Clinical Advances in Periodontics Vol. 3, No. 2, May 2013 : Page-68

C A S E R E P O R T replacement graft materials because of its ability to achieve supracrestal regeneration along with complete fill of Class III furcations, its use unfortunately carries the added morbidity associated with its procurement along with root resorption that has occurred in a number of cases during the healing process, condemning the tooth that had been treated. 11 There are several concerns surrounding the current treat-ment approach. Two of these include whether allogenic reactions might occur with the use of MSCs and whether these cells may indeed cause the same root resorption seen with hip marrow. MSCs appear to have an immune-privileged status that has been supported by at least one in vivo study. 12 Regarding root resorption, the cases to date have not demonstrated this phenomenon and may indeed be related to the cryopreservation of the tissue, as was the circumstance with hip marrow in the past. 13 n Summary Why is this case new information? j This case demonstrates the closure of a Class III furcation based on horizontal probing and radiographic bone fill, giving hope that this combined approach that uses a composite allograft using stem cells for regenerative care may hold promise for treating this most challenging of clinical dilemmas. Although this case focuses on the materials used to achieve this successful clinical result, it is the fundamentals of regenerative therapy that are paramount. These include proper patient selection, attaining a clean root surface, stabilizing the clot, maintaining space, modulating the biologics to achieve a favorable regenerative environment, and strict adherence to maintenance therapy with outstanding oral hygiene practiced throughout the healing process. What are the keys to successful management of this case? j What are the primary limitations to success in this case? There still remain certain key elements that are critical for regenerative success, including patient factors such as smoking and lack of compliance, the ability to access and achieve a root surface free of plaque and calculus, lack of occlusal control, which includes fremitus and mobility beyond degree 1, and close adherence to maintenance therapy. j Although the clinical result appears promising, confirmation with human histology is necessary to label it as a “ regenerative ” procedure. 14 j Acknowledgments The author thanks Dr. D. Walter Cohen, who has been inspirational in his commitment to dentistry and in partic-ular the field of periodontics. Dr. Rosen has received lecture fees from Snoasis Medical (Denver, Colorado). CORRESPONDENCE: Dr. Paul S. Rosen, 907 Floral Vale Blvd., Yardley, PA 19067. E-mail: p.rosen@psrperioimplant.com. 68 Clinical Advances in Periodontics, Vol. 3, No. 2, May 2013 Combination Therapy for a Class III Furcation

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