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SANZ et al .
Ethical considerations The perception is that regenerative therapies to promote tooth re - tention are preferred over tooth extraction (and replacement) or open flap debridement.
Clinical relevance and effect size It cannot be extrapolated.
Balance of benefit and harm The benefit of regenerative therapies to promote tooth retention out - weighs the adverse events which consist mainly of local wound failure. Ethical considerations The expert perception is that regenerative therapies to promote tooth retention are preferred over tooth extraction or open flap debridement.
Regulatory consideration All the studies reported FDA- or CE-approved devices.
Economic considerations Regenerative surgery has additional costs, which appear to be justi - fied by the added benefits (furcation improvements).
Regulatory consideration All the studies reported FDA- or CE-approved devices.
Patient preferences Minimal data are available.
Economic considerations Regenerative surgery has additional costs which appear to be justi - fied by the added benefits (furcation improvements).
Applicability Teeth presenting with favourable patient, tooth and defect-related conditions.
Patient preferences No data are reported.
R3.12 | What is the adequate management of residual deep pockets associated with maxillary buccal Class II furcation involvement? Evidence-based recommendation (3.12) We suggest treating molars with residual pockets associated with maxillary buccal Class II furcation involvement with periodontal regenerative surgery. Supporting literature Jepsen et al. (2019) Quality of evidence Three RCTs ≥12 months (82 patients). Grade of recommendation Grade B—↑ Strength of consensus Consensus (8.5% of the group abstained due to potential CoI)
Applicability Teeth presenting with favourable patient, tooth and defect-related conditions.
R3.13 | What is the adequate choice of regenerative biomaterials for the regenerative treatment of residual deep pockets associated with Class II mandibular and maxillary buccal furcation involvement? Evidence-based recommendation (3.13) We recommend treating molars with residual pockets associated with mandibular and maxillary buccal Class II furcation involvement with periodontal regenerative therapy using enamel matrix derivative alone or bone-derived graft with or without resorbable membranes* Supporting literature Jepsen et al. (2019) Quality of evidence Seventeen RCTs ≥12 months (493 patients) for mandibular class II, 3 RCTs ≥12 months (82 patients) for maxillary buccal Class II, and support from indirect evidence, expert opinion. Grade of recommendation Grade A—↑↑ Strength of consensus Simple majority (12.7% of the group abstained due to potential CoI) *Clinicians should select a specific biomaterial to be used to promote regeneration at intrabony defects (or class II furcation involvements) based on satisfaction of all of the following criteria (Proceedings of the, 1996 World Workshop in Periodontics, 1996): (a) availability of solid preclinical research identifying plausible mechanism(s) of action leading to periodontal regeneration; (b) human histological evidence of regeneration in the specific application; and (c) evidence of efficacy in applicable, high-quality randomized controlled clinical trials. While there are biomaterials that satisfy all these criteria, it must be understood that many biomaterials do not meet them in spite of being CE marked or FDA-approved/cleared.
Background
Intervention See previous sections.
Available evidence The evidence base includes three RCTs with 82 patients (Garrett et al., 1997; Hugoson et al., 1995; de Santana, Gusman, & Van Dyke, 1999). The quality of the evidence for the statement was assessed according to GRADE and considered to be moderate. Of these studies only one (de Santana et al., 1999) had a clear compari - son towards OFD indicating an added benefit.
Risk of bias Study quality assessment identified an unclear/high risk of bias.
Consistency Regenerative treatment demonstrated added benefits.
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