Medium‐ and long‐term clinical benefits of periodontal regenerative/reconstructive procedures in intrabony defects: Systematic review and network meta‐analysis of randomized controlled clinical studies. (21st January 2021)

• Record Type: Journal Article
• Authors: Stavropoulos, Andreas; Bertl, Kristina; Spineli, Loukia M.; Sculean, Anton; Cortellini, Pierpaolo; Tonetti, Maurizio
• Is Part Of: Journal of clinical periodontology. Volume 48:Number 3(2021)
• Page Start: 410
• Page End: 430
• Publication Date: 2021-01-21
• Subjects: bone grafts -- bone substitutes -- EMD -- enamel matrix proteins -- GTR -- long‐term -- periodontal regeneration -- systematic review; Periodontics -- Periodicals; 617.6
• DOI: 10.1111/jcpe.13409
• Languages: English
• ISSNs: 0303-6979

Abstract

Abstract: Background: Systematic reviews have established the short‐term improvements of periodontal regenerative/reconstructive procedures compared to conventional surgical treatment in intrabony defects. However, a hierarchy of periodontal regenerative/reconstructive procedures regarding the medium‐ to long‐term results of treatment does not exist. Aim: To systematically assess the literature to answer the focused question "In periodontitis patients with intrabony defects, what are the medium‐ and long‐term benefits of periodontal regenerative/reconstructive procedures compared with open flap debridement (OFD), in terms of clinical and/or radiographic outcome parameters and tooth retention?". Material & Methods: Randomized controlled clinical trials (RCTs), reporting on clinical and/or radiographic outcome parameters of periodontal regenerative/reconstructive procedures ≥3 years post‐operatively, were systematically assessed. Clinical [residual probing pocket depth (PD) and clinical attachment level (CAL) gain, tooth loss] and radiographic [residual defect depth (RDD), bone gain (RBL)] outcome parameters were assessed. Descriptive statistics were calculated, and Bayesian random‐effects network meta‐analyses (NMA) were performed where possible. Results: Thirty RCTs, presenting data 3 to 20 years after treatment with grafting, GTR, EMD, as monotherapies, combinations thereof, and/or adjunctive use of blood‐derived growth factor constructs or with OFD only, were included. NMA based on 21 RCTs showed that OFD was clearly the least efficacious treatment; regenerative/reconstructive treatments resulted in significantly shallower residual PD in 4 out 8 comparisons [range of mean differences (MD): −2.37 to −0.60 mm] and larger CAL gain in 6 out 8 comparisons (range of MD: 1.26 to 2.66 mm), and combination approaches appeared as the most efficacious. Tooth loss after regenerative/reconstructive treatment was less frequent (0.4%) compared to OFD (2.8%), but the evidence was sparse. There were only sparse radiographic data not allowing any relevant comparisons. Conclusion: Periodontal regenerative/reconstructive therapy in intrabony defects results, in general, in shallower residual PD and larger CAL gain compared with OFD, translating in high rates of tooth survival, on a medium (3–5 years) to long‐term basis (5–20 years). Combination approaches appear, in general, more efficacious compared to monotherapy in terms of shallower residual PD and larger CAL gain. A clear hierarchy could, however, not be established due to limited evidence.