Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta‐analysis
Background A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In a...
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| Vydané v: | Journal of periodontology (1970) Ročník 93; číslo 12; s. 1803 - 1826 |
|---|---|
| Hlavní autori: | , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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United States
01.12.2022
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| ISSN: | 0022-3492, 1943-3670, 1943-3670 |
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| Abstract | Background
A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood‐dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet‐derived growth factor‐BB (rhPDGF‐BB), on the regenerative outcomes of infrabony defects.
Methods
A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed‐modeling approach to network meta‐analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration.
Results
A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet‐rich fibrin [PRF], platelet‐rich plasma [PRP] or rhPDGF‐BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF‐BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF‐BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF‐BB was deemed in favor.
Conclusions
Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects. |
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| AbstractList | Background
A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood‐dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet‐derived growth factor‐BB (rhPDGF‐BB), on the regenerative outcomes of infrabony defects.
Methods
A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed‐modeling approach to network meta‐analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration.
Results
A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet‐rich fibrin [PRF], platelet‐rich plasma [PRP] or rhPDGF‐BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF‐BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF‐BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF‐BB was deemed in favor.
Conclusions
Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects. A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects.BACKGROUNDA large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects.A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration.METHODSA detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration.A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor.RESULTSA total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor.Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.CONCLUSIONSBiologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects. A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects. A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration. A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor. Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects. |
| Author | Chen, Chia‐Yu (Jennifer) Kim, David M. Barootchi, Shayan Tavelli, Lorenzo |
| Author_xml | – sequence: 1 givenname: Lorenzo orcidid: 0000-0003-4864-3964 surname: Tavelli fullname: Tavelli, Lorenzo organization: Harvard School of Dental Medicine – sequence: 2 givenname: Chia‐Yu (Jennifer) orcidid: 0000-0003-3829-1256 surname: Chen fullname: Chen, Chia‐Yu (Jennifer) organization: Harvard School of Dental Medicine – sequence: 3 givenname: Shayan orcidid: 0000-0002-5347-6577 surname: Barootchi fullname: Barootchi, Shayan organization: University of Michigan School of Dentistry – sequence: 4 givenname: David M. surname: Kim fullname: Kim, David M. email: dkim@hsdm.harvard.edu organization: Harvard School of Dental Medicine |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36279121$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | 2022 American Academy of Periodontology. |
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| ISSN | 0022-3492 1943-3670 |
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| Issue | 12 |
| Keywords | infrabony defects periodontal regeneration bone grafts gingival recession growth factors |
| Language | English |
| License | 2022 American Academy of Periodontology. |
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| PublicationTitle | Journal of periodontology (1970) |
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| PublicationYear | 2022 |
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Part A: intra‐bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta‐analysis publication-title: J Clin Periodontol – volume: 9 start-page: 100 year: 2015 end-page: 108 article-title: Evaluation of intrabony defects treated with platelet‐rich fibrin or autogenous bone graft: a comparative analysis publication-title: Eur J Dent – volume: 15 start-page: 225 year: 2011 end-page: 232 article-title: Comparative study of DFDBA in combination with enamel matrix derivative versus DFDBA alone for treatment of periodontal intrabony defects at 12 months post‐surgery publication-title: Clin Oral Investig – volume: 74 start-page: 1725 year: 2003 end-page: 1735 article-title: Enamel matrix proteins and bovine porous bone mineral in the treatment of intrabony defects: a comparative controlled clinical trial publication-title: J Periodontol – volume: 73 start-page: 3 year: 2002 end-page: 12 article-title: Enamel matrix proteins and guided tissue regeneration with titanium‐reinforced expanded polytetrafluoroethylenemembranes in the treatment of infrabony defects: a comparative controlled clinical trial publication-title: J Periodontol – volume: 72 start-page: 1695 year: 2001 end-page: 1701 article-title: Treatment of intrabony defects with enamel matrix proteins or bioabsorbable membranes. A 4‐year follow‐up split‐mouth study publication-title: J Periodontol – volume: 73 start-page: 433 year: 2002 end-page: 440 article-title: Clinical comparison of an enamel matrix derivative used alone or in combination with a bovine‐derived xenograft for the treatment of periodontal osseous defects in humans publication-title: J Periodontol – volume: 81 start-page: 1411 year: 2010 end-page: 1418 article-title: The combined use of Nd: yAG laser and enamel matrix proteins in the treatment of periodontal infrabony defects publication-title: J Periodontol – volume: 6 start-page: S153 year: 2016 end-page: 159 article-title: Efficacy of platelet rich fibrin in the treatment of human intrabony defects with or without bone graft: a randomized controlled trial publication-title: J Int Soc Prev Community Dent – volume: 15 start-page: 900 year: 2021 end-page: 914 article-title: Recombinant Human Derived Growth and Differentiating Factors in treatment of periodontal intrabony defects: systematic review and network meta‐analysis publication-title: J Tissue Eng Regen Med – volume: 26 start-page: 833 year: 1999 end-page: 840 article-title: The use of barrier membranes and enamel matrix proteins in the treatment of angular bone defects. A prospective controlled clinical study publication-title: J Clin Periodontol – volume: 79 start-page: 811 year: 2008 end-page: 818 article-title: Tissue‐engineered cultured periosteum used with platelet‐rich plasma and hydroxyapatite in treating human osseous defects publication-title: J Periodontol – volume: 15 start-page: 382 year: 2004 end-page: 402 article-title: The use of enamel matrix derivative in the treatment of periodontal defects: a literature review and meta‐analysis publication-title: Crit Rev Oral Biol Med – volume: 28 start-page: 181 year: 2001 end-page: 188 article-title: Autocrine growth factors in human periodontal ligament cells cultured on enamel matrix derivative publication-title: J Clin Periodontol – volume: 134 start-page: 178 year: 2021 end-page: 189 article-title: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews publication-title: J Clin Epidemiol – volume: 34 start-page: 254 year: 2007 end-page: 261 article-title: Effect of platelet‐rich plasma on the healing of intra‐bony defects treated with a natural bone mineral and a collagen membrane publication-title: J Clin Periodontol – volume: 84 start-page: 1546 year: 2013 end-page: 1555 article-title: Five‐year results evaluating the effects of platelet‐rich plasma on the healing of intrabony defects treated with enamel matrix derivative and natural bone mineral publication-title: J Periodontol – volume: 44 start-page: 422 year: 2018 end-page: 428 article-title: Network meta‐analysis, a new statistical technique at urologists' disposal to improve decision making publication-title: Int Braz J Urol – volume: 162 start-page: 777 year: 2015 end-page: 784 article-title: The PRISMA extension statement for reporting of systematic reviews incorporating network meta‐analyses of health care interventions: checklist and explanations publication-title: Ann Intern Med – volume: 7 start-page: 32 year: 2015 end-page: 37 article-title: Comparative evaluation of platelet‐rich fibrin biomaterial and open flap debridement in the treatment of two and three wall intrabony defects publication-title: J Int Oral Health – volume: 86 start-page: S105 year: 2015 end-page: 107 article-title: Periodontal regeneration – intrabony defects: a consensus report from the AAP Regeneration Workshop publication-title: J Periodontol – volume: 12 start-page: 764 year: 2015 end-page: 773 article-title: Treatment of intrabony defects by DFDBA alone or in combination with PRP: a split‐mouth randomized clinical and three‐dimensional radiographic trial publication-title: J Dent (Tehran) – volume: 83 start-page: 1499 year: 2012 end-page: 1507 article-title: Comparative evaluation of autologous platelet‐rich fibrin and platelet‐rich plasma in the treatment of 3‐wall intrabony defects in chronic periodontitis: a randomized controlled clinical trial publication-title: J Periodontol – volume: 66 start-page: 75 year: 2022 end-page: 85 article-title: The Evolution of Surgical Techniques and Biomaterials for Periodontal Regeneration publication-title: Dent Clin North Am – volume: 31 start-page: 545 year: 2004 end-page: 549 article-title: Five‐year results following treatment of intrabony defects with enamel matrix proteins and guided tissue regeneration publication-title: J Clin Periodontol – volume: 11 start-page: Zc09 year: 2017 end-page: zc13 article-title: Comparative Evaluation of Bioactive Glass Putty and Platelet Rich Fibrin in the Treatment of Human Periodontal Intrabony Defects: a Randomized Control Trial publication-title: J Clin Diagn Res – year: 2021 article-title: Treatment of periodontal intrabony defects using bovine porous bone mineral and guided tissue regeneration with/without platelet‐rich fibrin: a randomized controlled clinical trial publication-title: J Periodontol – volume: 46 start-page: 231 year: 2019 end-page: 240 article-title: Enamel matrix derivative stabilizes blood clot and improves clinical healing in deep pockets after flapless periodontal therapy: a Randomized Clinical Trial publication-title: J Clin Periodontol – volume: 43 start-page: 955 year: 2016 end-page: 964 article-title: Evaluation of the adjunctive effect of platelet‐rich fibrin to enamel matrix derivative in the treatment of intrabony defects. Six‐month results of a randomized, split‐mouth, controlled clinical study publication-title: J Clin Periodontol – volume: 19 start-page: 61 year: 2015 end-page: 65 article-title: Clinical and radiographic evaluation of nanocrystalline hydroxyapatite with or without platelet‐rich fibrin membrane in the treatment of periodontal intrabony defects publication-title: J Indian Soc Periodontol – volume: 8 start-page: 205 year: 2017 end-page: 210 article-title: Comparative evaluation of the efficacy of platelet‐rich fibrin and calcium phosphosilicate putty alone and in combination in the treatment of intrabony defects: a randomized clinical and radiographic study publication-title: Contemp Clin Dent – volume: 64 start-page: 128 year: 2018 end-page: 132 article-title: Comparing interventions with network meta‐analysis publication-title: J Physiother – volume: 34 start-page: 507 year: 2007 end-page: 513 article-title: Four‐year results of a prospective‐controlled clinical study evaluating healing of intra‐bony defects following treatment with an enamel matrix protein derivative alone or combined with a bioactive glass publication-title: J Clin Periodontol – volume: 38 start-page: 163 year: 2011 end-page: 172 article-title: Multi‐centre, randomized clinical trial on the efficacy and safety of recombinant human platelet‐derived growth factor with β‐tricalcium phosphate in human intra‐osseous periodontal defects publication-title: J Clin Periodontol – volume: 45 start-page: 193 year: 2007 end-page: 201 article-title: Recombinant human platelet‐derived growth factor enhanced dermal wound healing by a pathway involving ERK and c‐fos in diabetic rats publication-title: J Dermatol Sci – volume: 12 start-page: 133 year: 2018 end-page: 154 article-title: Effectiveness of platelet rich plasma and bone graft in the treatment of intrabony defects: a clinico‐radiographic study publication-title: Open Dent J – volume: 85 start-page: 1351 year: 2014 end-page: 1360 article-title: Efficacy of enamel matrix derivative with freeze‐dried bone allograft or demineralized freeze‐dried bone allograft in intrabony defects: a randomized trial publication-title: J Periodontol – volume: 66 start-page: 261 year: 1995 end-page: 266 article-title: The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures publication-title: J Periodontol – volume: 87 start-page: 654 year: 2016 end-page: 662 article-title: Crevicular fluid growth factors release profile following the use of platelet‐rich fibrin and plasma rich growth factors in treating periodontal intrabony defects: a randomized clinical trial publication-title: J Periodontol – volume: 47 start-page: 1108 year: 2020 end-page: 1120 article-title: Systematic review and sequential network meta‐analysis on the efficacy of periodontal regenerative therapies publication-title: J Clin Periodontol – volume: 343 year: 2011 article-title: The Cochrane Collaboration's tool for assessing risk of bias in randomised trials publication-title: BMJ – volume: 10 start-page: 227 year: 2006 end-page: 234 article-title: Enamel matrix derivative alone or in combination with a bioactive glass in wide intrabony defects publication-title: Clin Oral Investig – volume: 76 start-page: 2205 year: 2005 end-page: 2215 article-title: Platelet‐derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial publication-title: J Periodontol – volume: 25 start-page: 461 year: 2005 end-page: 473 article-title: Evaluation of efficacy of enamel matrix derivative in the treatment of intrabony defects: a 24‐month multicenter study publication-title: Int J Periodontics Restorative Dent – volume: 38 start-page: 333 year: 2003 end-page: 342 article-title: The effects of enamel matrix derivative (EMD) on osteoblastic cells in culture and bone regeneration in a rat skull defect publication-title: J Periodontal Res – volume: 37 start-page: 825 year: 2017 end-page: 832 article-title: Comparative Study of rhPDGF‐BB Plus Equine‐Derived Bone Matrix Versus rhPDGF‐BB Plus β‐TCP in the Treatment of Periodontal Defects publication-title: Int J Periodontics Restorative Dent – volume: 92 start-page: 931 year: 2021 end-page: 946 article-title: Interproximal attachment gain: the challenge of periodontal regeneration publication-title: J Periodontol – volume: 35 start-page: 420 year: 2008 end-page: 428 article-title: Clinical outcomes after treatment of intra‐bony defects with an EMD/synthetic bone graft or EMD alone: a multicentre randomized‐controlled clinical trial publication-title: J Clin Periodontol – volume: 41 start-page: 125 year: 2010 end-page: 134 article-title: Treatment of infrabony defects with or without enamel matrix proteins: a 24‐month follow‐up randomized pilot study publication-title: Quintessence Int – volume: 90 start-page: 584 year: 2019 end-page: 594 article-title: Clinical and radiographic evaluation and comparison of bioactive bone alloplast morsels when used alone and in combination with platelet‐rich fibrin in the treatment of periodontal intrabony defects‐A randomized controlled trial publication-title: J Periodontol – volume: 84 start-page: 456 year: 2013 end-page: 464 article-title: Platelet‐derived growth factor promotes periodontal regeneration in localized osseous defects: 36‐month extension results from a randomized, controlled, double‐masked clinical trial publication-title: J Periodontol – volume: 73 start-page: 1593 year: 1994 end-page: 1600 article-title: Mitogenic and chemotactic responses of human periodontal ligament cells to the different isoforms of platelet‐derived growth factor publication-title: J Dent Res – volume: 84 start-page: 444 year: 2013 end-page: 455 article-title: Enamel matrix derivative, alone or associated with a synthetic bone substitute, in the treatment of 1‐ to 2‐wall periodontal defects publication-title: J Periodontol – volume: 87 start-page: 1253 year: 2016 end-page: 1260 article-title: Clinical and Radiographic Evaluation of Demineralized Freeze‐Dried Bone Allograft Versus Platelet‐Rich Fibrin for the Treatment of Periodontal Intrabony Defects in Humans publication-title: J Periodontol – volume: 44 start-page: 225 year: 2017 end-page: 234 article-title: Regenerative potential of leucocyte‐ and platelet‐rich fibrin. Part B: sinus floor elevation, alveolar ridge preservation and implant therapy. A systematic review publication-title: J Clin Periodontol – volume: 35 start-page: 147 year: 2008 end-page: 156 article-title: Enamel matrix derivative and low‐level laser therapy in the treatment of intra‐bony defects: a randomized placebo‐controlled clinical trial publication-title: J Clin Periodontol – volume: 85 start-page: 1342 year: 2014 end-page: 1350 article-title: Clinical outcomes following regenerative therapy of non‐contained intrabony defects using a deproteinized bovine bone mineral combined with either enamel matrix derivative or collagen membrane publication-title: J Periodontol – volume: 73 start-page: 3 year: 2002 end-page: 12 article-title: Enamel matrix proteins and guided tissue regeneration with titanium‐reinforced expanded polytetrafluoroethylene membranes in the treatment of infrabony defects: a comparative controlled clinical trial publication-title: J Periodontol – volume: 11 year: 2018 article-title: Autologous platelet concentrates for treating periodontal infrabony defects publication-title: The Cochrane database of systematic reviews – volume: 28 start-page: 1016 year: 2001 end-page: 1022 article-title: The effectiveness of enamel matrix proteins used in combination with bovine porous bone mineral in the treatment of intrabony defects in humans publication-title: J Clin Periodontol – volume: 87 start-page: 1427 year: 2016 end-page: 1435 article-title: Synergistic approach using platelet‐rich fibrin and 1% alendronate for intrabony defect treatment in chronic periodontitis: a randomized clinical trial publication-title: J Periodontol – volume: 13 start-page: 179 year: 2009 end-page: 187 article-title: Use of platelet‐rich plasma in periodontal surgery–a prospective randomised double blind clinical trial publication-title: Clin Oral Investig – volume: 76 start-page: 2236 year: 2005 end-page: 2243 article-title: Clinical evaluation of an enamel matrix protein derivative combined with either a natural bone mineral or beta‐tricalcium phosphate publication-title: J Periodontol – volume: 75 start-page: 1668 year: 2004 end-page: 1677 article-title: Treatment of intrabony defects with bovine‐derived xenograft alone and in combination with platelet‐rich plasma: a randomized clinical trial publication-title: J Periodontol – volume: 26 start-page: 415 year: 2006 end-page: 423 article-title: Vertical ridge augmentation by means of deproteinized bovine bone block and recombinant human platelet‐derived growth factor‐BB: a histologic study in a dog model publication-title: Int J Periodontics Restorative Dent – volume: 41 start-page: 1519 year: 2012 end-page: 1526 article-title: Torus mandibularis bone chips combined with platelet rich plasma gel for treatment of intrabony osseous defects: clinical and radiographic evaluation publication-title: Int J Oral Maxillofac Surg – volume: 15 start-page: 943 year: 2017 article-title: Network meta‐analysis: a technique to gather evidence from direct and indirect comparisons publication-title: Pharm Pract (Granada) – volume: 80 start-page: 219 year: 2009 end-page: 227 article-title: Enamel matrix derivative versus bioactive ceramic filler in the treatment of intrabony defects: 12‐month results publication-title: J Periodontol – volume: 80 start-page: 62 year: 2009 end-page: 71 article-title: Clinical effectiveness of autologous platelet‐rich plasma and Peptide‐enhanced bone graft in the treatment of intrabony defects publication-title: J Periodontol – volume: 37 start-page: 59 year: 2010 end-page: 79 article-title: Do bone grafts or barrier membranes provide additional treatment effects for infrabony lesions treated with enamel matrix derivatives? 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A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal... A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony... |
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| SubjectTerms | Alveolar Bone Loss - drug therapy Alveolar Bone Loss - surgery Becaplermin - therapeutic use Biological Products bone grafts gingival recession growth factors Guided Tissue Regeneration, Periodontal - methods Humans infrabony defects Periodontal Attachment Loss - surgery periodontal regeneration |
| Title | Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta‐analysis |
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