Which reconstructive procedures are effective for treating the periodontal intraosseous defect?

Deep intraosseous defects represent a major challenge for the clinician. Sites with intraosseous lesions have been shown to be at higher risk of disease progression in subjects who had not received systematic periodontal therapy (78). Treatments of intrabony defects include scaling and root planing with or without surgical access flap. When the periodontal debridement is surgically performed, additional osseous resective therapy and ⁄ or reconstructive therapy by means of the application of membranes, biological agents or grafting biomaterials can be used to correct the bone deformities induced by destructive periodontal disease. In this respect, reconstructive procedures have been used with varying success during the past decades to accomplish the restitutio ad integrum of lost attachment apparatus in deep intraosseous defects. Although observations from histologic studies in humans (6, 19, 41, 105, 125) and data from controlled clinical trials have demonstrated that some of the available grafting procedures may result in healing that can be termed periodontal regeneration , complete and predictable reconstruction of periodontal tissues is still difficult to obtain. Despite the widely accepted effectiveness of the reconstructive procedures previously documented (28, 36, 89), there is a substantial variation in clinical response that can only in part be attributed to the biomaterials ⁄ biological agents adopted (54). Several traditional reviews have previously reported the additional effect of the use of different reconstructive procedures in intraosseous defects (9, 28, 32, 42, 46, 48, 50, 64, 65, 72, 87, 90, 101, 117). Unfortunately, it has been shown that many traditional medical reviews are haphazard and biased, often reflecting the opinion of the review’s authors. In contrast, systematic reviews follow explicit, well-documented, scientific methodology in order to reduce both systematic errors (biases) and random errors (those occurring by chance) and provide a more objective, comprehensive view of the research literature (30). Since all reconstructive procedures are time-consuming, technically demanding and financially costly, in view of the great expense of the reconstructive device ⁄ biomaterials and surgical time, systematic reviews are of paramount importance to assess the efficacy of reconstructive procedures in the treatment of periodontal intraosseous defects measured against the current standard of surgical periodontal treatment, access flap surgery. The aim of this article is to determine the effect of the use of guided tissue regeneration, grafting procedures or the application of enamel matrix proteins in addition to conventional open flap debridement (OFD) in the treatment of deep intraosseous defects. Specifically, the additional efficacy of each reconstructive procedure in comparison to the OFD-only procedure will be evaluated by means of clinical and patient-centered outcome parameters on a shortand long-term basis.