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Motta C, Cavagnetto D, Amoroso F, Baldi I, Mussano F. Bioactive glass for periodontal regeneration: a systematic review. BMC Oral Health 2023; 23:264. [PMID: 37158885 PMCID: PMC10169491 DOI: 10.1186/s12903-023-02898-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/20/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND One of the major clinical challenges of this age could be represented by the possibility to obtain a complete regeneration of infrabony defects. Over the past few years, numerous materials and different approaches have been developed to obtain bone and periodontal healing. Among all biomaterials, bioglasses (BG) are one of the most interesting due to their ability to form a highly reactive carbonate hydroxyapatite layer. Our aim was to systematically review the literature on the use and capability of BG for the treatment of periodontal defects and to perform a meta-analysis of their efficacy. METHODS A search of MEDLINE/PubMed, Cochrane Library, Embase and DOSS was conducted in March 2021 to identify randomized controlled trials (RCTs) using BG in the treatment of intrabony and furcation defects. Two reviewers selected the articles included in the study considering the inclusion criteria. The outcomes of interest were periodontal and bone regeneration in terms of decrease of probing depth (PD) and gain of clinical attachment level (CAL). A network meta-analysis (NMA) was fitted, according to the graph theory methodology, using a random effect model. RESULTS Through the digital search, 46 citations were identified. After duplicate removal and screening process, 20 articles were included. All RCTs were retrieved and rated following the Risk of bias 2 scale, revealing several potential sources of bias. The meta-analysis focused on the evaluation at 6 months, with 12 eligible articles for PD and 10 for CAL. As regards the PD at 6 months, AUTOGENOUS CORTICAL BONE, BIOGLASS and PLATELET RICH FIBRIN were more efficacious than open flap debridement alone, with a statistically significant standardized mean difference (SMD) equal to -1.57, -1.06 and - 2.89, respectively. As to CAL at 6 months, the effect of BIOGLASS is reduced and no longer significant (SMD = -0.19, p-value = 0.4) and curiously PLATELET RICH FIBRIN was more efficacious than OFD (SMD =-4.13, p-value < 0.001) in CAL gain, but in indirect evidence. CONCLUSIONS The present review partially supports the clinical efficacy of BG in periodontal regeneration treatments for periodontal purposes. Indeed, the SMD of 0.5 to 1 in PD and CAL obtained with BG compared to OFD alone seem clinically insignificant even if it is statistically significant. Heterogeneity sources related to periodontal surgery are multiple, difficult to assess and likely hamper a quantitative assessment of BG efficacy.
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Affiliation(s)
- Chiara Motta
- Department of Surgical Sciences UNITO, CIR Dental School, via Nizza 230, Turin, 10126, Italy.
| | - Davide Cavagnetto
- Department of Surgical Sciences UNITO, CIR Dental School, via Nizza 230, Turin, 10126, Italy.
- Politecnico di Torino, Corso Duca Degli Abruzzi 24, Torino, 10129, Italy.
| | - Federico Amoroso
- Department of Surgical Sciences UNITO, CIR Dental School, via Nizza 230, Turin, 10126, Italy
- Politecnico di Torino, Corso Duca Degli Abruzzi 24, Torino, 10129, Italy
| | - Ileana Baldi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, via Loredan 18, Padova, 35131, Italy
| | - Federico Mussano
- Department of Surgical Sciences UNITO, CIR Dental School, via Nizza 230, Turin, 10126, Italy
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Abushahba F, Algahawi A, Areid N, Hupa L, Närhi T. Bioactive Glasses in Periodontal Regeneration
A Systematic Review
. Tissue Eng Part C Methods 2023; 29:183-196. [PMID: 37002888 DOI: 10.1089/ten.tec.2023.0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Bioactive glasses (BAGs) are surface-active ceramic materials that can be used in bone regeneration due to their known osteoconductive and osteoinductive properties. This systematic review aimed to study the clinical and radiographic outcomes of using BAGs in periodontal regeneration. The selected studies were collected from PubMed and Web of Science databases, and included clinical studies investigating the use of BAGs on periodontal bone defect augmentation between January 2000 and February 2022. The identified studies were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 115 full-length peer-reviewed articles were identified. After excluding duplicate articles between the databases and applying the inclusion and exclusion criteria, 14 studies were selected. The Cochrane risk of bias tool for randomized trials was used to assess the selected studies. Five studies compared using BAGs with open flap debridement (OFD) without grafting materials. Two of the selected studies were performed to compare the use of BAGs with protein-rich fibrin, one of which also included an additional OFD group. Also, one study evaluated BAG with biphasic calcium phosphate and used a third OFD group. The remaining six studies compared BAG filler with hydroxyapatite, demineralized freeze-dried bone allograft, autogenous cortical bone graft, calcium sulfate β-hemihydrate, enamel matrix derivatives, and guided tissue regeneration. This systematic review showed that using BAG to treat periodontal bone defects has beneficial effects on periodontal tissue regeneration. OSF Registration No.: 10.17605/OSF.IO/Y8UCR.
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Affiliation(s)
- Faleh Abushahba
- University of Turku, 8058, Department of Prosthetic Dentistry and Stomatognathic Physiology, Turku, Varsinais-Suomi, Finland,
| | - Ahmed Algahawi
- University of Turku, 8058, Department of Periodontology, Turku, Varsinais-Suomi, Finland,
| | - Nagat Areid
- University of Turku, 8058, Department of Prosthetic Dentistry and Stomatognathic Physiology Institute of Dentistry, University of Turku, Turku, Finland,
| | - Leena Hupa
- Åbo Akademi University, Johan Gadolin Process Chemistry Centre, Turku, Finland,
| | - Timo Närhi
- University of Turku Faculty of Medicine, 60654, Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, Turku, Finland,
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Tavelli L, Chen CYJ, Barootchi S, Kim DM. Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis. J Periodontol 2022; 93:1803-1826. [PMID: 36279121 DOI: 10.1002/jper.22-0120] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects. METHODS A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration. RESULTS A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor. CONCLUSIONS Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Chia-Yu Jennifer Chen
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - David M Kim
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Nibali L, Koidou VP, Nieri M, Barbato L, Pagliaro U, Cairo F. Regenerative surgery versus access flap for the treatment of intra‐bony periodontal defects: A systematic review and meta‐analysis. J Clin Periodontol 2020; 47 Suppl 22:320-351. [DOI: 10.1111/jcpe.13237] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Luigi Nibali
- Periodontology Unit Faculty of Dentistry, Oral & Craniofacial Sciences Centre for Host‐Microbiome Interactions King's College London London UK
| | - Vasiliki P. Koidou
- Centre for Oral Immunobiology and Regenerative Medicine and Centre for Oral Clinical Research Institute of Dentistry Queen Mary University London (QMUL) London UK
| | - Michele Nieri
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
| | - Umberto Pagliaro
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
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Sali DD, Pauline George J. Demineralized Freeze Dried Bone Allograft With Amniotic Membrane in the Treatment of Periodontal Intrabony Defects - 12 Month Randomized Controlled Clinical Trial. J Periodontol 2016:1-18. [PMID: 27834121 DOI: 10.1902/jop.2016.160260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The goal of randomized controlled clinical study was to compare the clinical and radiological outcomes of the combination of Open flap debridement, Amniotic membrane and Demineralized Freeze Dried bone Allograft with Open flap debridement and Demineralized Freeze Dried bone Allograft alone in the management of periodontal intrabony defects. METHOD 10 patients with bilaterally similar intrabony defects were selected. Each of the intrabony defects were randomly allocated for control and test groups. Control group (n= 10) received open flap debridement (OFD) and Demineralized Freeze Dried bone Allograft (DFDBA) while the test group (n=10) received OFD, DFDBA and Amniotic membrane. Pocket Probing Depth reduction (PPD), Clinical Attachment Level (CAL) gain and radiographic bone gain were assessed. RESULTS Both the groups demonstrated statistically significant PPD reduction, CAL gain and radiographic bone gain. The Intrabony defect (IBD) reduction of 1.78 ± 0.04 mm in radiovisiography (RVG) and 2.02 ± 0.83 mm in cone beam computed tomography (CBCT) with defect resolution of 58.28 % (RVG) and 58.24 % (CBCT) was noted in test group when compared to control group. CONCLUSION All the parameters measured showed similar improvement such as PPD reduction, CAL gain, IBD reduction and defect resolution with OFD + DFDBA + AM and OFD + DFDBA, no statistical significant difference was observed between the two groups .
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Affiliation(s)
- Deepthi D Sali
- Post Graduate Student, Department of Periodontology Krishnadevaraya College of Dental Sciences and Hospital, Hunsamaranahalli, International Airport Road, Bangalore - 562157, India
| | - Joann Pauline George
- Professor, Department of Periodontology Krishnadevaraya College of Dental Sciences and Hospital, Hunsamaranahalli, International Airport Road, Bangalore - 562157, India
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Shukla S, Chug A, Mahesh L, Grover HS. Effect of Addition of Platelet-rich Plasma to Calcium Phosphosilicate Putty on Healing at 9 Months in Periodontal Intrabony Defects. J Contemp Dent Pract 2016; 17:230-234. [PMID: 27207203 DOI: 10.5005/jp-journals-10024-1832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Combination of platelet-rich plasma (PRP) and bone substitutes for the surgical treatment of periodontal intrabony defects is based on a sound biologic rationale; however, the clinical results indicative of the synergistic effect of PRP remain ambiguous. The objective of the present study was to clinically and radiographically evaluate the use of calcium phosphosilicate (CPS) putty alone and in combination with PRP in the treatment of periodontal intrabony defects. MATERIALS AND METHODS The study was performed at an outpatient facility at a teaching dental institute in north India. A split-mouth design was employed to assess the clinical parameters and radiographic bone fill following the use of CPS putty with and without PRP in patients scheduled for surgical periodontal treatment of intrabony osseous defects. Each defect was randomized to receive treatment with open flap debridement, with CPS putty alone (Group PUT), or open flap debridement with CPS putty and PRP (Group PRp). Probing pocket depth (PPD), plaque index (PI), gingival index (GI), and clinical attachment levels (CALs) were recorded at the investigated sites utilizing custom-made reference guides for measurement reproducibility. Standardized periapical radiographs were also obtained to evaluate defect fill at the surgical sites. RESULTS Twenty patients each with at least two defects located in different quadrants were enrolled. The reduction in PPD from baseline to 1st, 3rd, 6th, and 9th month was found to be significant (p < 0.05). The percent reduction in PPD among PUT group was 57.18 ± 10.71% and among PRP group was 51.39 ± 12.60%. No statistically significant difference was observed in the percent reduction in PPD among two groups at 9 months (p = 0.48). Sites in both groups exhibited statistically significant reductions in PI and GI that were maintained throughout the study period. Similar results were seen while measuring CAL. CONCLUSION Calcium phosphosilicate Putty alone provides significant improvement in outcomes for the treatment of periodontal intraosseous defects. The addition of PRP to CPS putty does not seem to provide any additive benefit to treatment and the additional surgical time and trauma can be avoided.
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Affiliation(s)
- Sagrika Shukla
- Faculty, Department of Periodontology, Seema Dental College and Hospital, Rishikesh, Uttarakhand, c-488 SFS Flats, Sheikh Sarai Phase - I, New Delhi -110017, India Phone: +91-9873090671, e-mail:
| | - Ashi Chug
- Department of Dentistry and Oral and Maxillofacial Surgery All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Lanka Mahesh
- Private Practice, The Specialist Clinic, Saket, New Delhi, India
| | - Harpreet Singh Grover
- Department of Periodontology, Faculty and Dental Sciences SGT Dental College and Hospital, SGT University, Gurgaon Haryana, India
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Kotsakis GA, Javed F, Hinrichs JE, Karoussis IK, Romanos GE. Impact of Cigarette Smoking on Clinical Outcomes of Periodontal Flap Surgical Procedures: A Systematic Review and Meta-Analysis. J Periodontol 2015; 86:254-63. [DOI: 10.1902/jop.2014.140452] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Rai JJ, Kalantharakath T. Biomimetic ceramics for periodontal regeneration in infrabony defects: A systematic review. J Int Soc Prev Community Dent 2014; 4:S78-92. [PMID: 25558455 PMCID: PMC4278107 DOI: 10.4103/2231-0762.146207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Biomimetic materials are widely used in the treatment of osseous defects as an alternative to autogenous bone graft. The aim of this article was to review the literature and compare the quality of published articles on biomimetic ceramic material used for periodontal regeneration in the treatment of infrabony defects and to discuss the future direction of research. The bibliographic databases PubMed, Ebsco, and Google Scholar were searched from January 2000 to March 2014 for randomized control trials in which biomimetic ceramic graft material was compared with open flap debridement or in combination with any other regenerative material. To avoid the variability of the search terms, the thesaurus Mesh was used. The primary outcome variable assessed was clinical attachment level (CAL). The screening of eligible studies, assessment of the methodological quality of the trials, and data extraction were performed by two observers independently. Twenty-six articles were identified and included in this systematic review. The primary outcome was CAL. Out of the 26 studies, 24 showed more than 2 mm of CAL gain. The difference in CAL change between test and control groups varied from 1.2 mm to 5.88 mm with respect to different biomaterials/biomimetic materials, which was clinically and statistically significant. Meta-analysis was not done due to heterogeneity in results between studies. Overall, biomaterials were found to be more effective than open flap debridement in improving the attachment levels in intraosseous defects. Future research should aim at increasing the osteoinductive capacity of these biomimetic graft materials.
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Affiliation(s)
- Jasuma Jagdish Rai
- Department of Periodontics, K. M. Shah Dental College and Hospital, Sumadeep Vidyapeeth, Gujarat, India
| | - Thanveer Kalantharakath
- Department of Public Health Dentistry, K. M. Shah Dental College and Hospital, Sumadeep Vidyapeeth, Gujarat, India
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Shioyama H, Mizutani K, Aoyama N, Suda T, Tanaka K, Endo A, Kusunoki Y, Yamawaki F, Fujiwara-Takahashi K, Kinoshita A, Arakawa S, Oda S, Izumi Y. Evaluation of Advanced Dental Technology with Enamel Matrix Derivative and Examination of Prognostic Factors in Periodontal Regenerative Therapy. ACTA ACUST UNITED AC 2014. [DOI: 10.2329/perio.56.302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Hidehiro Shioyama
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
- Oral Health Care Clinic, Dental Hospital, Tokyo Medical and Dental University
| | - Koji Mizutani
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Norio Aoyama
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tomonari Suda
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Keiko Tanaka
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Akiko Endo
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Yukako Kusunoki
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Fumihiro Yamawaki
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Kaori Fujiwara-Takahashi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Atsuhiro Kinoshita
- Department of Educational Media Development, Institute for Library and Media Information Technology, Tokyo Medical and Dental University
| | - Shinichi Arakawa
- Deparment of Lifetime Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Shigeru Oda
- Diagnosis and General Dentistry, Dental Hospital, Tokyo Medical and Dental University
| | - Yuichi Izumi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
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Mueller VT, Welch K, Bratu DC, Wang HL. Early and late studies of EMD use in periodontal intrabony defects. J Periodontal Res 2012; 48:117-25. [PMID: 22860751 DOI: 10.1111/j.1600-0765.2012.01510.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The clinical efficacy of EMDs for the treatment of periodontal infrabony defects has been reported. However, recent publications have questioned the validity of results from early findings. Hence, the purpose of this study was to compare the results obtained from early and late studies when EMD was used as an adjunct in treating human intrabony defects during flap surgery. The aim of this meta-analysis was to evaluate the validity of results published from early studies compared with those published from later studies. MATERIAL AND METHODS PubMed and MEDLINE searches were performed. The evaluation period was 1997-2010 and it was divided into two groups of equal periods of time: early studies (1997-2003) and late studies (2004-2010). The clinical parameters assessed were clinical attachment level (CAL), probing pocket depth and bone gain (BG; measured as a percentage or in mm). RESULTS No statistically significant difference was found between the results obtained from early studies (1997-2003) and late studies (2004-2010) with regards to CAL gain, probing pocket depth reduction and BG. Nonetheless, both study periods showed a benefit for using EMD to treat periodontal infrabony defects when compared with the groups without EMD during open flap surgery. CONCLUSIONS The results obtained from this study failed to show any potential differences between the results published from early studies and late studies with regards to the clinical effectiveness of EMD in treating periodontal infrabony defects.
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Affiliation(s)
- V T Mueller
- Graduate Periodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA
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Koop R, Merheb J, Quirynen M. Periodontal regeneration with enamel matrix derivative in reconstructive periodontal therapy: a systematic review. J Periodontol 2011; 83:707-20. [PMID: 22050544 DOI: 10.1902/jop.2011.110266] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Enamel matrix derivative (EMD) is commonly used in periodontal therapy. The aim of this systematic review is to give an updated answer to the question of whether the additional use of EMD in periodontal therapy is more effective compared with a control or other regenerative procedures. METHODS A literature search in MEDLINE (PubMed) for the use of EMD in periodontal treatment was performed up to May 2010. The use of EMD in treatment of intrabony defects, furcations, and recessions was evaluated. Only randomized controlled trials with ≥1 year of follow-up were included. The primary outcome variable for intrabony defects was the change in clinical attachment level (CAL), for furcations the change in horizontal furcation depth, and for recession complete root coverage. RESULTS After screening, 27 studies (20 for intrabony defects, one for furcation, and six for recession) were eligible for the review. A meta-analysis was performed for intrabony defects and recession. The treatment of intrabony defects with EMD showed a significant additional gain in CAL of 1.30 mm compared with open-flap debridement, EDTA, or placebo, but no significant difference compared with resorbable membranes was shown. The use of EMD in combination with a coronally advanced flap compared with a coronally advanced flap alone showed significantly more complete root coverage (odds ratio of 3.5), but compared with a connective tissue graft, the result was not significantly different. The use of EMD in furcations (2.6 ± 1.8 mm) gave significantly more improvement in horizontal defect depth compared with resorbable membranes (1.9 ± 1.4 mm) as shown in one study. CONCLUSIONS In the treatment of intrabony defects, the use of EMD is superior to control treatments but as effective as resorbable membranes. The additional use of EMD with a coronally advanced flap for recession coverage will give superior results compared with a control but is as effective as a connective tissue graft. The use of EMD in furcations will give more reduction in horizontal furcation defect depth compared with resorbable membranes.
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Affiliation(s)
- Richard Koop
- Department of Periodontology, Catholic University Leuven, Leuven, Belgium
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Sohrabi K, Saraiya V, Laage TA, Harris M, Blieden M, Karimbux N. An evaluation of bioactive glass in the treatment of periodontal defects: a meta-analysis of randomized controlled clinical trials. J Periodontol 2011; 83:453-64. [PMID: 21861641 DOI: 10.1902/jop.2011.110347] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The regenerative surgical treatment of intrabony defects caused by periodontal disease has been examined in several systematic reviews and meta-analyses. The use of bioactive glass (BG) as a graft material to treat intrabony defects has been reported, but all data have not been synthesized and compiled. Our objective was to systematically review the literature on the use of BG for the treatment of intrabony defects and to perform a meta-analysis of its efficacy. METHODS A search of PubMed, EMBASE, and Cochrane Database of Systematic Reviews, as well as a manual search of recently published periodontology journals, were conducted to identify randomized controlled trials of the use of BG in the treatment of intrabony and furcation defects. Criteria included publication in English, follow-up duration of ≥6 months, baseline and follow-up measures of probing depth (PD) and clinical attachment levels (CAL) with 95% confidence intervals (CIs), and an appropriate control arm. Twenty-five citations were identified, 15 of which were included in the final analysis. Data, including study methods and results, as well as CONSORT (Consolidated Standards of Reporting Trials) criteria, were extracted from eligible studies and cross-checked by at least two reviewers. RESULTS Meta-analyses of eligible studies were performed to ascertain summary effects for changes in PD and CAL among experimental and control groups, using the mean change plus standard deviation for each study. Pooled analyses showed that BG was superior to control for both measures: the mean (95% CIs) difference from baseline to follow-up between BG and controls was 0.52 mm (0.27, 0.78, P <0.0001) in reduction for PD and 0.60 mm (0.18, 1.01, P = 0.005) in gain for CAL. Analyses of CAL revealed heterogeneity across studies (I(2) = 60.5%), although studies reporting PD measures were homogeneous (I(2) = 0.00%). CAL heterogeneity appeared secondary to active controls versus open flap debridement (OFD) alone and to defect-type modifying BG treatment success. Per subgroup analyses, the benefit of BG over control treatment was highly significant only in studies comparing BG to OFD (P <0.0001), with mean difference change in CAL being 1.18 mm (95% CI = 0.74, 1.62 mm) between the BG and OFD group. CONCLUSION Treatment of intrabony defects with BG imparts a significant improvement in both PD and CAL compared to both active controls and OFD.
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Affiliation(s)
- Keyvan Sohrabi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA 02115, USA
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Esposito M, Grusovin MG, Papanikolaou N, Coulthard P, Worthington HV. Enamel matrix derivative (Emdogain(R)) for periodontal tissue regeneration in intrabony defects. Cochrane Database Syst Rev 2009; 2009:CD003875. [PMID: 19821315 PMCID: PMC6786880 DOI: 10.1002/14651858.cd003875.pub3] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. OBJECTIVES To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects. SEARCH STRATEGY We searched the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomised controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: February 2009. SELECTION CRITERIA RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years. DATA COLLECTION AND ANALYSIS Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed. MAIN RESULTS Thirteen trials were included out of 35 potentially eligible trials. No included trial presented data after 5 years of follow up, therefore all data refer to the 1-year time point. A meta-analysis including nine trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.1 mm, 95% CI 0.61 to 1.55) and PPD reduction (0.9 mm, 95% CI 0.44 to 1.31) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had < 2 mm PAL gain in the control group, with RR 0.53 (95% CI 0.34 to 0.82). Approximately nine patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 25%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating only trials at a low risk of bias in a sensitivity analysis (four trials), the effect size for PAL was 0.62 mm (95% CI 0.28 to 0.96), which was less than 1.1 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed statistically significant more postoperative complications (three trials, RR 0.12, 95% CI 0.02 to 0.85) and more REC (0.4 mm 95% CI 0.15 to 0.66). The only trial comparing EMD with a bioactive ceramic filler found statistically significant more REC (-1.60 mm, 95% CI -2.74 to -0.46) at the EMG treated sites. AUTHORS' CONCLUSIONS One year after its application, EMD significantly improved PAL levels (1.1 mm) and PPD reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less REC than EMD.
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Affiliation(s)
- Marco Esposito
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthCoupland Building 3, Oxford RoadManchesterUKM13 9PL
| | | | - Nikolaos Papanikolaou
- School of Dentistry, The University of ManchesterDepartment of Oral and Maxillofacial SurgeryHigher Cambridge StreetManchesterUKM15 6FH
| | - Paul Coulthard
- Institute of Dentistry, Queen Mary University of LondonDean's Office, Floor 5, Turner StreetLondonUKE1 2AD
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthCoupland Building 3, Oxford RoadManchesterUKM13 9PL
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