title: A systematic review of graft materials and biological agents for periodontal intraosseous defects.
abstract: OBJECTIVE
  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% CI 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.
authors.affiliation: Research Center for the Study of Periodontal Diseases, University of Ferrara, Italy. l.trombelli@unife.it
authors.forename: Leonardo
authors.initials: L
authors.lastname: Trombelli
authors.forename: Lisa J A
authors.initials: LJ
authors.lastname: Heitz-Mayfield
authors.forename: Ian
authors.initials: I
authors.lastname: Needleman
authors.forename: David
authors.initials: D
authors.lastname: Moles
authors.forename: Alessandro
authors.initials: A
authors.lastname: Scabbia
mesh_terms: D016301:Alveolar Bone Loss / Q000601:surgery*; D018786:Bone Substitutes; D016025:Bone Transplantation; D006801:Humans; D010512:Periodontal Index; D016032:Randomized Controlled Trials as Topic; D013357:Subgingival Curettage
chemical_list: D018786:Bone Substitutes