title: A Bayesian network meta-analysis on comparisons of enamel matrix derivatives, guided tissue regeneration and their combination therapies.
abstract: OBJECTIVE
  Guided tissue regeneration (GTR) and enamel matrix derivatives (EMD) are two popular regenerative treatments for periodontal infrabony lesions. Both have been used in conjunction with other regenerative materials. We conducted a Bayesian network meta-analysis of randomized controlled trials on treatment effects of GTR, EMD and their combination therapies.
  
  
  METHODS
  A systematic literature search was conducted using the Medline, EMBASE, LILACS and CENTRAL databases up to and including June 2011. Treatment outcomes were changes in probing pocket depth (PPD), clinical attachment level (CAL) and infrabony defect depth. Different types of bone grafts were treated as one group and so were barrier membranes.
  
  
  RESULTS
  A total of 53 studies were included in this review, and we found small differences between regenerative therapies which were non-significant statistically and clinically. GTR and GTR-related combination therapies achieved greater PPD reduction than EMD and EMD-related combination therapies. Combination therapies achieved slightly greater CAL gain than the use of EMD or GTR alone. GTR with BG achieved greatest defect fill.
  
  
  CONCLUSIONS
  Combination therapies performed better than single therapies, but the additional benefits were small. Bayesian network meta-analysis is a promising technique to compare multiple treatments. Further analysis of methodological characteristics will be required prior to clinical recommendations.
authors.affiliation: Department of Periodontology, Leeds Dental Institute, University of Leeds, UK. y.k.tu@leeds.ac.uk
authors.forename: Yu-Kang
authors.initials: YK
authors.lastname: Tu
authors.forename: Ian
authors.initials: I
authors.lastname: Needleman
authors.forename: Leandro
authors.initials: L
authors.lastname: Chambrone
authors.forename: Hsein-Kun
authors.initials: HK
authors.lastname: Lu
authors.forename: Clovis Mariano
authors.initials: CM
authors.lastname: Faggion
mesh_terms: D016301:Alveolar Bone Loss / Q000601:surgery / Q000628:therapy*; D001499:Bayes Theorem; D001861:Bone Regeneration / Q000187:drug effects; D018786:Bone Substitutes; D016025:Bone Transplantation; D003746:Dental Enamel Proteins / Q000494:pharmacology / Q000627:therapeutic use*; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D008567:Membranes, Artificial; D016032:Randomized Controlled Trials as Topic
chemical_list: D018786:Bone Substitutes; D003746:Dental Enamel Proteins; D008567:Membranes, Artificial; C109069:enamel matrix proteins