Minimally Invasive Surgery Combined with Regenerative Biomaterials in Treating Intra-Bony Defects: A Meta-Analysis

Abstract

BackgroundWith the popularity of minimally invasive surgery (MIS) in periodontics, numerous publications have evaluated the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects. However, it is unclear if it is necessary to use biomaterials in MIS. Thus, we conducted a meta-analysis of randomized clinical trials in patients with intra-bony defects to compare the clinical outcomes of MIS with regenerative biomaterials for MIS alone.MethodsThe authors retrieved English publications on relevant studies from Cochrane CENTRAL, PubMed, Medline, Embase, Clinical Evidence, and ClinicalTrails.gov (up to June 30, 2015). The main clinical outcomes were the reduction of probing pocket depths (PPDs), gain of clinical attachment level (CAL), recession of gingival margin (REC) and radiographic bone fill. Review Manager 5.2 (Cochrane Collaboration, Oxford, England) was used to calculate the heterogeneity and mean differences of the main clinical outcomes.ResultsIn total, 464 studies in the literature were identified but only four were ultimately feasible. The results showed no significant difference regarding CAL gain (P = 0.32) and PPD reduction (P = 0.40) as well as REC increase (P = 0.81) and radiographic bone fill (P = 0.64) between the MIS plus biomaterials group and the MIS alone group.ConclusionsThe meta-analysis suggested no significant difference in treatment of intra-bony defects between the MIS plus biomaterials group and the MIS alone group, indicating that it is important to take costs and benefits into consideration when a decision is made about a therapeutic approach. There needs to be an in-depth exploration of the induction of intrinsic tissue healing of MIS without biomaterials to achieve optimal outcomes.

Clinical performance of minimally invasive periodontal surgery in the treatment of infrabony defects: Systematic review and meta‐analysis

“…In thirteen studies of this systematic review, no biomaterials or biologic agents were used in at least one analysed group. The use of biomaterials or membranes does not seem to contribute to the improvement of clinical periodontal parameters after a minimally invasive periodontal surgery (Cortellini & Tonetti, ; Liu, Hu, Zhang, Li, & Song, ). This is not true for the traditional periodontal surgery, since the absence of a regenerative material has a significant impact on the effectiveness of these surgical procedures (Needlemann et al, ).…”

“…The precise management of the surgical site, obtained by the use of magnification instruments, could facilitate clot stability and maturation, good flap perfusion and space maintenance (Cortellini et al, ; Trombelli et al, ). These intrinsic aspects of MIPS may also explain why a substantial amount of PPD reduction and CAL gain can be achieved even when the use of biomaterials or membranes is not associated with minimally invasive approaches (Liu et al, ).…”

Regenerative surgery versus access flap for the treatment of intra‐bony periodontal defects: A systematic review and meta‐analysis

“…(Cortellini & Tonetti, 2011;Schincaglia, Hebert, Farina, Simonelli, & Trombelli, 2015). In this context, it is important to highlight how studies have consistently shown no differences in clinical and radiographic outcomes when GTR (Trombelli, Simonelli, Pramstraller, Wikesjo, & Farina, 2010) or EMD (Cortellini & Tonetti, 2011) was used as adjunct to minimally invasive surgeries, as observed in a recent meta-analysis (Liu, Hu, Zhang, Li, & Song, 2016).…”

Minimally invasive periodontal therapy

“…19,20 Cortellini and Tonetti (2007) in their case cohort study involving 13 intrabony defects inferred that MIST along with enamel matrix derivative resulted in gain in clinical attachment level and gain in the bone fill with limited patient morbidity. 21 In a meta-analysis conducted by Liu et al (2016), there were no statistically significant difference regarding clinical attachment level gain and probing pocket depth reduction, gain in the recession levels and radiographic bone fill between the MIS plus biomaterials group and the MIS group alone indicating that it is important to take costs and benefits into consideration while making a decision about therapeutic approach. 22 Advantages of MIST:…”