Non-Cochrane · intervention · PM41535244
Efficacy of Biologics for Surgical Treatment of Periodontal Suprabony Defects: A Systematic Review and Meta-Analysis of Controlled Clinical Trials.
Baniameri Sahar, Hazrati Parham, Sabri Hamoun, et al. · Journal of clinical periodontology · 2026 · PubMed · doi:10.1111/jcpe.70078
Findings
28 findings
| Population | ||||
|---|---|---|---|---|
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual probing depth (PD), mm 8 to 12 months · Surgical periodontal therapy of suprabony defects · Surgical technique: modified/simplified papilla preservation technique | MD -1.11 [-2.12, -0.09] GRADE not reported 2 studies · 115 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual gingival recession depth (REC), mm 8 months · Surgical periodontal therapy of suprabony defects · Follow-up: 8 months | MD -0.37 [-1.07, 0.33] GRADE not reported 1 study · 40 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Bleeding indices 8 to 12 months · Surgical periodontal therapy of suprabony defects | SMD -0.33 [-0.81, 0.15] -0.33 [-0.81, 0.15] SD Very low Downgraded: imprecision, indirectness 3 studies · 144 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual clinical attachment level (CAL), mm 8 to 12 months · Surgical periodontal therapy of suprabony defects | MD -1.32 [-2.00, -0.64] -1.32 [-2.00, -0.64] mm Low Downgraded: inconsistency 4 studies · 194 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual probing depth (PD), mm 8 months · Surgical periodontal therapy of suprabony defects · Follow-up: 8 months | MD -0.67 [-1.99, 0.65] GRADE not reported 1 study · 40 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Plaque indices 8 to 12 months · Surgical periodontal therapy of suprabony defects | SMD 0.02 [-0.45, 0.48] 0.02 [-0.45, 0.48] SD Very low Downgraded: imprecision, indirectness 2 studies · 105 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual probing depth (PD), mm 12 months · Surgical periodontal therapy of suprabony defects · Follow-up: 12 months | MD -1.04 [-1.65, -0.42] GRADE not reported 3 studies · 154 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual clinical attachment level (CAL), mm 12 months · Surgical periodontal therapy of suprabony defects · Follow-up: 12 months | MD -1.41 [-2.41, -0.42] GRADE not reported 3 studies · 154 participants |
| Adults with periodontitis and suprabony (horizontal) periodontal defects | Enamel matrix derivative (EMD) with open flap debridement | Open flap debridement alone (without biologics) | Residual recession depth (REC), mm 12 months · Periodontal surgery (suprabony defects) · Surgical technique: modified/simplified papilla preservation technique | Random-effects model | MD -0.65 [-0.95, -0.35] GRADE not reported 2 studies · 115 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual probing depth (PD), mm 8 to 12 months · Surgical periodontal therapy of suprabony defects · Surgical technique: conventional open flap debridement | MD -0.74 [-1.52, 0.04] GRADE not reported 2 studies · 79 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual clinical attachment level (CAL), mm 8 to 12 months · Surgical periodontal therapy of suprabony defects · Surgical technique: conventional open flap debridement | MD -0.77 [-1.44, -0.11] GRADE not reported 2 studies · 79 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual clinical attachment level (CAL), mm 8 to 12 months · Surgical periodontal therapy of suprabony defects · Surgical technique: modified/simplified papilla preservation technique | MD -1.87 [-2.42, -1.32] GRADE not reported 2 studies · 115 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual probing depth (PD), mm 8 to 12 months · Surgical periodontal therapy of suprabony defects | MD -0.89 [-1.45, -0.32] -0.89 [-1.45, -0.32] mm Very low Downgraded: imprecision, inconsistency 4 studies · 194 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual gingival recession depth (REC), mm 8 to 12 months · Surgical periodontal therapy of suprabony defects | MD -0.61 [-0.88, -0.33] -0.61 [-0.88, -0.33] mm Moderate Downgraded: imprecision 3 studies · 155 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual gingival recession depth (REC), mm 12 months · Surgical periodontal therapy of suprabony defects · Follow-up: 12 months | MD -0.65 [-0.95, -0.35] GRADE not reported 2 studies · 115 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus enamel matrix derivative (EMD) | OFD alone without biologics | Residual clinical attachment level (CAL), mm 8 months · Surgical periodontal therapy of suprabony defects · Follow-up: 8 months | MD -1.09 [-2.09, -0.09] GRADE not reported 1 study · 40 participants |
| Adults with periodontitis and suprabony (horizontal) periodontal defects | Enamel matrix derivative (EMD) with open flap debridement | Open flap debridement alone (without biologics) | Residual recession depth (REC), mm 8 months · Periodontal surgery (suprabony defects) · Surgical technique: conventional open flap debridement | Random-effects model | MD -0.37 [-1.07, 0.33] GRADE not reported 1 study · 40 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus platelet-rich fibrin (PRF) | OFD alone without biologics | Residual probing depth (PD), mm 6 to 9 months · Surgical periodontal therapy of suprabony defects · Surgical technique: conventional open flap debridement | MD -0.57 [-0.82, -0.31] GRADE not reported 3 studies · 93 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus platelet-rich fibrin (PRF) | OFD alone without biologics | Residual clinical attachment level (CAL), mm 6 to 9 months · Surgical periodontal therapy of suprabony defects | MD -0.69 [-1.05, -0.33] -0.69 [-1.05, -0.33] mm Low Downgraded: risk of bias, imprecision 4 studies · 123 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus platelet-rich fibrin (PRF) | OFD alone without biologics | Residual gingival recession depth (REC), mm 6 to 9 months · Surgical periodontal therapy of suprabony defects | MD -0.07 [-0.42, 0.29] -0.07 [-0.42, 0.29] mm Very low Downgraded: imprecision, indirectness 2 studies · 75 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus platelet-rich fibrin (PRF) | OFD alone without biologics | Residual clinical attachment level (CAL), mm 6 to 9 months · Surgical periodontal therapy of suprabony defects · Surgical technique: conventional open flap debridement | MD -0.77 [-1.16, -0.37] GRADE not reported 3 studies · 93 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus platelet-rich fibrin (PRF) | OFD alone without biologics | Residual probing depth (PD), mm 6 to 9 months · Surgical periodontal therapy of suprabony defects | MD -0.42 [-0.72, -0.12] -0.42 [-0.72, -0.12] mm Low Downgraded: risk of bias, imprecision 4 studies · 123 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus platelet-rich fibrin (PRF) | OFD alone without biologics | Plaque indices 6 to 9 months · Surgical periodontal therapy of suprabony defects | SMD -0.31 [-0.76, 0.14] -0.31 [-0.76, 0.14] SD Very low Downgraded: imprecision, indirectness 3 studies · 78 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus platelet-rich fibrin (PRF) | OFD alone without biologics | Residual clinical attachment level (CAL), mm 6 months · Surgical periodontal therapy of suprabony defects · Follow-up: 6 months | MD -0.73 [-1.31, -0.15] GRADE not reported 2 studies · 62 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus platelet-rich fibrin (PRF) | OFD alone without biologics | Residual probing depth (PD), mm 9 months · Surgical periodontal therapy of suprabony defects · Follow-up: 9 months | MD -0.54 [-0.81, -0.27] GRADE not reported 2 studies · 61 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus platelet-rich fibrin (PRF) | OFD alone without biologics | Residual probing depth (PD), mm 6 months · Surgical periodontal therapy of suprabony defects · Follow-up: 6 months | MD -0.37 [-1.01, 0.26] GRADE not reported 2 studies · 62 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus platelet-rich fibrin (PRF) | OFD alone without biologics | Residual clinical attachment level (CAL), mm 9 months · Surgical periodontal therapy of suprabony defects · Follow-up: 9 months | MD -0.56 [-1.13, 0.01] GRADE not reported 2 studies · 61 participants |
| Adults with periodontitis and at least one suprabony (horizontal) periodontal defect after phase I and II therapy | Surgical OFD plus platelet-rich fibrin (PRF) | OFD alone without biologics | Bleeding indices 6 months · Surgical periodontal therapy of suprabony defects | SMD -0.32 [-0.97, 0.33] -0.32 [-0.97, 0.33] SD Very low Downgraded: imprecision, indirectness 2 studies · 62 participants |
Included primary studies 9
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Kizildag 2018 The effect of leukocyte-platelet-rich fibrin on bone morphogenetic protein-2 and insulin-like growth factor-1 levels in patients with… PMID:30624092 | 2018 | 1 other review | not stated | not extracted yet |
| Debnath 2018 Treatment of horizontal defect with and without platelet-rich fibrin matrix: A randomized comparative clinical study. PMID:30210189 | 2018 | this review only | not stated | not extracted yet |
| Di Tullio 2013 Treatment of supra-alveolar-type defects by a simplified papilla preservation technique for access flap surgery with or without enamel… PMID:23030240 | 2013 | this review only | not stated | not extracted yet |
| Iorio-Siciliano 2021 Healing of periodontal suprabony defects following treatment with open flap debridement with or without an enamel matrix derivative: A… PMID:32562077 | 2021 | this review only | not stated | not extracted yet |
| Jentsch 2008 A clinical study evaluating the treatment of supra-alveolar-type defects with access flap surgery with and without an enamel matrix… PMID:18631246 | 2008 | this review only | not stated | not extracted yet |
| Joseph 2014 Clinical evaluation of autologous platelet rich fibrin in horizontal alveolar bony defects. PMID:25584315 | 2014 | this review only | not stated | not extracted yet |
| Subramanian 2025 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Vela 2024 Healing of Periodontal Suprabony Defects following Treatment with Open Flap Debridement with or without Hyaluronic Acid (HA) Application. PMID:38793012 | 2024 | this review only | not stated | not extracted yet |
| Yilmaz 2003 Enamel matrix proteins in the treatment of periodontal sites with horizontal type of bone loss. PMID:12631177 | 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 | Shared studies | Jaccard |
|---|---|---|
| Efficacy of Leukocyte and Platelet-Rich Fibrin (L-PRF) as an adjunct to Open Flap Debridement (OFD) in periodontal intrabony defects: a… (2026) | 1 | 0.02 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (18 years or older) with periodontitis (1999 or 2018 classification) and at least one suprabony defect who completed phase I and II therapy | Adults with periodontitis and suprabony defects (303 patients, 9 studies) |
| Intervention | Biologics (EMD, PRF, rh-PDGF, hyaluronic acid, PRP and related) with surgical treatment of suprabony defects regardless of flap design | EMD (4 studies), PRF (4 studies), hyaluronic acid (1 study) with OFD or papilla preservation flaps |
| Comparison | Conventional surgical approaches (open flap debridement, papilla preservation flaps) without adjunctive biologics | OFD alone or incision variants without adjunctive therapy (9 studies) |
| Outcomes | Primary: residual PD. Secondary: residual CAL, REC, BOP, plaque index, radiographic or clinical bone-level changes, pocket closure | Residual PD, CAL, REC (pooled for EMD and PRF); BOP, plaque index and bone-level changes in Appendix; pocket closure in one study |
| Study designs | Controlled clinical trials (randomised or non-randomised), parallel-group or split-mouth, at least 5 patients per arm | 9 controlled trials (8 RCTs, 1 non-randomised; 5 parallel-arm, 4 split-mouth) |
| Timing | Minimum follow-up 6 months | Follow-up 6 to 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 | No | No | yes |
| 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 | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | Yes | Yes | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: Yes | 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 | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |