The Connective Tissue Graft Wall Technique in the Regenerative Management of Grade II Furcation Involvements: A Pilot Study

Introduction
Grade II furcation involvement is considered the most suitable indication for regenerative periodontal surgery, providing favorable conditions for periodontal regeneration. These lesions are associated with reduced periodontal support and an increased risk of tooth loss if left untreated. This pilot study evaluated the clinical effectiveness of the connective tissue graft (CTG) wall technique for the regenerative treatment of Grade II furcation involvements.

Materials and Methods
Three patients (n = 3 defects) presenting with Grade II furcation involvement in multirooted molars were consecutively enrolled at the Department of Dentistry, University of Bari. Following defect debridement and root surface preparation, a CTG was harvested from the palate and positioned beneath a coronally advanced flap, where it acted as a biological wall, supporting and protecting the blood clot. Regeneration relied on the blood clot alone; no bone graft substitute, barrier membrane, or biological mediator was applied. The CTG provided mechanical stabilization of the clot, minimized flap collapse into the defect, and helped maintain a secluded space favorable for periodontal regeneration. Probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BoP) were recorded at baseline and at 5-month follow-up.

Results
All three defects healed uneventfully, without postoperative complications. PPD decreased from 8 to 4 mm (Case 1), 10 to 4 mm (Case 2), and 8 to 3 mm (Case 3), with a mean reduction of 5.0 ± 1.0 mm. Mean CAL gain was 1.0 ± 0.0 mm, with a corresponding mean increase in gingival recession of 4.0 ± 1.0 mm.

Conclusions
Within the limitations of this pilot study, notably the small sample size (n = 3), the absence of a control group, and the short follow-up, the CTG wall technique appears a safe feasible regenerative approach. These preliminary findings require confirmation in larger controlled prospective studies with longer follow-up.