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Efficacy of regenerative therapy in aggressive periodontitis: a systematic review and meta-analysis of randomised controlled clinical trials

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Abstract

Objectives

To analyse evidence regarding the efficacy of periodontal regenerative procedures in intrabony defects in patients treated for aggressive periodontitis (AgP).

Material and Methods

A systematic search of the literature for randomised controlled clinical trials including patients treated for aggressive periodontitis that compared a group treated with regenerative therapy with another group treated with surgical debridement alone was conducted by two independent reviewers.

Results

Six studies were included in the meta-analysis of clinical and/or radiographic parameters at 6 and 12 months. Probing pocket depth was smaller at 6 months in patients treated with regenerative therapies compared with those treated with regular debridement (1.00 mm, p < 0.001, 95% CI (0.67, 1.34)). At 12 months this difference was more marked (0.41 mm, p = 0.12, 95% CI (− 0.10, 0.91)). The distance between the cemento-enamel junction and the alveolar crest at both 6 (1.36 mm, p < 0.001, 95% CI (1.03, 1.68)) and 12 months (0.90 mm, p = 0.01, 95% CI (0.24, 1.56)) was smaller in the group treated with regeneration.

Conclusions

The use of biomaterials for regenerative therapy in AgP may be more effective than surgical debridement. Better outcomes were observed in terms of probing pocket depth and distance between the cemento-enamel junction and the alveolar crest at 6 months. Regeneration should be considered as a therapy to prevent tooth loss, although more studies with larger sample size and longer follow-up are needed.

Clinical relevance

Periodontal regeneration is effective in the treatment of intrabony defects in patients with AgP, as it leads to better outcomes in clinical and radiographic parameters.

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References

  1. Armitage GC (1999) Development of a classification system for periodontal diseases and conditions. Ann Periodontol 4:1–6. https://doi.org/10.1902/annals.1999.4.1.1

    Article  PubMed  Google Scholar 

  2. Loe H, Brown LJ (1991) Early onset periodontitis in the United States of America. J Periodontol 62:608–616. https://doi.org/10.1902/jop.1991.62.10.608

    Article  PubMed  Google Scholar 

  3. Albandar JM, Tinoco EM (2002) Global epidemiology of periodontal diseases in children and young persons. Periodontol 2000(29):153–176

    Article  Google Scholar 

  4. Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS (2018) A new classification scheme for periodontal and peri-implant diseases and conditions - introduction and key changes from the 1999 classification. J Clin Periodontol 45(Suppl 20):S1–S8. https://doi.org/10.1111/jcpe.12935

    Article  PubMed  Google Scholar 

  5. Tonetti MS, Greenwell H, Kornman KS (2018) Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Clin Periodontol 45(Suppl 20):S149–S161. https://doi.org/10.1111/jcpe.12945

    Article  PubMed  Google Scholar 

  6. Fine DH, Patil AG, Loos BG (2018) Classification and diagnosis of aggressive periodontitis. J Periodontol 89(Suppl 1):S103–S119. https://doi.org/10.1002/JPER.16-0712

    Article  PubMed  Google Scholar 

  7. Teughels W, Dhondt R, Dekeyser C, Quirynen M (2014) Treatment of aggressive periodontitis. Periodontol 2000 65:107–133. https://doi.org/10.1111/prd.12020

    Article  PubMed  Google Scholar 

  8. Guerrero A, Griffiths GS, Nibali L, Suvan J, Moles DR, Laurell L, Tonetti MS (2005) Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol 32:1096–1107. https://doi.org/10.1111/j.1600-051X.2005.00814.x

    Article  PubMed  Google Scholar 

  9. Trombelli L, Heitz-Mayfield LJ, Needleman I, Moles D, Scabbia A (2002) A systematic review of graft materials and biological agents for periodontal intraosseous defects. J Clin Periodontol 29(Suppl 3):117–135 discussion 160-2

    Article  PubMed  Google Scholar 

  10. Baumer A, Pretzl B, Cosgarea R, Kim TS, Reitmeir P, Eickholz P, Dannewitz B (2011) Tooth loss in aggressive periodontitis after active periodontal therapy: patient-related and tooth-related prognostic factors. J Clin Periodontol 38:644–651. https://doi.org/10.1111/j.1600-051X.2011.01733.x

    Article  PubMed  Google Scholar 

  11. Graetz C, Dorfer CE, Kahl M, Kocher T, Fawzy El-Sayed K, Wiebe JF, Gomer K, Ruhling A (2011) Retention of questionable and hopeless teeth in compliant patients treated for aggressive periodontitis. J Clin Periodontol 38:707–714. https://doi.org/10.1111/j.1600-051X.2011.01743.x

    Article  PubMed  Google Scholar 

  12. Nibali L, Farias BC, Vajgel A, Tu YK, Donos N (2013) Tooth loss in aggressive periodontitis: a systematic review. J Dent Res 92:868–875. https://doi.org/10.1177/0022034513501878

    Article  PubMed  Google Scholar 

  13. Diaz-Faes L, Guerrero A, Magan-Fernandez A, Bravo M, Mesa F (2016) Tooth loss and alveolar bone crest loss during supportive periodontal therapy in patients with generalized aggressive periodontitis: retrospective study with follow-up of 8 to 15 years. J Clin Periodontol 43:1109–1115. https://doi.org/10.1111/jcpe.12596

    Article  PubMed  Google Scholar 

  14. Graetz C, Salzer S, Plaumann A, Schlattmann P, Kahl M, Springer C, Dorfer C, Schwendicke F (2017) Tooth loss in generalized aggressive periodontitis: prognostic factors after 17 years of supportive periodontal treatment. J Clin Periodontol 44:612–619. https://doi.org/10.1111/jcpe.12725

    Article  PubMed  Google Scholar 

  15. Caton J, Nyman S, Zander H (1980) Histometric evaluation of periodontal surgery. II Connective tissue attachment levels after four regenerative procedures. J Clin Periodontol 7:224–231

    Article  PubMed  Google Scholar 

  16. Karring T, Nyman S, Gottlow J, Laurell L (1993) Development of the biological concept of guided tissue regeneration--animal and human studies. Periodontol 2000 1:26–35

    Article  PubMed  Google Scholar 

  17. Needleman I, Tucker R, Giedrys-Leeper E, Worthington H (2002) A systematic review of guided tissue regeneration for periodontal infrabony defects. J Periodontal Res 37:380–388

    Article  PubMed  Google Scholar 

  18. Needleman IG, Worthington HV, Giedrys-Leeper E, Tucker RJ (2006) Guided tissue regeneration for periodontal infra-bony defects. Cochrane Database Syst Rev CD001724. https://doi.org/10.1002/14651858.CD001724.pub2

  19. Murphy KG, Gunsolley JC (2003) Guided tissue regeneration for the treatment of periodontal intrabony and furcation defects. A systematic review. Ann Periodontol 8:266–302. https://doi.org/10.1902/annals.2003.8.1.266

    Article  PubMed  Google Scholar 

  20. Aichelmann-Reidy ME, Reynolds MA (2008) Predictability of clinical outcomes following regenerative therapy in intrabony defects. J Periodontol 79:387–393. https://doi.org/10.1902/jop.2008.060521

    Article  PubMed  Google Scholar 

  21. Corbella S, Weinstein R, Francetti L, Taschieri S, Del Fabbro M (2017) Periodontal regeneration in aggressive periodontitis patients: a systematic review of the literature. J Investig Clin Dent 8. https://doi.org/10.1111/jicd.12245

  22. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012. https://doi.org/10.1016/j.jclinepi.2009.06.005

    Article  PubMed  Google Scholar 

  23. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  PubMed  Google Scholar 

  24. Buchmann R, Nunn ME, Van Dyke TE, Lange DE (2002) Aggressive periodontitis: 5-year follow-up of treatment. J Periodontol 73:675–683. https://doi.org/10.1902/jop.2002.73.6.675

    Article  PubMed  Google Scholar 

  25. Machtei EE, Oettinger-Barak O, Peled M (2003) Guided tissue regeneration in smokers: effect of aggressive anti-infective therapy in class II furcation defects. J Periodontol 74:579–584. https://doi.org/10.1902/jop.2003.74.5.579

    Article  PubMed  Google Scholar 

  26. Schincaglia GP, Hebert E, Farina R, Simonelli A, Trombelli L (2015) Single versus double flap approach in periodontal regenerative treatment. J Clin Periodontol 42:557–566. https://doi.org/10.1111/jcpe.12409

    Article  PubMed  Google Scholar 

  27. Zucchelli G, Brini C, De Sanctis M (2002) GTR treatment of intrabony defects in patients with early-onset and chronic adult periodontitis. Int J Periodontics Restorative Dent 22:323–333

    PubMed  Google Scholar 

  28. Sant'Ana AC, Passanezi E, Todescan SM, de Rezende ML, Greghi SL, Ribeiro MG (2009) A combined regenerative approach for the treatment of aggressive periodontitis: long-term follow-up of a familial case. Int J Periodontics Restorative Dent 29:69–79

    PubMed  Google Scholar 

  29. Vandana KL, Shah K, Prakash S (2004) Clinical and radiographic evaluation of emdogain as a regenerative material in the treatment of interproximal vertical defects in chronic and aggressive periodontitis patients. Int J Periodont Rest 24:185–191

    Google Scholar 

  30. Gupta G (2014) Clinical and radiographic evaluation of intra-bony defects in localized aggressive periodontitis patients with platelet rich plasma/hydroxyapatite graft: a comparative controlled clinical trial. Contemp Clin Dent 5:445–451. https://doi.org/10.4103/0976-237X.142806

    Article  PubMed  PubMed Central  Google Scholar 

  31. Evans GH, Yukna RA, Sepe WW, Mabry TW, Mayer ET (1989) Effect of various graft materials with tetracycline in localized juvenile periodontitis. J Periodontol 60:491–497. https://doi.org/10.1902/jop.1989.60.9.491

    Article  PubMed  Google Scholar 

  32. Mengel R, Soffner M, Flores-de-Jacoby L (2003) Bioabsorbable membrane and bioactive glass in the treatment of intrabony defects in patients with generalized aggressive periodontitis: results of a 12-month clinical and radiological study. J Periodontol 74:899–908. https://doi.org/10.1902/jop.2003.74.6.899

    Article  PubMed  Google Scholar 

  33. Queiroz AC, Nobrega PB, Oliveira FS, Novaes AB Jr, Taba M Jr, Palioto DB, Grisi MF, Souza SL (2013) Treatment of intrabony defects with anorganic bone matrix/p-15 or guided tissue regeneration in patients with aggressive periodontitis. Braz Dent J 24:204–212. https://doi.org/10.1590/0103-6440201302169

    Article  PubMed  Google Scholar 

  34. Artzi Z, Tal H, Platner O, Wasersprung N, Weinberg E, Slutzkey S, Gozali N, Carmeli G, Herzberg R, Kozlovsky A (2015) Deproteinized bovine bone in association with guided tissue regeneration or enamel matrix derivatives procedures in aggressive periodontitis patients: a 1-year retrospective study. J Clin Periodontol 42:547–556. https://doi.org/10.1111/jcpe.12413

    Article  PubMed  Google Scholar 

  35. Sirirat M, Kasetsuwan J, Jeffcoat MK (1996) Comparison between 2 surgical techniques for the treatment of early-onset periodontitis. J Periodontol 67:603–607. https://doi.org/10.1902/jop.1996.67.6.603

    Article  PubMed  Google Scholar 

  36. Kumar PG, Kumar JA, Anumala N, Reddy KP, Avula H, Hussain SN (2011) Volumetric analysis of intrabony defects in aggressive periodontitis patients following use of a novel composite alloplast: a pilot study. Quintessence Int 42:375–384

    PubMed  Google Scholar 

  37. Bajaj P, Agarwal E, Rao NS, Naik SB, Pradeep AR, Kalra N, Priyanka N, Kumari M (2017) Autologous platelet-rich fibrin in the treatment of 3-wall intrabony defects in aggressive periodontitis: a randomized controlled clinical trial. J Periodontol 88:1186–1191. https://doi.org/10.1902/jop.2017.120661

    Article  PubMed  Google Scholar 

  38. DiBattista P, Bissada NF, Ricchetti PA (1995) Comparative effectiveness of various regenerative modalities for the treatment of localized juvenile periodontitis. J Periodontol 66:673–678. https://doi.org/10.1902/jop.1995.66.8.673

    Article  PubMed  Google Scholar 

  39. Rakmanee T, Griffiths GS, Auplish G, Darbar U, Petrie A, Olsen I, Donos N (2016) Radiographic outcomes following treatment of intrabony defect with guided tissue regeneration in aggressive periodontitis. Clin Oral Investig 20:1227–1235. https://doi.org/10.1007/s00784-015-1609-y

    Article  PubMed  Google Scholar 

  40. Rakmanee T, Griffiths GS, Auplish G, Darbar U, Petrie A, Olsen I, Donos N (2016) Treatment of intrabony defects with guided tissue regeneration in aggressive periodontitis: clinical outcomes at 6 and 12 months. Clin Oral Investig 20:1217–1225. https://doi.org/10.1007/s00784-015-1608-z

    Article  PubMed  Google Scholar 

  41. Cortellini P, Prato GP, Tonetti MS (1999) The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. Int J Periodontics Restorative Dent 19:589–599

    PubMed  Google Scholar 

  42. Ramfjord SP, Nissle RR (1974) The modified Widman flap. J Periodontol 45:601–607. https://doi.org/10.1902/jop.1974.45.8.2.601

    Article  PubMed  Google Scholar 

  43. Kornman KS, Robertson PB (2000) Fundamental principles affecting the outcomes of therapy for osseous lesions. Periodontol 2000(22):22–43

    Article  Google Scholar 

  44. Tonetti MS, Prato GP, Cortellini P (1996) Factors affecting the healing response of intrabony defects following guided tissue regeneration and access flap surgery. J Clin Periodontol 23:548–556

    Article  PubMed  Google Scholar 

  45. Tonetti MS, Pini-Prato G, Cortellini P (1993) Periodontal regeneration of human intrabony defects. IV. Determinants of healing response. J Periodontol 64:934–940. https://doi.org/10.1902/jop.1993.64.10.934

    Article  PubMed  Google Scholar 

  46. Cortellini P, Tonetti MS (2000) Focus on intrabony defects: guided tissue regeneration. Periodontol 2000(22):104–132

    Article  Google Scholar 

  47. Cortellini P, Tonetti MS (2009) Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects. J Clin Periodontol 36:157–163. https://doi.org/10.1111/j.1600-051X.2008.01352

    Article  PubMed  Google Scholar 

  48. Rasperini G, Acunzo R, Barnett A, Pagni G (2013) The soft tissue wall technique for the regenerative treatment of non-contained infrabony defects. Int J Periodontics Restorative Dent 33:e79–e87. https://doi.org/10.11607/prd.1628

    Article  PubMed  Google Scholar 

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Acknowledgements

This research is part of the doctoral thesis “Meta-analysis and retrospective study in Aggressive Periodontitis” conducted by Lucía Díaz-Faes (PhD Program in Clinical Medicine and Public Health, University of Granada, Spain).

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Authors and Affiliations

  1. Department of Periodontics, Faculty of Dentistry, University of Granada, Granada, Spain

    Lucía Díaz-Faes, Antonio Magán-Fernández & Francisco Mesa

  2. Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain

    Ana Fernández-Somoano

  3. Biomedical Research Consortium in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain

    Ana Fernández-Somoano

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  1. Lucía Díaz-Faes
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  2. Ana Fernández-Somoano
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Correspondence to Lucía Díaz-Faes.

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Díaz-Faes, L., Fernández-Somoano, A., Magán-Fernández, A. et al. Efficacy of regenerative therapy in aggressive periodontitis: a systematic review and meta-analysis of randomised controlled clinical trials. Clin Oral Invest 24, 1369–1378 (2020). https://doi.org/10.1007/s00784-020-03237-0

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