Pocket resolution in regenerative treatment of intrabony defects with papilla preservation techniques: A systematic review and meta‐analysis of randomized clinical trials

Abstract

Aim To systematically assess the clinical performance of different approaches for periodontal regeneration of intrabony defects in terms of pocket resolution compared to access surgery with papilla preservation techniques (PPTs). Material and Methods Systematic literature searches were conducted on PubMed, EMBASE, and CENTRAL up to April 2020 to identify RCTs on regenerative treatment [guided tissue regeneration (GTR) or enamel matrix derivative (EMD) with or without biomaterials] of intrabony defects using PPTs. Results were expressed as weighted mean percentages (WMP) or risk ratios of pocket resolution at 12 months (considering both final PD ≤ 3 mm and ≤4 mm). Results A total of 12 RCTs were included. Based on a final PD ≤ 3 mm or PD ≤ 4 mm, the WMP of pocket resolution was 61.4% and 92.1%, respectively. EMD and GTR obtained comparable results. Pairwise meta‐analysis identified a greater probability of achieving pocket resolution for GTR compared to PPTs. The number needed to treat for GTR to obtain one extra intrabony defect achieving PD ≤ 3 mm or PD ≤ 4 mm over PPTs was 2 and 4, respectively. Conclusion Regenerative surgery represents a viable approach to obtain final PD ≤ 4 mm in the short‐term.

Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta‐analysis

“…A manual search was also performed in the Journal of Periodontology, Journal of Clinical Periodontology, Journal of Dental Research, Journal of Periodontal Research, International Journal of Periodontics and Restorative Dentistry, and Clinical Oral Investigations . Previous systematic reviews in the surgical treatment of infrabony defects were also assessed 8,15,33,40–48 …”

“…Previous systematic reviews in the surgical treatment of infrabony defects were also assessed. 8,15,33,[40][41][42][43][44][45][46][47][48]…”

Metabolomics of gingival crevicular fluid to identify biomarkers for periodontitis: A systematic review with meta‐analysis

“…Designing longitudinal studies to follow up which G or P sites encounter further progression would be valuable, as well as following healing sites after periodontal rigeneration. 64,65 Proteome quantification and cytokine multiplex assays have already provided strong markers for P, although they are able to detect pathological changes only once they have become clinically evident. 18 To this regard, the high-resolution information provided by GCF derived metabolites may represent a powerful tool to identify early signs of homeostasis disruption within the periodontal microenvironment.…”

Guest Editorial: Time to reflect on new evidence about periodontal regenerative surgery of intrabony defects

“…Regenerative/reconstructive periodontal therapy of infrabony defects has been an established practice for some decades now. The systematic review published by Aimetti and co-workers in this issue (Aimetti et al, 2021) is one of a number of systematic reviews published in this topic in recent months. This shows how much the data from clinical trials on regenerative periodontal surgery of infrabony defects are being carefully dissected and analysed by many researchers in different institutions and countries.…”

“…localised, narrow, mainly 2-3-wall defects), the use of biomaterials may have less relevance. An effort needs to be made to improve predictability, as it can be argued that NNT of 2-4 compared with OFD (Aimetti et al, 2021) is still far from ideal. The message for the periodontal researcher is to focus studies on minimal intervention techniques, striving to improve the predictability of regenerative procedures, and to employ outcomes useful for clinical decision-making, such as PROMs, long-term tooth survival, NNT, cost-effectiveness and composite clinical measurements accounting for gingival recession and combination of pocket depth reduction and CAL gain (Trombelli et al, 2020).…”