Periodontal Regeneration - Furcation Defects: Practical Applications From the AAP Regeneration Workshop
Periodontal Regeneration - Furcation Defects: Practical Applications From the AAP Regeneration Workshop
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DOI：
10.1902/cap.2015.140068
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发表时间：
2015-02-01
影响因子：
0.7
通讯作者：
Reddy, Michael S.
中科院分区：
文献类型：
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作者：
Aichelmann-Reidy, Mary E.;Avila-Ortiz, Gustavo;Reddy, Michael S.
重点临床问题：如何通过牙周再生治疗来治疗牙周功能缺损？治疗选择应采用哪些参数？摘要：分岔缺陷的处理可以根据分岔的类型和位置而变化。获得可预测的再生结果依赖于局部和全身因素的控制。联合治疗方法（屏障和骨置换移植物加或不加生物制剂）通常比单一治疗提供更好的治疗效果。I类缺损可以通过传统的牙周非手术和/或手术治疗来治疗，而II类缺损通常通过再生治疗获得更好的效果。有微弱的证据，仅限于病例报告，III类功能缺陷可以成功地治疗再生疗法。结论：对于I类功能缺陷，再生治疗在某些临床情况下可能是有益的，尽管大多数I类功能缺陷可以通过非再生治疗成功治疗。上颌磨牙ⅱ类分支缺损的成功治疗，应控制全身和局部因素，充分进行手术清创和术后维护。虽然有有限的证据再生的第三类功能缺陷，可能有一个适度的改善，允许牙齿保留。最终，对于严重分叉受累的牙齿，在治疗指征时应考虑保留牙齿的益处和费用。
Focused Clinical Question: How should periodontal furcation defects be managed via periodontal regenerative therapy, and what parameters should be used for treatment selection?Summary: The treatment of furcation defects can vary based on the type and location of the furcation involvement. Attaining predictable regenerative outcomes is dependent on the control of local and systemic factors. A combined treatment approach (barrier and bone replacement graft with or without biologic) generally offers the better therapeutic outcome over monotherapy. Class I furcation defects can be managed via conventional periodontal non-surgical and/or surgical therapy, whereas Class II furcation defects generally attain better outcomes with regenerative therapy. There is weak evidence, limited to case reports, that Class III furcation defects can be treated successfully with regenerative therapy.Conclusions: In Class I furcation defects, regenerative therapy might be beneficial in certain clinical scenarios, although most Class I furcation defects can be treated successfully with non-regenerative therapy. For successful treatment of maxillary and mandibular molars with Class II furcation defects, systemic and local factors should be controlled, and surgical debridement and postoperative maintenance should be performed adequately. Although there is limited evidence for regeneration of Class III furcation defects, there may be a modest improvement allowing for tooth retention. Ultimately, the benefit of tooth retention and cost should be considered in the indication of therapy for teeth with severe furcation involvement.