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

Abstract

Background: The aim of this systematic review was to compare clinical, radiographic and patient-reported outcomes (PROMs) in intra-bony defects treated with regenerative surgery or access flap. Materials and Methods: A systematic review protocol was written following the PRISMA checklist. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) on regenerative treatment of deep intra-bony defects (≥3 mm) with a follow-up of at least 12 months. Primary outcome variables were probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain and tooth loss. Secondary outcome variables were Rec, radiographic bone gain, pocket "closure," PROMs and adverse events. Meta-analysis was carried out when possible. To evaluate treatment effect, odds ratios were combined for dichotomous data and mean differences for continuous data using a random-effect model. Results: A total of 79 RCTs (88 articles) published from 1990 to 2019 and accounting for 3,042 patients and 3,612 intra-bony defects were included in this systematic review. Only 10 of included studies were rated at low risk of bias. A total of 13 metaanalyses were performed. All regenerative procedures provided adjunctive benefit in terms of CAL gain (1.34 mm; 0.95-1.73) compared with open flap debridement alone. Both enamel matrix derivative (EMD) and guided tissue regeneration (GTR) were superior to OFD alone in improving CAL (1.27 mm; 0.79-1.74 mm and 1.43 mm; 0.76-2.22, respectively), although with moderate-high heterogeneity. Among biomaterials, the addition of deproteinized bovine bone mineral (DBBM) improved the clinical outcomes of both GTR with resorbable barriers and EMD. Papillary preservation flaps enhanced the clinical outcomes. The strength of evidence was low to moderate. Conclusion: EMD or GTR in combination with papillary preservation flaps should be considered the treatment of choice for residual pockets with deep (≥3 mm) intrabony defects.

Periodontal regeneration using a xenogeneic bone substitute seeded with autologous periodontal ligament‐derived mesenchymal stem cells: A 12‐month quasi‐randomized controlled pilot clinical trial

“…The CAL gains and PPD reductions reported in the present investigation in both groups were modest in comparison with other studies evaluating different regenerative technologies (Matarasso et al., 2015; Nibali et al., 2019). These limited clinical improvements may be explained by the patient and defect selection, since only one‐ and two‐wall non‐contained intraosseous lesions were selected, with the objective of assessing the added value of MSCs in the treatment of those defects lacking a predictable regenerative outcome.…”

Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline

“…For this guideline, a total of 15 systematic reviews (SRs) were conducted to support the guideline development process (Carra et al., 2020; Dommisch, Walter, Dannewitz, & Eickholz, 2020; Donos et al., 2019; Figuero, Roldan, et al., 2019; Herrera et al., 2020; Jepsen et al., 2019; Nibali et al., 2019; Polak et al., 2020; Ramseier et al., 2020; Salvi et al., 2019; Sanz‐Sanchez et al., 2020; Slot, Valkenburg, & van der Weijden, 2020; Suvan et al., 2019; Teughels et al., 2020; Trombelli et al., 2020). The corresponding manuscripts are published within this special issue of the Journal of Clinical Periodontology.…”

Periodontal infrabony defects: Systematic review of healing by defect morphology following regenerative surgery

“…With the currently available regeneration procedures, materials and technologies, intra-bony defects can be successfully regenerated, subject to patient factors such as plaque control, smoking and medical history, as well as tooth mobility, restorative and endodontic condition (Nibali et al, 2019). Several publications reported on the superiority of periodontal regenerative therapy in the treatment of intra-bony defects over the conventional surgeries such as periodontal access flap, known as open-flap debridement surgery (OFD), in terms of probing pocket depth (PPD) and clinical attachment loss (CAL) reductions (Castro et al, 2017;Needleman et al, 2006;Nibali et al, 2019).…”