A systematic review of graft materials and biological agents for periodontal intraosseous defects

Objectives: To determine the adjunctive effect of grafting biomaterials/biological agents with open flap debridement (OFD) in the treatment of deep intraosseous defects. Background: No systematic review of treatment outcomes in patients who received graft biomaterials or biological agents have been published. Methods: A rigorous systematic review of randomized controlled trials of at least 6-month duration was conducted comparing grafting biomaterials/biological agents (alone or in combination) + OFD (test group) to OFD alone or in combination with a placebo (control group). Results: The difference in CAL change between test and control groups varied from -1.45 mm to 1.40 mm with respect to different biomaterials/biological agents. Meta-analysis showed that CAL change significantly improved after treatment for coralline calcium carbonate (weighted mean difference 0.90 mm; 95% CI: 0.53-1.27), bioactive glass (weighted mean difference 1.04 mm; 95% CI: 0.31-1.76), hydroxyapatite (weighted mean difference 1.40 mm, 95% Cl 0.64-2.16), and enamel matrix proteins (weighted mean difference 1.33 mm, 95% CI 0.78-1.88). However, heterogeneity in results between studies was highly statistically significant for most of biomaterials/biologicals and could not be fully explained. Conclusions: Overall, the use of specific biomaterials/biologicals was more effective than OFD in improving attachment levels in intraosseous defects. Difference in CAL gain varied greatly with respect to different biomaterial/biological agent. Due to a significant heterogeneity in results between studies in most treatment groups, general conclusions about the expected clinical benefit of graft biomaterials/biologicals need to be interpreted with caution. Further research should focus on understanding this variability.