Guided tissue regeneration for the treatment of periodontal intrabony and furcation defects. A systematic review.

BACKGROUND Many clinical studies have demonstrated that guided tissue regeneration (GTR) is a successful treatment modality of periodontal reconstructive surgery and it has become an accepted procedure in most periodontal practices. RATIONALE The purpose of this structured review was to assess the efficacy of guided tissue regeneration (GTR) procedures in patients with periodontal osseous defects compared with surgical controls on clinical, radiographic, adverse, and patient-centered outcomes. It extends the scope of previous GTR systematic reviews, which were limited to randomized controlled studies, by the scope of outcome measures examined, and the duration of the study. FOCUSED QUESTION In patients with periodontal osseous defects, what is the effect of physical barriers compared with surgical controls on clinical, radiographic, adverse, and patient-centered outcomes? SEARCH PROTOCOL An electronic search of the Cochrane Oral Health Group Trials Register and MEDLINE databases was performed. Manual searching of journals included Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research up to January 2002. This manual search also included review of relevant bibliographies. Two manufacturers of GTR devices were contacted regarding unpublished data. SELECTION CRITERIA INCLUSION CRITERIA Studies were selected for review if the evidence level was 3B (cohort) or above, at least 6 months duration, and compared a test GTR intervention with a surgical control. EXCLUSION CRITERIA Studies with experimental design problems; histologic or microbiological investigations; or those with outcome measurements, study populations, or study duration not consistent with the inclusion criteria were excluded. Primary outcome measures for intrabony defects were: clinical attachment level (CAL) gain, probing depth reduction (PD), gingival recession (REC) reduction; for furcation defects: vertical probing attachment level (VPAL) gain, vertical probing depth reduction (VPD), horizontal probing depth reduction (HPD), horizontal open probing attachment level gain (HOPA), and vertical open probing attachment level gain (VOPA). Meta-analysis was performed to compare GTR procedures to other surgical treatments and to examine the resulting clinical outcomes. MAIN RESULTS 1. For the primary outcome variables, in both intrabony-defect and furcation-defect studies, GTR was favored over open flap debridement (OFD) therapies (P < 0.0001). 2. No differences were detected among barrier types, but barrier types could explain some heterogeneity in the results. 3. Augmentation of the GTR barrier with a particulate graft enhanced VPD (P < 0.05), VPAL, and HOPA, but none of the intrabony outcomes. REVIEWER'S CONCLUSIONS Overall, GTR is consistently more effective than OFD in the gain of clinical attachment and probing depth reduction in the treatment of intrabony and furcation defects.