Double-sided entire papilla preservation for mandibular distal furcation defect: A case report.

Abstract

Background: Distal furcation-associated intrabony defects in mandibular molars are difficult to manage because of limited surgical access, restricted visibility, and complex root anatomy. This case report describes the regenerative management of a distal furcation-associated intrabony defect in a mandibular first molar using recombinant human fibroblast growth factor-2 (rhFGF-2) with a double-sided entire papilla preservation technique-based approach (DEPPT-BA).

Methods: A 56-year-old systemically healthy woman presented with stage III, grade B periodontitis and Hamp Class II distal furcation involvement of the mandibular left first molar, with a maximum probing pocket depth (PPD) of 8 mm. After initial periodontal and endodontic therapy, periodontal regenerative surgery was performed using the DEPPT-BA to obtain buccal and lingual access while preserving the interdental papilla. rhFGF-2 was applied to the defect without adjunctive bone graft material.

Results: Healing progressed without major complications. At 12 months postoperatively, PPDs were ≤2 mm at all sites, bleeding on probing was absent, and the distal furcation involvement was clinically resolved without gingival recession. Cone-beam computed tomography demonstrated substantial bone fill within the intrabony defect and clinical resolution of the distal furcation involvement.

Conclusions: Within the limitations of a single case report, this application of DEPPT-BA combined with rhFGF-2 may improve buccal and lingual access while maintaining interdental soft-tissue stability in distal furcation-associated intrabony defects with buccolingual extension in mandibular molars.

Key points: Distal furcation-associated intrabony defects in mandibular molars pose considerable regenerative challenges, given limited access, restricted visibility, and complex root anatomy. DEPPT-BA provided buccal and lingual access to the distal furcation defect while preserving the interdental papilla and maintaining wound stability. Favorable 12-month clinical and radiographic outcomes were achieved using rhFGF-2 without adjunctive bone grafting material.

Plain language summary: This case report describes the treatment of a difficult periodontal defect affecting the distal furcation area of a mandibular molar using DEPPT with rhFGF-2. The technique improved surgical access while maintaining soft-tissue stability, resulting in favorable clinical healing and substantial bone fill at 12 months.