Periodontal surgery for furcation defects

The management of periodontal disease associated with multi-rooted teeth can be challenging because of the anatomical features of the root furcation. The aim of this review was to assess the effectiveness of access flap surgery in the treatment of class II furcation defects.

Methods

Searches were conducted in the Cochrane Oral Health Group trials register, Medline and Embase. This was supplemented by hand searches of the Journal of Periodontology, the Journal of Periodontal Research, and the Journal of Clinical Periodontology. Only randomised controlled trials (RCTs) were considered. Three reviewers independently screened the studies, extracted data and carried out quality assessment. The primary outcomes were tooth survival and change in the horizontal clinical attachment level (HCAL). Changes in vertical clinical attachment level (VCAL), reduction of pocket probing depth (PPD), recession increase (REC), horizontal (HBL), and vertical bone level (VBL) were also collected.

Results

11 RCTs involving a total of 199 patients (251 teeth) were included.
A majority of the studies (9) were split mouth design.
None of the studies were considered to be at low risk of bias.

Outcome	No. of studies	No of patients	Weighted mean difference (mm)	95% CI
PPD reduction	9	174	1.38	0.91 to 1.85
VCAL gain	10	147	0.55	0.00 to 1.10
HCAL gain	5	94	0.96	0.60 to 1.32
REC increase	10	159	0.73	0.37 to 1.09
HBL gain	5	75	0.09	-0.16 to 0.34
VBL gain	8	155	-0.17	-0.21, to -0.13

Conclusions

The authors concluded: –

Teeth with mandibular class II furcation involvement treated with access flap surgery show significant clinical improvements 6 months after surgery. Nevertheless, in order to better understand the magnitude of these changes and their clinical relevance, prospective long-term trials are needed.

Comments

Only a small number of small trials were included in this review with the majority of the studies being only of six months duration (8 out of 11) with the longest study being of 24 months duration. While this review does demonstrate some small improvements for periodontal parameters none of the studies reported on the primary aim of this review, which was to evaluate tooth survival. There was also a substantial degree of heterogeneity between the studies and the overall methodological quality of the studies was low. As a result the findings of this review should be interpreted cautiously and further high quality studies are needed.