Single Buccal Envelope Flap with Connective Tissue Graft Wall and Fibroblast Growth Factor-2 Combined with Autogenous Bone Graft for Mandibular Class III Furcation Defect: A Case Report

During supportive periodontal care, teeth with Class III furcation involvement are at a higher risk of loss. When performing surgery on molars with through-and-through furcation defects, elevating the flaps on both sides of the tooth may result in tissue wall loss, gingival recession, and exposure of the furcation entrance. This case report presents the Single Buccal Envelope Flap with Connective Tissue Graft (CTG) Wall Technique for the treatment of mandibular Class III furcation defects. We used a single-flap approach for the buccal side, while preserving the lingual side as an intact soft tissue wall. After thorough debridement of the furcation area, fibroblast growth factor-2 was first applied to the tooth surface and then mixed with autogenous bone, which was grafted into the defect. A CTG was placed on the buccal side, followed by buccal flap suturing. Preoperatively, the probing depths at the furcation sites were 7 mm and 9 mm on the buccal and lingual sides, respectively. At 12 months postoperatively, these were reduced to 4 mm and 3 mm, respectively. The radiographic comparison with preoperative images revealed bone regeneration within the defect area. Furthermore, the furcation entrance remained unexposed and stable during the 12-month follow-up period.