Jepsen, S;
Gennai, S;
Hirschfeld, J;
Kalemaj, Z;
Buti, J;
Graziani, F;
(2020)
Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta‐analysis of randomized clinical trials.
Journal of Clinical Periodontology
, 47
(S22)
pp. 352-374.
10.1111/jcpe.13238.
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Abstract
AIMS: To investigate the clinical performance of regenerative periodontal surgery in the treatment of furcation defects versus open flap debridement (OFD) and to compare different regenerative modalities. MATERIAL AND METHODS: A systematic search was conducted to identify RCTs evaluating regenerative surgical treatment of furcations with a minimum of 12-months follow-up. Three authors independently reviewed, selected and extracted data from the search conducted and assessed risk of bias. Primary outcomes were tooth loss, furcation improvement (closure/conversion) (FImp), gain of horizontal bone level (HBL) and attachment level (HCAL). Secondary outcomes were gain in vertical attachment level (VCAL), probing pocket depth (PPD) reduction, PROMs and adverse events. Data were summarized into Bayesian Standard and Network Meta-Analysis in order to estimate direct and indirect treatment effects and to establish a ranking of treatments. RESULTS: The search identified 19 articles, reporting on 20 RCTs (19 on class II, 1 on class III furcations) with a total of 575 patients/787 defects. Tooth loss was not reported. Furcation closure ranged between 0% - 60% (10 trials), and class I conversion from 29% -100% (6 trials). Regenerative techniques were superior to OFD for FImp (OR = 20.9; 90% Crl = 5.81, 69.41), HCAL gain (1.6 mm), VCAL gain (1.3 mm), and PPD reduction (1.3 mm). Bone replacement grafts (BRG) resulted in the highest probability (Pr = 61%) of being the best treatment for HBL gain. Non-resorbable membranes + BRG ranked as the best treatment for VCAL gain (Pr = 75%) and PPD reduction (Pr = 56%). CONCLUSIONS: Regenerative surgery of class II furcations is superior to OFD. FImp (furcation closure or class I conversion) can be expected for the majority of defects. Treatment modalities involving BRG are associated with higher performance.
| Type: | Article |
|---|---|
| Title: | Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta‐analysis of randomized clinical trials |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/jcpe.13238 |
| Publisher version: | https://doi.org/10.1111/jcpe.13238 |
| Language: | English |
| Additional information: | This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Periodontitis, furcation defect, meta-analysis, periodontal regeneration, systematic review |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Eastman Dental Institute UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Eastman Dental Institute > Restorative Dental Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10088642 |
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