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

The aim of this article was to determine the effect ofGTR, grafting procedures or the application ofenamel matrix proteins in addition to OFD in thetreatment of deep intraosseous defects. Overall, dataresulting from systematic reviews indicate that allreconstructive treatment modalities produce comparableand more favorable clinical improvements inhard and soft tissue parameters of healing response(i.e. clinical attachment gain, pocket reduction andbone fill) compared to conventional OFD procedures.Although the biomaterial-supplemented reconstructiveprocedures are associated with a generallypositive treatment effects with respect to OFD, asignificant heterogeneity was found among studiesin the different reconstructive procedures. This limitsthe possibility of drawing general conclusions aboutthe clinical relevance (in particular, the magnitudeof the adjunctive effect) of the additional use of GTR,grafting procedures or enamel matrix proteins forthe treatment of intraosseous defects. Some of thepossible causes of heterogeneity have been explored;however, the limited number of studies currentlyavailable did not permit definite conclusions aboutwhich factors account for the variability in treatmentoutcome. More research is therefore needed toidentify patient, site, choice of material and techniquefactors associated with the successful outcomeof treatment of intraosseous defects.This review indicates that different reconstructiveprocedures support comparable clinical outcomes. Itshould, however, be considered that similarimprovements in clinical parameters do not necessarilyimply similar wound healing processes on ahistologic level. Whereas the use of some reconstructiveprocedures, such as GTR and enamel matrixproteins, has been demonstrated to result in a trueand complete periodontal regeneration, for some ofthe graft biomaterials the effect on the formationof a new attachment apparatus, including bone, cementum and periodontal ligament, rather thanperiodontal repair, is still a matter of debate.Due to limited information on long-term outcomes,it is unclear whether the stability of periodontal supportand tooth survival are affected by the additionalapplication of reconstructive devices ⁄ biomaterials.While the improvements in probing recordings may bereasonably considered surrogate measurements relatedto a better long-term tooth prognosis, we recommendthat more clinical studies should examinewhether and to what extent more compromised teethcould be saved using a reconstructive procedure.There are at present insufficient data to permitanalytic comparisons among different reconstructiveprocedures with OFD with respect to patient-centeredoutcomes. When considering the adjunctiveeffect of reconstructive procedures, evaluation ofadverse effects related to the additional use of biomaterials⁄ biological agents, postoperative complications,ease of maintenance, change in aestheticappearance, estimation of patient well-being, andcost ⁄ benefit ratio (including estimation of additionaltreatment time and costs for implant ⁄ placement ofbiomaterials ⁄ biological agents) should be carriedout. Studies including patient-centered outcomes willbe critical, as well as long-term follow-up cohorts toexamine the effect of a reconstructive biomaterial⁄ device on true therapeutic endpoints