Non-Cochrane · intervention · PM41373090
The influence of flap design on the relevance of biomaterials in regenerative periodontal surgery.
Menhadji Payvand, Kansagra Neha, Nibali Luigi · Journal of periodontology · 2026 · PubMed · doi:10.1002/jper.70034
Findings
Population Adults with periodontitis and intrabony defects with residual pockets after non-surgical periodontal therapy
6 findings
| Access flap with biomaterials (GTR, EMD, growth factors, bone grafts or combinations) | Access flap alone (no biomaterial) | Clinical attachment level (CAL) gain 12 months | SMD 2.46 [0.37, 4.56] GRADE not reported 6 studies |
| Access flap with biomaterials (GTR, EMD, growth factors, bone grafts or combinations) | Access flap alone (no biomaterial) | Probing pocket depth (PPD) reduction 12 months | SMD 1.31 [-0.33, 2.96] GRADE not reported 6 studies |
| Papilla preservation flap with biomaterials (GTR, EMD, growth factors, bone grafts or combinations) | Papilla preservation flap alone (no biomaterial) | Probing pocket depth (PPD) reduction 12 months | SMD 1.86 [0.29, 3.42] GRADE not reported 17 studies |
| Papilla preservation flap with biomaterials (GTR, EMD, growth factors, bone grafts or combinations) | Papilla preservation flap alone (no biomaterial) | Clinical attachment level (CAL) gain 12 months | SMD 2.15 [0.59, 3.7] GRADE not reported 18 studies |
| Single-flap variant (M-MIST or entire papilla preservation) with biomaterials (EMD with or without bone substitute) | Single-flap variant alone (no biomaterial) | Probing pocket depth (PPD) reduction 12 months | SMD -0.08 [-0.5, 0.33] GRADE not reported 3 studies |
| Single-flap variant (M-MIST or entire papilla preservation) with biomaterials (EMD with or without bone substitute) | Single-flap variant alone (no biomaterial) | Clinical attachment level (CAL) gain 12 months | SMD -0.02 [-0.43, 0.39] GRADE not reported 3 studies |
Included primary studies 28
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Mazzonetto 2020 Clinical, radiographic, and patient‐centered outcomes after use of enamel matrix proteins for the treatment of intrabony defects in… DOI:10.1002/jper.20-0493 | 2020 | 2 other reviews | not stated | not extracted yet |
| Pham 2021 INTRABONY DEFECT TREATMENT WITH PLATELET-RICH FIBRIN, GUIDED TISSUE REGENERATION AND OPEN-FLAP DEBRIDEMENT: A RANDOMIZED CONTROLLED TRIAL DOI:10.1016/j.jebdp.2021.101545 | 2021 | 2 other reviews | not stated | not extracted yet |
| Apatzidou 2021 A tissue‐engineered biocomplex for periodontal reconstruction. A proof‐of‐principle randomized clinical study DOI:10.1111/jcpe.13474 | 2021 | 1 other review | not stated | not extracted yet |
| Aslan 2020 Clinical outcomes of the entire papilla preservation technique with and without biomaterials in the treatment of isolated intrabony… DOI:10.1111/jcpe.13255 | 2020 | 1 other review | not stated | not extracted yet |
| de Santana 2015 Human intrabony defect regeneration with rh <scp>FGF</scp> ‐2 and hyaluronic acid – a randomized controlled clinical trial DOI:10.1111/jcpe.12406 | 2015 | 1 other review | not stated | not extracted yet |
| Liu 2022 Efficacy of periodontal minimally invasive surgery with and without regenerative materials for treatment of intrabony defect: a randomized… DOI:10.1007/s00784-021-04134-w | 2021 | 1 other review | not stated | not extracted yet |
| Paolantonio 2010 Autogenous Periosteal Barrier Membranes and Bone Grafts in the Treatment of Periodontal Intrabony Defects of Single‐Rooted Teeth: A… DOI:10.1902/jop.2010.100094 | 2010 | 1 other review | not stated | not extracted yet |
| Briguglio 2013 DOI:10.3290/j.qi.a29054 | NR | this review only | not stated | not extracted yet |
| Cortellini 2001 Microsurgical Approach to Periodontal Regeneration. Initial Evaluation in a Case Cohort DOI:10.1902/jop.2001.72.4.559 | 2001 | this review only | not stated | not extracted yet |
| Cortellini 2011 Clinical and radiographic outcomes of the modified minimally invasive surgical technique with and without regenerative materials: a… DOI:10.1111/j.1600-051x.2011.01705.x | 2011 | this review only | not stated | not extracted yet |
| Cortellini 2022 Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials—10‐year follow‐up of a… DOI:10.1111/jcpe.13627 | 2022 | this review only | not stated | not extracted yet |
| De Leonardis 2013 Enamel Matrix Derivative, Alone or Associated With a Synthetic Bone Substitute, in the Treatment of 1‐ to 2‐Wall Periodontal Defects DOI:10.1902/jop.2012.110656 | 2013 | this review only | not stated | not extracted yet |
| Esposito 2015 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Francetti 2004 Enamel matrix proteins in the treatment of intra‐bony defects DOI:10.1111/j.0303-6979.2004.00437.x | 2003 | this review only | not stated | not extracted yet |
| Francetti 2005 Evaluation of efficacy of enamel matrix derivative in the treatment of intrabony defects: a 24-month multicenter study. PMID:16250568 | 2005 | this review only | not stated | not extracted yet |
| Heitz-Mayfield 2006 Microbial colonization patterns predict the outcomes of surgical treatment of intrabony defects DOI:10.1111/j.1600-051x.2005.00872.x | 2005 | this review only | not stated | not extracted yet |
| Linares 2006 Guided tissue regeneration/deproteinized bovine bone mineral or papilla preservation flaps alone for treatment of intrabony defects. II:… DOI:10.1111/j.1600-051x.2006.00911.x | 2006 | this review only | not stated | not extracted yet |
| Minenna 2005 Adjunctive effect of a polylactide/polyglycolide copolymer in the treatment of deep periodontal intra‐osseous defects: a randomized… DOI:10.1111/j.1600-051x.2005.00696.x | 2005 | this review only | not stated | not extracted yet |
| Paolantonio 2008 Surgical Treatment of Periodontal Intrabony Defects With Calcium Sulfate Implant and Barrier Versus Collagen Barrier or Open Flap… DOI:10.1902/jop.2008.080076 | 2008 | this review only | not stated | not extracted yet |
| Sculean 2004 Five‐year results following treatment of intrabony defects with enamel matrix proteins and guided tissue regeneration DOI:10.1111/j.1600-051x.2004.00518.x | 2004 | this review only | not stated | not extracted yet |
| Sculean 2005 Healing of intra‐bony defects following treatment with a composite bovine‐derived xenograft (Bio‐Oss Collagen) in combination with a… DOI:10.1111/j.1600-051x.2005.00758.x | 2005 | this review only | not stated | not extracted yet |
| Shirakata 2008 Comparison of Injectable Calcium Phosphate Bone Cement Grafting and Open Flap Debridement in Periodontal Intrabony Defects: A Randomized… DOI:10.1902/jop.2008.070141 | 2008 | this review only | not stated | not extracted yet |
| Slotte 2012 A Randomized Study of Open‐Flap Surgery of 32 Intrabony Defects With and Without Adjunct Bovine Bone Mineral Treatment DOI:10.1902/jop.2011.110490 | 2012 | this review only | not stated | not extracted yet |
| Stein 2009 Clinical Evaluation of a Biphasic Calcium Composite Grafting Material in the Treatment of Human Periodontal Intrabony Defects: A 12‐Month… DOI:10.1902/jop.2009.090229 | 2009 | this review only | not stated | not extracted yet |
| Tonetti 2002 Enamel matrix proteins in the regenerative therapy of deep intrabony defects DOI:10.1034/j.1600-051x.2002.290407.x | 2002 | this review only | not stated | not extracted yet |
| Tonetti 2004 Clinical outcomes following treatment of human intrabony defects with GTR/bone replacement material or access flap alone DOI:10.1111/j.1600-051x.2004.00562.x | 2004 | this review only | not stated | not extracted yet |
| Tsitoura 2004 Baseline radiographic defect angle of the intrabony defect as a prognostic indicator in regenerative periodontal surgery with enamel… DOI:10.1111/j.1600-051x.2004.00555.x | 2004 | this review only | not stated | not extracted yet |
| Wachtel 2003 Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study DOI:10.1034/j.1600-051x.2003.00013.x | 2003 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adult patients with periodontitis who completed non-surgical therapy with intraosseous defects and residual pockets | Adults with periodontitis and intrabony defects, sample sizes 20 to 166, age 21 to 75 years (n=28 studies) |
| Intervention | Regenerative/reconstructive surgery with GTR, EMD, growth factors, or combination | Biomaterials (enamel matrix derivative, bone substitutes, resorbable membranes, growth factors) with access flaps (n=6), papilla preservation flaps (n=18) or single-flap variants (n=3) |
| Comparison | Access flap, papilla preservation flap or single-flap variant with no biomaterial | Same flap design without biomaterial |
| Outcomes | Primary: PPD reduction and CAL gain; secondary: recession, bone gain, pocket closure, tooth loss, NNT, PROMs, adverse events | PPD reduction and CAL gain at 12 months |
| Study designs | Randomized controlled trials with at least 20 patients and at least 12 months follow-up | 28 RCTs (29 publications) |
| Timing | At least 12 months | 12 months to 10 years follow-up; meta-analysis at 12 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | No | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: N/A | NRSI: N/A · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |