Comparison of the clinical efficacy of bone grafting and bone grafting combined with guided tissue regeneration in periodontal regenerative therapy: a meta-analysis
DOI:
https://doi.org/10.2340/aos.v83.40255Keywords:
Bone grafting, bone grafting combined with guided tissue regeneration, periodontal regenerative, meta-analysisAbstract
Objective: This study aims to compare the clinical efficacy of simple bone grafting and bone grafting combined with guided tissue regeneration (GTR) in periodontal regenerative therapy.
Methods: The authors systematically searched PubMed, the Web of Science, The National Library of Medicine, the China National Knowledge Infrastructure database and the Wanfang database and collected randomized controlled trials relating to bone graft co-guided tissue regeneration. The retrieval was conducted between January 1990 and December 2022. This study included relevant literature about the clinical efficacy of bone grafting combined with GTR according to the population, intervention, control and outcomes principle and excluded studies using other materials in addition to bone graft and membrane materials. After independently screening the literature, extracting the data and evaluating the risk of bias in the included studies, data analysis was performed using RevMan 5.3 software.
Results: Eighteen studies met the inclusion criteria, and, after further evaluation, a total of 327 teeth that were featured in 15 articles were finally included for meta-analysis. The meta-analysis showed that there was no significant statistical difference in clinical attachment level, probing depth and bone gain between the test group (bone grafting with GTR) and the control group (bone grafting only) at 6 months after the operation (p > 0.05). In terms of gingival recession (GR), the use of non-resorbable membranes produced more recession in the test group compared with the control group (p < 0.05), whereas the use of resorbable membranes produced less recession (p < 0.05).
Conclusion: Both simple bone grafting and bone grafting combined with membrane materials have good clinical efficacy in periodontal regenerative therapy, and no significant difference in clinical efficacy is indicated between the two, with the exception of GR.
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Liccardo D, Cannavo A, Spagnuolo G, et al. Periodontal disease: a risk factor for diabetes and cardiovascular disease. Int J Mol Sci. 2019;20(6):1414. https://doi.org/10.3390/ijms20061414 DOI: https://doi.org/10.3390/ijms20061414
Yan FH, Li LL. Development in periodontal re-generative treatment. J Oral Sci Res. 2018;34(3):217–22.
Darby IB, Morris KH. A systematic review of the use of growth factors in human periodontal regenera-tion. J Periodontol. 2013;84(4):465–76. https://doi.org/10.1902/jop.2012.120145 DOI: https://doi.org/10.1902/jop.2012.120145
Reynolds MA, Aichelmann-Reidy ME, Branch-Mays GL, et al. The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A sys-tematic review. Ann Periodontol. 2003;8(1):227–65. https://doi.org/10.1902/annals.2003.8.1.227 DOI: https://doi.org/10.1902/annals.2003.8.1.227
Stoecklin-Wasmer C, Rutjes AWS, da Costa BR, et al. Absorbable collagen membranes for periodontal regeneration: a systematic review. J Dent Res. 2013;92(9):773–81. https://doi.org/10.1177/0022034513496428 DOI: https://doi.org/10.1177/0022034513496428
Agarwal A, Gupta ND. Comparative evaluation of decalcified freeze-dried bone allograft use alone and in combination with polylactic acid, polyglycolic acid membrane in the treatment of noncontained human periodontal infrabony defects. Quintes-sence Int. 2012;43(9):761–68.
Chung YM, Lee JY, Jeong SN. Comparative study of two collagen membranes for guided tissue regeneration therapy in periodontal intrabony defects: a ran-domized clinical trial. J Periodontal Implant Sci. 2014;44(4):194–200. https://doi.org/10.5051/jpis.2014.44.4.194 DOI: https://doi.org/10.5051/jpis.2014.44.4.194
Guillemin MR, Mellonig JT, Brunsvold MA, et al. Healing in periodontal defects treated by decalcified freeze-dried bone allografts in combination with ePTFE membranes. Assessment by computerized densitometric analysis. J Clin Periodontol. 1993;20(7):520–7. https://doi.org/10.1111/j.1600-051X.1993.tb00401.x DOI: https://doi.org/10.1111/j.1600-051X.1993.tb00401.x
Keles GC, Sumer M, Cetinkaya BO, et al. Effect of autogenous cortical bone grafting in conjunction with guided tissue regeneration in the treatment of intraosseous periodontal defects. Eur J Dent. 2010;4(4):403–11. https://doi.org/10.1055/s-0039-1697860 DOI: https://doi.org/10.1055/s-0039-1697860
Khashu H, Vandana KL. Clinical and radiographic evaluation of human periodontal osseous defect (mandibular grade furcation) treated with PepGen P-15 and a bioresorbable membrane (Atrisorb). J Indian Soc Periodontol. 2012;16(4):569–76. https://doi.org/10.4103/0972-124X.106917 DOI: https://doi.org/10.4103/0972-124X.106917
Kiliç AR, Efeoğlu E, Yilmaz S. Guided tissue re-generation in conjunction with hydroxyapatite-collagen grafts for intrabony defects. A clinical and radiolo-gical evaluation. J Clin Periodontol. 1997;24(6):372–83. https://doi.org/10.1111/j.1600-051X.1997.tb00200.x DOI: https://doi.org/10.1111/j.1600-051X.1997.tb00200.x
Kini V, Nayak DG, Uppoor AS. A clinical evaluation of biphasic calcium phosphate alloplast with and without a flowable bioabsorbable guided tissue regeneration barrier in the treatment of mandibular molar class II furcation defects. J Contemp Dent Pract. 2016;17(2):143–8. https://doi.org/10.5005/jp-journals-10024-1817 DOI: https://doi.org/10.5005/jp-journals-10024-1817
Kumar A, Chandra RV, Reddy AA, et al. Evaluation of clinical, antiinflammatory and antiinfective pro-perties of amniotic membrane used for guided tissue regeneration: a randomized controlled trial. Dent Res J (Isfahan). 2015;12(2):127–35.
Lyons LC, Weltman RL, Moretti AJ, et al. Regenera-tion of degree ii furcation defects with a 4% doxycy-cline hyclate bioabsorbable barrier. J Periodontol. 2008;79(1):72–9. https://doi.org/10.1902/jop.2008.070161 DOI: https://doi.org/10.1902/jop.2008.070161
Mehrotra S, Chowdhary Z, Rastogi T. Evaluation and comparison of hydroxyapatite crystals with collagen fibrils bone graft alone and in combination with guided tissue regeneration membrane. J Indian Soc Periodontol. 2019;23(3):234–41. https://doi.org/10.4103/jisp.jisp_386_18 DOI: https://doi.org/10.4103/jisp.jisp_386_18
Nygaard-Østby P, Bakke V, Nesdal O, et al. Perio-dontal healing following reconstructive surgery: effect of guided tissue regeneration using a bioresor-bable barrier device when combined with autogenous bone grafting. A randomized controlled clinical trial. J Clin Periodontol. 2008;35(1):37–43. https://doi.org/10.1111/j.1600-051X.2007.01160.x DOI: https://doi.org/10.1111/j.1600-051X.2007.01160.x
Pajnigara NG, Kolte AP, Kolte RA, et al. Volumetric assessment of regenerative efficacy of demineralized freeze-dried bone allograft with or without amnion membrane in grade furcation defects: a cone beam computed tomography study. Int J Periodontics Restorative Dent. 2017;37(2):255–62. https://doi.org/10.11607/prd.2901 DOI: https://doi.org/10.11607/prd.2901
Reddy KP, Nayak DG, Uppoor AS. A clinical evalua-tion of anorganic bovine bone graft plus 10% collagen with or without a barrier in the treatment of class furcation defects. J Contemp Dent Pract. 2006;7(1):60–70. https://doi.org/10.5005/jcdp-7-1-60 DOI: https://doi.org/10.5005/jcdp-7-1-60
Sali DD, George JP. Demineralized freeze dried bone allograft with amniotic membrane in the treatment of periodontal intrabony defects-12 month randomized controlled clinical trial. J Periodontol. 2016;88(5):1–18. https://doi.org/10.1902/jop.2016.160260 DOI: https://doi.org/10.1902/jop.2016.160260
Srivastava S, Tandon P, Gupta K, et al. A comparative clinico-radiographic study of guided tissue regenera-tion with bioresorbable membrane and a composite synthetic bone graft for the treatment of periodontal osseous defects. J Indian Soc Periodontol. 2015;19(4):416–23. https://doi.org/10.4103/0972-124X.154544 DOI: https://doi.org/10.4103/0972-124X.154544
Taheri M, Molla R, Radvar M, et al. An evaluation of bovine derived xenograft with and without a bioab-sorbable collagen membrane in the treatment of mandibular Class furcation defects. Aust Dent J. 2009;54(3):220–7. https://doi.org/10.1111/j.1834-7819.2009.01122.x DOI: https://doi.org/10.1111/j.1834-7819.2009.01122.x
Tsao YP, Neiva R, Al-Shammari K, et al. Effects of a mineralized human cancellous bone allograft in re-generation of mandibular Class furcation defects. J Periodontol. 2006;77(3):416–25. https://doi.org/10.1902/jop.2006.050109 DOI: https://doi.org/10.1902/jop.2006.050109
Zhang L, Sun Y, Sui Q. Comparison of the effect of simple bone grafting and guided tissue regeneration combined with bone grafting in the treatment of periodontal subosseous defects. Henan Med Res. 2020;29(17):3157–8.
Needleman I, Tucker R, Giedrys-Leeper E, et al. Guided tissue regeneration for periodontal intrabony defects: a Cochrane systematic review. Periodontol 2000. 2005;37:106–23. https://doi.org/10.1111/j.1600-0757.2004.37101.x DOI: https://doi.org/10.1111/j.1600-0757.2004.37101.x
Kiany F, Moloudi F. Amnion membrane as a novel barrier in the treatment of intrabony defects: a con-trolled clinical trial. Int J Oral Maxillofac Implants. 2015;30(3):639–47. https://doi.org/10.11607/jomi.3590 DOI: https://doi.org/10.11607/jomi.3590
Zhou XY, Fang JQ. Bias in meta-analysis. J Evid- Based Med. 2002;2(4):216–20.
Al-Hamdan K, Eber R, Sarment D, et al. Guided tissue regeneration-based root coverage: meta-analysis. J Periodontol. 2003;74(10):1520–33. https://doi.org/10.1902/jop.2003.74.10.1520 DOI: https://doi.org/10.1902/jop.2003.74.10.1520
Ling LJ, Hung SL, Lee CF, et al. The influence of membrane exposure on the outcomes of guided tissue regeneration: clinical and microbiological aspects. J Periodont Res. 2003;38(1):57–63. https://doi.org/10.1034/j.1600-0765.2003.01641.x DOI: https://doi.org/10.1034/j.1600-0765.2003.01641.x
Sanz M, Tonetti MS, Zabalegui I, et al. Treatment of intrabony defects with enamel matrix proteins or barrier membranes: results from a multicenter practice-based clinical trial. J Periodontol. 2004;75(5):726–33. https://doi.org/10.1902/jop.2004.75.5.726 DOI: https://doi.org/10.1902/jop.2004.75.5.726
Slutzkey S, Kozlovsky A, Artzi Z, et al. Collagen barrier membranes May accelerate bacterial growth in vitro: a potential clinical risk to regenerative procedures. Quintessence Int. 2015;46(1):43–50.
Nevins ML, Camelo M, Lynch SE, et al. Evaluation of periodontal regeneration following grafting intrabony defects with bio-oss collagen: a human histologic report. Int J Periodontics Restorative Dent. 2003;23(1):9–17.
Nevins ML, Camelo M, Rebaudi A, et al. Three-dimensional micro-computed tomographic evalua-tion of periodontal regeneration: a human report of intrabony defects treated with Bio-Oss collagen. Int J Periodontics Restorative Dent. 2005;25(4):365–73.
Sculean A, Nikolidakis D, Schwarz F. Regeneration of periodontal tissues: combinations of barrier mem-branes and grafting materials-biological foundation and preclinical evidence: a systematic review. J Clin Periodontol. 2008;35(8 Suppl):106–16. https://doi.org/10.1111/j.1600-051X.2008.01263.x DOI: https://doi.org/10.1111/j.1600-051X.2008.01263.x
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Acta Odontologica Scandinavica publishes original research papers as well as critical reviews relevant to the diagnosis, epidemiology, health service, prevention, aetiology, pathogenesis, pathology, physiology, microbiology, development and treatment of diseases affecting tissues of the oral cavity and associated structures including papers on cause and effect or explanatory/associative relationships for experimental or observational studies.
