Clinical performance of minimally invasive periodontal surgery in the treatment of infrabony defects: Systematic review and meta-analysis

Aim To assess the effectiveness, in terms of clinical performance and patient perception, of minimally invasive periodontal surgeries (MIPSs), and to compare MIPSs to traditional surgery in the treatment of periodontal infrabony defects. Materials and Methods An electronic search and a manual search were carried out to identify studies investigating clinical (CAL, PPD, REC), radiographic (bone fill) and patient's centred (VAS) outcomes at least 6 months after MIPSs. A linear mixed-effect model was used for meta-analysis. Subgroup analyses were performed according to the study quality (RCT or case series). A meta-analysis assessing differences in clinical parameters between MIPSs and traditional flaps was also performed. Results Meta-analysis from the 18 included studies revealed a PPD reduction of 4.24 mm (95% CI = 3.79-4.69 mm), a CAL gain of 3.89 mm (95% CI = 3.42-4.35 mm), a REC increase of 0.44 mm (95% CI = 0.11-0.77 mm), a radiographic bone fill gain of 58.25% (95% CI = 42.30%-74.21%) and a VAS value of 1.16 (95% CI = 0.78-1.54). Based on 2 RCTs, MIPSs are more effective than traditional surgery for PPD reduction (0.93 mm, 95% CI = 1.71-0.15) and CAL gain (1 mm, 95% CI = 1.75-.24). Conclusion Minimally invasive periodontal surgeries may be considered for the treatment of periodontal infrabony defects. However, the real effect cannot be systematically evaluated due to the paucity of studies comparing MIPSs to traditional flap for periodontal reconstructive surgery.