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

Tavelli, Lorenzo; Chen, Chia-Yu; Barootchi, Shayan; Kim, David M.

doi:10.1002/jper.22-0120

Cited by 27 publications

(50 citation statements)

References 212 publications

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“…The pairwise meta‐analysis studies 8 showed that PRF provided comparable clinical effects to bone grafts or enamel matrix derivative (EMD), which was also in line with this review. Contrary to our study, previous meta‐analysis 33 showed that PRF demonstrated higher radiographic bone gain ( p < 0.05) than EMD in the treatment of intrabony defects whereas PRF provided a comparable effect to EMD in clinical attachment level gain and probing pocket depth reduction ( p > 0.05), 33 which in line with our current NMA.…”

Section: Discussionsupporting

confidence: 85%

Network meta‐analysis of platelet‐rich fibrin in periodontal intrabony defects

Mashrah

et al. 2023

J Oral Pathology Medicine

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Objectives: To evaluate the effect of platelet-rich fibrin alone or in combination with different biomaterials for the treatment of periodontal intra-bony defect. Methods: Up to April 2022, Cochrane library, Medline, EMBASE, and Web of Science databases were searched for randomized clinical trials. The outcomes of interest were probing pocket depth reduction, clinical attachment level gain, bone gain, and bone defect depth reduction. Bayesian network meta-analysis with 95% credible intervals was calculated. Results: Thirty-eight studies with 1157 participants were included. Platelet-rich fibrin alone or platelet-rich fibrin +biomaterials showed a statistically significant difference when compared with open flap debridement (p < 0.05, low to high certainty evidence). Neither biomaterials alone nor platelet-rich fibrin +biomaterials showed a statistically significant difference when compared to platelet-rich fibrin alone (p > 0.05, very low to high certainty evidence). Platelet-rich fibrin +biomaterials showed insignificant differences as compared to biomaterials alone (p > 0.05, very low to high certainty evidence). Allograft +collagen membrane ranked the best in probing pocket depth reduction while platelet-rich fibrin +hydroxyapatite ranked the best in bone gain. Conclusion: It seems that (1) platelet-rich fibrin with/without biomaterials were more effective than open flap debridement. (2) Platelet-rich fibrin alone provides a comparable effect to biomaterials alone and platelet-rich fibrin +biomaterials. (3) Plateletrich fibrin +biomaterials provide a comparable effect to biomaterials alone. Although allograft +collagen membrane and platelet-rich fibrin +hydroxyapatite ranked the best in terms of probing pocket depth reduction and bone gain respectively, the difference between different regenerative therapies remains insignificant, and therefore, further studies are still needed to confirm these results.

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Section: Discussionsupporting

confidence: 85%

Network meta‐analysis of platelet‐rich fibrin in periodontal intrabony defects

Mashrah

et al. 2023

J Oral Pathology Medicine

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“…According to current available evidence and within the limitations of a systematic review prepared prior to the consensus conference, the following conclusions can be drawn from the frequentist mixed‐modeling approach to network meta‐analysis: 13 The use of biologics (i.e., ABPs, EMD, and rhPDGF‐BB) may significantly enhance the clinical and radiographic outcomes after the surgical treatment of infrabony defects. rhPDGF‐BB and PRF are associated with superior clinical and radiographic outcomes compared to EMD and platelet‐rich plasma (PRP). Combination therapies involving bone grafts, either with a biologic or barrier membrane, are the most effective strategies for the treatment of infrabony defects. However, the use of membranes with biologics should be avoided when graft containment is feasible since their combined use may prevent some of the benefits associated with the use of biologics (i.e., chemotaxis for pluripotential mesenchymal cell migration from soft tissue niches). Allogeneic and xenogeneic bone grafts are associated with greater clinical benefits regarding clinical outcomes than autogenous and synthetic bone grafts. Xenogeneic bone grafts with rhPDGF‐BB or PRF are the best combination therapy to maintain the stability of the gingival margin following regenerative treatment of periodontal infrabony defects. …”

Section: Focused Clinical Questionmentioning

confidence: 99%

Section: Focused Clinical Questionmentioning

confidence: 99%

American Academy of Periodontology best evidence consensus statement on the use of biologics in clinical practice

Ávila‐Ortiz

Ambruster

Barootchi

et al. 2022

Journal of Periodontology

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A biologic is a therapeutic agent with biological activity that is administered to achieve an enhanced regenerative or reparative effect. The use of biologics has progressively become a core component of contemporary periodontal practice. However, some questions remain about their safety, indications, and effectiveness in specific clinical scenarios. Given their availability for routine clinical use and the existing amount of related evidence, the goal of this American Academy of Periodontology (AAP) best evidence consensus (BEC) was to provide a state‐of‐the‐art, evidence‐based perspective on the therapeutic application of autologous blood‐derived products (ABPs), enamel matrix derivative (EMD), recombinant human platelet‐derived growth factor BB (rhPDGF‐BB), and recombinant human bone morphogenetic protein 2 (rhBMP‐2). A panel of experts with extensive knowledge on the science and clinical application of biologics was convened. Three systematic reviews covering the areas of periodontal plastic surgery, treatment of infrabony defects, and alveolar ridge preservation/reconstruction and implant site development were conducted a priori and provided the foundation for the deliberations. The expert panel debated the merits of published data and exchanged experiential information to formulate evidence‐based consensus statements and recommendations for clinical practice and future research. Based on an analysis of the current evidence and expert opinion, the panel concluded that the appropriate use of biologics in periodontal practice is generally safe and provides added benefits to conventional treatment approaches. However, therapeutic benefits and risks range based on the specific biologics used as well as patient‐related local and systemic factors. Given the limited evidence available for some indications (e.g., gingival augmentation therapy, alveolar ridge preservation/reconstruction, and implant site development), future clinical studies that can expand the knowledge base on the clinical use of biologics in periodontal practice are warranted.

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“…Evidence quality rating and strength of recommendation of STA procedures at implant sites were assessed in terms of levels of certainty in the body of evidence, net benefit rating (benefit‐harm estimation), and strength of recommendation, as previously described (Avila‐Ortiz et al, 2022; Tavelli, Chen, Barootchi, & Kim, 2022). Additional information are depicted in the Appendix S1.…”

Section: Methodsmentioning

confidence: 99%

Do soft tissue augmentation techniques provide stable and favorable peri‐implant conditions in the medium and long term? A systematic review

Stefanini,

Barootchi,

Sangiorgi

et al. 2023

Clinical Oral Implants Res

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ObjectivesTo review the available literature on the medium‐ and long‐term effects of soft tissue augmentation (STA) at implant sites and to explore the effects of the different approaches on clinical‐, patient‐reported, and health‐related parameters.Materials and MethodsA comprehensive electronic and manual search was performed to identify prospective clinical studies that assessed the medium‐ and long‐term (≥36 months) outcomes following STA, including number of sites maintaining peri‐implant health and number of sites developing peri‐implant disease, incidence of complications, stability of the clinical, volumetric, and radiographic parameters, and patient‐reported outcome measures (PROMs).ResultsFifteen studies were included in the qualitative analysis. STA was performed with either a bilaminar‐ or an apically positioned flap (APF) approach, in combination with autogenous grafts (free gingival graft [FGG] and connective tissue graft [CTG]) or substitutes (acellular dermal matrix [ADM] and xenogeneic cross‐linked collagen matrix [CCM]). An overall high survival rate was observed. Most of the augmented implant sites maintained peri‐implant health in the medium and long term, with the incidence of peri‐implant mucositis and peri‐implantitis ranging from 0% to 50% and from 0% to 7.14%, respectively. The position of the soft tissue margin following APF + FGG and bilaminar approaches involving CTG or CCM was found to be stable over time. No substantial changes were reported for plaque score/index, bleeding on probing/bleeding index, and probing depth between early time points and following visits. CTG‐based STA procedures resulted in a stable or increased dimension of keratinized mucosa width (KMW) and mucosal thickness (MT)/volumetric outcomes over time, when compared with early follow‐ups. Most of the included studies described stable marginal bone levels at the grafted implant sites over time. No substantial changes for patient‐reported outcomes and professionally assessed esthetic results were reported at different time points.ConclusionsImplants that received STA showed overall high survival rate and relatively low incidence of peri‐implantitis in the medium and long term. Augmented sites seem to maintain the level of soft tissue margin and marginal bone over time, while non‐augmented implants may exhibit apical shift of the soft tissue margin. The overall favorable early outcomes obtained with STA are maintained in the medium and long term, with an increase in KMW and MT that may be expected over time at CTG‐augmented sites.

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

Cited by 27 publications

References 212 publications

Network meta‐analysis of platelet‐rich fibrin in periodontal intrabony defects

Network meta‐analysis of platelet‐rich fibrin in periodontal intrabony defects

American Academy of Periodontology best evidence consensus statement on the use of biologics in clinical practice

Do soft tissue augmentation techniques provide stable and favorable peri‐implant conditions in the medium and long term? A systematic review

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