Aichelmann-Reidy Mary E, Avila-Ortiz Gustavo, Klokkevold Perry R, Murphy Kevin G, Rosen Paul S, Schallhorn Robert G, Sculean Anton, Wang Hom-Lay, Reddy Michael S
Department of Periodontics, School of Dentistry, University of Maryland, Baltimore, MD.
Department of Periodontics, University of Iowa, Iowa City, IA.
Clin Adv Periodontics. 2015 Feb;5(1):30-39. doi: 10.1902/cap.2015.140068.
Focused Clinical Question: How should periodontal furcation defects be managed via periodontal regenerative therapy, and what parameters should be used for treatment selection? Summary: The treatment of furcation defects can vary based on the type and location of the furcation involvement. Attaining predictable regenerative outcomes is dependent on the control of local and systemic factors. A combined treatment approach (barrier and bone replacement graft with or without biologic) generally offers the better therapeutic outcome over monotherapy. Class I furcation defects can be managed via conventional periodontal non-surgical and/or surgical therapy, whereas Class II furcation defects generally attain better outcomes with regenerative therapy. There is weak evidence, limited to case reports, that Class III furcation defects can be treated successfully with regenerative therapy. Conclusions: In Class I furcation defects, regenerative therapy might be beneficial in certain clinical scenarios, although most Class I furcation defects can be treated successfully with non-regenerative therapy. For successful treatment of maxillary and mandibular molars with Class II furcation defects, systemic and local factors should be controlled, and surgical debridement and postoperative maintenance should be performed adequately. Although there is limited evidence for regeneration of Class III furcation defects, there may be a modest improvement allowing for tooth retention. Ultimately, the benefit of tooth retention and cost should be considered in the indication of therapy for teeth with severe furcation involvement.
如何通过牙周再生治疗来处理牙周根分叉病变，以及应使用哪些参数来选择治疗方法？总结：根分叉病变的治疗方法会因根分叉受累的类型和位置而有所不同。获得可预测的再生效果取决于对局部和全身因素的控制。联合治疗方法（使用或不使用生物制剂的屏障和骨替代移植物）通常比单一疗法能提供更好的治疗效果。I类根分叉病变可通过传统的牙周非手术和/或手术治疗来处理，而II类根分叉病变通常采用再生治疗能取得更好的效果。仅有限于病例报告的薄弱证据表明III类根分叉病变可通过再生治疗成功治愈。结论：在I类根分叉病变中，再生治疗在某些临床情况下可能有益，尽管大多数I类根分叉病变可通过非再生治疗成功治愈。为成功治疗上颌和下颌的II类根分叉病变磨牙，应控制全身和局部因素，并充分进行手术清创和术后维护。尽管III类根分叉病变再生的证据有限，但可能会有适度改善从而允许保留牙齿。最终，在重度根分叉受累牙齿的治疗指征中应考虑保留牙齿的益处和成本。
