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J Periodontol • February 2001

Clinical Comparison of Bioactive Glass

Bone Replacement Graft Material and
Expanded Polytetrafluoroethylene Barrier
Membrane in Treating Human Mandibular
Molar Class II Furcations*
Raymond A. Yukna, Gerald H. Evans, Mary Beth Aichelmann-Reidy, and Elizabeth T. Mayer

Background: Class II furcations present difficult treatment prob-

lems and historically several treatment approaches to obtain fur-
cation fill have been used.
Methods: The response of mandibular Class II facial furcations
to treatment with either bioactive glass (PG) bone replacement
graft material or expanded polytetrafluoroethylene (ePTFE) barrier
membrane was evaluated in 27 pairs of mandibular molars in 27

M
anagement of moderate to ad-
patients with moderate to advanced periodontitis. Following initial vanced furcation invasions
preparation, full thickness flaps were raised in the area being presents one of the major chal-
treated, the bone and furcation defects debrided of granulomatous lenges in periodontal treatment.1-5
tissue, and the involved root surfaces mechanically prepared and Teeth with furcation involvement
chemically conditioned. By random allocation, PG or ePTFE was undergo more extensive and rapid
placed into or fitted over the furcations, packed or secured in place, clinical probing attachment loss and
and the host flap replaced or coronally positioned with sutures. are lost with greater frequency than
Postsurgical deplaquing was performed every 10 days leading up are single-rooted teeth.5-10 Class I fur-
to ePTFE removal at about 6 weeks. Continuing periodontal main- cations are generally well managed
tenance therapy was provided until surgical reentry at 6 months for with routine periodontal procedures,
documentation and any further necessary treatment. while Class III furcations generally
Results: Direct clinical measurements demonstrated essentially require more extensive therapy such
similar clinical results with both treatments for bone and soft tis- as tunneling, root amputation or hemi-
sue changes. There were no statistically or clinically significant section, or extraction. Class II furca-
differences (e.g., mean horizontal furcation fill 1.4 mm PG, 1.3 mm tions present a common clinical prob-
ePTFE; mean percent horizontal furcation fill 31.6% PG, 31.1% lem that has perplexed clinicians for
ePTFE, both P >0.85). Seventeen of the PG treated and 18 of the many years.1-8,11-21
ePTFE furcations became Class I clinically and 1 furcation com- The ideal goal of furcation therapy
pletely closed clinically with each treatment. Intrapatient compar- is to retain the tooth intact and to
isons showed similar horizontal furcation responses with both treat- completely close the furcation, thereby
ments. returning the local condition to one of
Conclusion: The findings of this study suggest essentially equal anatomic normalcy, facilitating long-
clinical results with PG bone replacement graft material and term maintenance therapy, and im-
e-PTFE barriers in mandibular molar Class II furcations. PG use was proving the likelihood of tooth reten-
associated with simpler application and required no additional tion. Several techniques have been
material removal procedures. J Periodontol 2001;72:125-133. proposed and promoted to treat and
KEY WORDS improve the prognosis of mandibular
Class II furcation involved molars.
Bone regeneration; furcation/surgery; furcation/therapy;
Guided tissue regeneration (GTR) has
membrane, barrier; membrane, artificial; polytetrafluoroethylene/
shown very promising results based
therapeutic use; glass, biologically active.
on early reports of substantial attach-
ment gain and bone fill in furcations.
* Department of Periodontics, Louisiana State University School of Dentistry, New Orleans, LA.
However, GTR is technique sensitive
and is associated with increased post-

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Bioactive Glass Versus ePTFE in Mandibular Furcations
operative problems. A major drawback to ePTFE and
other non-resorbable membranes is the need for their
removal after 4 to 6 weeks, often with a surgical pro-
cedure, that adds to patient morbidity and may disturb
the young healing regenerating tissue.
Alternatively, in mandibular furcations, bone replace-
ment grafts (BRG) have achieved similar results to
GTR barriers. BRG have resulted in a 55% overall
improvement either complete or partial furcation fill
compared to 52% for GTR barriers, and only 16% for
open flap debridement in mandibular Class II furca-
tions.18 A bioactive silica calcium phosphate glass
(PG)† has shown good clinical and histologic profiles
when used in a variety of periodontal and oral surgi-
cal applications.22-30 If a predictable fill can be
achieved with PG, its use as a single stage surgical
treatment of Class II furcations may preclude the extra
expense and second surgery associated with the use
of ePTFE‡ and other non-resorbable membranes.
The purpose of this study was to clinically compare
the response of mandibular Class II furcations in
humans to a bioactive glass bone replacement graft
material or ePTFE barrier membrane material.
MATERIALS AND METHODS
Twenty-seven patients assigned to the LSUHSC School
of Dentistry Department of Periodontics Postgraduate
Clinic or Faculty Practice were included in this study
if they met the following selection criteria: at least 25
years of age; had a diagnosis of moderate to advanced
adult periodontitis in the molar areas; and had at least
2 mandibular molar teeth each with Class II furcation31
involvement, a minimum of 3 mm or greater attach-
ment loss measured from the cemento-enamel junc-
tion (CEJ), proximal bone height ≥75% of the root
length, proximal bone coronal to furcation bone, and
mobility ≤1. All subjects had to be in good systemic
health with no contra-indications for periodontal or oral
surgery and no contributing factors to the progression
of periodontal disease or impairment of wound heal-
ing such as smoking (for the first 20 subjects), dia-
betes, or certain medications. Female patients had to
have a negative pregnancy test immediately prior to
surgery. All subjects received a complete dental exam-
ination for initial documentation including, but not
limited to, a medical history, dental history, complete
periodontal charting, appropriate radiographs and pho-
tographs, and a comprehensive treatment plan. In-
formed consent was obtained according to the Insti-
tutional Review Board of the Louisiana State University
Health Sciences Center.
The basic protocol has been reported previ-
ously.11,12,16 Upon meeting the selection criteria,
patients received initial preparation procedures com-
mon to most periodontal practices today (oral hygiene
instruction, scaling and root planing, polishing, occlusal
126
Volume 72 • Number 2
adjustment, splinting, etc.) throughout the mouth as
necessary. When the patients demonstrated accept-
able oral hygiene practices as determined by a mod-
ified O’Leary plaque record score32 of ≥80% positive
and the tissues responded to the initial preparation,
surgical therapy was initiated.
Documentation included photographs and a com-
plete periodontal charting related to the CEJ or restora-
tion margin. This included measurements by a single
calibrated examiner (GHE) with standardized pressure-
sensitive manual probes§ to the nearest one-half mil-
limeter vertically at the middle of the mesial and dis-
tal roots and at a 30° angle in the middle of the
furcation from the CEJ-free gingival margin (FGM) to
evaluate recession; CEJ-base of pocket (BP) to eval-
uate attachment level changes; FGM-BP to evaluate
probing depth changes; and FGM-MGJ to evaluate
changes in the zone of keratinized gingiva. During
surgery, measurements to the nearest one-half mil-
limeter at the same points were made from the CEJ-
alveolar crest (AC) and CEJ-base of defect (BD). Hor-
izontal depth of furcation bone loss was measured
(HORIZ1 or 2) from a second periodontal probe posi-
tioned horizontally across the prominences of the buc-
cal roots 2 mm apical to the coronal aspect of the fur-
cation as a reference point.2,3 These measurements
allowed monitoring of changes in crestal height (CEJ-
AC), depth of defect and defect resolution (AC-BD),
the amount of defect fill (CEJ-BD) and furcation fill
(HORIZ1-HORIZ2) at standardized locations and not
necessarily the deepest part of the defect.11,12,16
All surgeries were performed by two of the authors
(RAY and MBA-R). The surgery at each site consisted
of reflection of a full thickness flap on the facial and
lingual surfaces of each tooth or area involved under
local anesthesia. Debridement of the osseous defects
and furcations of granulomatous tissue was followed
by ultrasonic (diamond coated tips) and hand scaling
and root planing of all exposed tooth surfaces and the
furcations.1,33 Tetracycline HCl (250 mg/5 ml saline)
was used for 2 minutes to condition the root sur-
faces.34-36 At this time the intra-operative measure-
ments of CEJ-alveolar crest (AC), CEJ-base of the
bony defect (BD), and horizontal bone loss (HORIZ1)
were taken. Treatment was randomly determined at
this point by the roll of a die. The ePTFE membrane
was shaped as needed to cover the root surfaces and
furcation defects from at least 3 mm apical and lateral
to the bony margins to the CEJ, and was secured into
place by ePTFE suture material. The surgical flaps
were then positioned over the outer surface of the
membranes and secured with coronally positioning
† PerioGlas, Block Drug Company, Inc., Jersey City, NJ.
‡ GoreTex Periodontal Material, W. L. Gore & Associates, Inc., Flagstaff, AZ.
§ Vivadent Ivoclar, Vivacare, Singapore, Vivadent Schwaan, Liechtenstein.
 Cavitron, Dentsply International Preventive Care, York, PA.
0090_IPC_AAP_553261 2/21/01 11:00 AM Page 127
J Periodontol • February 2001
non-resorbable sling sutures to bury the membranes
under at least 2 mm of gingival tissue. Teeth receiv-
ing the PG graft material were subjected to identical
treatment prior to placement of the graft. Either no
dressing or a non-pressure light-cured dressing¶ was
placed depending on the ability to retain a dressing
without disturbing the flap.
Prescribed medications included a non-steroidal anti-
inflammatory agent started prior to surgery and con-
tinued for 4 days; a narcotic-containing analgesic to
be taken postsurgically as needed; doxycycline 100
mg b.i.d. for 10 days starting the day of surgery; and
0.12% chlorhexidene gluconate mouthrinse# b.i.d. for
one month.
At the first postoperative appointment, the dressing
and flap-retaining sutures were removed and the sur-
gical area gently debrided with a 50:50 warm saline:
3% hydrogen peroxide solution. All subjects were
placed on a strict recall schedule following surgery.
Plaque removal and oral hygiene instruction was per-
formed every 10 days for the first month, followed by
prophylaxis at 2, 3, and 5 months.11,12,32,37 An over
the counter American Dental Association accepted
mouthrinse** was used as a plaque control adjunct
from the first month until reentry.38,39
In those sites where it was used, the ePTFE mem-
brane was surgically removed at about 6 weeks under
local anesthesia utilizing partial thickness flap exposure.
After barrier removal, the void was gently flushed with
3% hydrogen peroxide, the inner surface of the flap
curetted to attempt to remove any epithelium, and the
flap sutured snugly to the surface as near to the CEJ
as possible with resorbable or ePTFE‡ interproximal
or sling sutures. In cases where the flap receded api-
cal to the ePTFE membrane, the flap was contoured
for good adaptation and positioned coronal to the mar-
gin of the newly formed tissue. No dressings were
placed after membrane removal and postsurgical
antibacterial rinses were again prescribed until mechan-
ical oral hygiene measures could be re-instituted.
At least 6 months postoperatively, clinical furcation
grade was determined, soft tissue measurements were
repeated, and reentry flap surgery performed to expose
all furcations under investigation. The reentry proce-
dure utilized a partial thickness flap coronally, with the
incision begun near the gingival margin through the
gingiva to expose the healed tissues on the root sur-
faces, changing to a full thickness flap at the bone
margin. Any part of the soft tissue which was not clin-
ically attached to the root surface was excised. Alve-
olar crest height, defect depth, and horizontal furcation
depth were measured at the initially recorded sites,
and any residual defects were treated by various means
dictated by clinical judgement to be in the best inter-
est of the patient. The flaps were closed and similar
postoperative procedures as above were employed
Yukna, Evans, Aichelmann-Reidy, Mayer
until the patients were placed on maintenance ther-
apy.
Statistical analyses of the PG bone replacement
graft versus the ePTFE barrier treatment compared
changes in pre- and postsurgical probing depths, clin-
ical probing attachment level, recession, zone of ker-
atinized tissue, furcation depth, and defect depth for
each treatment utilizing both the t test and the Mann
Whitney U and Wilcoxon signed rank tests and the
Kruskal-Wallis repeated measures ANOVA by ranks
with significance determined at the P >0.05 level. The
analyses compared millimeters of defect and furcation
repair (CEJ-BD and HORIZ), percentage of defect
and furcation repair, millimeters of crestal change
(DCEJ-AC), gingival recession (CEJ-FGM), change
in zone of keratinized tissue, clinical probing attach-
ment level change (CEJ-BP), and probing depth
change (FGM-BP).11,12
RESULTS
Twenty-seven patients (23 non-smokers and 4 smok-
ers; 11 males and 16 females) with 27 pairs of
mandibular Class II furcation defects and a mean age
of 54 years (range, 39 to 72) participated in this study.
Fourteen first molars, 12 second molars, and 1 third
molar received PG while 12 first molars and 15 sec-
ond molars received ePTFE.
The responses to the 2 tested treatments were
divided into analysis groups consisting of the vertical
furcation response to therapy (Table 1), the horizon-
tal furcation response to treatment (Table 2), and the
response of the adjacent mid-root surfaces (Table 3).
Since comparison of non-smokers with the small sub-
set of smokers and comparison of results obtained by
the 2 surgeons revealed no statistical or clinical dif-
ferences, all patients were evaluated as a single data
set.
Table 1 demonstrates that no real difference was
found between the PG graft and ePTFE barrier treat-
ments in the vertical bony defects associated with
Class II mandibular molar facial furcations. Both treat-
ments resulted in significant reductions in the origi-
nal bony defect depth, probing depth, and width of
keratinized tissue, P ≤0.001 for the change from base-
line for both PG and ePTFE; and P = 0.47 for the dif-
ference between treatment groups. Table 1 also shows
that the decrease in probing depth was due more to
gingival recession than to gain in clinical attachment.
Horizontal furcation results (Table 2) also show no
statistically significant difference between the 2 treat-
ments for any clinical measurement. Both treatments
resulted in significant reduction in horizontal probing
depth and horizontal furcation defect depth (P <0.001)
¶ Barricaid, L.D. Caulk Company, Milford, DE.
# Peridex, Procter & Gamble Co., Cincinnati, OH.
** Listerine, Warner-Lambert Co., Morris Plains, NJ.
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Bioactive Glass Versus ePTFE in Mandibular Furcations Volume 72 • Number 2

Table 1. Table 2.
Response of Mandibular Class II Furcations Response of Mandibular Class II Furcations
to Treatment With Bioactive Glass Bone to Treatment With Bioactive Glass Bone
Replacement Graft Material or ePTFE Barrier: Replacement Graft Material or ePTFE
6-Month Reentry Vertical Mid-Furcation Barrier: 6-Month Reentry Horizontal
Results Mid-Furcation Results

P Value* P value*

PG ePTFE t test MWU PG ePTFE t test MWU

Initial intrabony 2.3 ± 1.4† 2.5 ± 1.0 .39 Initial furcation 4.3 ± 1.0† 4.3 ± 10.7 96
‡
defect depth 2 (0 – 6) 2.5 (1 – 5)§ .39 horizontal 4 (2 – 6) 4 (3 – 6)§ ‡ .95
defect depth
Reentry defect 0.7 ± 1.0 0.7 ± 0.8 .85
depth 0 (0 – 4) 0.5 (0 – 3) .84 Reentry 3.1 ± 1.4 3.0 ± 1.0 .80
furcation 3 (1 – 6.5) 3 (1 – 5) .81
Amount of 1.1 ± 1.9 1.0 ± 1.1 .79 defect depth
defect fill 1 (–3 – 5) 1 (–1 – 3.5) .66
Amount of 1.4 ± 1.4 1.3 ± 1.1 .96
Crestal 0.5 ± 1.2 0.8 ± 0.9‡ .24 furcation 1.5 (–2 – 4) 1.5 (–0.5 – 3.5) .97
resorption 0 (–2 – 3) –1 (–0.5 – 3) .22 horizontal
Percent 47.3 ± 40.8 43.1 ± 36.1 .69 defect fill
defect fill 38 (0 – 100) 50 (0 – 100) .78 Percent 31.6 ± 24.0 31.1 ± 22.4 .94
Percent defect 64.5 ± 37.3 71.7 ± 34.9 .47 horizontal 33 (0 – 80) 30 (0 – 75) .98
resolution 68 (0 – 100) 80 (0 – 100) .48 furcation
defect fill
Presurgical 4.3 ± 1.2 3.9 ± 1.0 .17
probing depth 4 (2 – 7) 4 (2 – 6.5) .17 Initial horizontal 4.4 ± 1.4 4.2 ± 0.8 .87
probing depth 4 (3 – 10) 4 (2 – 6) .87
Postsurgical 3.0 ± 0.8 2.8 ± 0.9 .38
probing depth 3 (1 – 5) 4 (2 – 8.5) .75 6 month 2.8 ± 1.0 2.9 ± 0.9 .83
horizontal 3 (1 – 5) 3 (1 – 4) .83
Decrease in 1.4 ± 1.2 1.1 ± 1.1 .51 probing depth
probing depth 1 (–1 – 3) 1 (–1– 4) .51
Change in 1.5 ± 1.3 1.2 ± 1.2 .41
Gingival 0.9 ± 1.2‡ 0.8 ± 1.1‡ .54 horizontal 1.5 (–1 – 6) 1 (–2 – 3.5) .43
recession 0.5 (–1.5 – 4) 1 (–2 – 4) .98 probing depth
Clinical gain in 0.4 ± 1.0‡ 0.3 ± 0.9‡ .73 * Parametric t test and non-parametric Mann Whitney U test for 27 pairs of
probing 0 (–1.5 – 3) 0 (–1 – 2) .81 furcations.
† Mean ± standard deviation.
attachment ‡ Vertical brackets or single values denote differences in presurgical and
postsurgical findings which are statistically significant at P ≤0.05 using
Change in width –0.6 ± 1.2‡ –0.7 ± 1.1‡ .86 both paired t test and the Wilcoxon signed ranks test.
of keratinized –0.5 (–3 – 1) –1 (–2 – 3) .70 § Median and (range).
tissue
* Parametric t test and non-parametric Mann Whitney U test for 27 pairs of tions treated with PG were Class I, 18/27 (67%) fur-
furcations. cations treated with ePTFE were Class I, and one fur-
† Mean ± standard deviation.
‡ Vertical brackets or single value denote differences in presurgical and cation completely closed clinically with each treat-
postsurgical findings which are statistically significant at P ≤0.05 using both ment.
paired t test and the Wilcoxon signed ranks test.
§ Median and (range). The effects of PG graft and ePTFE barrier use on the
mid-root periodontal tissues adjacent to the furcations
are presented in Table 3. Since analysis of the indi-
for the change from baseline for both PG (1.2 mm) vidual mesial and distal mid-root data yielded no sta-
and ePTFE (1.4 mm); and P = 0.48 for the difference tistically significant difference on any tooth, those 2
between treatments. The average percent horizontal data points were combined and averaged for analysis.
furcation fill was 31.6% for PG and 31.1% for ePTFE There were no statistically significant differences
with P = 0.74 for the difference between treatments. between treatments. While both treatments resulted in
Prior to the reentry surgery, clinical determination a significant decrease in defect depth, only the PG
of furcation grade revealed that 17/27 (63%) furca- yielded a significant reduction in probing depth. It

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J Periodontol • February 2001 Yukna, Evans, Aichelmann-Reidy, Mayer

Table 3. should be noted that in this area of the tooth, defect

resolution was the result more of crestal resorption
Response of Adjacent Mid-Root Tissues to than defect fill. Similarly, the decrease in probing depth
Treatment of Mandibular Class II was due more to gingival recession as both treatments
Furcations With Bioactive Glass Bone lost clinical attachment.
Replacement Graft Material or ePTFE Intrapatient comparisons are shown in Table 4.
Barrier: 6-Month Reentry Results Results were essentially equally divided between the
treatments, with PG and ePTFE yielding equal results
P value* in most patients, except for vertical percent defect fill
where PG yielded a better result in more patients.
PG ePTFE t test MWU No signs of root resorption were noted in any of the
Original 1.0 ± 1.5† 0.8 ± 1.0 .48 treated teeth. No discernible changes were noted on
intrabony 0(0 – 5) 3(1 – 4)§ ‡ .88 visual comparison of pretreatment and 6-month post-
defect treatment radiographs.
depth Six of the ePTFE surgeries (22%) and none of the
PG surgeries had postoperative complications. One
Reentry 0.4 ± 0.8 0.3 ± 0.8 .73
subject developed hyperplastic tissue, 2 subjects devel-
defect 0(0 – 3) 0(0 – 3.5) .88
oped buccal space infections, and 3 subjects experi-
depth
enced a physical problem with the barrier and/or sur-
Amount of 0.3 ± 1.7 –0.3 ± 1.1 .72 gical flap. These were managed with local drainage,
defect fill 0(–2 – 5) –0.5(–3 – 3) .62 in-office irrigation, and/or systemic administration of
Crestal 0.3 ± 1.1 0.7 ± 0.7‡ .18 antibiotics until the ePTFE was removed. This phe-
resorption 1(–3 – 1.5) –1(–2.5 – 1) .29 nomenon did not appear to affect the healing between
the ePTFE and the tooth. There were no similar infec-
Percent 19.8 ± 36.1 11.1 ± 26.7 .32 tions associated with the use of PG. Clinical examples
defect fill 0(0 – 100) 0(0 – 100) .44 are shown in Figures 1 and 2.
Percent 28.1 ± 42.1 32.6 ± 44.0 .71
defect 0(0 – 100) 0(0-100) .32
resolution
Table 4.
Presurgical 3.1 ± 1.1 2.7 ± 0.9 .19
probing 3(1.5 – 5.5) 2.5(1.5 – 4.5) .24 Intrapatient Comparison of Response of
depth Mandibular Class II Furcations to
Postsurgical 2.4 ± 0.8 2.6 ± 0.8 .48 Treatment With Bioactive Glass Bone
probing 2.5(1 – 3.5) 2.5(1 – 4.5) .48 Replacement Graft Material or ePTFE
depth Barrier: 6-Month Reentry Results
Decrease in 0.7 ± 1.1 0.1 ± 0.8 .15
probing 0(–2 – 2) 0(–1.5 – 2) .20 PG > ePTFE PG = ePTFE PG < ePTFE
depth
Horizontal defect fill* 4 15 8
Gingival 0.8 ± 1.2‡ 0.8 ± 1.1‡ .35
recession 1(–1 – 3.5) –0.5(–3.5 – 1) .65 Horizontal percent 4 18 5
defect fill†
Clinical gain –0.2 ± 1.1‡ –0.6 ± 0.9‡ .56
in probing 0(–2 – 2) 0(–2.5 – 0.5) .24 Improvement in 4 15 3
attachment clinical furcation
class
Change in –0.6 ± 1.3‡ –0.2 ± 1.1 .34
keratinized 0.5(–1.5 – 3.5) 0.5(–2 – 2) .28 Vertical defect fill* 10 8 9
tissue Vertical percent 12 7 8
Mesial and distal mid-root data for each tooth were combined since analysis defect fill†
revealed no statistically significant differences in findings between the 2
surfaces for any tooth. Vertical clinical 8 12 7
* Parametric t test and non-parametric Mann Whitney U test for 27 pairs of probing attachment
teeth.
† Mean ± standard deviation. gain*
‡ Vertical brackets and single values denote differences in presurgical and
postsurgical findings which are statistically significant at P ≤0.05 using * Difference of ≥1 mm or 1 furcation class used to determine comparative
both paired t test and the Wilcoxon signed ranks test. superiority or inferiority of particular treatment in each patient.
§ Median and (range). † Difference of ≥15% used to determine comparative superiority or inferiority
of particular treatment in each patient.

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Bioactive Glass Versus ePTFE in Mandibular Furcations
DISCUSSION
The results of this study suggest that both PG and
ePTFE used as regenerative materials yield generally
favorable clinical results in mandibular Class II furca-
tions, and that there are essentially no differences in
results between the 2 materials used as monotherapy.
This was evident from the objective data presented in
Tables 1 through 4 as well as the more subjective clin-
ical evaluation of furcation class that showed 1 com-
plete closure with each treatment and the 63% PG and
67% ePTFE frequency of change from Class II to Class
I. There were no differences in results related to tooth
130
Volume 72 • Number 2
Figure 1.
Female, 46 years old, Caucasian. Facial furcations #18 and #19
treated. All are mirror views. A. Preoperative view. B. Initial furcation
defects. Horizontal furcation defect #18 = 5.5 mm, #19 = 6 mm;
both Class II. C. Bioactive glass placed in furcation #19 and ePTFE
placed over furcation #18. D. Flap closure. E. Reentry view
demonstrating substantial clinical fill of both furcations. Residual
horizontal furcation defect depth #18 = 2 mm, #19 = 2 mm; both
now Class I.
number, as 38% of first molars and 37% of second
molars responded favorably.
Only one instance of complete clinical furcation
closure with each procedure was found in this study.18
Several studies have shown the new velvety, red gran-
ulation tissue evident at ePTFE removal at or coronal
to the CEJ.19,20,40,41 While this phenomenon was also
seen in this study, the “new attachment” tissue receded
and regressed toward the initial levels over the next
several months.
This study suggests that PG and ePTFE are equally
effective in the treatment of Class II furcations. More-
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J Periodontol • February 2001 Yukna, Evans, Aichelmann-Reidy, Mayer

Figure 2.
Female, 41 years old, Black. Facial furcations #30 and #31 treated. All are mirror views. A. Preoperative view. B. Initial furcation defects. Horizontal
furcation defect depth #30 = 4 mm, #31 = 4 mm; both Class II. C. ePTFE placed over furcation #30. D. Bioactive glass placed in furcation #31.
E. Flap closure. F. Reentry view demonstrating substantial clinical fill of both furcations. Residual horizontal furcation defect depth #30 = 2 mm, #31
= 2 mm; both now Class I.

over, the performance of the ePTFE treatment in this
study is within the range reported by others in con-
trolled clinical trials of regenerative therapy for
mandibular Class II furcations.18,21 Earlier investiga-
tions tended to report better improvement with ePTFE
than have been reported recently. Our reported com-
plete and partial response of 44% is only slightly lower
than the 49% based on all studies with 20 or more
patients from 1993 through 1996.18 Furthermore, our
reported 74% of vertical defect depth resolution and
30% horizontal defect resolution with ePTFE is similar
to results presented by Yukna11 in which 50% vertical

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Bioactive Glass Versus ePTFE in Mandibular Furcations
defect resolution and 20% horizontal defect fill was
found. In addition, PG was associated with no untoward
events in this study compared to 6 such events with
ePTFE.
In general, the clinical findings relative to furcation
fill and gain in clinical attachment are less positive than
those reported in other studies using ePTFE19,41-43
and other bone replacement graft materials.44-48 Other
reports utilizing regenerative approaches have also
experienced a universal lack of complete or only occa-
sional true complete fill bone fill in mandibular Class
II facial furcations.18 This study was performed to eval-
uate the 2 regenerative materials as monotherapy. It
is suggested from other studies that combination treat-
ment utilizing both a barrier and a graft may be more
beneficial than using either alone.18
A major clinical question has to be whether partial
results in mandibular Class II facial furcations, such as
shown here and by others,18 actually improve the prog-
nosis of the tooth. About one-third of the time, the repair
resulted in a shallow-moderate Class II furcation rather
than a deep Class II furcation. It is doubtful whether this
actually changes the patient’s or dental office’s ability
to perform adequate plaque control in that region. This
pattern is also found in other studies.18
Although there is now a substantial body of litera-
ture indicating that smoking has a detrimental effect
on the periodontal healing process, the small number
of smokers did not allow the effect of smoking to be
investigated in this group.
The results of this study demonstrate that the use
of PG bone replacement graft material and ePTFE bar-
rier material yield equivalent clinical results in mandibu-
lar Class II furcations. Both treatments gained about 0.3
to 0.4 mm of vertical clinical probing attachment level
and 1.3 to 1.5 mm of horizontal clinical probing attach-
ment level, and both treatments resulted in a positive
change in clinical furcation grade 67 to 70% of the
time. PG bone replacement graft material appears to be
an effective monotherapy for the treatment of mandibu-
lar Class II furcations, and is essentially equivalent to
the “gold standard” treatment with ePTFE barriers.
ACKNOWLEDGMENTS
The clinical assistance of Stephanie Weil, Susan Bil-
liot, Dr. Brent Depta, and Dr. Ali Shayestamanesh; bib-
liographic verification provided by Julie Breaux; and
the manuscript preparation efforts of Connie Holland
Gandy are appreciated and recognized. In addition,
the administrative and organizational support of Dr.
Edward Santucci, Dr. Emanuel Troullos, and Dr. Arlene
Swern, Block Drug Company, was vital to the com-
pletion of this project. This study was supported by a
grant from Block Drug Company, which provided sup-
plies and funding for this study, and by W.L. Gore &
Associations, which provided the ePTFE membranes.
132
Volume 72 • Number 2
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Send reprint requests to: Dr. R.A. Yukna, Periodontics, Box
138, 1100 Florida Ave., New Orleans, LA 70119. Fax:
504/619-8652.
Accepted for publication July 7, 2000.
133