Treatment of intrabony defects by different surgical procedures. A literature review

This article reviews studies presented during the last 20 years on the surgical treatment of intrabony defects. Treatments include open flap debridement alone (OFD); OFD plus demineralized freeze-dried bone allograft (DFDBA), freeze-dried bone allografts (FDBA), or autogenous bone; and guided tissue regeneration (GTR). The review includes only studies that presented baseline and final data on probing depths, intrabony defect depths as measured during surgery, clinical attachment level (CAL) gain, and/or bone fill. Some reports were case studies and some controlled studies comparing different treatments. In order to assess what can be accomplished in terms of pocket reduction, clinical attachment level gain, and bone fill with the various treatment modalities, data from studies of each treatment category were pooled for meta-analysis in which the data from and power of each study were weighted according to the number of defects treated. In addition, where there were data for each individual defect treated, these were used for simple regression analysis evaluating the influence of intrabony defect depth on treatment outcome in terms of CAL gain and bone fill. This was done in an effort to assess some predictability of the outcome of the various treatments. OFD alone resulted in limited pocket reduction, CAL gain averaged 1.5 mm and bone fill 1.1 mm. Bone fill, but not CAL gain, correlated significantly to the depth of the defect (R=0.3; P < 0.001), but the regression coefficient was only 0.25. OFD plus bone graft resulted in limited pocket reduction. CAL gain and bone fill averaged 2.1 mm. Bone fill showed a somewhat stronger correlation to defect depth than following OFD alone (R=0.43; P < 0.001) with a regression coefficient of 0.37. GTR resulted in significant pocket reduction, CAL gain of 4.2 mm, and bone fill averaging 3.2 mm. CAL gain and bone fill correlated significantly (P < 0.001) to defect depth (R=0.52 and 0.53 respectively) with the largest regression coefficients (0.54 and 0.58 respectively) among the three treatment modalities. By comparing outcomes following the various treatments it became obvious that to benefit from GTR procedures, the intrabony defect has to be at least 4 mm deep.