Morphological Characteristics of Mandibular Molar Furcation Involvement and Efficacy of Regenerative Surgical Treatment

Morphological Characteristics of Furcation Involvement in Mandibular Molars and Efficacy of Regenerative Surgical Treatment: A Cross-Sectional and Interventional Trial

This study consists of two components evaluating furcation involvement in mandibular molars among Stage III or Stage IV periodontitis patients. Component 1 is a cross-sectional study evaluating the prevalence and morphological characteristics of Hamp Class II furcation defects during initial screening. Component 2 is a randomized controlled clinical trial in 30 selected patients comparing the diagnostic accuracy of Cone Beam Computed Tomography (CBCT) against direct intra-operative clinical measurements, as well as evaluating the clinical and radiographic outcomes of regenerative periodontal surgery using Acellular Dermal Matrix (ADM) + Enamel Matrix Derivative (EMD) + Xenograft versus Autogenous Connective Tissue Graft (CTG) + EMD + Xenograft.

Inclusion Criteria:

• Patients aged 18 years or older who signed the informed consent form.

• Diagnosed with Stage III or Stage IV periodontitis according to the 2017 AAP/EFP classification.

• Completed non-surgical periodontal therapy with full-mouth plaque score (FMPS) and bleeding on probing (FMBS) <= 20%.

• Presence of at least one mandibular molar with Hamp Class II furcation involvement (horizontal bone loss > 3 mm without through-and-through communication).

• Target tooth requirements:

  • Probing pocket depth (PPD) >= 5 mm.
  • Clinical attachment loss (CAL) >= 3 mm.
  • Tooth mobility <= Grade I (Miller index).
  • Vital pulp or adequately filled root canal treatment without periapical radiolucency.
  • Gingival margin positioned coronal to the furcation entrance.
  • Intact tooth structure without root fractures or furcation caries.

Exclusion Criteria:

• Uncontrolled systemic diseases (e.g., uncontrolled diabetes, hypertension, cardiovascular disease, severe osteoporosis).

• Pregnant or lactating women.

• Current smokers or individuals who quit smoking less than 6 months prior to enrollment.

• Use of antibiotics, anti-inflammatory agents, or medications affecting bone metabolism (e.g., bisphosphonates, high-dose corticosteroids, anti-resorptive drugs) within the past 3 months.

• Previous periodontal surgery at the evaluation site within the past 6 months.

• Target teeth presenting with:

  • Miller Grade II or Grade III tooth mobility.
  • Severe bone destruction extending to the root apex.
  • Metallic restorations (metal crowns, amalgam fillings, or large metallic posts) causing significant scatter/artifacts on CBCT scans.
  • Fused roots or abnormal root anatomy.