Three-Year Outcome of Periodontal Regenerative Therapy for a Hopeless Maxillary Molar with Multiple Class II and...

Managing maxillary multi-rooted teeth presenting with multiple Class II furcation involvement (FI) and deep vertical attachment loss remains challenging, and long-term clinical outcomes of periodontal regenerative therapy are limited.

A 44-year-old woman with generalized periodontitis presented with bleeding and suppuration associated with the maxillary left first molar (#26). Clinical and radiographic examinations revealed buccal, mesial, and distal Class II FI and a deep vertical defect extending to the apical third (vertical subclass C), corresponding to a hopeless prognosis. Following phase I infection control, periodontal regenerative surgery was performed using a papilla-preservation flap. After meticulously debridement and root surface conditioning, enamel matrix derivative was applied, and carbonate apatite granules soaked with fibroblast growth factor-2 were placed and covered with a resorbable collagen membrane. Primary closure was obtained with internal mattress and sling sutures. Supportive periodontal care was provided monthly, with re-evaluations at 12 and 36 months.

Uneventful primary wound healing was achieved. At 36 months, FI reduced to Class I at all furcation entrances, and the vertical subclass improved from C to A. 36 months after surgery, clinical attachment level improved from 9 mm to 3 mm, probing pocket depth from 8 mm to 3 mm, and recession from 1 mm to 0 mm compared to baseline.

Within the limitations of a single case, periodontal regenerative therapy combining biologics and bone graft substitutes under a papilla-preservation approach may change prognosis of maxillary molars with advanced multi-furcation defects when strict infection control and supportive care are maintained.