Regenerative surgical treatment of furcation defects: a systematic review and Bayesian network meta-analysis of randomized clinical trials

Research output: Contribution to journalReview articlepeer-review


  • Søren Jepsen
  • Stefano Gennai
  • Zamira Kalemaj
  • Jacopo Buti
  • Filippo Graziani

Colleges, School and Institutes

External organisations

  • University of Bonn, Bonn, Germany.
  • Sub-Unit of Periodontology, Halitosis and Periodontal Medicine University Hospital of Pisa, Italy.
  • Private Practice, Milano, Italy.
  • University College London


AIMS: To investigate the clinical performance of regenerative periodontal surgery in the treatment of furcation defects versus open flap debridement (OFD) and to compare different regenerative modalities.

MATERIAL AND METHODS: A systematic search was conducted to identify RCTs evaluating regenerative surgical treatment of furcations with a minimum of 12-months follow-up. Three authors independently reviewed, selected and extracted data from the search conducted and assessed risk of bias. Primary outcomes were tooth loss, furcation improvement (closure/conversion) (FImp), gain of horizontal bone level (HBL) and attachment level (HCAL). Secondary outcomes were gain in vertical attachment level (VCAL), probing pocket depth (PPD) reduction, PROMs and adverse events. Data were summarized into Bayesian Standard and Network Meta-Analysis in order to estimate direct and indirect treatment effects and to establish a ranking of treatments.

RESULTS: The search identified 19 articles, reporting on 20 RCTs (19 on class II, 1 on class III furcations) with a total of 575 patients/787 defects. Tooth loss was not reported. Furcation closure ranged between 0% - 60% (10 trials), and class I conversion from 29% -100% (6 trials). Regenerative techniques were superior to OFD for FImp (OR = 20.9; 90% Crl = 5.81, 69.41), HCAL gain (1.6 mm), VCAL gain (1.3 mm), and PPD reduction (1.3 mm). Bone replacement grafts (BRG) resulted in the highest probability (Pr = 61%) of being the best treatment for HBL gain. Non-resorbable membranes + BRG ranked as the best treatment for VCAL gain (Pr = 75%) and PPD reduction (Pr = 56%).

CONCLUSIONS: Regenerative surgery of class II furcations is superior to OFD. FImp (furcation closure or class I conversion) can be expected for the majority of defects. Treatment modalities involving BRG are associated with higher performance.

Bibliographic note

© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Original languageEnglish
Pages (from-to)352-374
Number of pages23
JournalJournal of Clinical Periodontology
Issue numberS22
Early online date20 Dec 2019
Publication statusPublished - Jul 2020


  • furcation defect, meta‐analysis, periodontal regeneration, periodontitis, systematic review