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SANZ et al .
Background
Risk of bias Study quality assessment identified an unclear risk of bias for the majority of the studies. There is a mix of researcher and industry- initiated studies. Consistency The procedures with the highest ranking for horizontal bone gain are bone-replacement graft, bone-replacement graft with resorb - able membranes or enamel matrix derivative.
Intervention See previous sections.
Available evidence Six observational studies with 633 patients (Class II interproximal).
Risk of bias Low quality of evidence for observational studies.
Clinical relevance and effect size It cannot be extrapolated among the therapies.
Consistency Following non-regenerative treatment of maxillary interproximal Class II furcation involvement, moderate to substantial heteroge - neity in the size of the effect (wide ranges of tooth survival) was observed. The reasons cannot be determined from the existing data. Clinical relevance and effect size Following non-regenerative treatment of maxillary interproximal Class II furcation involvement, reasonable survival rates were ob - served over 4–30.8 years. Balance of benefit and harm We did not identify data about harm directly related to procedures. Regarding tooth survival, a benefit of root amputation/resection, root separation or tunnelling compared to SRP or OFD cannot be currently stated. For the individual choice of procedure, however, the clinician should consider criteria beyond class of furcation in - volvement (e.g. bone loss, jaw). Economic considerations Simulations based on the German health system have indicated that tooth retention after complex periodontal therapy of teeth with furcation involvement is more cost-effective than their extraction and replacement with an implant supported fixed partial denture (Schwendicke et al., 2014). A study assessing the actual cost of reten - tion of molars in the same health system showed that cost for retain - ing periodontally compromised molars were minimal (Schwendicke et al., 2016). Patient preferences There is a strong patient preference for tooth retention (IQWiG, 2016). Applicability The guideline can be applied since it is independent of availability of materials and a segment of the dental workforce has been trained or can be trained to deliver surgical furcation treatment in the different European health systems.
Balance of benefit and harm The benefit of regenerative therapies to promote tooth retention outweighs the adverse events which consist mainly of local wound failure. Ethical considerations The perception is that regenerative therapies to promote tooth reten - tion are preferred over tooth extraction and 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). Patient preferences Enamel matrix derivative showed less postoperative swelling and pain than non-resorbable membranes. Applicability Teeth presenting with favourable patient, tooth and defect-related conditions. R3.14 | What is the adequate management of maxillary interdental Class II furcation involvement? Evidence-based recommendation (3.14) In maxillary interdental Class II furcation involvement non-surgical instrumentation, OFD, periodontal regeneration, root separation or root resection may be considered . Supporting literature Dommisch et al. (2020); Huynh-Ba et al. (2009); Jepsen, Eberhard, Herrera, and Needleman, (2002) Quality of evidence Six observational studies (633 patients) with low quality of evidence for non-regenerative approaches and two systematic reviews with low quality of evidence for regenerative treatment. Grade of recommendation Grade 0—↔ Strength of consensus Consensus (4.3% of the group abstained due to potential CoI)
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