Department of Oral Biology, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi, Pakistan.
College of Medicine and Dentistry, MClinDent in Periodontology, Birmingham, UK. Email:
J Int Acad Periodontol. 2021 Jan 1;23(1):31-56.
To determine the differences in the long-term clinical outcomes between Regeneration (REG) and Conservative Surgery (CS) in infra-bony defects.
Three databases were searched [PubMed, Medline and Embase] up to April 2019. Following screening, 17 studies were included. Randomized Controlled Clinical Trials, Controlled Clinical Trials and retrospective studies with long-term clinical observations (≥ 24-months) were selected. After subgrouping the studies regarding the grafting material and the used flap, meta-analysis was performed for different outcomes [clinical attachment level gain (CALGain), probing pocket depth reduction (PPDRed), recession increase (RECInc) and bone fill (BF)] at different follow-ups (24-, 36-, 48- to 60- and 120- to 240-months).
The time-related meta-analysis favoured REG at every interval for every outcome. In subgroup analysis, enamel matrix derivative (EMD) performed significantly better for both CALGain [24- (p less than 0.0001), 36- (p=0.02) and 60-months (p less than 0.00001)] and PPDRed [24- (p=0.0004), 36- (p=0.003) and 60-months (p less than 0.00001)]. For Ceramic Grafts (CGs), CALGain at 48-months (p less than 0.00001) and PPDRed at 24- (p=0.0006), 36- (p less than 0.00001) and 48-months (p less than 0.00001) follow-up showed better results.
The better outcomes from REG using EMD or CGs can be maintained for a longer duration, suggesting a potential longevity of the occurred healing.
确定再生（REG）和保守手术（CS）治疗骨下缺损的长期临床结果差异。
检索了三个数据库[PubMed、Medline 和 Embase]，截至 2019 年 4 月。筛选后，纳入了 17 项研究。选择了随机对照临床试验、对照临床试验和具有长期临床观察（≥24 个月）的回顾性研究。根据移植物材料和使用的皮瓣对研究进行分组后，对不同结果[临床附着水平增加（CALGain）、探诊袋深度减少（PPDRed）、退缩增加（RECInc）和骨填充（BF）]在不同随访时间（24、36、48-60 和 120-240 个月）进行了荟萃分析。
时间相关的荟萃分析表明，REG 在每个时间点对每个结果都有优势。在亚组分析中，釉基质衍生物（EMD）在 CALGain[24-（p 小于 0.0001）、36-（p=0.02）和 60 个月（p 小于 0.00001）]和 PPDRed[24-（p=0.0004）、36-（p=0.003）和 60 个月（p 小于 0.00001）]方面的表现明显更好。对于陶瓷移植物（CGs），48 个月时的 CALGain（p 小于 0.00001）和 24-、36-和 48 个月时的 PPDRed（p 小于 0.00001）的结果更好。
使用 EMD 或 CGs 的 REG 可获得更好的结果，并能维持更长的时间，这表明发生的愈合具有潜在的长期效果。
