Ian Needleman1. 1. International Centre for Evidence-Based Oral Health and Unit of Periodontology, Division of Restorative Dental Sciences, University College London Eastman Dental Institute, London, UK.
Abstract
DATA SOURCES: A Medline search and handsearching of the following journals were carried out: International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, Journal of Periodontal Research and Journal of Periodontology as well as reference lists of publications selected. STUDY SELECTION: To be eligible for inclusion in this review, studies had to be longitudinal in nature. Prospective and retrospective cohort studies were considered. Studies were screened and quality assessed independently by two reviewers. Review articles, case reports and studies of fewer than 5-years' duration were excluded, as were those not providing information on tooth survival or furcation involvement. DATA EXTRACTION AND SYNTHESIS: Data was abstracted independently by two reviewers. Owing to the heterogeneity of the data, a meta-analysis could not be performed. A qualitative synthesis was conducted grouping the studies into the following areas: nonsurgical furcation therapy; surgical therapy not involving tooth structures; tunnelling surgical resective therapy (eg, root resection and/ or root separation); and guided tissue regeneration (GTR) and grafting procedures. RESULTS: Twenty-two publications met the inclusion criteria. The survival rate of molars treated nonsurgically was >90% after 5-9 years. The corresponding values for the different surgical procedures were: surgical therapy, 43.1-96% (observation period, 5-53 years); tunnelling procedures, 42.9-92.9% (observation period, 5-8 years); surgical resective procedures including amputation(s) and hemisections, 62-100% (observation period, 5-13 years); and GTR, 83.3-100% (observation period, 5-12 years). The most frequent complications included caries in the furcation area after tunnelling procedures and root fractures after root-resective procedures. CONCLUSIONS: Good long-term survival rates (up to 100%) of multirooted teeth with furcation involvement were obtained following various therapeutic approaches. Initial furcation involvement (degree I) could be successfully managed by nonsurgical mechanical debridement. Vertical root fractures and endodontic failures were the most frequent complications observed following resective procedures.
DATA SOURCES: A Medline search and handsearching of the following journals were carried out: International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, Journal of Periodontal Research and Journal of Periodontology as well as reference lists of publications selected. STUDY SELECTION: To be eligible for inclusion in this review, studies had to be longitudinal in nature. Prospective and retrospective cohort studies were considered. Studies were screened and quality assessed independently by two reviewers. Review articles, case reports and studies of fewer than 5-years' duration were excluded, as were those not providing information on tooth survival or furcation involvement. DATA EXTRACTION AND SYNTHESIS: Data was abstracted independently by two reviewers. Owing to the heterogeneity of the data, a meta-analysis could not be performed. A qualitative synthesis was conducted grouping the studies into the following areas: nonsurgical furcation therapy; surgical therapy not involving tooth structures; tunnelling surgical resective therapy (eg, root resection and/ or root separation); and guided tissue regeneration (GTR) and grafting procedures. RESULTS: Twenty-two publications met the inclusion criteria. The survival rate of molars treated nonsurgically was >90% after 5-9 years. The corresponding values for the different surgical procedures were: surgical therapy, 43.1-96% (observation period, 5-53 years); tunnelling procedures, 42.9-92.9% (observation period, 5-8 years); surgical resective procedures including amputation(s) and hemisections, 62-100% (observation period, 5-13 years); and GTR, 83.3-100% (observation period, 5-12 years). The most frequent complications included caries in the furcation area after tunnelling procedures and root fractures after root-resective procedures. CONCLUSIONS: Good long-term survival rates (up to 100%) of multirooted teeth with furcation involvement were obtained following various therapeutic approaches. Initial furcation involvement (degree I) could be successfully managed by nonsurgical mechanical debridement. Vertical root fractures and endodontic failures were the most frequent complications observed following resective procedures.