Clinical evaluation of HTR polymer bone replacement grafts in human mandibular class II molar furcations
The purpose of this study was to clinically evaluate treatment response of human periodontal furcation defects to the placement of HTR polymer bone replacement grafts. Nine patients with at least two similar class II mandibular molar furcations (for a total of 15 pairs) were evaluated. Defects were selected with interproximal bone height of 75% or more. Patients received oral hygiene instructions and were scaled and root planed. Patients were ready for the surgical phase only if plaque scores were at least 80%. The two bone-replacement graft materials compared were HTR and autogenous osseous coagulum (AOC). Selection of defects as either experimental (HTR) or control (AOC) was made at the time of each surgery by a coin flip. The furcations treated at the same setting received alternating treatments. All surgical sites were coated with antibiotic ointment and protected with a light-cured periodontal pack. Patients were prescribed NSAIDS, narcotics/analgesics, and doxycycline 100 mg BID for 10 days. Zinc gluconate 100 mg and folic acid 1 mg BID (first two weeks) were also given. Oral hygiene instructions and deplaquing were accomplished every 10 days for the first month followed by deplaquing every month of the supportive periodontal therapy schedule.
About 6-12 months postsurgically, reentry surgery was performed. Parameters measured were recession (CEJ-FGM), attachment level changes (CEJ-base of pocket), and pocket depth FGM-base of pocket). Horizontal depth of furcation was measured from a reference point. A perio probe was placed horizontally across the prominences of adjacent roots (3 mm apical to the coronal aspect of the furcation).The study compared millimeters of defect and furcation fill with millimeters changed on crestal bone. Ten first molars and five second mandibular molars were treated with HTR, and eight first molars and seven second molars were treated with AOC. No real differences were found between HTR and AOC in vertical bone defects. Horizontal furcation results were statistically significant in favoring HTR (HTR 44.4 + 21.2 versus AOC 17.1 + 12.1). HTR had one furcation completely filled, 11 partially filled, and 3 without improvement versus AOC, which had 0 completely filled, 6 partially filled, and 9 without improvement. HTR had 50% filled 80% of the time. In conclusion, bone-replacement grafts such as HTR polymer may be of some clinical benefit in treatment of mandibular class II furcations. [c.c.]
Yukna, R.A., J Periodont, 65:342, 1994