Reddy Michael S, Aichelmann-Reidy Mary E, Avila-Ortiz Gustavo, Klokkevold Perry R, Murphy Kevin G, Rosen Paul S, Schallhorn Robert G, Sculean Anton, Wang Hom-Lay
Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL.
J Periodontol. 2015 Feb;86(2 Suppl):S131-3. doi: 10.1902/jop.2015.140379.
Treatment of furcation defects is a core component of periodontal therapy. The goal of this consensus report is to critically appraise the evidence and to subsequently present interpretive conclusions regarding the effectiveness of regenerative therapy for the treatment of furcation defects and recommendations for future research in this area.
A systematic review was conducted before the consensus meeting. This review aims to evaluate and 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. During the meeting, the outcomes of the systematic review, as well as other pertinent sources of evidence, were discussed by a committee of nine members. The consensus group members submitted additional material for consideration by the group in advance and at the time of the meeting. The group agreed on a comprehensive summary of the evidence and also formulated recommendations for the treatment of furcation defects via regenerative therapies and the conduction of future studies.
Histologic proof of periodontal regeneration after the application of a combined regenerative therapy for the treatment of maxillary facial, mesial, distal, and mandibular facial or lingual Class II furcation defects has been demonstrated in several studies. Evidence of histologic periodontal regeneration in mandibular Class III defects is limited to one case report. Favorable outcomes after regenerative therapy for maxillary Class III furcation defects are limited to clinical case reports. In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although generally Class I furcation defects may be treated predictably with non-regenerative therapies. There is a paucity of data regarding quantifiable patient-reported outcomes after surgical treatment of furcation defects.
Based on the available evidence, it was concluded that regenerative therapy is a viable option to achieve predictable outcomes for the treatment of furcation defects in certain clinical scenarios. Future research should test the efficacy of novel regenerative approaches that have the potential to enhance the effectiveness of therapy in clinical scenarios associated historically with less predictable outcomes. Additionally, future studies should place emphasis on histologic demonstration of periodontal regeneration in humans and also include validated patient-reported outcomes.
Based on the prevailing evidence, the following clinical recommendations could be offered. 1) Periodontal regeneration has been established as a viable therapeutic option for the treatment of various furcation defects, among which Class II defects represent a highly predictable scenario. Hence, regenerative periodontal therapy should be considered before resective therapy or extraction; 2) The application of a combined therapeutic approach (i.e., barrier, bone replacement graft with or without biologics) appears to offer an advantage over monotherapeutic algorithms; 3) To achieve predictable regenerative outcomes in the treatment of furcation defects, adverse systemic and local factors should be evaluated and controlled when possible; 4) Stringent postoperative care and subsequent supportive periodontal therapy are essential to achieve sustainable long-term regenerative outcomes.
根分叉病变的治疗是牙周治疗的核心组成部分。本共识报告的目的是严格评估现有证据，并随后就再生治疗对根分叉病变的治疗效果提出解释性结论，以及针对该领域未来研究的建议。
在共识会议之前进行了系统评价。本评价旨在评估并呈现与传统手术治疗相比，不同再生方法在特定临床场景中治疗根分叉病变有效性的现有证据。会议期间，由九名成员组成的委员会讨论了系统评价的结果以及其他相关证据来源。共识小组成员提前并在会议期间提交了其他材料供小组审议。该小组就证据的全面总结达成一致，并制定了通过再生疗法治疗根分叉病变及未来研究开展的建议。
多项研究已证实，应用联合再生疗法治疗上颌面部、近中、远中以及下颌面部或舌侧II度根分叉病变后有牙周再生的组织学证据。下颌III度根分叉病变组织学牙周再生的证据仅限于一篇病例报告。上颌III度根分叉病变再生治疗后的良好效果仅限于临床病例报告。在I度根分叉病变中，再生治疗在某些临床场景中可能有益，尽管一般来说I度根分叉病变采用非再生疗法可获得可预测的治疗效果。关于根分叉病变手术治疗后可量化的患者报告结局的数据较少。
基于现有证据，得出结论：在某些临床场景中，再生治疗是实现根分叉病变可预测治疗效果的可行选择。未来研究应测试新型再生方法的疗效，这些方法有可能在历史上治疗效果较难预测的临床场景中提高治疗效果。此外，未来研究应着重于人类牙周再生的组织学证明，还应纳入经过验证的患者报告结局。
基于现有证据，可提供以下临床建议。1）牙周再生已被确立为治疗各种根分叉病变的可行治疗选择，其中II度病变是高度可预测的情况。因此，在进行切除治疗或拔牙之前应考虑再生牙周治疗；2）联合治疗方法（即屏障、使用或不使用生物制剂的骨替代移植物）的应用似乎比单一治疗方案更具优势；3）为了在根分叉病变治疗中获得可预测的再生效果，应评估并尽可能控制不利的全身和局部因素；4）严格的术后护理及后续的支持性牙周治疗对于实现可持续的长期再生效果至关重要。
