Periodontal Regenerative Therapy for Preventing Bone Defects Distal to Mandibular Second Molars After Surgical Removal of Impacted Third Molars: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Abstract

The purpose of this study was to assess which regenerative techniques are most effective for preventing periodontal defects after extraction of the third molars, as well as to compare these procedures with spontaneous healing of the socket. Five electronic databases were searched to identify randomized clinical trials that fulfilled the eligibility criteria. Two independent reviewers conducted literature screening, article selection, and data extraction. The outcome measures were mean clinical attachment level (CAL) gain, mean probing depth (PD) reduction, mean alveolar bone level (ABL) gain, and adverse events. The influence of several variables of interest on the outcomes of periodontal regenerative therapy was explored via subgroup analyses. Among 1,205 potentially eligible articles, 21 randomized clinical trials were included. Eighteen trials assessed periodontal regenerative therapy as an alternative to extraction alone. Statistically significant differences were found in CAL gain (1.98mm; 95% confidence interval [CI], 1.44 to 2.52mm; P<.001), PD reduction (1.76mm; 95% CI, 1.20 to 2.31mm; P<.001), and ABL gain (1.21mm; 95% CI, 0.21 to 2.21mm; P=.018). The risk of complications developing at treated sites did not increase with the regenerative procedures (odds ratio, 1.49; 95% CI, 0.71 to 3.14; P=.290). There was no evidence of any regenerative procedure being better than any other. However, osseous grafting techniques were associated with a significantly higher adverse event rate. Regenerative periodontal therapy, in comparison with spontaneous healing of the wound, is more effective regarding initial improvement in CAL gain, PD reduction, and ABL gain, without increasing the risk of postoperative complications.