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

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.