Clinicoradiographic evaluation of marginal periosteal membrane with or without osseous graft in the treatment of Grade II furcation defects of mandibular molars: A single-blinded randomized clinical trial.

Background: Furcation defects in periodontitis present treatment challenges due to complex anatomy. While guided tissue regeneration aids regeneration, periosteal isolation limits osteoblast contribution. The marginal periosteal membrane (MPM) serves as a biological barrier, potentially enhancing regeneration. Hence, the study aims to evaluate the application of a vascularized MPM in the treatment of mandibular Grade II furcation defects with and without bone graft in terms of defect depth reduction. Materials and Methods: A total of 60 patients, 30-50 years of age group having Stage III periodontitis with Grade II buccal furcation defect in a mandibular molar with vertical probing pocket depth (PPD) ≥5 mm at mid-furcation area were chosen. Control group (n = 30) was treated with MPM, and the test group (n = 30) with MPM with bone graft. Follow-up was done at the 3rd and 12th months following surgery for clinical parameters, i.e., mean plaque index (PI), modified sulcular bleeding index (mSBI), Visual Analog Scale score, healing index score, mean PPD, and relative clinical attachment level (RCAL) and 12 months for radiographic parameters such as horizontal defect depth and vertical defect depth with intraoral periapical radiograph and cone-beam computed tomography (CBCT), following which the statistical analysis was performed. Results: Both groups improved significantly in PI, mSBI, PPD, and RCAL (P < 0.05). The test group showed better RCAL at 3 months (9.37 ± 1.10 mm vs 10.87 ± 0.68 mm) and 12 months (6.73 ± 1.40 mm vs. 8.77 ± 1.10 mm) (P < 0.05) while CBCT results revealed greater defect depth reduction (horizontal: 1.41 ± 0.25 mm vs. 1.55 ± 0.14 mm and vertical: 1.47 ± 0.23 mm vs. 1.62 ± 0.15 mm) (P < 0.05). No differences in wound healing score (P > 0.7) or pain perception (P > 0.68) were seen. Conclusion: The study demonstrates that MPM significantly improves clinical and radiographic outcomes in Grade II furcation defects. MPM showed superior results when combined with bone graft, with greater RCAL gain and enhanced defect depth reduction. Hence, MPM with bone graft offers a more predictable regenerative approach for mandibular molar furcation defects.