An Umbrella Review of the Treatment Efficacy of Molar Class II Furcation

This review evaluated the methodology, quality, and outcomes of systematic reviews (SRs) assessing the efficacy of treatments for molar class II furcation defects. An electronic search was conducted across Cochrane Library, Medline/PubMed, Scopus, and Web of Science. AMSTAR 2 and ROBIS tools were used. Eleven SRs, encompassing a total of 98 randomized clinical trials (RCTs) were included. Three SRs were rated as high quality and low to moderate risk of bias according to the AMSTAR 2 and ROBIS assessments, respectively. Most SRs were rated as moderate by both tools. Open flap debridement (OFD) alone demonstrated limited clinical benefit. Guided tissue regeneration (GTR), using either resorbable or non-resorbable membranes, showed greater efficacy, particularly when combined with bone grafting materials, resulting in superior horizontal and vertical attachment and bone level gains compared to OFD. The efficacy of adjunctive therapies including enamel matrix derivatives and platelet concentrates remains inconclusive. Regenerative techniques, especially GTR combined with grafting, appear to be the most effective treatment for class II furcation defects. The heterogeneity among the RCTs reported in the included SRs highlights the importance of standardized methodologies in future research to strengthen the evidence base and enhance clinical recommendations. This review was registered in PROSPERO (CRD420251029622).