Regenerative surgical treatment of furcation defects: a systematic review and Bayesian network meta-analysis of randomized clinical trials

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Regenerative surgical treatment of furcation defects : a systematic review and Bayesian network meta-analysis of randomized clinical trials. / Jepsen, Søren; Gennai, Stefano; Hirschfeld, Josefine; Kalemaj, Zamira; Buti, Jacopo; Graziani, Filippo.

In: Journal of Clinical Periodontology, Vol. 47, No. S22, 07.2020, p. 352-374.

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Jepsen, Søren ; Gennai, Stefano ; Hirschfeld, Josefine ; Kalemaj, Zamira ; Buti, Jacopo ; Graziani, Filippo. / Regenerative surgical treatment of furcation defects : a systematic review and Bayesian network meta-analysis of randomized clinical trials. In: Journal of Clinical Periodontology. 2020 ; Vol. 47, No. S22. pp. 352-374.

Bibtex

@article{c1f20742fe97475c9a5585bc196d5bd9,
title = "Regenerative surgical treatment of furcation defects: a systematic review and Bayesian network meta-analysis of randomized clinical trials",
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.",
keywords = "furcation defect, meta‐analysis, periodontal regeneration, periodontitis, systematic review",
author = "S{\o}ren Jepsen and Stefano Gennai and Josefine Hirschfeld and Zamira Kalemaj and Jacopo Buti and Filippo Graziani",
note = "{\textcopyright} 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",
year = "2020",
month = jul,
doi = "10.1111/jcpe.13238",
language = "English",
volume = "47",
pages = "352--374",
journal = "Journal of Clinical Periodontology",
issn = "0303-6979",
publisher = "Wiley",
number = "S22",

}

RIS

TY - JOUR

T1 - Regenerative surgical treatment of furcation defects

T2 - a systematic review and Bayesian network meta-analysis of randomized clinical trials

AU - Jepsen, Søren

AU - Gennai, Stefano

AU - Hirschfeld, Josefine

AU - Kalemaj, Zamira

AU - Buti, Jacopo

AU - Graziani, Filippo

N1 - © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PY - 2020/7

Y1 - 2020/7

N2 - 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.

AB - 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.

KW - furcation defect

KW - meta‐analysis

KW - periodontal regeneration

KW - periodontitis

KW - systematic review

U2 - 10.1111/jcpe.13238

DO - 10.1111/jcpe.13238

M3 - Review article

C2 - 31860125

VL - 47

SP - 352

EP - 374

JO - Journal of Clinical Periodontology

JF - Journal of Clinical Periodontology

SN - 0303-6979

IS - S22

ER -