Guided tissue regeneration for periodontal infra-bony defects

Area of Science:

• Periodontal Medicine
• Regenerative Dentistry
• Oral Surgery

Background:

• Conventional periodontal therapy halts disease progression but does not restore lost bone or connective tissue.
• Guided tissue regeneration (GTR) is a surgical approach designed to regenerate periodontal tissues in advanced cases, addressing limitations of traditional methods.

Purpose of the Study:

• To evaluate the effectiveness of GTR for treating periodontal infra-bony defects compared to open flap debridement (OFD).
• To identify factors influencing treatment outcomes in GTR procedures.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted, searching major databases up to April 2004.
• Included RCTs compared GTR (with or without graft materials) to OFD for periodontal infra-bony defects, with a minimum 12-month follow-up.
• Data extraction and quality assessment were performed independently; meta-analysis used random-effects models.

Main Results:

• GTR demonstrated a statistically significant improvement in clinical attachment gain (1.22 mm) and probing depth reduction (1.21 mm) compared to OFD.
• GTR also showed a significant benefit in reducing the number of sites failing to gain 2 mm attachment (NNT=8).
• Greater hard tissue gain at re-entry surgery was observed with GTR (1.39 mm), with increased gain when bone substitutes were used (3.37 mm).

Conclusions:

• GTR yields superior probing outcomes compared to OFD, including enhanced attachment gain and reduced pocket depth.
• Significant variability among studies and unclear clinical relevance necessitate cautious interpretation of GTR's overall benefit.
• Further research is recommended to identify factors affecting outcomes and to explore patient-centered results, with open flap surgery as the standard control.