Furcation involvement and attachment loss are major predictors of tooth loss. The aim of this study was to describe specific designs for papilla preservation flaps (PPFs) and minimally invasive surgery to be used in compromised molars and report proof-of-principle data with 3 to 16-year follow-up in severely compromised molars due to the presence of combined furcation and intrabony defects.
Forty-nine subjects with furcated molars and deep intrabony defects were treated with PPFs, application of periodontal regenerative devices. Improvement as a consequence of therapy was defined as tooth retention, reduction in horizontal and vertical furcation involvement, decrease in probing depths, and increases in clinical attachment level. Subjects were maintained with regular supportive periodontal care.
At 1 year, 100% of maxillary and 92% of mandibular molars showed improvements. Improvements were not observed in molars with baseline hypermobility: two mandibular molars with hypermobility were extracted at the 1-year follow-up. Improvement in vertical sub-classification was observed in 87.5% of maxillary and in 84.6% of mandibular molars. One-year improvements could be maintained over the 3 to 16-year follow-up.
PPFs and periodontal regeneration can be applied and provide clinical benefits to severely compromised molars due to the combined presence of furcation involvement and deep intrabony defects. These results were obtained in cases with an interdental peak of bone and gingival margin coronal to the furcation entrance in well-maintained and compliant subjects. Randomized controlled clinical trials with medium- to long-term follow-up are needed to confirm these findings.

BACKGROUND: Furcation involvement is a major predictor of tooth survival. Focus has so far been on the predictive value of the horizontal component of furcation involvement. Residual periodontal support on each of the roots is likely to play a major role on retention of the furcated molar. Aim of this clinical audit study was to preliminarily assess the impact of vertical subclassification on tooth retention.
METHODS: Tooth retention of class II furcated molars in 200 consecutive patients compliant with periodontal supportive care for a minimum of 10 years was retrospectively evaluated in a single practice. Randomly selected furcated molars were retrospectively diagnosed in terms of vertical subclassification (residual periodontal support on the most compromised root), and time to tooth extraction/loss was determined in clinical records. Kaplan-Meier survival curves were constructed.
RESULTS: Ten-year survival of molar with class II furcation involvement was 52.5%. Survival was 91% for subclass A, 67% for subclass B and 23% for subclass C. Mean years of survival were 9.5-10.1, 8.5-9.3 and 6-7.3 for subclasses A, B and C, respectively. Tests of equality of the survival distributions showed highly significant differences in all portions of the curve (p < .001). Stratified analyses by smoking showed significant differences for the two groups (p < .001). Hazard rates for tooth extraction/loss were 4.2 and 14.7 for subclasses B and C, respectively.
CONCLUSIONS: Residual periodontal support assessed as vertical subclassification of furcation involvement seems to be a good predictor of survival of molar with class II horizontal furcation. This has implication for prognosis, treatment planning and development of effective molar retention strategies.

OBJECTIVE: Data showed that among 5-year-old Chinese, 96.7% of cavitated primary teeth were left untreated. The study aimed to report on the course of cavitated primary teeth within the Chinese health-care system over a period of 3.5 years.
METHODS: Selection of high caries risk children for inclusion in a sealant comparison study was based on the presence of cavitated dentine lesions in their primary teeth. At the 6-month sealant evaluation point many of these cavitated dentine lesions had not been treated. This necessitated monitoring these cavitated teeth 6-monthly for those exfoliated, restored, with a cavity left open, having caused toothache (symptom) and having (or having had) an abscess or fistulae (symptom). Care-seeking instruction was given at every evaluation point. anova and t-test were used in analysing the data.
RESULTS: A total of 1012 cavitated primary teeth in 305 children (7.6 to 9.3 years old), were followed for 3.5 years. A total of 92.9% of cavitated primary teeth were left open, while 7.1% were restored at some stage during the observation period; 98.5% of restored teeth and 95.5% of cavitated teeth left open exfoliated and 93.9% of restored teeth and 81.5% of cavitated primary teeth left open exfoliated without any symptoms. Having (or having had) toothache was the symptom most frequently related to exfoliated restored teeth and to exfoliated cavitated teeth left open. Restored primary teeth survived statistically significantly longer than cavitated primary teeth left open: 1.99 ± 0.07 years and 1.68 ± 0.03 years, respectively.
CONCLUSIONS: The large majority of cavitated primary teeth in this child population exfoliated without symptoms.