Periodontal Regeneration in Class II Furcation Defects: From Regenerative Therapy to Soft-Tissue Management. A Narrative Review

Background: Furcation involvement (FI) represents one of the most challenging conditions in periodontal therapy due to the anatomic complexity of multi-rooted teeth and the progressive interradicular attachment loss that compromises long-term tooth stability. Deep periodontal pockets in molars and premolars often present as combined defects, including horizontal FI and infrabony components. Conventional non-surgical and surgical approaches, including resective procedures, have shown limited long-term advantages, with tooth-survival outcomes comparable to those achieved by open flap debridement. Regenerative strategies, supported by advances in biomaterials, biologic agents, and soft tissue management, have gained increasing interest for Class II and selected Class III defects. Methods: This narrative review summarizes current evidence on regenerative and soft-tissue surgical approaches for Class II furcation defects, focusing on indications, outcomes, and underlying biologic principles. Results: Current evidence, largely derived from heterogeneous study designs, suggests regenerative procedures for Class II furcation defects may improve clinical attachment level and probing depth reduction when case selection is appropriate. Adjunctive soft tissue grafting may help support wound stability and regenerative healing, although its specific contribution remains to be established. Conclusions: Regenerative therapy appears to be a promising option for selected furcation defects, though the evidence base remains heterogeneous and partly preliminary. Soft tissue management may represent a biologically plausible adjunct to regenerative endpoints and long-term stability, but its incremental effect on true periodontal regeneration remains to be established through controlled clinical trials.