Abstract
BackgroundWith the popularity of minimally invasive surgery (MIS) in periodontics, numerous publications have evaluated the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects. However, it is unclear if it is necessary to use biomaterials in MIS. Thus, we conducted a meta-analysis of randomized clinical trials in patients with intra-bony defects to compare the clinical outcomes of MIS with regenerative biomaterials for MIS alone.MethodsThe authors retrieved English publications on relevant studies from Cochrane CENTRAL, PubMed, Medline, Embase, Clinical Evidence, and ClinicalTrails.gov (up to June 30, 2015). The main clinical outcomes were the reduction of probing pocket depths (PPDs), gain of clinical attachment level (CAL), recession of gingival margin (REC) and radiographic bone fill. Review Manager 5.2 (Cochrane Collaboration, Oxford, England) was used to calculate the heterogeneity and mean differences of the main clinical outcomes.ResultsIn total, 464 studies in the literature were identified but only four were ultimately feasible. The results showed no significant difference regarding CAL gain (P = 0.32) and PPD reduction (P = 0.40) as well as REC increase (P = 0.81) and radiographic bone fill (P = 0.64) between the MIS plus biomaterials group and the MIS alone group.ConclusionsThe meta-analysis suggested no significant difference in treatment of intra-bony defects between the MIS plus biomaterials group and the MIS alone group, indicating that it is important to take costs and benefits into consideration when a decision is made about a therapeutic approach. There needs to be an in-depth exploration of the induction of intrinsic tissue healing of MIS without biomaterials to achieve optimal outcomes.
Highlights
Periodontitis, a chronic infectious disease destroying the tooth’s supporting attachment apparatus, is the leading cause of tooth loss as well as a potential hazard for the development of systematic diseases [1].To repair the damage, traditional periodontal surgery, such as open flap debridement, has often been used over the last decades [2,3]
The main clinical outcomes were the reduction of probing pocket depths (PPDs), gain of clinical attachment level (CAL), recession of gingival margin (REC) and radiographic bone fill
The results showed no significant difference regarding CAL gain (P = 0.32) and PPD reduction (P = 0.40) as well as REC increase (P = 0.81) and radiographic bone fill (P = 0.64) between the minimally invasive surgery (MIS) plus biomaterials group and the MIS alone group
Summary
Periodontitis, a chronic infectious disease destroying the tooth’s supporting attachment apparatus, is the leading cause of tooth loss as well as a potential hazard for the development of systematic diseases [1].To repair the damage, traditional periodontal surgery, such as open flap debridement, has often been used over the last decades [2,3]. The results generated by traditional surgeries seemed unsatisfactory due to limited regenerated periodontal tissue. Invasive surgery (MIS), as a modern surgical procedure in a multitude of medical fields, was first introduced into the periodontal field with the intent to treat multiple and isolated periodontal intra-bony defects in 1995 [4,5,6,7,8]. With the popularity of minimally invasive surgery (MIS) in periodontics, numerous publications have evaluated the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects. It is unclear if it is necessary to use biomaterials in MIS. We conducted a meta-analysis of randomized clinical trials in patients with intra-bony defects to compare the clinical outcomes of MIS with regenerative biomaterials for MIS alone
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