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.

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.

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.

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.

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.

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.

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.

Detection of furcation involvement using periapical radiography and 2 cone-beam computed tomography imaging protocols with and without a metallic post: An animal study

PURPOSE: The purpose of this study was to assess the accuracy, sensitivity, and specificity of the diagnosis of incipient furcation involvement with periapical radiography (PR) and 2 cone-beam computed tomography (CBCT) imaging protocols, and to test metal artifact interference. MATERIALS AND METHODS: Mandibular second molars in 10 macerated pig mandibles were divided into those that showed no furcation involvement and those with lesions in the furcation area. Exams using PR and 2 different CBCT imaging protocols were performed with and without a metallic post. Each image was analyzed twice by 2 observers who rated the absence or presence of furcation involvement according to a 5-point scale. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy, sensitivity, and specificity of the observations. RESULTS: The accuracy of the CBCT imaging protocols ranged from 67.5% to 82.5% in the images obtained with a metallic post and from 72.5% to 80% in those without a metallic post. The accuracy of PR ranged from 37.5% to 55% in the images with a metallic post and from 42.5% to 62.5% in those without a metallic post. The area under the ROC curve values for the CBCT imaging protocols ranged from 0.813 to 0.802, and for PR ranged from 0.503 to 0.448. CONCLUSION: Both CBCT imaging protocols showed higher accuracy, sensitivity, and specificity than PR in the detection of incipient furcation involvement. Based on these results, CBCT may be considered a reliable tool for detecting incipient furcation involvement following a clinical periodontal exam, even in the presence of a metallic post.

Effect of concentrated growth factors on the treatment of degree Ⅱ furcation involvements of mandibular molars / 北京大学学报(医学版)

Objective:Concentrated growth factors (CGF),a new generation of platelet concentrate products,appears to have more abundant growth factors because of its special centrifugation process.However,there are few studies supporting this.This study was designed to evaluate the effect of CGFs in the treatment of Ⅱ ° furcations of mandibular molars.Methods:In the present study,thirty-one Ⅱ ° furcation involvements in twenty mandiblular molars were included and randomly divided into two groups.The furcation involvements in the experimental group were treated with bone graft therapy combined with CGFs,and the furcation involvements in the control group were treated with bone graft therapy alone.The clinical examination and cone beam computed tomography (CBCT) were performed at baseline and 1 year post-surgery for the two groups.The changes of clinical and CBCT data at baseline and 1 year postsurgery were compared between the experimental group and the control group.Results:At baseline,there were no significant differences between the two groups in the probing depth (PD),vertical clinical attachment loss (CAL-V) and horizontal clinical attachment loss (CAL-H):PD (7.36 ± 2.32) mm (the experimental group) vs.(7.53 ±2.06) mm (the control group);CAL-V (8.69 ± 1.65) mm (the experimental group) vs.(8.81 ±1.53) mm (the control group);CAL-H (5.24 ±2.01) mm (the experimental group) vs.(5.35 ±2.14) mm (the control group).At the end of 1 year post-surgery,the clinical parameters of both groups were significantly improved (P ＜ 0.001).For the experimental group,the average vertical attachment gain was (2.78 ± 1.66) mm,and the vertical attachment loss was improved significantly compared with the baseline (P ＜ 0.001);the average horizontal attachment gain was (2.10 ± 1.89) mm,and the horizontal attachment loss were improved significantly compared with the baseline (P ＜ 0.001).Furthermore,the improvement degree of the experimental group was significantly higher than that of the control group (P ＜ 0.001).At baseline,there were no statistical differences in the vertical bone loss (BL-V) or horizontal bone loss (BL-H) between the two groups (P ＞ 0.05):BL-V (5.08 ± 2.17) mm (the experimental group) vs.(5.84 ± 2.65) mm (the control group);BL-H (5.85 ±2.13) mm (the experimental group) vs.(6.01 ±2.27) mm (the control group).At 1 year post-surgery,both groups showed significant radiographic bone gain at vertical and horizontal directions compared with baseline (P ＜ 0.001).For the experimental group,the average vertical radiographic bone gain was (2.20 ± 1.98) mm,the horizontal radiographic bone gain was (2.51 ±2.18) mm,the vertical and horizontal radiographic bone loss were both significantly reduced compared with the baseline (P ＜ 0.001).For the control group,the average vertical radiographic bone gain was (1.89 ± 2.15) mm,the horizontal radiographic bone gain was (1.30 ± 2.47) mm,the vertical and horizontal radiographic bone losses were both significantly reduced compared with the baseline (P ＜ 0.001).And the experimental group showed significantly higher bone gain at vertical and horizontal directions compared with the control group (P ＜ 0.001).Conclusion:Within the limitation of the present study,CGFs showed positive role in the treatment of Ⅱ° furcation involvements of mandibular molars.

Characteristics of the molar surface after removal of cervical enamel projections: comparison of three different rotating instruments

PURPOSE: The aim of this study was to evaluate and compare tooth surface characteristics in extracted human molars after cervical enamel projections (CEPs) were removed with the use of three rotating instruments. METHODS: We classified 60 extracted molars due to periodontal lesion with CEPs into grade I, II, or III, according to the Masters and Hoskins' criteria. Each group contained 20 specimens. Three rotating instruments were used to remove the CEPs: a piezoelectric ultrasonic scaler, a periodontal bur, and a diamond bur. Tooth surface characteristics before and after removal of the projections were then evaluated with scanning electron microscopy (SEM). We analyzed the characteristics of the tooth surfaces with respect to roughness and whether the enamel projections had been completely removed. RESULTS: In SEM images, surfaces treated with the diamond bur were smoothest, but this instrument caused considerable harm to tooth structures near the CEPs. The piezoelectric ultrasonic scaler group produced the roughest surface but caused less harm to the tooth structure near the furcation. In general, the surfaces treated with the periodontal bur were smoother than those treated with the ultrasonic scaler, and the periodontal bur did not invade adjacent tooth structures. CONCLUSIONS: For removal of grade II CEPs, the most effective instrument was the diamond bur. However, in removing grade III projections, the diamond bur can destroy both adjacent tooth structures and the periodontal apparatus. In such cases, careful use of the periodontal bur may be an appropriate substitute.

Hemisection: Resection For Conservation.

Abstract: Furcation defects represent a formidable problem in the treatment of periodontal disease, principally related to the complex and irregular anatomy of furcations. The presence and severity of a furcation lesion reduces the success rate of conventional periodontal therapy in these specific areas and therefore worsens the long-term prognosis of that particular tooth.While regeneration of the periodontium is an accepted treatment goal, not all furcation defects can be effectively treated using regenerative procedures. Hence, resective therapies like root resection, bicuspidization or hemisection for the treatment of furcation defects is an essential part of the periodontal treatment, which must be performed in order to attain a result which can eventually be considered more conservative. Here is a case report of a 38-year-old male with hemisection procedure performed in the right mandibular 1st molar with grade III furcation involvementfollowed by fixed partial denture.

Correlation between clinical and radiographic findings on the occurrence of furcation involvement in patients with periodontitis.

Aim : The aim of the present study was to determine the occurrence of furcation involvement in the molars of patients with chronic periodontitis and correlate clinical and radiographic findings. Materials and Methods: Seventy subjects aged 35-69 years enrolled for treatment at a periodontics specialization program in Pernambuco, Brazil (EAP-SCDP-ABO/PE) participated in the study, comprising a total of 350 molars examined. The clinical diagnosis of furcation involvement was performed with a horizontal Nabers probe, whereas the radiographic examination was performed with periapical and bite-wing radiographs. The images were analyzed with an X-ray viewer at 3× magnification. The Chi-square test was used, with the level of significance set at 5%. Results: A total of 64.5% individuals presented with furcation involvement, 43.1% of whom had degree II furcation. A significant association (P = 0.0060) was found between tooth type and frequency of furcation involvement. The first lower and upper molars were affected in 64.5 and 58.5% of cases, respectively. Adequate agreement (0.65) was observed between the clinical and radiographic findings. Conclusion: Taking into consideration the method employed and the results obtained, it may be concluded that the clinical and radiographic examinations performed are effective tools for diagnosing furcation involvement in teeth affected with periodontal disease.

Comparative analysis of physicochemical properties of root perforation sealer materials

OBJECTIVES: This study evaluated the solubility, dimensional alteration, pH, electrical conductivity, and radiopacity of root perforation sealer materials. MATERIALS AND METHODS: For the pH test, the samples were immersed in distilled water for different periods of time. Then, the samples were retained in plastic recipients, and the electrical conductivity of the solution was measured. The solubility, dimensional alteration, and radiopacity properties were evaluated according to Specification No. 57 of the American National Standards Institute/American Dental Association (ANSI/ADA). Statistical analyses were carried out using analysis of variance (ANOVA) and Tukey's test at a significance level of 5%. When the sample distribution was not normal, a nonparametric ANOVA was performed with a Kruskal-Wallis test (alpha = 0.05). RESULTS: The results showed that white structural Portland cement (PC) had the highest solubility, while mineral trioxide aggregate (MTA)-based cements, ProRoot MTA (Dentsply-Tulsa Dental) and MTA BIO (Angelus Ind. Prod.), had the lowest values. MTA BIO showed the lowest dimensional alteration values and white PC presented the highest values. No differences among the tested materials were observed in the the pH and electrical conductivity analyses. Only the MTA-based cements met the ANSI/ADA recommendations regarding radiopacity, overcoming the three steps of the aluminum step wedge. CONCLUSIONS: On the basis of these results, we concluded that the values of solubility and dimensional alteration of the materials were in accordance with the ANSI/ADA specifications. PCs did not fulfill the ANSI/ADA requirements regarding radiopacity. No differences were observed among the materials with respect to the pH and electrical conductivity analyses.

Bicuspidised Molar as a Potential Prosthetic Abutment- A Case Report

Conservative management of periodontally compromised teeth with advanced furcation defects has proved to be challenging to the periodontists since ages. With the evolution of implant-based oral rehabilitation of edentulism, the ideology of preservation of the natural dentition is slowly fading. This case report aims at highlighting the conservative management of a grade III furcation-involved molar by bicuspidisation procedure and use of the treated tooth as an abutment for fixed prosthesis. Bicuspidisation is a surgical procedure performed on the mandibular molars for the separation of the mesial and distal roots with their respective crown portions; this separation eliminates the existence of a furcation and facilitates effective oral hygiene practice. The use of bicuspidisation still remains to be one of the most viable traditional options for the management of a Glickman's classification grade III furcation defect in the mandibular molar teeth to facilitate reduction in periodontal infection, oral hygiene maintenance, preservation of natural tooth structure and having the potential to serve as abutments for a fixed partial denture. A bicuspidised multirooted tooth can successfully serve as a potential abutment.

Clinical and radiographic evaluation of Bio-Gen with biocollagen compared with Bio-Gen with connective tissue in the treatment of class II furcation defects: a randomized clinical trial

OBJECTIVE: Treatment of furcation defects are thought to be challenging. The purpose of this study was to evaluate the clinical and radiographic parameters of Bio-Gen with Biocollagen compared with Bio-Gen with connective tissue in the treatment of Class II furcation defects. MATERIAL AND METHODS: In this clinical trial, 24 patients with Class II furcation defect on a buccal or lingual mandibular molar were recruited. After oral hygiene instruction, scaling and root planing and achievement of acceptable plaque control, the patients were randomly chosen to receive either connective tissue and Bio-Gen (case group) or Biocollagen and Bio-Gen (control group). The following parameters were recorded before the first and re-entry surgery (six months later): vertical clinical attachment level (VCAL), gingival index (GI), plaque index (PI), horizontal probing depth (HPD), vertical probing depth (VPD), gingival recession (GR), furcation vertical component (FVC), furcation to alveolar crest (FAC), fornix to base of defect (FBD), and furcation horizontal component (FHC) were calculated at the time of first surgery and during re-entry. A digital periapical radiograph was taken in parallel before first surgery and re-entry. The radiographs were then analyzed by digital subtraction. The differences with p value <0.05 were considered significant. RESULTS: Only the mean changes of FAC, FHC, mean of FHC, FBD in re-entry revealed statistically significant differences between the two groups. HPD, VPD, FBD, FAC, and FHC showed statistically significant differences after 6 months in the case group. However, in the control group, statistically significant differences were found in GR and HPD. We did not observe any significant difference in radiographic changes among the two groups. CONCLUSION: The results of this trial indicate that better clinical outcomes can be obtained with connective tissue grafts in combination with bone material compared ...

Effect of Early Membrane Removal on the Treatment of Mandibular Class II Furcation Defects - A Controlled Clinical Trial with Re-entry after 12 Months

In a previous study in dogs, the early removal of expanded polytetrafluoroethylene (ePTFE) membrane (2 weeks after placement) showed histomorphometric results (of new bone, cementum and periodontal ligament) similar to that obtained with membrane removal at 4 weeks after placement. This study evaluated the influence of early removal of an ePTFE membrane on the treatment of Class II furcation defects. Twelve patients who provided 12 pairs of mandibular furcation defects were recruited for the study. Baseline clinical measurements were recorded: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival margin position (GMP) and relative clinical attachment level (RCAL). Full flaps were elevated and hard tissue measurements were performed during the surgery: relative vertical (RVBL) and horizontal (RHBL) bone level. The ePTFE membranes were adapted and sutured to their correspondent tooth and removed at 2 weeks in the test group (TGr) and at 4 weeks in the control group (CGr). After 1 year all sites were re-entered, and soft and hard tissue measurements were recorded. There were no statistically significant differences between TGr and CGr for any baseline measurement. After 12 months, there were no statistically significant differences between TGr and CGr in the PD (p=0.74), GMP (p=0.76) and RCAL (p=0.44) values. However, the RHBL resolution was significant for both groups (CGr p=0.01 and TGr p=0.02), without difference between groups (p=0.39). Early removal of membranes did not affect the outcome on the treatment of Class II furcation defects.

Em estudo prévio, em cães, a remoção precoce da membrana de politetrafluoretileno expandido (PTFE-e), 2 semanas após a colocação, mostrou resultados histomorfométricos (formação de novo osso, cemento e ligamento periodontal) similares aos de remoção da membrana 4 semanas após a sua colocação. Este estudo avaliou a influência da remoção precoce de uma membrana de PTFE-e no tratamento de defeitos de bifurcação classe II. Foram selecionados para o estudo 12 pacientes, com 12 pares de defeitos de bifurcação mandibulares. Foram feitas as seguintes medidas clínicas iniciais: índice de placa (IP), índice gingival (IG), sangramento à sondagem (SAS), profundidade de sondagem (PS), posição da margem gingival (PMG) e nível relativo da inserção clínica (NRIC). Foram elevados retalhos totais e as medidas do tecido ósseo foram tomadas transcirurgicamente: níveis ósseos vertical (NOV) e horizontal (NOH). Membranas de PTFE-e foram adaptadas e suturadas aos dentes correspondentes e removidas após 2 semanas no grupos teste (GT) ou quatro semanas no grupo controle (GC). Após 1 ano, em todos os sites foi realizada reentrada cirúrgica e medidas clínicas e ósseas foram novamente feitas. Não houve diferenças estatisticamente significantes entre GT e GC para nenhuma das medidas iniciais avaliadas. Após 12 meses, não houve diferenças estatisticamente significantes entre GT e GC para os valores de PS (p=0,74), PMG (p=0,76) e NRIC (p=0,44). Entretanto, a resolução do nível ósseo horizontal foi significante para ambos os grupos (GC: p=0,01 e GT: p=0,02), sem diferenças entre grupos (p=0,39). A remoção precoce da membrana não afetou os resultados do tratamento de defeitos de bifurcação Classe II.

Portland cement with additives in the repair of furcation perforations in dogs / Cimento Portland com aditivos na reparação de perfurações radiculares em cães

PURPOSE: To evaluate the use of Portland cements with additives as furcation perforation repair materials and assess their biocompatibility. METHODS: The four maxillary and mandibular premolars of ten male mongrel dogs (1-1.5 years old, weighing 10-15 kg) received endodontic treatment (n=80 teeth). The furcations were perforated with a round diamond bur (1016 HL). The perforations involved the dentin, cementum, periodontal ligament, and alveolar bone. A calcium sulfate barrier was placed into the perforated bone to prevent extrusion of obturation material into the periradicular space. The obturation materials MTA (control), white, Type II, and Type V Portland cements were randomly allocated to the teeth. Treated teeth were restored with composite resin. After 120 days, the animals were sacrificed and samples containing the teeth were collected and prepared for histological analysis. RESULTS: There were no significant differences in the amount of newly formed bone between teeth treated with the different obturation materials (p=0.879). CONCLUSION: Biomineralization occurred for all obturation materials tested, suggesting that these materials have similar biocompatibility.

OBJETIVO: Avaliar o uso de cimentos Portland aditivados na reparação de perfurações radiculares e a biocompatibilidade destes materiais. MÉTODOS: Oitenta pré-molares, quatro da arcada dentária superior e quatro da arcada inferior de 10 cães machos, sem raça definida, com idade em torno de um a um ano e meio, pesando entre 10 e 15 kg foram submetidos a tratamento endodôntico, sendo realizadas perfurações nas furcas com broca de diamante 1016 HL. A cavidade envolveu dentina e cemento, como também periodonto e o osso alveolar. Na porção óssea da obturação, barreira de sulfato de cálcio foi utilizada evitando extravasamento do cimento para o espaço periodontal. Foi realizada a distribuição randomizada dos cimentos MTA (controle), Portland tipo II, Portland tipo V e Portland branco estrutural nas obturações. Os dentes foram restaurados com resina composta. Após 120 dias realizou-se eutanásia, retirada dos dentes, preparação e análise histológica. RESULTADOS: Entre os cimentos não houve diferença estatística significante quanto à neoformação óssea (p=0,879). CONCLUSÃO: Ocorreu biomineralização com os diferentes cimentos usados no estudo, sugerindo que estes são similares em termos de biocompatibilidade.

Detection of simulated incipient furcation involvement by CBCT: an in vitro study using pig mandibles

The aim of the present study was to test the reproducibility, sensitivity, and specificity of cone-beam computed tomography (CBCT) in detecting incipient furcation involvement. Fifteen macerated pig mandibles, with intact second molar teeth and preserved adjacent cortical areas, were used. Simulated lesions were created in the furcation region of these teeth by applying 70% perchloric acid in up to four possible buccal/lingual sites in the right/left sides of each mandible. The mandibles were then submitted to a CBCT scan. Two blinded and calibrated experienced oral and maxillofacial radiologists interpreted the exams. Furcation involvement was also assessed in the regions without simulated lesions. CBCT showed high levels of accuracy, ranging from 78% to 88%. The variations in Kappa values for intra- and inter-observer agreement (0.41-0.59) were considered moderate. CBCT can be considered a reliable and accurate method for detecting incipient furcation involvement.

Platelet-rich plasma in the treatment of Class II furcation defects: a histometrical study in dogs

OBJECTIVE: This study was designed to evaluate the potential adjunctive benefits of platelet-rich plasma (PRP) when used with guided-tissue regeneration (GTR) and bioactive glass (BG) in the treatment of Class II furcation lesions. MATERIAL AND METHODS: Bilateral Class II furcation lesions were surgically created and allowed to become chronic in the mandibular third premolars of 9 dogs. The defects were randomly assigned to: A) GTR+BG and B) GTR+BG+PRP. Similar defects were created in the maxillary third premolars and received the same treatments after 45 days. Dogs were sacrificed 90 days after the first treatment. The histometric parameters evaluated were: connective tissue adaptation, new cementum, new bone, mineralized bone area, non-mineralized bone area, and residual BG particle area. RESULTS: Data analysis showed a superior length of new cementum and a greater mineralized bone area for group B in both periods (p<0.05). The non-mineralized bone area was greater in the control group (p<0.05) in both periods. CONCLUSION: Within the limits of this study, it can be concluded that the use of PRP in the treatment of Class II furcation defects may enhance the amount of new cementum and provide a more mineralized bone in a shorter period of time.