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Bone replacement grafts with guided tissue regeneration in treatment of grade II furcation defects: a systematic review and meta-analysis

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Abstract

Aim

The present systematic review appended with meta-analysis aimed to evaluate the efficacy of bone replacement graft (BRG) with guided tissue regeneration (GTR) over BRG or open flap debridement (OFD) alone in the treatment of grade II furcation defects.

Materials and methods

An electronic literature search of PubMed, Cochrane Library and Google Scholar databases accompanied with manual searching was done. Randomized controlled trials (RCTs) up to October 2019, comparing BRG+GTR with BRG or OFD in grade II furcation defects, were identified. Clinical attachment level (CAL) gain, changes in gingival marginal level (GML), vertical defect fill (VDF), horizontal defect fill (HDF) and reduction in defect volume were the outcome parameters.

Results

Of a total of 12, 9 studies compared BRG+GTR vs BRG while 3 compared BRG+GTR vs OFD. Meta-analysis was carried out for CAL gain, VDF, HDF and GML changes. In the BRG+GTR vs BRG comparison group, out of 9 studies, 6 RCTs showed standardized mean difference (SMD) of 0.513 for VDF, 9 RCTs showed SMD of 0.83 for HDF and 2 RCTs showed SMD of 0.651 for CAL gain, whereas only 2 studies in the same group reported reduction in defect volume. Three studies of the BRG+GTR vs OFD group exhibited significant VDF and CAL gain with SMD of 2.002 and 1.161 respectively. However, no significant change was recorded for GML in both groups.

Conclusion

The present systematic review indicates supplemental benefits of combination therapy of BRG+GTR over monotherapy in resolving grade II furcation defects.

Clinical relevance

In our quest to achieve maximum regeneration in grade II furcation defects, combination therapies such as BRG+GTR have been accepted as treatment choices over other modalities. Clinical situations warranting near-complete regeneration of the tissues in such defects are better suited for combination therapies.

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Acknowledgements

The authors would like to acknowledge Dr. Dhananjay Raje, Ph.D. Statistics, mds Bioanalytics, Nagpur, for performing statistical analysis.

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  1. Department of Periodontics & Implantology, VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur, 440019, India

    Renuka K. Swami, Abhay P. Kolte, Girish H. Bodhare & Rajashri A. Kolte

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All authors have given final approval and agreed to be accountable for the work done, ensuring its integrity and accuracy. RS, AK and GB contributed to conception, design, literature search, analysis, interpretation and drafted the manuscript. RK contributed to literature search, analysis, interpretation and critically revised the manuscript.

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Correspondence to Abhay P. Kolte.

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Swami, R.K., Kolte, A.P., Bodhare, G.H. et al. Bone replacement grafts with guided tissue regeneration in treatment of grade II furcation defects: a systematic review and meta-analysis. Clin Oral Invest 25, 807–821 (2021). https://doi.org/10.1007/s00784-021-03776-0

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