Long-term clinical outcomes of periodontal regeneration with Enamel Matrix Derivative (EMD): a retrospective cohort study with a mean follow-up of 10 years

Long-term success and influencing factors of regenerative surgery for intra-bony defects: A retrospective cohort study

BACKGROUND

The composite outcome measure (COM) more comprehensively assesses the clinical efficacy of regenerative surgery than a single probing measurement. We aimed to assess long-term success defined by the COM (clinical attachment level [CAL] gain of ≥3 mm and postsurgery probing pocket depth [PPD] ≤ 4 mm) and influencing factors of regenerative surgery using bone substitutes and resorbable collagen membrane (RM) for intra-bony defects (IBDs).

METHODS

We retrospectively collected data from patients who underwent regenerative surgery using deproteinized bovine bone mineral (DBBM) and RM for IBDs. CAL and PPD values were compared at baseline (preoperative), 1 year (short-term), and at the last follow-up (5-10 years). Multivariate logistic regressions were performed to identify factors influencing COM-based long-term success.

RESULTS

Eighty-one defects in 75 teeth of 33 patients who completed follow-up (6.5 ± 1.4 years) were included. One tooth was lost. All defects with complete follow-up exhibited long-term average CAL gain (3.00 ± 2.00 mm, 95% confidence interval [CI]: 2.56-3.44 mm, p < 0.001) and PPD reduction (2.06 ± 1.91 mm, 95% CI: 1.64-2.49 mm, p < 0.001). Long-term success was achieved in 38.8% of IBDs. CAL and PPD values were comparable between 1 year and the last follow-up. Logistic regression analyses revealed that male sex (odds ratio [OR] = 0.23, 95% CI: 0.07-0.75) and bleeding on probing (BOP) during supportive periodontal therapy (OR = 0.96, 95% CI: 0.94-0.99) were risk factors for long-term success.

CONCLUSIONS

Regenerative surgery with DBBM and RM for IBDs can achieve some degree of long-term success defined by COM. However, within this study's limitations, male sex and higher BOP incidence postoperatively are negatively associated with optimal long-term success.

CLINICAL TRIAL NUMBER

ChiCTR2300069016.

Long-term treatment outcomes of single maxillary buccal peri-implant soft tissue dehiscences: A 10-year prospective study

INTRODUCTION

To evaluate the 10-year clinical outcomes following surgical treatment of shallow isolated peri-implant soft-tissue dehiscences (PSTD) at single tissue level dental implants.

METHODS

The baseline population included 16 patients (16 implants) displaying an isolated peri-implant maxillary buccal soft-tissue dehiscence. The recipient bed was prepared with a minimally-invasive split-thickness flap limited to the buccal aspect to stabilize the tuberosity connective tissue graft (CTG) onto the periosteum. At the end of treatment, patients were enrolled in an individualized supportive peri-implant care (SPC) program. The aesthetic outcome was evaluated on photographs by three clinicians using a visual analog scale (VAS).

RESULTS

SPC during the 10-years proceeded uneventfully in all patients. A total of 12 patients completed the 10-year examination, as 3 patients dropped-out and 1 implant was lost. Complete PSTD coverage was obtained at 7 implant sites (i.e., 58%) while the mean PSTD coverage amounted to 89.6% ± 17.1% without statistically significant differences between 1 and 10 years (p > 0.05). Stable peri-implant parameters (i.e., PD and BoP) and full-mouth scores (i.e., FMPS, FMBS) were recorded throughout the observation period (p > 0.05). The aesthetic improvements obtained in the short-term were maintained up to 10 years.

CONCLUSION

Within their limits, the present results indicate that the proposed surgical technique is a simple and reliable treatment option for the treatment of single maxillary buccal PSTDs in selected cases with positive results up to 10 years in patients under regular SPC (NCT04983758-this clinical trial was not registered prior to participant recruitment).

Long-term results of regenerative treatment of intrabony defects: a cohort study with 5-year follow-up

BACKGROUND

The aim of this retrospective cohort study was to evaluate the long-term clinical and radiographic outcomes and survival of teeth in periodontal regenerative treatment of intrabony defects using combined enamel matrix protein derivative (EMD) and deproteinized porcine bone mineral (DPBM) compared to EMD alone.

METHODS

A total of 333 intrabony defects in 176 patients (mean age: 54.7 ± 8.9 years) were followed-up for 58.6 ± 11.2 (range, 25-78) months after periodontal regenerative treatment. Changes in clinical (pocket probing depth and clinical attachment level) and radiographic (defect depth and defect width) parameters were analyzed using serial periapical radiographs. Kaplan-Meier and multivariate Cox proportional-hazards regression analyses for tooth loss were also performed.

RESULTS

Compared to periodontal surgery with EMD alone with a mean follow-up of 5 years, combined EMD and DPBM showed significantly better gain in clinical attachment level (EMD and DPBM: 2.8 ± 2.3 mm vs. EMD alone: 2.2 ± 2.2 mm) and reduction in probing pocket depth (EMD and DPBM: 2.8 ± 1.8 mm vs. EMD alone: 2.3 ± 1.8 mm), defect depth (EMD and DPBM: 2.5 ± 2.4 mm vs. EMD alone: 2.0 ± 2.4 mm) and defect width (EMD and DPBM: 0.6 ± 1.0 mm vs. EMD alone: 0.2 ± 1.3 mm). The overall survival rates of the teeth were 91.48% and 95.20% in the patient- and tooth-based analyses, respectively, showing no statistically significant difference.

CONCLUSIONS

Within the limitations of the current study, combined EMD and DPBM offered additional clinical and radiographic benefits over a mean of 5 years compared to EMD alone. However, tooth loss did not differ significantly between the two groups.

CLINICAL RELEVANCE

Compared to EMD alone, combined EMD and DPBM for intrabony defects has additional clinical advantages; however, patient- and tooth-related risk factors must be considered when performing periodontal regenerative surgery.

Defect angle as prognostic indicator in the reconstructive therapy of peri-implantitis

OBJECTIVE

To analyze the influence of the characteristics of bone defects caused by peri-implantitis on the clinical resolution and radiographic bone gain following reconstructive surgery.

METHODS

This is a secondary analysis of a randomized clinical trial. Periapical x-rays of bone defects, caused by peri-implantitis exhibiting intrabony component, were analyzed at baseline and 12-month follow-up after reconstructive surgery. Therapy consisted of anti-infective therapy along with a mixture of allografts with or without a collagen barrier membrane. The association of defect configuration, defect angle (DA), defect width (DW), and baseline marginal bone level (MBL) with clinical resolution (based on a prior defined composite criteria) and radiographic bone gain was correlated by means of generalized estimating equations.

RESULTS

Overall, 33 patients with a total of 48 implants exhibiting peri-implantitis were included. None of the evaluated variables yielded statistical significance with disease resolution. Defect configuration demonstrated statistical significance when compared to class 1B and 3B, favoring radiographic bone gain for the former (p = 0.005). DW and MBL did not demonstrate statistical significance with radiographic bone gain. On the contrary, DA exhibited strong statistical significance with bone gain (p < 0.001) in the simple and multiple logistic regression analyses. Mean DA reported in this study was 40°, and this resulted in 1.85 mm radiographic bone gain. To achieve ≥1 mm of bone gain, DA must be <57°, while to attain ≥2 mm of bone gain, DA must be <30°.

CONCLUSION

Baseline DA of peri-implantitis intrabony components predicts radiographic bone gain in reconstructive therapy (NCT05282667-this clinical trial was not registered prior to participant recruitment and randomization).

Association between periodontal disease and osteoporosis in postmenopausal women: A systematic review and meta-analysis

Objective

To evaluate the relationship between periodontitis and postmenopausal osteoporosis.

Methods

This research was carried out according to the principles laid down by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. We searched the Web of Science, Embase, PubMed, The Cochrane Library, CNKI, VIP, and WanFang databases from inception to July 1, 2023 to collect all relevant publications, with no restrictions on publication date or Languages. Cochrane's tool for assessing RoB was used to evaluate the RoB for RCTs. The Newcastle-Ottawa Scale was used to assess the RoB for cohort studies and case-control studies. Mean differences (MD) with 95 % confidence intervals (CI) were used for analysis of continuous data. Heterogeneity was measured using the I2 statistic. Revman 5.4 software was used for the meta-analysis.

Results

28 observational studies with 19611 patients, including 5813 cases in the postmenopausal osteoporosis group and 13798 cases in the non-osteoporosis group. The studies showed that the degrees of clinical attachment loss (CAL), probing depth (PD), gingival recession (GR), simplified oral hygiene index (OHIS), and percentage of sites with bleeding on probing (BOP) in the postmenopausal osteoporosis group were higher than those in the non-osteoporosis group[CAL(MD = 0.89(mm), 95 % CI [0.48,1.30], p < 0.00001), PD (MD = 0.27(mm), 95 % CI [0.13, 0.41], p = 0.0001), GR (MD = 0.28(mm), 95 % CI [0.20, 0.35], p < 0.00001), OHIS (MD = 1.32,95 % CI [1.12,1.51], p < 0.00001), BOP(MD = 12.71(%), 95 % CI [3.24,22.18], p = 0.009)]. Eleven studies found that bone mineral density (BMD) in the postmenopausal osteoporosis group was lower than that in non-osteoporosis group (MD = -0.41(U/cm2), 95 % CI [-0.77,-0.05], p = 0.03). The combined analysis results of the studies in the two groups showed that there were no significant differences in the loss of alveolar crestal height (ACH)[(MD = -1.76(%),95%CI [-3.64,0.12], p = 0.07)].

Conclusion

Postmenopausal osteoporosis patients are more likely to suffer from periodontitis, and the condition is easily aggravated.

Effects of enamel matrix derivative in nonsurgical periodontal therapy on pro-inflammatory profiles, microbial environment and clinical outcome: a randomized clinical trial

OBJECTIVES

This study aimed to evaluate the impact of enamel matrix derivative (EMD) application following subgingival instrumentation of residual pockets in periodontitis patients on inflammatory host response, microbiological composition, and clinical outcome.

METHODS

In this double-blinded randomized controlled trial, a total of 22 patients with generalized periodontitis stage III or IV presenting with ≥ 6 mm probing pocket depth (PPD) at re-evaluation after initial periodontal therapy were included. Participants were randomly allocated at a 1:1 ratio to subgingival instrumentation with (EMD +) or without (EMD-) non-surgical EMD application into the pocket. PPD, clinical attachment level (CAL), bleeding on probing (BoP), plaque index (PI), as well as a panel of pro-inflammatory cytokines and periodontal pathogen count in the gingival crevicular fluid (GCF) of the respective sites were evaluated at baseline (T0) and six months afterwards (T1).

RESULTS

Both treatment groups showed a significant PPD reduction (EMD + 1.33 ± 1.15 mm, p < 0.001; EMD- 1.32 ± 1.01 mm, p < 0.001) as well as CAL gain (EMD + 1.13 ± 1.58 mm, p < 0.001; EMD- 0.47 ± 1.06 mm, p = 0.005) from T0 to T1. While no intergroup differences for PPD reduction were observed, CAL gain was higher in EMD + sites compared to EMD- (p = 0.009). No essential effects on cytokine expression as well as bacterial count were detected.

CONCLUSIONS

Application of EMD as an adjunct to subgingival instrumentation of residual pockets yielded benefits regarding CAL gain; however, effects on PPD reduction, inflammatory cytokines, and bacterial count were negligible.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT04449393), registration date 26/06/2020.

CLINICAL RELEVANCE

Based on the obtained results, additional non-surgical EMD application compared to subgingival instrumentation alone showed no clinically relevant effects on treatment outcome and underlying biological mechanisms.

Prognostic value of a composite outcome measure for periodontal stability following periodontal regenerative treatment: A retrospective analysis at 4 years

BACKGROUND

Recently, a composite outcome measure (COM) was proposed to describe the short-term results of periodontal regenerative treatment. The present retrospective study aimed at evaluating the prognostic value of COM on clinical attachment level (CAL) change over a 4-year period of supportive periodontal care (SPC).

METHODS

Seventy-four intraosseous defects in 59 patients were evaluated at 6 months and 4 years following regenerative treatment. Based on 6-month CAL change and probing depth (PD), defects were classified as: COM1 (CAL gain ≥3 mm, PD ≤4 mm); COM2 (CAL gain <3 mm, PD ≤4 mm); COM3 (CAL gain ≥3 mm, PD >4 mm); or COM4 (CAL gain <3 mm, PD >4 mm). COM groups were compared for "stability" (i.e., CAL gain, no change in CAL or CAL loss <1 mm) at 4 years. Also, groups were compared for mean change in PD and CAL, need for surgical retreatment, and tooth survival.

RESULTS

At 4 years, the proportion of stable defects in COM1, COM2, COM3, and COM4 group was 69.2%, 75%, 50%, and 28.6%, respectively, with a substantially higher probability for a defect to show stability for COM1, COM2, and COM3 compared with COM4 (odds ratio 4.6, 9.1, and 2.4, respectively). Although higher prevalence of surgical reinterventions and lower tooth survival were observed in COM4, no significant differences were detected among COM groups.

CONCLUSIONS

COM may be of value in predicting CAL change at sites undergoing SPC following periodontal regenerative surgery. Studies on larger cohorts, however, are needed to substantiate the present findings.

Complications and treatment errors related to regenerative periodontal surgery

Regenerative periodontal surgical procedures are an important component in the treatment of advanced periodontitis. They aim to improve the long-term prognosis of teeth that are periodontally compromised by the presence of intrabony and/or furcation defects, resulting biologically in formation of root cementum, periodontal ligament, and alveolar bone and evidenced clinically by reduction of deep pockets to maintainable probing depths and/or improvements of vertical and horizontal furcation depth. Over the last 25 years, substantial clinical evidence has been accumulated to support the value of regenerative procedures in periodontally compromised dentitions. However, treatment success requires close attention to certain factors on the level of the patient, the tooth/defect, and the operator. Ignoring these factors in case selection, treatment planning, and treatment execution will increase the risk of complications that may jeopardize clinical success and may even be considered as treatment errors. Based on the currently available evidence from clinical practice guidelines, treatment algorithms, and on expert opinion, the present article provides an overview on the main factors, which influence the outcomes of regenerative periodontal surgery and gives recommendations on how to prevent complications and treatment errors.

Cementum protein 1 gene-modified adipose-derived mesenchymal stem cell sheets enhance periodontal regeneration in osteoporosis rat

BACKGROUND AND OBJECTIVES

Osteoporosis (OP) and periodontitis are both diseases with excessive bone resorption, and the number of patients who suffer from these diseases is expected to increase. OP has been identified as a risk factor that accelerates the pathological process of periodontitis. Achieving effective and safe periodontal regeneration in OP patients is a meaningful challenge. This study aimed to assess the efficacy and biosecurity of human cementum protein 1 (hCEMP1) gene-modified cell sheets for periodontal fenestration defect regeneration in an OP rat model.

MATERIALS AND METHODS

Rat adipose-derived mesenchymal stem cells (rADSCs) were isolated from Sprague-Dawley rats. After primary culture, rADSCs were subjected to cell surface analysis and multi-differentiation assay. And rADSCs were transduced with hCEMP1 by lentiviral vector, and hCEMP1 gene-modified cell sheets were generated. The expression of hCEMP1 was evaluated by reverse transcription polymerase chain reaction and immunocytochemistry staining, and transduced cell proliferation was evaluated by Cell Counting Kit-8. The hCEMP1 gene-modified cell sheet structure was detected by histological analysis and scanning electron microscopy. Osteogenic and cementogenic-associated gene expression was evaluated by real-time quantitative polymerase chain reaction. In addition, an OP rat periodontal fenestration defect model was used to evaluate the regeneration effect of hCEMP1 gene-modified rADSC sheets. The efficacy was assessed with microcomputed tomography and histology, and the biosecurity of gene-modified cell sheets was evaluated by histological analysis of the spleen, liver, kidney and lung.

RESULTS

The rADSCs showed a phenotype of mesenchymal stem cells and possessed multi-differentiation capacity. The gene and protein expression of hCEMP1 through lentiviral transduction was confirmed, and there was no significant effect on rADSC proliferation. Overexpression of hCEMP1 upregulated osteogenic and cementogenic-related genes such as runt-related transcription factor 2, bone morphogenetic protein 2, secreted phosphoprotein 1 and cementum attachment protein in the gene-modified cell sheets. The fenestration lesions in OP rats treated with hCEMP1 gene-modified cell sheets exhibited complete bone bridging, cementum and periodontal ligament formation. Furthermore, histological sections of the spleen, liver, kidney and lung showed no evident pathological damage.

CONCLUSION

This pilot study demonstrates that hCEMP1 gene-modified rADSC sheets have a marked ability to enhance periodontal regeneration in OP rats. Thus, this approach may represent an effective and safe strategy for periodontal disease patients with OP.

Prognostic factors affecting periodontal regenerative therapy using recombinant human fibroblast growth factor-2: A 3-year cohort study

Introduction

Fibroblast growth factor-2 (FGF-2) has been reported to promote periodontal tissue regeneration. However, no study has investigated the long-term prognosis of periodontal regenerative therapy using FGF-2 to date. The aim of this study was to observe the long-term outcomes as well as to investigate the factors affecting the prognosis of periodontal regenerative therapy using FGF-2.

Methods

Sixty intrabony defects were prospectively investigated for three years after periodontal regenerative therapy with recombinant human FGF-2 (rhFGF-2) by evaluating probing pocket depth (PPD) and radiographic bone defect depth (RBD). The factors influencing RBD were assessed by conducting a multivariate linear regression analysis after adjusting for confounders.

Results

The mean age of the participants was 62.4 ± 13.4 years, and baseline PPD and RBD were 6.1 ± 1.9 mm and 4.5 ± 1.8 mm, respectively. At six months, one year, and three years after surgery, PPD and RBD had significantly improved to 4.2 ± 1.7, 3.7 ± 1.4, 4.0 ± 1.9 mm and to 3.08 ± 2.05, 2.73 ± 1.90, 2.51 ± 2.15 mm, respectively. At the three-year examination, a significant positive association was deteced between RBD reduction and RBD at baseline, while the association was not significant between RBD reduction and the radiographic bony angle, number of bony walls of the defect, or the furcation involvement at baseline.

Conclusions

rhFGF-2 was effective for alveolar bone regeneration in patients with periodontitis and maintained the improved parameters over the three-year observation period. The radiographic bone defect depth at baseline was found to be the factor affecting the periodontal regenerative therapy using rhFGF-2 in the intrabony defects.

Trial registration number

UMIN000027979.

•

Mid-term observation following periodontal regenerative therapy using rhFGF-2.

•

Reductions in PPD and radiographic defect depth were maintained for 3 years.

•

Evaluation of prognostic factors of rhFGF-2 application in intrabony defects.

•

Preoperative radiographic defect depth predicts postoperative bone fill.

Comparative evaluation of demineralized freeze-dried bone allograft with and without concentrated growth factor membrane in the treatment of periodontal intrabony defects: a randomized controlled clinical trial

BACKGROUND

The current study's aim was to evaluate and compare demineralized freeze-dried bone allograft (DFDBA) with and without concentrated growth factor (CGF) membrane in the treatment of periodontal intrabony defects on both a clinical and radiographic level.

METHODS

30 stage III grade B periodontitis patients with bilateral intrabony defects were involved in the split mouth randomized controlled trial, and they received either DFDBA alone (control group) or DFDBA plus CGF membrane treatment (test group). At baseline and 6 and 12 months, the gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR) were assessed, whereas cone beam computed tomography was used to assess the bone defect height (BDH), vertical bone loss (VBL), bone defect depth (BDD), mesio-distal bone defect width (MDBDW), bucco-lingual bone defect width (BLBDW), and bone defect volume (CBCT) at baseline and 12 months.

RESULTS

The radiographic measures BDH, BDD, MDBDW, BLBDW, and BDV in the test group likewise showed a higher reduction in PPD and gain in CAL than the control group. The results of the intergroup comparison showed that the test group had statistically significant differences in BDH, BDD, and MDBDW.

CONCLUSION

The data show that the test group achieved better results, with greater reductions in PPD, gains in CAL, and decreases in BDH, BDD, MDBDW, BLBDW, and BDV.

CLINICAL RELEVANCE

The use of concentrated growth factor in conjunction with demineralized freeze-dried bone allograft may be suggested for the treatment of periodontal intrabony defects.

Kuronale Kaydırılan Flep ve Bağ Doku Grefti ile Tedavi Edilen Dişeti Çekilmelerinin Retrospektif Analizi

Aim: The aim of this retrospective study was to evaluate the effectiveness of coronally advanced flap and connective tissue graft (CAF+CTG) in the treatment of gingival recessions (GR).Method: Periodontal records of 32 single and multiple GR in 11 patients treated with CAF+CTG were selected for the study. According to Cairo’s classification, recession type 1 defects were included. Recession depth (RD), probing depth (PD) and clinical attachment level (CAL) were assessed at baseline and follow-ups. Mean root coverage (MRC) and complete root coverage (CRC) were evaluated. Compliance with supportive periodontal therapy (SPT) was also determined.Results: Mean age of 11 patients was 29.6±4.4 years. The mean observation time of 32 recessions was 37.6±24.2 months. All clinical parameters showed an improvement between baseline and the latest follow-up. After treatment with CAF+CTG, MRC was 92.6±13.1% and CRC was achieved in 75% of the recessions. Compliance to SPT was calculated at 83.3%.Conclusion: The use of CAF+CTG yielded positive outcomes in terms of all clinical parameters and complete root coverage in Cairo recession type 1 defects with a mean observation period of &gt;3 years. The results of the present study confirm the use of CAF+CTG as a gold standard for the treatment of gingival recessions.

Challenges and tissue engineering strategies of periodontal guided tissue regeneration

Periodontitis is a chronic infectious oral disease with a high prevalence rate in the world, and is a major cause of tooth loss. Nowadays, people have realized that the local microenvironment that includes proteins, cytokines, and extracellular matrix has a key influence on the functions of host immune cells and periodontal ligament stem cells during a chronic infectious disease such as periodontitis. The above pathological process of periodontitis will lead to a defect of periodontal tissues. Through the application of biomaterials, biological agents, and stem cells therapy, guided tissue regeneration (GTR) makes it possible to reconstruct healthy periodontal ligament tissue after local inflammation control. To date, substantial advances have been made in periodontal guided tissue regeneration. However, the process of periodontal remodeling experiences complex microenvironment changes, and currently periodontium regeneration still remains to be a challenging feat. In this review, we summarized the main challenges in each stage of periodontal regeneration, and try to put forward appropriate biomaterial treatment mechanisms or potential tissue engineering strategies that provide a theoretical basis for periodontal tissue engineering regeneration research.

The predictive performance of surgical treatment in upper molars with combined bony defect and furcation involvement: a retrospective cohort study

BACKGROUND

To evaluate the impact of combined defects, bony destruction and furcation involvement, on disease resolution after surgery in terms of pocket elimination, absence of inflammation, furcation improvement and predictive performance.

METHODS

Combined bony (intrabony (+) or (-)) and furcation defects (FI degree 1 or 2) at maxillary molars in patients diagnosed as periodontitis stage III to IV, being through periodontal surgery and at least 6 months follow-up were retrospectively screened. Cumulative predictability (CR, %), failure of treatment and the change of clinical parameters from baseline at pre-operative visit to the latest maintenance care, including pocket depth (PD), horizontal and vertical furcation involvement (FI) were analyzed. Failure of treatment with low predictability was defined as residual PD > 4 mm with bleeding on probing during maintenance period.

RESULTS

Thirty-three patients with fifty-one combined defects were included. Statistical analysis showed significant overall PD reduction and FI improvement (p < 0.001). Combined FI degree 2 with intrabony (+) defects revealed more horizontal furcation improvement compared with FI degree 2 with suprabony defect (p = 0.007). However, type of combined defects was not relevant to CR (p = 0.702) and PD reduction (p = 0.707). Among all parameters, baseline PD with proximal FI degree 2 was indicated to failure of treatment.

CONCLUSIONS

Different types of combined defects, deep baseline pocket and proximal FI degree 2 would compromise the predictability of treatment outcomes in upper molars. Nevertheless, the combination of surgical treatment and strict maintenance care could still yield high predictability and survival rate.

TRIAL REGISTRATION

retrospectively registered.

Enamel matrix derivative as adjunctive to non-surgical periodontal therapy: a systematic review and meta-analysis of randomized controlled trials

Objectives

To assess the potential additional benefit of the local application of enamel matrix derivative (EMD) on the clinical outcomes following non-surgical periodontal therapy (NSPT) (steps 1 and 2 periodontal therapy).

Materials and Methods

A systematic literature search was performed in several electronic databases, including Medline/PubMed, Embase, The Cochrane Register of Central Trials (CENTRAL), LILACS, and grey literature. Only randomized controlled clinical trials (RCTs) were eligible for inclusion. Clinical attachment level (CAL) change (primary outcome), probing pocket depth (PPD), and bleeding on probing (BoP) reductions (secondary outcomes) were evaluated. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the quality of the included trials. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated using a random-effect model for amount of mean CAL and PPD change.

Results

Six RCTs were included for the qualitative analysis, while data from 4 studies were used for meta-analysis. Overall analysis of CAL gain (3 studies) and PPD reduction (4 studies) presented WMD of 0.14 mm (p = 0.74; CI 95% − 0.66; 0.94) and 0.46 mm (p = 0.25; CI 95% − 0.33; 1.26) in favor of NSPT + EMD compared to NSPT alone respectively. Statistical heterogeneity was found to be high in both cases (I² = 79% and 87%, respectively).

Conclusions

Within their limitations, the present data indicate that the local application of EMD does not lead to additional clinical benefits after 3 to 12 months when used as an adjunctive to NSPT. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of EMD.

Clinical relevance

The adjunctive use of EMD to NSPT does not seem to additionally improve the clinical outcomes obtained with NSPT alone.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-022-04474-1.

Treatment of Intrabony Defects with a Combination of Hyaluronic Acid and Deproteinized Porcine Bone Mineral

Background: this study evaluates the clinical outcomes of a novel approach in treating deep intrabony defects utilizing papilla preservation techniques with a combination of hyaluronic acid (HA) and deproteinized porcine bone mineral. Methods: 23 patients with 27 intrabony defects were treated with a combination of HA and deproteinized porcine bone mineral. Clinical attachment level (CAL), pocket probing depth (PPD), gingival recession (REC) were recorded at baseline and 6 months after the surgery. Results: At 6 months, there was a significant CAL gain of 3.65 ± 1.67 mm (p < 0.001) with a PPD reduction of 4.54 ± 1.65 mm (p < 0.001), which was associated with an increase in gingival recession (0.89 ± 0.59 mm, p < 0.001). The percentage of pocket resolution based on a PPD ≤4 mm was 92.6% and the failure rate based on a PPD of 5 mm was 7.4%. Conclusions: the present findings indicate that applying a combined HA and xenograft approach in deep intrabony defects provides clinically relevant CAL gains and PPD reductions compared to baseline values and is a valid new approach in treating intrabony defects.

Association between periodontal disease and osteoporosis in postmenopausal women: a protocol for systematic review and meta-analysis

INTRODUCTION

Periodontal disease and osteoporosis are common chronic diseases, especially for the postmenopausal women. Several original studies explore the association, but there still controversial. Therefore, we will conduct this systematic review and meta-analysis to assess the association between periodontal disease and osteoporosis in postmenopausal women.

METHODS AND ANALYSIS

This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Protocols. We will systematically search Medline/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science and Scopus from inception to August 2021 to collect all relevant publications, with no restrictions on publication date or languages. Study selection, data extraction and risk of bias assessment will be conducted independently by two trained reviewers independently. The Cochrane's tool for assessing risk of bias, Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality will be used for the risk of bias assessment. OR, HR and risk ratio with 95% CI were considered as the effect size for dichotomous outcomes, weighted mean difference with 95% CI were calculated as the effect size for continuous outcomes. Random-effects models will be used. Heterogeneity between studies will be assessed via the forest plot and I². Publication bias will detected by funnel plots, Begg's test and Egger's test. The subgroup analyses and sensitivity ananlyses will also be used to explore and interpret the heterogeneity.

ETHICS AND DISSEMINATION

This study does not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42021225746.