title: Clinical performance of access flap surgery in the treatment of the intrabony defect. A systematic review and meta-analysis of randomized clinical trials.
abstract: OBJECTIVE
  To systematically review the literature and to determine the clinical performance of conservative surgery (CS) for the treatment of intrabony defects (ID).
  
  
  METHODS
  RCTs on ID treatment with 12 months of follow-up were identified through electronic databases and hand-searched journals. Primary outcomes were tooth survival, clinical attachment (CAL) gain, probing depth (PD) reduction and gingival recession increase (REC). Weighted means and forest plots were calculated for each outcome variable 12 months after surgery. Long-term stability was explored with RCTs of at least 24 months of follow-up. Subgroup analysis was performed according to the type of flap.
  
  
  RESULTS
  Twenty-seven trials reporting 647 subjects and 734 defects were identified. Twelve months after CS, tooth survival was 98% (IQ: 96.77-100), CAL gain 1.65 mm (95% CI: 1.37-1.94; p < 0.0001), PD reduction 2.80 mm (CI: 2.43-3.18; p < 0.0001) and REC increase 1.26 mm (CI: 0.94-1.49; p < 0.0001). Longer follow-up showed similar findings. CI of CAL gain were 1.44-3.52 for recently introduced papilla preservation flaps and 1.25-1.89 mm for access flaps.
  
  
  CONCLUSIONS
  The treatment of intrabony defect with CS is associated with high tooth retention and improvement of periodontal clinical parameters. Clinical performance may vary according to the type of surgical flap used.
authors: Department of Surgery, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy. filippo.graziani@med.unipi.it
authors: Filippo
authors: F
authors: Graziani
authors: Stefano
authors: S
authors: Gennai
authors: Silvia
authors: S
authors: Cei
authors: Francesco
authors: F
authors: Cairo
authors: Angelo
authors: A
authors: Baggiani
authors: Mario
authors: M
authors: Miccoli
authors: Mario
authors: M
authors: Gabriele
authors: Maurizio
authors: M
authors: Tonetti
mesh_terms: D016301:Alveolar Bone Loss / Q000150:complications / Q000601:surgery*; D001861:Bone Regeneration; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D019647:Oral Surgical Procedures / Q000145:classification / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010512:Periodontal Index; D010538:Peritonitis / Q000150:complications* / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D013524:Surgical Flaps
chemical_list: D018786:Bone Substitutes