Systematic review and sequential network meta‐analysis on the efficacy of periodontal regenerative therapies

Aims We aimed to update a previous network meta‐analysis comparing the efficacy of periodontal regenerative therapies on the treatment of infrabony lesions. Materials and Methods Seven clinical trials were added after literature research for studies published between January 2011 and September 2019....

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Bibliographic Details
Published in:Journal of clinical periodontology 2020-09, Vol.47 (9), p.1108-1120
Main Authors: Tsai, Shang‐Jie, Ding, Yu‐Wei, Shih, Ming‐Chieh, Tu, Yu‐Kang
Format: Article
Language:English
Subjects:
Alveolar Bone Loss - surgery
Bone grafts
Bone Transplantation
Clinical trials
Dental enamel
Dental Enamel Proteins - therapeutic use
Dentistry
enamel matrix derivatives
Follow-Up Studies
guided tissue regeneration
Guided Tissue Regeneration, Periodontal
Humans
Meta-analysis
Network Meta-Analysis
Periodontal Attachment Loss - surgery
periodontal regenerative therapies
Regeneration
sequential network meta‐analysis
Treatment Outcome
trial sequential analysis
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Summary:Aims We aimed to update a previous network meta‐analysis comparing the efficacy of periodontal regenerative therapies on the treatment of infrabony lesions. Materials and Methods Seven clinical trials were added after literature research for studies published between January 2011 and September 2019. We conducted network meta‐analysis (NMA) to compare the effects of guided tissue regeneration (GTR), enamel matrix derivatives (EMD) and their combination therapies on probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain. Sequential network meta‐analysis (SNMA) was also used to control the type‐I error rate due to multiple testing. Results A total of 60 studies were included. For both PPD reduction and CAL gain, the flap operation (FO) was the least effective treatment. Although the differences between periodontal regenerative therapies were small, GTR attained the greatest reduction in PPD, and EMD with bone graft the greatest CAL gain compared to other therapies. SNMA used stricter efficacy criteria, yielding slightly different results from NMA. Conclusions EMD, GTR, and their combined therapies were more effective than flap operation, although the differences between regenerative therapies remain small in this updated study. SNMA reduces the risk of false‐positive findings, thereby providing more robust evidence on the superiority of treatments.
ISSN:0303-6979
1600-051X
DOI:10.1111/jcpe.13338