Avila-Ortiz Gustavo, De Buitrago Juan G, Reddy Michael S
Department of Periodontics, University of Iowa, Iowa City, IA.
J Periodontol. 2015 Feb;86(2 Suppl):S108-30. doi: 10.1902/jop.2015.130677.
The aim of this review is to present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy to provide clinical guidelines for the therapeutic management of furcation defects and to identify priorities for future research that may advance the understanding of periodontal regenerative medicine.
A comprehensive search based on predetermined eligibility criteria was conducted to identify human original studies and systematic reviews on the topic of periodontal regeneration of furcation defects. Two reviewers independently screened the title and abstract of the entries yielded from the initial search. Subsequently, both reviewers read the full-text version of potentially eligible studies, made a final article selection, and extracted the data of the selected studies considering specific clinical scenarios. The clinical scenarios contemplated in this review included the following: 1) facial and interproximal Class I defects in maxillary molars; 2) facial and lingual Class I defects in mandibular molars; 3) facial and interproximal Class II furcation defects in maxillary molars; 4) facial and lingual Class II furcation defects in mandibular molars; 5) Class III furcation defects in maxillary molars; 6) Class III furcation defects in mandibular molars; and 7) Class I, II, or III furcation defects in maxillary premolars. Endpoints of interest included different clinical, radiographic, microbiologic, histologic, and patient-reported outcomes.
The initial search yielded a total of 1,500 entries. The final selection consisted of 150 articles, of which six were systematic reviews, 109 were clinical trials, 27 were case series, and eight were case reports. A summary of the main findings of previously published systematic reviews and the available evidence relative to the indication of regenerative approaches for the treatment of furcation defects compared with conventional surgical therapy are presented. Given the marked methodologic heterogeneity and the wide variety of materials and techniques applied in the selected clinical trials, the conduction of a meta-analysis was not viable.
On the basis of the reviewed evidence, the following conclusions can be drawn. 1) Periodontal regeneration has been demonstrated histologically and clinically for the treatment of maxillary facial or interproximal and mandibular facial or lingual Class II furcation defects. 2) Although periodontal regeneration has been demonstrated histologically for the treatment of mandibular Class III defects, the evidence is limited to one case report. 3) Evidence supporting regenerative therapy in maxillary Class III furcation defects in maxillary molars is limited to clinical case reports. 4) In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although most Class I furcation defects may be successfully treated with non-regenerative therapy. 5) Future research efforts should be primarily directed toward the conduction of clinical trials to test novel regenerative approaches that place emphasis primarily on patient-reported outcomes and also on histologic demonstration of periodontal regeneration. Investigators should also focus on understanding the influence that local, systemic, and technical factors may have on the outcomes of regenerative therapy in furcation defects.
本综述的目的是提供现有证据，以比较不同再生方法与传统手术治疗在特定临床场景下治疗根分叉病变的有效性，从而为根分叉病变的治疗管理提供临床指南，并确定未来研究的重点，以推动对牙周再生医学的理解。
根据预定的纳入标准进行全面检索，以识别关于根分叉病变牙周再生主题的人类原始研究和系统评价。两名 reviewers 独立筛选初始检索得到的条目的标题和摘要。随后，两名 reviewers 阅读潜在符合条件研究的全文版本，进行最终文章选择，并考虑特定临床场景提取所选研究的数据。本综述考虑的临床场景包括：1）上颌磨牙的颊侧和邻面 I 类病变；2）下颌磨牙的颊侧和舌侧 I 类病变；3）上颌磨牙的颊侧和邻面 II 类根分叉病变；4）下颌磨牙的颊侧和舌侧 II 类根分叉病变；5）上颌磨牙的 III 类根分叉病变；6）下颌磨牙的 III 类根分叉病变；7）上颌前磨牙的 I、II 或 III 类根分叉病变。感兴趣的终点包括不同的临床、影像学、微生物学、组织学和患者报告的结果。
初始检索共得到 1500 个条目。最终选择包括 150 篇文章，其中 6 篇是系统评价，109 篇是临床试验，27 篇是病例系列，8 篇是病例报告。本文呈现了先前发表的系统评价的主要发现总结，以及与传统手术治疗相比，再生方法治疗根分叉病变适应症的现有证据。鉴于所选临床试验中显著的方法学异质性以及应用的材料和技术种类繁多，进行荟萃分析不可行。
基于所审查的证据，可以得出以下结论。1）组织学和临床研究均已证实牙周再生可用于治疗上颌颊侧或邻面以及下颌颊侧或舌侧 II 类根分叉病变。2）虽然组织学上已证实牙周再生可用于治疗下颌 III 类病变，但证据仅限于一篇病例报告。3）支持上颌磨牙 III 类根分叉病变再生治疗的证据仅限于临床病例报告。4）在 I 类根分叉病变中，再生治疗在某些临床场景中可能有益，尽管大多数 I 类根分叉病变可用非再生治疗成功治疗。5）未来的研究工作应主要致力于开展临床试验，以测试主要强调患者报告结果以及牙周再生组织学证据的新型再生方法。研究人员还应关注理解局部、全身和技术因素对根分叉病变再生治疗结果可能产生的影响。
