Failure of resin ionomers in the retention of multi-rooted teeth with Class III furcation involvement: A rebuttal case report

Background: Severe periodontal furcation invasion has long been a treatment dilemma for the clinician. Many techniques have been advocated in the trea tment of multi-rooted posterior teeth ranging fi-om conventional scaling an d root planing (SRP), apically positioned flaps, root amputations, root res ections, tunnel procedures, guided tissue regeneration, and restorations. T he keys to success depend on the clinician's ability to access the furcatio n to remove local factors and create an environment that enhances the patie nt's own hygiene efforts. Long-term success in treating teeth with furcatio n invasion depends upon tooth retention and arresting the destructive proce sses within the furcation area. Methods: A Class III furcation invasion in a mandibular molar was treated b y surgical access for SRP along with obliterating the furcation utilizing a resin ionomer restoration. Results: Initially, the patient was asymptomatic. Within 3 months of treatm ent, the patient presented with suppuration that was refractory to local ef forts. Radiographs taken only 5 months postsurgery demonstrated advanced bo ne loss apical to the restoration. The tooth ultimately was extracted becau se mobility increased and the tooth became symptomatic. Conclusions: The clinician must consider the multi-factorial etiology of pe riodontal breakdown within a furcation. For this patient, the technique of sealing off the exposed furcation with restorative material appeared to hav e resulted in progressive bone loss and accelerate tooth loss. This single case report is presented as a rebuttal to recently published articles, whic h have demonstrated excellent results when treating furcations with ionomer restorations.