What question did this study set out to answer?

To present a decision aid that combines regenerative potential with long-term maintenance factors for managing Class II furcation involvement.

July 20, 2026Clinical Oral Investigations0 citationsOpen Access

A conceptual regeneration–maintenance decision aid for class II furcation involvement

AVAnete Vaskevica MKMeltem Özdemir Kabalak JKJenna Kompuinen

Key Points

To present a decision aid that combines regenerative potential with long-term maintenance factors for managing Class II furcation involvement.
Conducted a structured narrative review of Class II furcation involvement literature using PubMed, EBSCO, and Scopus databases.
Extracted variables influencing regenerative outcomes and long-term tooth survival, grouped into Morphological Regenerability and Maintenance Accessibility Scores.
Derived scoring ranges and thresholds based on the effect sizes reported in the literature.
The Morphological Regenerability Score incorporates five defect-related variables, ranging from -5 to 9 points, and identifies metrics important for decision-making.
The Maintenance Accessibility Score includes seven maintenance-related variables, spanning from 0 to 13 points, guiding towards possible treatment options.
Thresholds of MRS ≥ 5 and MAS ≥ 7 define four clinical quadrants for treatment strategy selection.

Abstract

Abstract Objective To introduce a practical, evidence-based and prognosis-oriented conceptual decision aid for the management of Class II furcation involvement, integrating defect-specific regenerative potential with long-term maintenance feasibility. Materials and methods A structured narrative review of the literature on Class II furcation involvement regeneration, prognostic factors, and long-term maintenance outcomes was conducted using PubMed, EBSCO, and Scopus databases. Variables with documented influence on regenerative outcomes or long-term tooth survival were extracted and grouped into two conceptual axes: a Morphological Regenerability Score, capturing defect anatomy, and a Maintenance Accessibility Score, capturing site-related and patient-related factors. Scoring ranges and thresholds were derived from the magnitude and consistency of reported effect sizes. Results The Morphological Regenerability Score integrates five defect-related variables (vertical furcation involvement component, root divergence at crestal bone, furcation entrance width, defect location and root trunk length) with modifiers for mobility, cervical enamel projections, exposed furcation entrance, and enamel pearls, spanning − 5 to 9 points. The Maintenance Accessibility Score integrates seven maintenance-related variables (plaque control, supportive periodontal treatment compliance, smoking, diabetes control, site/operator accessibility, endodontic status and tissue phenotype), spanning 0 to 13 points. Midpoint thresholds (MRS ≥ 5; MAS ≥ 7) define four clinical quadrants guiding case selection between regeneration, staged treatment strategy, non-surgical or resective approaches, and extraction. Conclusions The proposed framework consolidates heterogeneous evidence on Class II furcation involvement prognosis and proposed treatment strategies into a single transparent decision aid. Prospective validation is required before routine clinical adoption. Clinical relevance This framework supports evidence-based, individualised decision-making for Class II furcation involvement based on defect regenerability and long-term maintenance, and highlights modifiable risk factors that should be addressed before attempting regenerative surgery.

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