6 research outputs found
Which reconstructive procedures are effective for treating the periodontal intraosseous defect?
The aim of this article was to determine the effect of
GTR, grafting procedures or the application of
enamel matrix proteins in addition to OFD in the
treatment of deep intraosseous defects. Overall, data
resulting from systematic reviews indicate that all
reconstructive treatment modalities produce comparable
and more favorable clinical improvements in
hard and soft tissue parameters of healing response
(i.e. clinical attachment gain, pocket reduction and
bone fill) compared to conventional OFD procedures.
Although the biomaterial-supplemented reconstructive
procedures are associated with a generally
positive treatment effects with respect to OFD, a
significant heterogeneity was found among studies
in the different reconstructive procedures. This limits
the possibility of drawing general conclusions about
the clinical relevance (in particular, the magnitude
of the adjunctive effect) of the additional use of GTR,
grafting procedures or enamel matrix proteins for
the treatment of intraosseous defects. Some of the
possible causes of heterogeneity have been explored;
however, the limited number of studies currently
available did not permit definite conclusions about
which factors account for the variability in treatment
outcome. More research is therefore needed to
identify patient, site, choice of material and technique
factors associated with the successful outcome
of treatment of intraosseous defects.
This review indicates that different reconstructive
procedures support comparable clinical outcomes. It
should, however, be considered that similar
improvements in clinical parameters do not necessarily
imply similar wound healing processes on a
histologic level. Whereas the use of some reconstructive
procedures, such as GTR and enamel matrix
proteins, has been demonstrated to result in a true
and complete periodontal regeneration, for some of
the graft biomaterials the effect on the formation
of a new attachment apparatus, including bone, cementum and periodontal ligament, rather than
periodontal repair, is still a matter of debate.
Due to limited information on long-term outcomes,
it is unclear whether the stability of periodontal support
and tooth survival are affected by the additional
application of reconstructive devices ⁄ biomaterials.
While the improvements in probing recordings may be
reasonably considered surrogate measurements related
to a better long-term tooth prognosis, we recommend
that more clinical studies should examine
whether and to what extent more compromised teeth
could be saved using a reconstructive procedure.
There are at present insufficient data to permit
analytic comparisons among different reconstructive
procedures with OFD with respect to patient-centered
outcomes. When considering the adjunctive
effect of reconstructive procedures, evaluation of
adverse effects related to the additional use of biomaterials
⁄ biological agents, postoperative complications,
ease of maintenance, change in aesthetic
appearance, estimation of patient well-being, and
cost ⁄ benefit ratio (including estimation of additional
treatment time and costs for implant ⁄ placement of
biomaterials ⁄ biological agents) should be carried
out. Studies including patient-centered outcomes will
be critical, as well as long-term follow-up cohorts to
examine the effect of a reconstructive biomaterial
⁄ device on true therapeutic endpoints