Treatments of Furcation Involvements

To date, treatment of multirooted teeth with lesions of varying degrees within the interradicular space has been one of the most challenging problems in periodontal therapy. The destruction of this area can be related to different causes; thus, proper diagnosis plays a fundamental role to select the correct therapy. The etiology of furcation involvement has been attributed to the extension of periodontal inflammatory disease, trauma from occlusion in the presence of inflammation, pulpal disease, defective plaque-retentive restorations or anatomic variations. The treatment of furcation involvements is difficult because of the anatomical problems that interfere with the clinician's accessibility in treating the area and the patient's ability in maintaining adequate plaque control afterward. Conventional treatment of furcation involvement is aimed mainly at resolving the inflammatory lesion within the interradicular area. This treatment can be performed with nonsurgical therapy or surgical therapy. The surgical approaches have two different treatment modalities ; one attempts to correct the accessibility of the furcation lesions through tunnel preparation, hemisection or root resection; the other one attempts to regenerate the lost attachment apparatus by bone grafting, root conditioning, coronally positioned flaps and guided tissue regeneration. In the last decade, experimental studies in animals have demonstrated that it is possible to favor the regeneration of the lost supporting attachment apparatus, that comprised root cementum, periodontal ligament and alveolar bone, by selectively permitting the coronal regrowth of the periodontal ligament. The technique using barrier membranes was introduced by Nyman et al. in 1982 and the term, guided tissue regeneration, was coined by Gottlow et al. in 1986. Currently, the use of guided tissue regeneration technique for treatment of furcation involvement tends to be increased. Based on short-term clinical studies, regenerative therapy in furcation-involved teeth seems to have achieved limited success. Improved clinical attachment levels and clinical furcation closure may be accomplished in class II but seldom in class III mandibular furcations following use of several procedures such as bone graft, guided tissue regeneration and coronally positioned flaps. Grade III and IV furcation involvements still have a poor long-term prognosis because predictable regenerative therapy for their treatment has not been demonstrated. In the selection of an appropriate treatment modality for molars with furcation invasion, however, the overall treatment plan of the case should play a primary role. In patients with isolated class II defects in molars associated with an intact dentition, a regenerative treatment modality should be considered. In the presence of different and more involved furcation lesions,