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Clinical Oral Investigations

, Volume 18, Issue 8, pp 1881–1892 | Cite as

Long-term periodontal tissue outcome in regenerated infrabony and furcation defects: a systematic review

  • Eduardo Aleixo Figueira
  • Angélica Oliveira de Assis
  • Sheyla Christinne Lira Montenegro
  • Diego Moura Soares
  • Anna Angélica Araújo Barros
  • Euler Maciel Dantas
  • Bruno César de Vasconcelos GurgelEmail author
Review

Abstract

Objectives

This study aimed to systematically evaluate the long-term results of periodontal tissues in regenerated infrabony and furcation defects.

Material and methods

A search of the Medline database was performed (1960 to 2012), complimented by an additional hand search. For inclusion in the review, clinical trials had to include the long-term evaluation of infrabony and furcation defects submitted to periodontal regeneration for up to 3 years of follow-up. Changes in clinical attachment level (CAL) from pre-surgery, at the first post-surgical, and final evaluations were used to analyze the effects of regenerative treatments over time.

Results

A total of 866 articles were found using the descriptors employed. Of these, 216 papers were selected for abstract reading by two evaluators. One hundred and eighty-nine were excluded for not fulfilling the eligibility criteria. Twenty-seven papers were selected for the analysis of the full texts, and 13 were excluded. Two studies were included after a manual search. Finally, 16 papers were selected for the present review.

Conclusions

Regenerative techniques for the treatment of infrabony and furcation defects resulted in improved CAL during long-term follow-up periods, even when attachment losses occurred during this period. This improvement should be carefully evaluated with regard to its clinical relevance for dental longevity.

Clinical relevance

The improvement in clinical attachment level achieved by regenerative techniques with biomaterials demonstrated satisfactory results over the long-term. However, regenerative techniques still present different success rates with regard to gain in clinical attachment level.

Keywords

Periodontal regeneration Furcation lesion Osseous defects Systematic review 

Notes

Conflict of interest

The authors declare that they have no conflicts of interests.

References

  1. 1.
    Karring H, Bjornsson A, Thirup S, Clark BF, Knudsen CR (2003) Functional effects of deleting the coiled-coil motif in Escherichia coli elongation factor Ts. Eur J Biochem 270(21):4294–4305PubMedCrossRefGoogle Scholar
  2. 2.
    Polimeni G, Xiropaidis AV, UM W (2006) Biology and principles of periodontal wound healing/regeneration. Periodontol 2000 41:30–47. doi: 10.1111/j.1600-0757.2006.00157.x PubMedCrossRefGoogle Scholar
  3. 3.
    Reynolds MA, Aichelmann-Reidy ME, Branch-Mays GL, Gunsolley JC (2003) The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A systematic review. Ann Periodontol 8(1):227–265. doi: 10.1902/annals.2003.8.1.227 PubMedCrossRefGoogle Scholar
  4. 4.
    Sculean A, Nikolidakis D, Schwarz F (2008) Regeneration of periodontal tissues: combinations of barrier membranes and grafting materials—biological foundation and preclinical evidence: a systematic review. J Clin Periodontol 35(8 Suppl):106–116. doi: 10.1111/j.1600-051X.2008.01263.x PubMedCrossRefGoogle Scholar
  5. 5.
    Caton JG, Greenstein G (1993) Factors related to periodontal regeneration. Periodontol 2000 1(1):9–15CrossRefGoogle Scholar
  6. 6.
    Sander L, Karring T (1995) Healing of periodontal lesions in monkeys following the guided tissue regeneration procedure. A histological study. J Clin Periodontol 22(4):332–337PubMedCrossRefGoogle Scholar
  7. 7.
    Bjorn H, Hollender L, Lindhe J (1965) Tissue regeneration in patients with periodontal disease. Odontol Revy 16(4):317–326PubMedGoogle Scholar
  8. 8.
    Melcher AH (1976) On the repair potential of periodontal tissues. J Periodontol 47(5):256–260PubMedCrossRefGoogle Scholar
  9. 9.
    Nyman S, Gottlow J, Lindhe J, Karring T, Wennstrom J (1987) New attachment formation by guided tissue regeneration. J Periodontal Res 22(3):252–254PubMedCrossRefGoogle Scholar
  10. 10.
    Bender SA, Rogalski JB, Mills MP, Arnold RM, Cochran DL, Mellonig JT (2005) Evaluation of demineralized bone matrix paste and putty in periodontal intraosseous defects. J Periodontol 76(5):768–777. doi: 10.1902/jop.2005.76.5.768 PubMedCrossRefGoogle Scholar
  11. 11.
    Brunsvold MA, Mellonig JT (1993) Bone grafts and periodontal regeneration. Periodontol 2000 1(1):80–91CrossRefGoogle Scholar
  12. 12.
    Pretzl B, Kim TS, Holle R, Eickholz P (2008) Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. IV. A case series of infrabony defects after 10 years. J Periodontol 79(8):1491–1499. doi: 10.1902/jop.2008.070571 PubMedCrossRefGoogle Scholar
  13. 13.
    Gottlow J, Nyman S, Lindhe J, Karring T, Wennstrom J (1986) New attachment formation in the human periodontium by guided tissue regeneration. Case reports. J Clin Periodontol 13(6):604–616PubMedCrossRefGoogle Scholar
  14. 14.
    Gottlow J, Nyman S, Karring T, Lindhe J (1984) New attachment formation as the result of controlled tissue regeneration. J Clin Periodontol 11(8):494–503PubMedCrossRefGoogle Scholar
  15. 15.
    Nyman S, Gottlow J, Karring T, Lindhe J (1982) The regenerative potential of the periodontal ligament. An experimental study in the monkey. J Clin Periodontol 9(3):257–265PubMedCrossRefGoogle Scholar
  16. 16.
    Caffesse RG, Nasjleti CE, Morrison EC, Sanchez R (1994) Guided tissue regeneration: comparison of bioabsorbable and non-bioabsorbable membranes. Histologic and histometric study in dogs. J Periodontol 65(6):583–591PubMedCrossRefGoogle Scholar
  17. 17.
    Camelo M, Nevins ML, Schenk RK, Simion M, Rasperini G, Lynch SE, Nevins M (1998) Clinical, radiographic, and histologic evaluation of human periodontal defects treated with Bio-Oss and Bio-Gide. Int J Periodontics Restorative Dent 18(4):321–331PubMedGoogle Scholar
  18. 18.
    Cortellini P, Paolo G, Prato P, Tonetti MS (1996) Long-term stability of clinical attachment following guided tissue regeneration and conventional therapy. J Clin Periodontol 23(2):106–111PubMedCrossRefGoogle Scholar
  19. 19.
    Warrer K, Karring T, Nyman S, Gogolewski S (1992) Guided tissue regeneration using biodegradable membranes of polylactic acid or polyurethane. J Clin Periodontol 19(9 Pt 1):633–640PubMedCrossRefGoogle Scholar
  20. 20.
    Hammarstrom L (1997) Enamel matrix, cementum development and regeneration. J Clin Periodontol 24(9 Pt 2):658–668PubMedCrossRefGoogle Scholar
  21. 21.
    Lyngstadaas SP, Lundberg E, Ekdahl H, Andersson C, Gestrelius S (2001) Autocrine growth factors in human periodontal ligament cells cultured on enamel matrix derivative. J Clin Periodontol 28(2):181–188PubMedCrossRefGoogle Scholar
  22. 22.
    Okubo K, Kobayashi M, Takiguchi T, Takada T, Ohazama A, Okamatsu Y, Hasegawa K (2003) Participation of endogenous IGF-I and TGF-beta 1 with enamel matrix derivative-stimulated cell growth in human periodontal ligament cells. J Periodontal Res 38(1):1–9PubMedCrossRefGoogle Scholar
  23. 23.
    Schwartz Z, Carnes DL Jr, Pulliam R, Lohmann CH, Sylvia VL, Liu Y, Dean DD, Cochran DL, Boyan BD (2000) Porcine fetal enamel matrix derivative stimulates proliferation but not differentiation of pre-osteoblastic 2 T9 cells, inhibits proliferation and stimulates differentiation of osteoblast-like MG63 cells, and increases proliferation and differentiation of normal human osteoblast NHOst cells. J Periodontol 71(8):1287–1296. doi: 10.1902/jop.2000.71.8.1287 PubMedCrossRefGoogle Scholar
  24. 24.
    Van der Pauw MT, Van den Bos T, Everts V, Beertsen W (2000) Enamel matrix-derived protein stimulates attachment of periodontal ligament fibroblasts and enhances alkaline phosphatase activity and transforming growth factor beta1 release of periodontal ligament and gingival fibroblasts. J Periodontol 71(1):31–43. doi: 10.1902/jop.2000.71.1.31 PubMedCrossRefGoogle Scholar
  25. 25.
    Kawase T, Okuda K, Yoshie H, Burns DM (2000) Cytostatic action of enamel matrix derivative (EMDOGAIN) on human oral squamous cell carcinoma-derived SCC25 epithelial cells. J Periodontal Res 35(5):291–300PubMedCrossRefGoogle Scholar
  26. 26.
    Crea A, Dassatti L, Hoffmann O, Zafiropoulos GG, Deli G (2008) Treatment of intrabony defects using guided tissue regeneration or enamel matrix derivative: a 3-year prospective randomized clinical study. J Periodontol 79(12):2281–2289. doi: 10.1902/jop.2008.080135 PubMedCrossRefGoogle Scholar
  27. 27.
    Eickholz P, Kim TS, Holle R, Hausmann E (2001) Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. I. Class II furcations. J Periodontol 72(1):35–42. doi: 10.1902/jop.2001.72.1.35 PubMedCrossRefGoogle Scholar
  28. 28.
    Eickholz P, Krigar DM, Pretzl B, Steinbrenner H, Dorfer C, Kim TS (2004) Guided tissue regeneration with bioabsorbable barriers. II. Long-term results in infrabony defects. J Periodontol 75(7):957–965. doi: 10.1902/jop.2004.75.7.957 PubMedCrossRefGoogle Scholar
  29. 29.
    Eickholz P, Pretzl B, Holle R, Kim TS (2006) Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. III. Class II furcations after 10 years. J Periodontol 77(1):88–94. doi: 10.1902/jop.2006.77.1.88 PubMedCrossRefGoogle Scholar
  30. 30.
    Heijl L, Heden G, Svardstrom G, Ostgren A (1997) Enamel matrix derivative (EMDOGAIN) in the treatment of intrabony periodontal defects. J Clin Periodontol 24(9 Pt 2):705–714PubMedCrossRefGoogle Scholar
  31. 31.
    Menezes LM, Rao J (2012) Long-term clinical evaluation of platelet-rich plasma in the treatment of human periodontal intraosseous defects: a comparative clinical trial. Quintessence Int 43(7):571–582PubMedGoogle Scholar
  32. 32.
    Mengel R, Schreiber D, Flores-de-Jacoby L (2006) Bioabsorbable membrane and bioactive glass in the treatment of intrabony defects in patients with generalized aggressive periodontitis: results of a 5-year clinical and radiological study. J Periodontol 77(10):1781–1787. doi: 10.1902/jop.2006.060029 PubMedCrossRefGoogle Scholar
  33. 33.
    Nickles K, Ratka-Kruger P, Neukranz E, Raetzke P, Eickholz P (2009) Open flap debridement and guided tissue regeneration after 10 years in infrabony defects. J Clin Periodontol 36(11):976–983. doi: 10.1111/j.1600-051X.2009.01474.x PubMedCrossRefGoogle Scholar
  34. 34.
    Nygaard-Ostby P, Bakke V, Nesdal O, Susin C, Wikesjo UM (2010) Periodontal healing following reconstructive surgery: effect of guided tissue regeneration using a bioresorbable barrier device when combined with autogenous bone grafting. A randomized-controlled trial 10-year follow-up. J Clin Periodontol 37(4):366–373. doi: 10.1111/j.1600-051X.2010.01532.x PubMedCrossRefGoogle Scholar
  35. 35.
    Orsini M, Orsini G, Benlloch D, Aranda JJ, Sanz M (2008) Long-term clinical results on the use of bone-replacement grafts in the treatment of intrabony periodontal defects. Comparison of the use of autogenous bone graft plus calcium sulfate to autogenous bone graft covered with a bioabsorbable membrane. J Periodontol 79(9):1630–1637. doi: 10.1902/jop.2008.070282 PubMedCrossRefGoogle Scholar
  36. 36.
    Pietruska M, Pietruski J, Nagy K, Brecx M, Arweiler NB, Sculean A (2012) Four-year results following treatment of intrabony periodontal defects with an enamel matrix derivative alone or combined with a biphasic calcium phosphate. Clin Oral Investig 16(4):1191–1197. doi: 10.1007/s00784-011-0611-2 PubMedCrossRefGoogle Scholar
  37. 37.
    Pretzl B, Kim TS, Steinbrenner H, Dorfer C, Himmer K, Eickholz P (2009) Guided tissue regeneration with bioabsorbable barriers III 10-year results in infrabony defects. J Clin Periodontol 36(4):349–356. doi: 10.1111/j.1600-051X.2009.01378.x PubMedCrossRefGoogle Scholar
  38. 38.
    Sculean A, Donos N, Schwarz F, Becker J, Brecx M, Arweiler NB (2004) Five-year results following treatment of intrabony defects with enamel matrix proteins and guided tissue regeneration. J Clin Periodontol 31(7):545–549. doi: 10.1111/j.1600-051X.2004.00518.x PubMedCrossRefGoogle Scholar
  39. 39.
    Sculean A, Kiss A, Miliauskaite A, Schwarz F, Arweiler NB, Hannig M (2008) Ten-year results following treatment of intra-bony defects with enamel matrix proteins and guided tissue regeneration. J Clin Periodontol 35(9):817–824. doi: 10.1111/j.1600-051X.2008.01295.x PubMedCrossRefGoogle Scholar
  40. 40.
    Sculean A, Schwarz F, Chiantella GC, Donos N, Arweiler NB, Brecx M, Becker J (2007) Five-year results of a prospective, randomized, controlled study evaluating treatment of intra-bony defects with a natural bone mineral and GTR. J Clin Periodontol 34(1):72–77. doi: 10.1111/j.1600-051X.2006.01007.x PubMedCrossRefGoogle Scholar
  41. 41.
    Stavropoulos A, Karring T (2010) Guided tissue regeneration combined with a deproteinized bovine bone mineral (Bio-Oss) in the treatment of intrabony periodontal defects: 6-year results from a randomized-controlled clinical trial. J Clin Periodontol 37(2):200–210. doi: 10.1111/j.1600-051X.2009.01520.x PubMedCrossRefGoogle Scholar
  42. 42.
    Cetiner D, Parlar A, Balos K, Alpar R (2003) Comparative clinical study of connective tissue graft and two types of bioabsorbable barriers in the treatment of localized gingival recessions. J Periodontol 74(8):1196–1205. doi: 10.1902/jop.2003.74.8.1196 PubMedCrossRefGoogle Scholar
  43. 43.
    Kim YK, Kim SG, Lim SC, Lee HJ, Yun PY (2010) A clinical study on bone formation using a demineralized bone matrix and resorbable membrane. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109(6):e6–11. doi: 10.1016/j.tripleo.2010.01.012 PubMedCrossRefGoogle Scholar
  44. 44.
    Santana RB, de Mattos CM, Van Dyke T (2009) Efficacy of combined regenerative treatments in human mandibular class II furcation defects. J Periodontol 80(11):1756–1764. doi: 10.1902/jop.2009.080605 PubMedCrossRefGoogle Scholar
  45. 45.
    Murphy KG, Gunsolley JC (2003) Guided tissue regeneration for the treatment of periodontal intrabony and furcation defects. A systematic review. Ann Periodontol 8(1):266–302. doi: 10.1902/annals.2003.8.1.266 PubMedCrossRefGoogle Scholar
  46. 46.
    Parodi R, Santarelli GA, Gasparetto B (2004) Treatment of intrabony pockets with Emdogain: results at 36 months. Int J Periodontics Restorative Dent 24(1):57–63PubMedGoogle Scholar
  47. 47.
    Zetterstrom O, Andersson C, Eriksson L, Fredriksson A, Friskopp J, Heden G, Jansson B, Lundgren T, Nilveus R, Olsson A, Renvert S, Salonen L, Sjostrom L, Winell A, Ostgren A, Gestrelius S (1997) Clinical safety of enamel matrix derivative (EMDOGAIN) in the treatment of periodontal defects. J Clin Periodontol 24(9 Pt 2):697–704PubMedCrossRefGoogle Scholar
  48. 48.
    Sculean A, Donos N, Miliauskaite A, Arweiler N, Brecx M (2001) Treatment of intrabony defects with enamel matrix proteins or bioabsorbable membranes. A 4-year follow-up split-mouth study. J Periodontol 72(12):1695–1701. doi: 10.1902/jop.2001.72.12.1695 PubMedCrossRefGoogle Scholar
  49. 49.
    Sculean A, Pietruska M, Arweiler NB, Auschill TM, Nemcovsky C (2007) Four-year results of a prospective-controlled clinical study evaluating healing of intra-bony defects following treatment with an enamel matrix protein derivative alone or combined with a bioactive glass. J Clin Periodontol 34(6):507–513. doi: 10.1111/j.1600-051X.2007.01084.x PubMedCrossRefGoogle Scholar
  50. 50.
    Sculean A, Schwarz F, Miliauskaite A, Kiss A, Arweiler N, Becker J, Brecx M (2006) Treatment of intrabony defects with an enamel matrix protein derivative or bioabsorbable membrane: an 8-year follow-up split-mouth study. J Periodontol 77(11):1879–1886. doi: 10.1902/jop.2006.060002 PubMedCrossRefGoogle Scholar
  51. 51.
    Moher D, Altman DG, Liberati A, Tetzlaff J (2011) PRISMA statement. Epidemiology 22(1):128PubMedCrossRefGoogle Scholar
  52. 52.
    Evans D (2003) Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions. J Clin Nurs 12(1):77–84PubMedCrossRefGoogle Scholar
  53. 53.
    Christgau M, Schmalz G, Reich E, Wenzel A (1995) Clinical and radiographical split-mouth-study on resorbable versus non-resorbable GTR-membranes. J Clin Periodontol 22(4):306–315PubMedCrossRefGoogle Scholar
  54. 54.
    Eickholz P, Hausmann E (1997) Evidence for healing of class II and III furcations after GTR therapy: digital subtraction and clinical measurements. J Periodontol 68(7):636–644PubMedCrossRefGoogle Scholar
  55. 55.
    Garrett S, Polson AM, Stoller NH, Drisko CL, Caton JG, Harrold CQ, Bogle G, Greenwell H, Lowenguth RA, Duke SP, DeRouen TA (1997) Comparison of a bioabsorbable GTR barrier to a non-absorbable barrier in treating human class II furcation defects. A multi-center parallel design randomized single-blind trial. J Periodontol 68(7):667–675PubMedCrossRefGoogle Scholar
  56. 56.
    Hugoson A, Ravald N, Fornell J, Johard G, Teiwik A, Gottlow J (1995) Treatment of class II furcation involvements in humans with bioresorbable and nonresorbable guided tissue regeneration barriers. A randomized multi-center study. J Periodontol 66(7):624–634PubMedCrossRefGoogle Scholar
  57. 57.
    Cortellini P, Tonetti MS, Lang NP, Suvan JE, Zucchelli G, Vangsted T, Silvestri M, Rossi R, McClain P, Fonzar A, Dubravec D, Adriaens P (2001) The simplified papilla preservation flap in the regenerative treatment of deep intrabony defects: clinical outcomes and postoperative morbidity. J Periodontol 72(12):1702–1712. doi: 10.1902/jop.2001.72.12.1702 PubMedCrossRefGoogle Scholar
  58. 58.
    De Sanctis M, Zucchelli G (2000) Interleukin-1 gene polymorphisms and long-term stability following guided tissue regeneration therapy. J Periodontol 71(4):606–613. doi: 10.1902/jop.2000.71.4.606 PubMedCrossRefGoogle Scholar
  59. 59.
    Rivera-Hidalgo F (1986) Smoking and periodontal disease. A review of the literature. J Periodontol 57(10):617–624PubMedCrossRefGoogle Scholar
  60. 60.
    Cortellini P, Pini-Prato G, Tonetti M (1994) Periodontal regeneration of human infrabony defects (V). Effect of oral hygiene on long-term stability. J Clin Periodontol 21(9):606–610PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Eduardo Aleixo Figueira
    • 1
  • Angélica Oliveira de Assis
    • 1
  • Sheyla Christinne Lira Montenegro
    • 1
  • Diego Moura Soares
    • 1
  • Anna Angélica Araújo Barros
    • 1
  • Euler Maciel Dantas
    • 1
  • Bruno César de Vasconcelos Gurgel
    • 1
    Email author
  1. 1.Federal University of Rio Grande do NorteNatalBrazil

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