Regenerative therapy: furcation defects

The invasion of the furcation areas of multirooted teeth by periodontitis r epresents a serious complication in periodontal therapy. The furcation area is often inaccessible to adequate instrumentation, and frequently the root s present concavities and furrows which makes proper cleaning of the area i mpossible (8). As long as the pathological process is extending only a mino r distance (<5 mm; degrees I and II involvement) into the furcation area, f urther progress of the disease can usually be prevented by scaling and root planing provided that a proper oral hygiene program is established after t reatment (93). In more advanced cases (5-6 mm; degree II involvement) the i nitial cause related treatment is frequently supplemented with surgery invo lving contouring of the interradicular bone (osteoplasty) or reduction of t he tooth prominence at the furcation entrance by grinding (odontoplasty), i n order to reduce the horizontal extension of the furcation involvement (51 ). In cases where the involvement extends deeper into the furcation area (> 5 mm; degree II involvement) or a through and through defect (degree III in volvement) has developed, tunnel preparation or root resection has been adv ocated as the choice of treatment (18, 75). However, both of these latter t reatments involve a risk of complications on a long-term basis. Following t unnel preparation, caries frequently develops in the furcation area and roo t resected teeth often present non-periodontal complications, although cont roversial reports exist regarding the long-term results of these treatment modalities (12, 34, 44-46, 66). Considering the complexity of current techniques for the treatment of furca tion problems, and in the view of the long-term results and complications r eported following treatment of advanced furcation involvements by tradition ally resective therapy, predictable regeneration of the periodontium at fur cation-involved sites would represent a considerable progress in periodonti cs.