Cochrane · intervention · CD001724
Guided tissue regeneration for periodontal infra-bony defects
Cochrane Database of Systematic Reviews · 2006 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
18
current version
GRADE rated
0
No studies
4
Included studies
17
as reported
No studies 4 · 22.2%Ungraded 14 · 77.8%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with chronic periodontitis (aged 21 years or older) with periodontal infra-bony defects; furcation-involved teeth and aggressive periodontitis excluded | Age range of included studies 21 to 81 years; both sexes in all studies; one study with majority smokers (21 of 38) |
| Intervention | Guided tissue regeneration (GTR) alone; GTR combined with bone substitutes | GTR alone (n=16 studies); GTR + bone substitutes (n=2 studies) |
| Comparison | Open flap debridement (access flap surgery) | Open flap debridement (n=17) |
| Outcomes | Primary: tooth loss; change in attachment levels; patient well-being or quality of life. Secondary: change in probing depths; change in gingival recession; changes in bone/hard tissue (radiographic; hard tissue probing at surgical re-entry); disease recurrence; percentage of sites with <=4 mm probing depth at completion; aesthetics; post-operative complications; economic outcomes | Attachment level change (n=16); sites failing to gain 2 mm attachment (n=6); probing depth reduction (n=11); gingival recession (n=9); radiographic bone change (n=2); hard tissue probing at re-entry (n=3); tooth loss (n=17, none reported); adverse effects/membrane exposure (n=16); patient morbidity/pain (n=1); treatment time (n=1) |
| Study designs | Randomised controlled trials of at least 12 months duration | 8 parallel-group and 8 split-mouth RCTs (two studies with both elements); 17 total |
| Timing | At least 12 months duration | 12 months minimum follow-up |
Search date: 2004-04. Databases: Cochrane Oral Health Group Trials Register; MEDLINE; EMBASE; Journal of Periodontology; Journal of Clinical Periodontology; Journal of Periodontal Research
Questions and results
Current version onlyGuided tissue regeneration (GTR) with barrier membrane (resorbable or non-resorbable) vs Open flap debridement (access flap surgery)
Population: Patients with chronic periodontitis (aged 21 years or older) with periodontal infra-bony defects; furcation-involved teeth and aggressive periodontitis excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cost/benefit (treatment time plus estimated material costs) | No data were found for this outcome (listed under 'Other outcomes: No data were found for the following outcomes'). | 0 studies | No studies |
Aesthetics (patient's opinion) | No data were found for this outcome (listed under 'Other outcomes: No data were found for the following outcomes'). | 0 studies | No studies |
Change in clinical attachment level (attachment gain) >=12 months | MD 1.22 [0.80, 1.64] | 16 studies | Ungraded |
Hard tissue probing at surgical re-entry (bone gain) >=12 months | MD 1.39 [1.08, 1.71] | 3 studies | Ungraded |
Tooth loss | No tooth loss was reported in any study although these data are incomplete where patient follow-up was not complete (no events; no estimable effect). | 17 studies | Ungraded |
Treatment / surgical procedure time | MD 23.9 | 1 study | Ungraded |
Radiographic bone change >=12 months | Radiographic data was contained in two studies. Mayfield 1998 showed 0.6 mm gain in bone from the base of the defect in both test and control groups; Ratka-Kruger 2000 reported descriptively that only minute changes in… | 2 studies | Ungraded |
Change in gingival recession >=12 months | MD 0.26 [0.08, 0.43] | 9 studies | Ungraded |
Sites failing to gain 2 mm attachment (proportion) >=12 months | RR 0.54 [0.31, 0.96] | 6 studies | Ungraded |
Change in probing depth (probing depth reduction) >=12 months | MD 1.21 [0.53, 1.88] | 11 studies | Ungraded |
Disease recurrence (% sites with >=2 mm loss of probing attachment from 12 months after treatment) | No data were found for this outcome (listed under 'Other outcomes: No data were found for the following outcomes'). | 0 studies | No studies |
Ease of maintenance (% of sites with <4 mm probing depth) | No data were found for this outcome (listed under 'Other outcomes: No data were found for the following outcomes'). | 0 studies | No studies |
Patient well-being / quality of life | Cortellini 2001: 36% of GTR patients reported the procedure interfered with daily activity for an average of 2.7 days versus 32% of controls for an average of 2.4 days; no significant difference for postoperative pain… | 1 study | Ungraded |
Post-operative complications / adverse effects (including pain, infection) | Adverse effects were generally minor. Healing was generally uneventful for both test and control groups. Exposure of the GTR barrier membrane was widely reported, ranging from 20% of sites (non-resorbable… | 16 studies | Ungraded |
Guided tissue regeneration (GTR) combined with bone substitutes/graft vs Open flap debridement (access flap surgery)
Population: Patients with chronic periodontitis (aged 21 years or older) with periodontal infra-bony defects; furcation-involved teeth and aggressive periodontitis excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Hard tissue probing at surgical re-entry (bone gain) >=12 months | MD 3.37 [3.14, 3.61] | 1 study | Ungraded |
Change in clinical attachment level (attachment gain) >=12 months | MD 1.25 [0.89, 1.61] | 2 studies | Ungraded |
Change in probing depth (probing depth reduction) >=12 months | MD 1.24 [0.89, 1.59] | 2 studies | Ungraded |
Change in gingival recession >=12 months | MD -0.33 [-0.43, -0.23] | 1 study | Ungraded |
Guided tissue regeneration (GTR) with barrier membrane (resorbable or non-resorbable) vs Open flap debridement (access flap surgery)
Population: Patients with chronic adult periodontitis (aged 21 years or older) with periodontal infra-bony defects; furcation-involved teeth and early-onset periodontitis excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Radiographic bone change >=12 months | Radiographic data was contained in only one study (Mayfield 1998). This showed 0.6 mm gain in bone from the base of the defect in both test and control groups (no difference; no pooled estimate). | 1 study | Ungraded |
Cost/benefit (treatment time plus estimated material costs) | No data were found for this outcome (listed under 'Other outcomes: No data were found for the following outcomes'). | 0 studies | No studies |
Change in probing depth (probing depth reduction) >=12 months | MD 0.80 [0.14, 1.46] | 5 studies | Ungraded |
Change in gingival recession >=12 months | MD -0.06 [-0.33, 0.20] | 3 studies | Ungraded |
Aesthetics (patient's opinion) | No data were found for this outcome (listed under 'Other outcomes: No data were found for the following outcomes'). | 0 studies | No studies |
Post-operative complications / adverse effects (including pain, infection) | No data were found for this outcome (listed under 'Other outcomes: No data were found for the following outcomes'). | 0 studies | No studies |
Hard tissue probing at surgical re-entry (bone gain) >=12 months | MD 1.39 [1.08, 1.71] | 3 studies | Ungraded |
Patient well-being / quality of life | No data were found for this outcome (listed under 'Other outcomes: No data were found for the following outcomes'). | 0 studies | No studies |
Ease of maintenance (% of sites with <4 mm probing depth) | No data were found for this outcome (listed under 'Other outcomes: No data were found for the following outcomes'). | 0 studies | No studies |
Sites failing to gain 2 mm attachment (proportion) >=12 months | RR 0.58 [0.38, 0.88] | 4 studies · 255 participants | Ungraded |
Change in clinical attachment level (attachment gain) >=12 months | MD 1.11 [0.63, 1.59] | 10 studies | Ungraded |
Disease recurrence (% sites with >=2 mm loss of probing attachment from 12 months after treatment) | No data were found for this outcome (listed under 'Other outcomes: No data were found for the following outcomes'). | 0 studies | No studies |
Tooth loss | No data were found for this outcome (listed under 'Other outcomes: No data were found for the following outcomes'). | 0 studies | No studies |
Guided tissue regeneration (GTR) combined with bone substitutes/graft vs Open flap debridement (access flap surgery)
Population: Patients with chronic adult periodontitis (aged 21 years or older) with periodontal infra-bony defects; furcation-involved teeth and early-onset periodontitis excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in clinical attachment level (attachment gain) >=12 months | MD 1.25 [0.89, 1.61] | 2 studies | Ungraded |
Change in gingival recession >=12 months | MD -0.33 [-0.43, -0.23] | 1 study | Ungraded |
Change in probing depth (probing depth reduction) >=12 months | MD 1.24 [0.89, 1.59] | 2 studies | Ungraded |
Hard tissue probing at surgical re-entry (bone gain) >=12 months | MD 3.37 [3.14, 3.61] | 1 study | Ungraded |