâmetro que permitiu sua localização durante o tratamento endodôntico.

Láserterapia como coadyuvante del tratamiento de lesiones de furca grado II

Objetivo: evaluar la evidencia del láser como coadyuvante en el tratamiento quirúrgico de lesiones de furca grado II y reflejar la importancia clínica de los hallazgos para la toma de decisiones. Materiales y métodos: se realizó una búsqueda bibliográfica manual, se consultaron las siguientes bases de datos: PORTAL TIMBO FOCO, PUBMED, BVS, SciELO y GOOGLE SCHOOLAR. Esta búsqueda fue restringida a los últimos 15 años y los artículos seleccionados están en inglés. Resultados: Se seleccionaron 105 artículosque abordan la temática y se completó la búsqueda con el rastreo y la lectura de la bibliografía referenciada en esos artículos. Conclusiones: El láser de baja potencia tanto para la bioestimulación así como su efecto anti-inflamatorio, solo ha mostrado hasta ahora resultados positivos a corto plazo como coadyuvante del tratamiento periodontal regenerativo en lesiones de furca grado II. Sin embargo, sus resultados a largo plazo no son claros debido a la debilidad metodológica y al número insuficente de estudios existentes. Por otro lado, la terapia fotodinámica podría ser una alternativa para el control de pérdida ósea en lesiones de furca causadas por periodontitis. Por lo tanto, hacen falta más estudios para dilucidar la acción del la terapia fotodinámica y de la fotobiomodulación coadyuvantes del tratamiento de las lesiones de furca.

Objetivo: avaliar a evidência do laser como adjuvante no tratamento cirúrgico das lesões de furca grau II e refletir a importância clínica dos achados para a tomada de decisão. Materiais e métodos: foi realizada busca bibliográfica manual, consultadas as seguintes bases de dados: PORTAL TIMBO FOCO, PUBMED, BVS, SciELO e GOOGLE SCHOOL. Esta busca foi restrita aos últimos 15 anos e os artigos selecionados estão no idioma inglês. Resultados: foram selecionados 105 artigos que abordam o assunto e a busca foi concluída por meio de busca e leitura da bibliografia referenciada nesses artigos. Conclusões: O laser de baixa potência, tanto para a bioestimulação como para o seu efeito anti-inflamatório, apenas apresentou resultados positivos a curto prazo como adjuvante do tratamento periodontal regenerativo em lesões de furca grau II. No entanto, seus resultados a longo prazo não são claros devido a deficiências metodológicas e número insuficiente de estudos existentes. Por outro lado, a terapia fotodinâmica pode ser uma alternativa para controlar a perda óssea em lesões de furca causadas por periodontite. Portanto, mais estudos são necessários para elucidar a ação da Terapia Fotodinâmica e da fotobiomodulação como adjuvantes no tratamento da lesões de furca.

Objective: to evaluate the evidence of the efficacy of the adjuvant use of laser in the surgical treatment of grade II furcation lesions and to demonstrate the clinical importance of the findings for decision making. Materials and methods: a manual bibliographic search was carried out where the following databases were consulted: PORTAL TIMBO FOCO, PUBMED, SciELO, BVS and GOOGLE SCHOOL. This search was restricted to the last 15 years and the selected articles are in English. Results: 105 articles that addressed the subject were selected and the search was completed by searching and reading the referenced bibliography in those articles. Conclusions: Low-power laser, both for biostimulation and as an anti-inflammatory has so far only shown positive short-term results as an adjunct to regenerative periodontal treatment in grade II furcation lesions. However, its long-term results are not clear due to methodological weaknesses and the insufficient number of existing studies. On the other hand, photodynamic therapy could be an alternative to control bone loss in furcation lesions caused by periodontitis. However, more studies are needed to elucidate the action of photodynamic therapy and photobiomodulation as adjuvants in the treatment of furcation lesions.

Classification of furcation involvement of endodontically treated mandibular first permanent molars based on cone beam CT / 口腔疾病防治

Objective @#To classify the furcation involvement (FI) of endodontically treated mandibular first permanent molars based on cone beam computed tomography (CBCT), provide reference for individualized treatment of FI. @*Methods@#CBCT images of the FI of 164 endodontically treated mandibular first permanent molars from 163 patients in Nanjing Stomatological Hospital, Medical School of Nanjing University were collected retrospectively. On the CBCT images, the shape and extent of periapical and periodontitis bone resorption, the thickness of residual dentin in the pulp floor and root canal wall, and the periodontal bone resorption of the complete dentition were evaluated. The FI was classified into periodontal, periapical, perforated and mixed types.@* Results@#Among the 164 FIs of endodontically treated mandibular first permanent molars, the periapical type was the most common (41.5%), followed by the mixed type (26.2%), perforated type (18.3%), and periodontal type (14.0%). Among the 68 periapical-type FIs of endodontically treated mandibular first permanent molars, 48.5% were proper root canal filling, 44.1% were insufficient filling and 7.4% were overfilling. Among the 43 mixed-type FIs, the periodontal mixed periapical type was the most common (72.1%).@*Conclusion @#Detailed evaluation and classification of furcation involvement could be performed using CBCT images; therefore, the study has guiding significance for clinical treatment.

Application of digital technology and platelet-rich fibrin technology in a novel regenerative treatment for posterior lingual furcation defect: a 6-year follow-up case report / 华西口腔医学杂志

Conventional periodontal regenerative surgery has limited effect on tooth with severe periodontitis-related alveolar bone defects. This article reported a case of regenerative treatment in severe distal-bone defect of mandibular first molar. The treatment involved applying 3D printing, advanced/injectable platelet-rich fibrin, and guided tissue-regeneration technology. After the operation, the periodontal clinical index significantly improved and the alveolar bone was well reconstructed.

Assessment of Knowledge Regarding Furcation Defects among Dental Practitioners: A Multinational Survey

@#This study was undertaken to assess knowledge regarding furcation defects among dental fraternity. This is an open-ended, randomized, web-based cross-sectional multinational online survey. A total of 904 responses were gathered by sending 13 questions through a google form. Data were expressed in frequency and percentages. Chi-square test was performed to determine significant difference between gender, education level and variation between dentists of India and other countries. P value <0.05 was considered to be statistically significant. Present study had 650 dentists from India and 254 dentists from other countries. For overall knowledge regarding furcation, 90.7% (average of first and second question) of dentists had knowledge regarding furcation. There was no significant difference between males (range 54%-93%) and females (range 46%- 95%) (p>0.05) in terms of knowledge. Majority (88.7%) of post-graduates knew about the use of Nabers probe for furcation measurements and values were significant (p<0.05). Present study also revealed 65%-67% of undergraduates and post-graduates knew that Degree II furcation defects showed predictable periodontal regeneration, however values were non-significant (p>0.05). There was no statistical significance (p>0.05) between dentists of India and other countries. Dental fraternity in general had adequate knowledge regarding the furcation defects, their treatment modalities and expected complications.

Effectiveness of Platelet-Rich Fibrin with Decalcified Freeze-Dried Bone Allograft Compared to Decalcified Freeze-Dried Bone Allograft Alone in Mandibular Grade-II Furcation Defects: A Quasi-Experimental Study

ABSTRACT Objective: To assess the effectiveness of platelet-rich fibrin (PRF) with decalcified freeze-dried bone allograft (DFDBA) compared to DFDBA alone in mandibular grade-II furcation defects. Material and Methods: A quasi-experimental study was conducted on nine patients with chronic periodontitis, each having two almost identical mandibular grade II furcation defects. Test sites (left mandibular first molars) were treated with open flap debridement (OFD), DFDBA, and PRF, whereas control sites (right mandibular first molars) received OFD and DFDBA alone. Clinical parameters (plaque index (PI), gingival index (GI), vertical clinical attachment level (VCAL) and horizontal clinical attachment level (HCAL) into the furcation defect) and radiographic measurements (mean alveolar bone defect) were done at baseline and after six months postoperatively. Results: The gain in relative horizontal clinical attachment level (RHCAL) in the test sites was 2.94±0.52 mm compared to 1.33±0.35 mm in control sites (p=0.01). Improvement in mean alveolar bone defect (MABD) (was 1.21±0.5 mm2 at test sites compared to 1.15±0.7 mm2 at control sites) probing pocket depth (PPD), recession, relative vertical attachment level (RVCAL), and percentage of bone fill was found in the test sites compared to control, which statistically insignificant. Conclusion: The test sites had better outcomes than control sites, which was significant for the parameter RHCAL. Therefore, combining the biological benefits of autologous PRF with DFDBA is an efficient and economical treatment modality for the management of mandibular grade II furcation defects.

Alveolar and mandibular cortex bone status in individuals with type 1 diabetes mellitus: a cross-sectional paired study / Condição óssea alveolar e da cortical mandibular em indivíduos com diabetes mellitus tipo 1: um estudo transversal pareado

Aim: This study compared alveolar bone loss, teeth with furcation, and mandibular cortical modification between individuals with type 1 diabetes mellitus (T1DM) and nondiabetic individuals. Methods: Radiographs of 50 T1DM individuals and 100 nondiabetic individuals were examined to evaluate the presence of teeth with furcation, alveolar bone loss, and mandibular cortical modifications. The Mann-Whitney, Chi-square, and Student's t tests were used to analyze personal characteristics and bone status. Linear and logistic regression was performed to explore associations. Results: A significant difference was observed in the average number of teeth with furcation and in the median of alveolar bone loss between T1DM and the nondiabetic participants. T1DM individuals are more likely to have alveolar bone loss (OR = 3 2.250), teeth with furcation (OR = 8.903), and mandibular cortical modification (OR = 15.667) than are nondiabetic individuals. Among T1DM individuals, the glycemic control has a high influence in mandibular cortical modifications (p < 0.05). Conclusions: A high association between uncontrolled blood glucose and mandibular cortical modifications was observed among T1DM individuals. Alveolar bone loss of T1DM individuals was associated with age, time of diagnosis, glycemic control, and the existence of chronic complications.

Objetivo:Comparar a perda óssea alveolar, a presença de dentes com lesão de furca e a alteração da cortical óssea entre indivíduos com DMT1 e indivíduos não-diabéticos. Métodos: Foram examinadas radiografias de 50 indivíduos diabéticos e de 100 não-diabéticos para avaliar a presença de dentes com lesão de furca, perda óssea alveolar e alteração cortical mandibular. Para analisar as características individuais e as condições ósseas foram usados os testes de Mann-Whitney,Qui-quadrado e t de Student. Regressões linear e logística foram realizadas para identificar associações. Resultados: Foi encontrada diferença significativa na média de dentes com lesão de furca e na mediana da perda óssea alveolar entre diabéticos e não-diabéticos. Indivíduos com DMT1 possuem mais chance de apresentar perda óssea alveolar (OR = 32,250), lesão de furca (OR=8,903) e alteração da cortical mandibular (OR = 15,667) em comparação aos indivíduos não-diabéticos. Entre os diabéticos, o controle da glicemia possui grande influência nas alterações da cortical mandibular (p < 0,05). Conclusões: Existe uma alta associação entre os níveis de glicemia descontrolada e alterações na cortical mandibular entre os indivíduos com DMT1. A perda óssea alveolar de indivíduos com DMT1 foi associada aos fatores idade, tempo de diagnóstico, controle da glicemia e a presença de complicações crônicas.

Efectividad de la regeneración tisular guiada en lesiones de furcación dentarias mandibulares

RESUMEN Introducción: La lesión de furcación se define como la reabsorción patológica del hueso interradicular, con la consiguiente exposición de la furca, el aumento del riesgo de pérdida ósea y la aparición de defectos óseos difíciles de tratar, los que pueden mejorar con el uso de membranas a través de la regeneración tisular guiada. Objetivo: Determinar la efectividad de la regeneración tisular guiada en lesiones de furca dentarias mandibulares en la Clínica Estomatológica Provincial "Mártires del Moncada", de Santiago de Cuba, durante el periodo septiembre de 2018 a diciembre de 2019. Método: Se realizó un estudio cuasi-experimental de intervención terapéutica con una muestra de 20 pacientes con lesiones de furca mandibulares, seleccionados por muestreo no probabilístico intencional. Se conformaron 2 grupos aleatorios por orden de llegada de 10 pacientes cada uno. Un grupo estudio recibió la terapia regenerativa y un grupo control fue tratado de forma convencional. Ambos, cumplieron con el criterio diagnóstico y fueron examinados antes y después de los tratamientos a los 6 meses y al año. Resultados: Al evaluar al año de tratamiento, en el grupo I, el sangrado desapareció y la profundidad al sondaje disminuyó al menos 1 mm en el 100% de los casos, la ganancia de inserción tipo I se logró en el 60% de ellos, con marcada superioridad sobre el grupo control. Conclusiones: El tratamiento con regeneración tisular guiada demuestra ser efectivo en los pacientes tratados con lesión de furcación a diferencia del tratamiento convencional.

ABSTRACT Introduction: The furcation lesion is defined as a pathological resorption of the interradicular bone, with the consequent exposure of the furcation, increased risk of bone loss and the onset of difficult-to-treat bone defects, which can be improved with the use of membranes through guided tissue regeneration. Objective: To determine the effectiveness of guided tissue regeneration in mandibular dental furcation lesions at the Clínica Estomatológica Provincial "Mártires del Moncada" in Santiago de Cuba, from Septembre 2018 to December 2019. Method: A quasi-experimental study of therapeutic intervention was carried out with a sample of 20 patients with mandibular furcation lesions and selected by non-probabilistic purposive sampling. One cluster (study group) received regenerative therapy and the other cluster (control group) was treated conventionally. Both met the diagnostic criteria and were examined before and after the treatments (6 months after treatment and 1 year after treatment). Results: after assessed the year of treatment, in group I (study group), bleeding disappeared and probing depth decreased by at least 1 mm in 100% of the cases, type I insertion gain was achieved in 60% of them, with a marked superiority in the control group. Conclusions: Treatment with guided tissue regeneration has been shown to be effective in patients treated with furcation lesions in contrast to conventional treatment.

RESUMO Introdução: A lesão de furca é definida como a reabsorção patológica do osso interradicular, com a conseqüente exposição da furca, aumento do risco de perda óssea e aparecimento de defeitos ósseos de difícil tratamento, que podem melhorar com o uso de membranas através da regeneração tecidual guiada. Objetivo: Determinar a eficácia da regeneração tecidual guiada em lesões de furca dentária mandibular na Clínica Estomatológica Provincial "Mártires del Moncada", Santiago de Cuba, durante o período de setembro de 2018 a dezembro de 2019. Método: Foi realizado um quasi-estudo experimental de intervenção terapêutica com amostra de 20 pacientes com lesões de furca mandibular, selecionados por amostragem não probabilística intencional. 2 grupos randomizados foram formados em ordem de chegada de 10 pacientes cada. Um grupo de estudo recebeu terapia regenerativa e um grupo controle foi tratado de forma convencional. Ambos preencheram os critérios diagnósticos e foram examinados antes e depois dos tratamentos aos 6 meses e 1 ano. Resultados: Ao avaliar um ano de tratamento, no grupo I, o sangramento desapareceu e a profundidade de sondagem diminuiu em pelo menos 1 mm em 100% dos casos, o ganho de inserção tipo I foi alcançado em 60% deles, com acentuada superioridade sobre o grupo de controle. Conclusões: O tratamento com regeneração tecidual guiada mostra-se eficaz em pacientes tratados com lesão de furca, ao contrário do tratamento convencional.

Root Resection in Molars: Clinical Evaluation for 10 Years

ABSTRACT: Root resection (RR) is a therapeutic option for furcation lesions grade II and III, fracture of one of the roots and root caries. The aim of the study was to evaluate in each selected period (5, 8 and 10 years) the percentage of maintenance of molars that underwent RR therapy with furcation lesions grade II and III or with root fractures. Subjects received the therapy with RR in molars with periodontitis, with furcation lesion grades II or III, and with fractures, caries or endodontic reason, in one of the roots. The supportive periodontal therapy was made for at least one annual session during the assessed time. For the clinical therapy to be considered successful, the tooth is remaining in functional loading, without mobility above grade I, pocket depth ≥ 4 mm, absence of bleeding on probing or exudate, fractures and root caries. Were evaluated the files of 37 patients, 15 males and 22 females, with a mean age of 51.4 (SD = ± 12.46), with a total of 44 teeth with RR, 27 upper and 17 lower molars. The survival rates after the RR was 97.73 % for 05 years of evaluation (44 teeth), 95.35 % for the 08 years (43 teeth) and 97.57 % for the 10 years (41 teeth). 35 teeth were restored with total crows isolated or abutment of fixed prosthesis. The survival rates after 10-years was 90.91 %, and there was no statistical difference between the types of restorations performed and the tooth survival rate.

RESUMEN: La resección de la raíz (RR) es una opción terapéutica para lesiones de furca de grado II y III, fractura de una de las raíces y caries de la raíz. El objetivo del estudio fue evaluar en cada período seleccionado (5, 8 y 10 años) el porcentaje de mantenimiento de los molares que se sometieron a terapia RR con lesiones de furca de grado II y III o con fracturas de raíz. Los sujetos recibieron la terapia con RR en molares con periodontitis, con lesión de furca de grado II o III, y con fracturas, caries o razón endodóntica, en una de las raíces. La terapia periodontal de apoyo se realizó durante al menos una sesión anual durante el tiem- po evaluado. Para que la terapia clínica se considere exitosa, el diente permanece en carga funcional, sin movilidad por encima del grado I, profundidad de bolsillo ≥ 4 mm, ausencia de sangrado al sondaje o exudado, fracturas y caries de raíz. Se evaluaron los archivos de 37 pacientes, 15 hombres y 22 mujeres, con una edad média de 51,4 (DE = ± 12,46), con un total de 44 dientes con RR, 27 molares superiores y 17 inferiores. Las tasas de supervivencia después del RR fueron del 97,73 % durante 5 años de evaluación (44 dientes), 95,35 % para los 8 años (43 dientes) y 97,57% para los 10 años (41 dientes). Se restauraron 35 dientes con cuervos totales aislados los pilares de prótesis fija. Las tasas de supervivencia después de 10 años fueron del 90,91 %, y no hubo diferencia estadística entre los tipos de restauraciones realizadas y la tasa de supervivencia dental.

Combined periodontal regeneration of molar severely compromised by furcation, intrabony defects and attachment loss to the apex: a case report / Regeneración periodontal combinada de molar gravemente comprometido por furcación, defectos intraóseos y pérdida de inserción en el ápice: reporte de un caso

Introduction: Clinicians tend to encounter unfavorable situations in the treatment of teeth with severe attachment loss. Periodontal regeneration has been a successful therapeutic approach in treatments that require a long-term prognosis improvement. This case shows the benefits of combined regenerative periodontal therapy in a patient with a molar severely compromised by furcation, intrabony defects and attachment loss to the apex. Case Report: The clinical case included an endo-periodontal, class III furcation and intrabony defects in a generalized periodontitis, Stage III Grade C patient. After non-surgical periodontal treatment and re-evaluation, a full-thickness flap and surgical debridement were performed. Dental root surface was treated with EDTA and enamel matrix derivatives and the defects were filled with allograft and platelet-rich fibrin, additionally a collagen membrane was applied over the graft. After a 12-month follow-up there was a resolution of the intrabony defects and periodontal regeneration. Clinical and radiographic evaluation also showed the partial resolution of the class III furcation defect. Conclusion: Combined periodontal regeneration can be a therapeutic approach to improve the prognosis and prevent the extraction of molars severely compromised by furcation, intrabony defects and attachment loss to the apex.

Introducción: Los clínicos tienden a encontrar situaciones desfavorables en el tratamiento de dientes por pérdida de inserción severa. La regeneración periodontal ha sido un enfoque terapéutico exitoso en tratamientos que requieren una mejora del pronóstico a largo plazo. Este caso demuestra los beneficios de la terapia periodontal regenerativa combinada en un paciente con un molar gravemente comprometido por furcación, defectos intraóseos y por pérdida de inserción hasta el ápice. Reporte de caso: El caso clínico incluyó un defecto endoperiodontal, furcación clase III y defectos intraóseos en una Periodontitis estadio III generalizada grado C. Tras el tratamiento periodontal no quirúrgico y la reevaluación, se realizó un colgajo de espesor total y un desbridamiento quirúrgico. La superficie de la raíz dental se trató con EDTA y derivados de la matriz de esmalte y los defectos se rellenaron con aloinjerto y fibrina rica en plaquetas, adicionalmente se aplicó una membrana de colágeno sobre el injerto. Después de un seguimiento de 12 meses hubo resolución de los defectos intraóseos y regeneración periodontal. La evaluación clínica y radiográfica también mostró la resolución parcial del defecto de furcación de clase III. Conclusión: La regeneración periodontal combinada puede ser un abordaje terapéutico para mejorar el pronóstico y prevenir la extracción de molares severamente comprometidos por furcación, por defectos y hasta el ápice.

Periodontal treatment of furcation involvement at the mandibular first molar with a follow-up of 27 years / 华西口腔医学杂志

Due to the complicated anatomical structures in the furcation area of multirooted mandibular first molars, dental hygiene is greatly compromised once the furcation is involved in the periodontitis, leading to the unfavorable prognosis of teeth with furcation involvement. A patient came to a dental office with the chief complaint of "mobile mandibular posterior tooth" 27 years ago. The periapical film showed alveolar bone resorption at the root furcation of the right mandibular first molar. Flap surgery and fine supportive therapy were conducted. The patient was diagnosed with "furcation involvement Class Ⅲ" during a revisit three years ago. Satisfactory and healthy periodontal statuses were observed 2, 9, 24, and 33 months after the periodontal flap surgery plus tunneling procedures. A follow-up of 27 years in the present case demonstrated that a favorable prognosis of furcation involvement can be achieved after adequate periodontal treatment.

Periodontal regeneration: is it still a goal in clinical periodontology?

Abstract In the last decades, Periodontal Regeneration has been one of the most discussed topics in Periodontics, attracting the attention of researchers and clinicians. This can be justified by the evident and continuous progress observed in the field, characterized by a better understanding of the biological mechanisms involved, significant improvement of operative and technical principles, and the emergence of a wide range of biomaterials available for this purpose. Together, these aspects put the theme much in evidence in the search for functional and esthetic therapeutic solutions for periodontal tissue destruction. Despite the evident evolution, periodontal regeneration may be challenging and require the clinician to carefully evaluate each case before making a therapeutic decision. With a critical reassessment of the clinical and preclinical literature, the present study aimed to discuss the topic to answer whether Periodontal Regeneration is still a goal in clinical periodontology. The main aspects involved in the probability of success or failure of regenerative approaches were considered. A greater focus was given to intrabony and furcation defects, clinical conditions with greater therapeutic predictability. Aspects such as more appropriate materials/approaches, long-term benefits and their justification for a higher initial cost were discussed for each condition. In general, deep intrabony defects associated with residual pockets and buccal/lingual class II furcation lesions have predictable and clinically relevant results. Careful selection of the case (based on patient and defect characteristics) and excellent maintenance are essential conditions to ensure initial and long-term success.

Comparison of cone-beam computed tomography, clinical and surgical analysis for detection of maxillary molar furcation / Comparação da avaliação clínica, cirúrgica e por tomografia computadorizada de feixe cônico na detecção de lesões de furca em molares superiores

ABSTRACT The aim of this study was to compare the performance of conebeam computed tomography (CBCT), clinical and surgical probing in assessing maxillary molar furcation involvement (FI). Furcation defects (n= 120) were assessed through CBCT, clinical and intra-surgical evaluation (ISE). Furcation Involvement, vertical and horizontal bone loss were assessed through clinical probing, CBCT and probing during ISE. Three trained radiologists evaluated CBCT images and intra- and interobserver agreement were calculated by Kappa test and Intraclass Correlation Coefficient (ICC). McNemar and Wilcoxon tests were used to compare clinical probing, ISE and CBCT. Accuracy, sensitivity, specificity, positive and negative predictive values were calculated to detect FI. Clinical findings showed 28 sites with Degree I, 25 sites with Degree II, and 8 sites with Degree III. Good intra- (k=1.00) and interobserver agreement (k=0.773) were observed. Intraobserver and interobserver agreement for horizontal bone loss were moderate, k=0.485 and k=0.549, respectively. Intra-surgical findings showed Degree I at 21 sites, and Degree II and Degree III FI at fifteen sites each. Clinical evaluation showed 75% agreement with ISE and 78% with CBCT. Accuracy for clinical detection of FI was 75%, while for CBCT evaluation ranged from 72.5% to 77.5%, considering the 3 observers. Significant differences were found at distal sites using CBCT (p<0.05). Clinical evaluation and CBCT showed similar results for the presence or absence of FI. Concerning horizontal and vertical bone loss, CBCT was not considered a precise examination method for incipient bone defects.

RESUMO Este estudo teve como objetivo comparar o desempenho da tomografia computadorizada de feixe cônico (TCFC), sondagem clínica e cirúrgica na avaliação do envolvimento da furca de molares superiores (EF). Defeitos de furca (n= 120) foram avaliados por meio de TCFC, avaliação clínica e intra-cirúrgica (IC). O envolvimento da furca, perda óssea vertical e horizontal foram avaliados através de sondagem clínica, TCFC e sondagem durante IC. Três radiologistas treinados avaliaram as imagens de TCFC e a concordância intra e interobservador foi calculada pelo teste Kappa e Coeficiente de Correlação Intraclasse (ICC). Para comparação da sondagem clínica, IC e CBCT foram utilizados os testes de McNemar e Wilcoxon. A precisão, sensibilidade, especificidade, valores preditivos positivos e negativos foram calculados para a detecção de EF. Os achados clínicos mostraram 61 sítios com EF, sendo 28 Grau I, 25 locais de Grau II e 8 locais de Grau III. Observou-se boa concordância intra- (k = 1,00) e interobservador (k = 0,773). A concordância intraobservador e interobservador para perda óssea horizontal foi moderada, k = 0,485 e k = 0,549, respectivamente. Os achados intra-cirúrgicos mostraram EF grau I em 21 sítios e grau II e grau III em quinze sítios cada. A avaliação clínica mostrou 75% de concordância com IC e 78% com CBCT. A acurácia para detecção clínica de EF foi de 75%, enquanto para avaliação de CBCT variou de 72,5% a 77,5%, considerando os 3 observadores. Diferenças significativas foram encontradas em sítios distais em CBCT (p<0,05). A avaliação clínica e a TCFC mostraram resultados semelhantes para a presença ou ausência de EF. Em relação à perda óssea horizontal e vertical, a TCFC não foi considerada um exame preciso para defeitos ósseos incipientes.

Accuracy of cone beam computed tomography in assessing maxillary molar furcation involvement / 华西口腔医学杂志

OBJECTIVE@#This study aimed to assess the accuracy of cone beam computed tomography (CBCT) in detecting furcation involvement (FI) in maxillary molars.@*METHODS@#Thirty-one maxillary molars of 15 patients with generalized chronic periodontitis considered for furcation surgery were assessed. Clinical examination and CBCT were performed, and the FI degree was evaluated. Clinical and CBCT-based FI assessments were compared with intrasurgical data.@*RESULTS@#The agreement between clinical and intrasurgical assessments was weak in all sites, with a kappa of less than 0.4; the complete, overestimated, and underestimated agreement percentages were 42.0%, 24.7%, and 33.3%, respectively. The agreement between the CBCT and intrasurgical assessments was strong, with a ka ppa of 0.831; the complete, overestimated, and underestimated agreement percentages were 88.2%, 3.2%, and 8.6%, respectively. The agreement between both assessments was the highest in the buccal furcation entrance (κ=0.896), followed by that in the distopalatal (κ=0.822) and mesiopalatal (κ=0.767) furcation entrances.@*CONCLUSIONS@#CBCT images demonstrated high accuracy in assessing the horizontal bone loss of FI in maxillary molars.

Assessment of alveolar bone level and furcation involvement in periodontal diseases using dental cone-beam computed tomography (CBCT): a systematic review / Avaliação do nível ósseo alveolar e envolvimento da furca em doenças periodontais usando a Tomografia computadorizada de feixe cônico odontológica: uma revisão sistemática

The advent of CBCT has contributed significantly to dental imaging. In the field of periodontics, CBCT provides a multi-planar view to assess the alveolar bone in three dimensions. This helps the dentist to make measurements at any location that could significantly improve periodontal diagnosis. Objective: The aim of this systematic review is to evaluate the accuracy of using CBCT in the assessment of alveolar bone level and furcation involvement in periodontal diseases. Material and Methods: PubMed, LILACS and Google Scholar databases were searched for literature related to the application of CBCT in periodontal diseases. Keywords used for the search were CBCT, furcation involvement, measurement and their synonyms. Results: Fifteen full-text English language research papers were eligible for the systematic review using the PRISMA guidelines. Conclusion: From the results of the systematic review it can be concluded that conebeam computed tomography imaging technique offers significantly reliable images of the furcation involvement and height of the alveolar bone. (AU)

O advento da Tomografia computadorizada de feixe cônico (TCFC) contribuiu significativamente para a imageologia. No campo da periodontia, a TCFC fornece uma visão multiplano para avaliar o osso alveolar em três dimensões. Isso ajuda o dentista a fazer medições em qualquer local que possa melhorar significativamente o diagnóstico periodontal. Objetivo: O objetivo desta revisão sistemática foi avaliar a precisão do uso da TCFC na avaliação do nível ósseo alveolar e do envolvimento da furca em doenças periodontais. Material e Métodos: As bases de dados PubMed, LILACS e Google Scholar foram pesquisadas na literatura relacionada à aplicação da TCFC em doenças periodontais. As palavras-chave utilizadas para a pesquisa foram TCFC, envolvimento da furca, mensuração e seus sinônimos. Resultados: Quinze trabalhos de pesquisa em inglês com texto completo foram elegíveis para a revisão sistemática usando as diretrizes do PRISMA. Conclusão: A partir dos resultados da revisão sistemática, pode-se concluir que a técnica de imagem por tomografia computadorizada de feixe cônico oferece imagens significativamente confiáveis do envolvimento da furca e da altura do osso alveolar.(AU)

Accuracy of Cone Beam Computed Tomography in the Assessment of Mandibular Molar Furcation Defects

Abstract Objective: To evaluate the accuracy of cone-beam computed tomography (CBCT) in the assessment of mandibular molar furcation defects. Material and Methods: Thirty patients with furcation defects were selected, oral hygiene instructions, scaling, and root planing with ultrasonic devices and hand instruments and occlusal adjustments were performed. Pre-surgical clinical measurements were carried out at the buccal aspect of the selected mandibular molars. The horizontal furcation measurements were measured with a Nabers Probe starting at the furcation entrance to the greatest horizontal depth. The degree of furcation involvement was graded from 0 to III. Bone loss in the horizontal and vertical direction and the width of the furcation entrance were measured on CBCT and after reflecting the full-thickness flap and debridement of the defects. The data were analyzed using t-test and Pearson's correlation coefficient. Results: The width of furcation entrance in clinical method was 3.27 ± 0.77, while in CBCT method was 3.35 ± 0.71, clinically the vertical bone loss was 3.61±1.09, while in CBCT was 3.57 ± 1.15, horizontal bone loss in clinical method was 5.08 ± 2.21, while in CBCT was 5.11 ± 2.23. No significant difference between the two methods was noted, and a high correlation between the two methods was observed. With regards to the agreement between the two methods of assessment, the width of furcation entrance revealed a difference between the two methods by 0.08 ± 0.21, while vertical bone loss showed difference between the two methods by -0.04 ± 0.19, the horizontal bone loss showed a mean difference between the two methods by 0.03 ± 0.21. Conclusion: CBCT provided high accuracy for the furcation involvement detection and anatomy of surrounding periodontal tissues.

The accuracy of linear measurements in cone beam computed tomography for assessing intrabony and furcation defects: a systematic review and meta-analysis / La precisión de las mediciones lineales en la tomografía computarizada de haz cónico para evaluar defectos intraóseos y de furcación: una revisión sistemática y un metanálisis

Objective: This study aims to assess the accuracy of the linear measurements of intrabony and/or furcation defect quantified by cone beam computed tomography (CBCT). Material and Methods: A systematic search of the literature was conducted by two authors independently from the PubMed, Scopus, and EBSCO for full articles published in journals between January 2003 and March 2017. Eligible studies were assessed for quality and heterogeneity using the QUADAS-2 tool. A meta-analysis was performed to identify the accuracy of CBCT in the measurement of intrabony defects. The effect size was estimated and reported as the standardised mean difference (SMD). Results: A total of 105 titles and abstracts were screened. Of those, 11 articles met the inclusion criteria for the systematic review while only four were selected for meta-analysis. The overall effects of standardized mean difference and 95% CI was -0.03 [95% CI -0.67 to 0.60] with a x2 statistic of 0.49 with 3 degrees of freedom (p>0.05), I2= 0.01%. Conclusion: CBCT is highly accurate and reproducible regarding linear measurements for assessing intrabony defects with a weighted standardized mean difference of 0.03 mm. More randomised controlled trials are required to assess the accuracy of CBCT in assessing patients with periodontal defects.

Objetivo: Este estudio tiene como objetivo evaluar la precisión de las mediciones lineales de defectos intraóseos y/o de furcación cuantificados por tomografía computarizada de haz cónico (CBCT). Material y Métodos: Dos autores, independientemente realizaron una búsqueda sistemática de la literatura en PubMed, Scopus y EBSCO, para obtener artículos completos publicados en revistas entre Enero de 2003 y Marzo de 2017. Los estudios elegibles se evaluaron para determinar la calidad y la heterogeneidad utilizando la herramienta QUADAS-2. Se realizó un metanálisis para identificar la precisión de CBCT en la medición de defectos intraóseos. El tamaño del efecto se estimó y se informó como la diferencia de medias estandarizada (DME). Resultados: Se seleccionaron un total de 105 títulos y resúmenes. De ellos, 11 artículos cumplieron con los criterios de inclusión para la revisión sistemática, mientras que solo cuatro fueron seleccionados para el metanálisis. Los efectos generales de la diferencia de medias estandarizada y el IC del 95% fueron -0.03 [IC del 95%: -0.67 a 0.60] con una estadística X2 de 0.49 con 3 grados de libertad (p>0.05), I2= 0.01%. Conclusión: CBCT es altamente preciso y reproducible con respecto a mediciones lineales para evaluar defectos intraóseos con una diferencia de medias estandarizada ponderada de 0.03 mm. Se requieren más ensayos controlados aleatorios para evaluar la precisión de CBCT en la evaluación de pacientes con defectos periodontales.

Evaluation of Dental CBCT in Assessing the Furcation Involvement in Mandibular Molars

Furcation involvement (FI) refers to the invasion of the bifurcation and trifurcation areas of multi-rooted teeth by periodontal disease. Diagnosis of FI by 2D radiographs can be overcome by the use of cone-beam computed tomography (CBCT) imaging technique. Objective: To compare the measurements of furcation depth by clinical method and CBCT in assessing the FI. Methods: The present study comprised of 60 furcation involved mandibular molars from 45 patients suffering from Chronic Generalized Severe Periodontitis. Teeth having probing pocket depth of ≥6mm were considered for the study. Clinical measurements of furcation depth were made on buccal or lingual sides of mandibular molars by using endodontic file with stopper which was done by two clinicians. The CBCT measurements were performed by measuring the deepest vertical and horizontal furcation defects at each furcation entrance. These measurements were then recorded, compiled and statistically analysed. Results: The comparison of furcation involvement clinically by clinician 1 and CBCT measurements in buccal side was statistically significant (p=0.0255*), while it was statistically not significant (p=0.3696 NS) on lingual side. Similarly, the comparison of furcation involvement clinically by clinician 2 and CBCT measurements in buccal side was statistically significant (p=0.0278*), while it was statistically not significant (p=0.4951 NS) on lingual side. Conclusion: CBCT technique can be considered a reliable tool for detecting FI as CBCT imaging showed high accuracy and moderate reproducibility in the assessment of furcation depth.