The Last Molar - Entire Pad Preservation Technique (L-EPPT) as a Regenerative Surgical Approach for Combined Distal Intrabony Defects and Furcation Involvement: Case Reports

Primary wound closure is the most important factor in successful periodontal tissue regeneration when using biomaterials. However, in the distal region of the last molar, there is concern that direct surgical access to an intraosseous defect may induce biomaterial leakage, impair the blood supply, and make healing difficult. This case series introduces the last molar-entire pad preservation technique (L-EPPT), which was designed to preserve the gingiva of the last molar centrum and secure the operative field of the furcation and distal bone defects, thereby providing an optimal environment for wound healing for regenerative therapy. This technique for preservation of the distal gingiva was applied in two cases involving the combination of a buccal class II furcation defect and a two- to three-wall intrabony defect in the last molar for the use of a combination of bone graft and enamel matrix derivatives in periodontal regeneration. Clinical outcomes were recorded at 18 months (Case 1) and 8 months (Case 2) after surgery. In both cases, the class II furcation defects were completely closed, and the probing pocket depth was improved (< 3 mm) with no bleeding on probing. Further research is warranted to verify the efficacy of this technique.