Long-term Clinical Performance of Regeneration versus Conservative Surgery in the Treatment of Intra-bony Defects

Objectives: To determine the differences in the long-term clinical outcomes between Regeneration (REG) and Conservative Surgery (CS) in infra-bony defects. Sources: Three databases were searched [PubMed, Medline (Ovid) and Embase]. Study Selection: Randomized Controlled Clinical Trials (RCTs), Controlled Clinical Trials (CCTs) and retrospective studies with long-term clinical observations were selected. Quality assessment was done using Jadad Scale. Meta-analysis was performed for different outcomes including clinical attachment level gain (CALGain), probing pocket depth reduction (PPDRed), recession increase (RECInc) and bone fill (BF) at 24-, 36-, 48- to 60- and 120- to 240-months follow-up. Subgroup analyses was done for enamel matrix derivative (EMD) (CALGain and PPDRed) and Ceramic Grafts + open flap debridement (OFD) (CALGain, PPDRed and RECInc) groups at different long-term intervals. Data: Following screening, 17 studies were included. The time-related meta-analysis showed better results of REG than CS at every interval for every outcome except RECInc at 36-months (p = 0.62) and BF at 120- to 240-months (p = 0.38) favouring CS, though insignificantly. In subgroup analysis, EMD performed significantly better for both CALGain [24- (p < 0.0001), 36- (p = 0.02) and 60-months (p < 0.00001)] and PPDRed [24- (p= 0.0004), 36- (p = 0.003) and 60-months (p < 0.00001)]. For Ceramic Grafts, CALGain at 48-months (p < 0.00001) and PPDRed at 24- (p = 0.0006), 36- (p < 0.00001) and 48-months (p < 0.00001) follow-up showed better results. Conclusion: The outcomes from EMD and Ceramic Grafts can be maintained for longer duration, suggesting longevity of periodontal REG, though future research is needed to clarify the long-term benefits of other regenerative materials. Furthermore, investigations will be needed on the clinical performance of CS as REG might not always be a first indication for treating infra-bony defects. Clinical Significance: A clinical problem with respect to REG is whether or not the achieved outcomes can be sustained over an extended time period. These results are supporting the better outcomes as well as the longevity of results obtained from REG compared to a Conservative surgical approach.