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. 2020 Sep;47(9):1108-1120.
doi: 10.1111/jcpe.13338. Epub 2020 Jul 16.

Systematic review and sequential network meta-analysis on the efficacy of periodontal regenerative therapies

Shang-Jie Tsai  1   2 , Yu-Wei Ding  1 , Ming-Chieh Shih  1 , Yu-Kang Tu  1   2   3
Affiliations

Systematic review and sequential network meta-analysis on the efficacy of periodontal regenerative therapies

Shang-Jie Tsai et al. J Clin Periodontol. 2020 Sep.

Abstract

Aims: We aimed to update a previous network meta-analysis comparing the efficacy of periodontal regenerative therapies on the treatment of infrabony lesions.

Materials and methods: Seven clinical trials were added after literature research for studies published between January 2011 and September 2019. We conducted network meta-analysis (NMA) to compare the effects of guided tissue regeneration (GTR), enamel matrix derivatives (EMD) and their combination therapies on probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain. Sequential network meta-analysis (SNMA) was also used to control the type-I error rate due to multiple testing.

Results: A total of 60 studies were included. For both PPD reduction and CAL gain, the flap operation (FO) was the least effective treatment. Although the differences between periodontal regenerative therapies were small, GTR attained the greatest reduction in PPD, and EMD with bone graft the greatest CAL gain compared to other therapies. SNMA used stricter efficacy criteria, yielding slightly different results from NMA.

Conclusions: EMD, GTR, and their combined therapies were more effective than flap operation, although the differences between regenerative therapies remain small in this updated study. SNMA reduces the risk of false-positive findings, thereby providing more robust evidence on the superiority of treatments.

Keywords: enamel matrix derivatives; guided tissue regeneration; network meta-analysis; periodontal regenerative therapies; sequential network meta-analysis; trial sequential analysis.

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