Periodontal Therapy
A bayesian network meta-analysis on comparisons of enamel matrix derivatives, guided tissue regeneration and their combination therapies
Yu-Kang Tu,
Ian Needleman,
Leandro Chambrone,
Hsein-Kun Lu,
Clovis Mariano Faggion Jr,
Corresponding Author
Yu-Kang Tu
Department of Periodontology, Leeds Dental Institute, University of Leeds, Leeds, UK
Division of Biostatistics, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
Address:
Y.-K. Tu
Division of Biostatistics, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Room 8.01, Level 8, Worsley Building, Clarendon Way, Leeds, LS2 9JT, UK
E-mail: [email protected]
Search for more papers by this authorIan Needleman
Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, London, UK
Search for more papers by this authorLeandro Chambrone
Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorHsein-Kun Lu
Department of Periodontology, Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorClovis Mariano Faggion Jr
Department of Prosthodontics, School of Dentistry, University of Heidelberg, Heidelberg, Germany
Search for more papers by this authorYu-Kang Tu,
Ian Needleman,
Leandro Chambrone,
Hsein-Kun Lu,
Clovis Mariano Faggion Jr,
Corresponding Author
Yu-Kang Tu
Department of Periodontology, Leeds Dental Institute, University of Leeds, Leeds, UK
Division of Biostatistics, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
Address:
Y.-K. Tu
Division of Biostatistics, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Room 8.01, Level 8, Worsley Building, Clarendon Way, Leeds, LS2 9JT, UK
E-mail: [email protected]
Search for more papers by this authorIan Needleman
Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, London, UK
Search for more papers by this authorLeandro Chambrone
Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorHsein-Kun Lu
Department of Periodontology, Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorClovis Mariano Faggion Jr
Department of Prosthodontics, School of Dentistry, University of Heidelberg, Heidelberg, Germany
Search for more papers by this authorConflict of interest and source of funding statement:
The authors declare that they have no conflict of interests.
The first author was funded by the United Kingdom government's Higher Education Funding Council for England (HEFCE). The last author is partially funded by a postdoctoral fellowship from the Medical Faculty of the University of Heidelberg.
Abstract
Aims
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.
Material and 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.
Conclusion
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.
Supporting Information
| Filename | Description |
|---|---|
| jcpe1844-sup-0001-FigureS1.docWord document, 661.5 KB | Fig. S1. Network for the comparisons amongst EMD, GTR, different combination therapies and flap operation. |
| jcpe1844-sup-0002-TableS1.docWord document, 140.5 KB | Table S1. Quality Assessment of included RCTs for network meta-analysis. |
| jcpe1844-sup-0003-TableS2.docWord document, 183 KB | Table S2. Summary of studies included in the network meta-analysis for PPD reduction. |
| jcpe1844-sup-0004-TableS3.docWord document, 189 KB | Table S3. Summary of studies included in the network meta-analysis for CAL gain. |
| jcpe1844-sup-0005-TableS4.docWord document, 94 KB | Table S4. Summary of studies included in the network meta-analysis for clinical or radiographical infrabony defect fill. |
| jcpe1844-sup-0006-TableS5.docWord document, 35.5 KB | Table S5. The number of included studies in each of pair-wise comparisons for PPD reduction, CAL gain and infrabony defect fill. |
| jcpe1844-sup-0007-TableS6.docWord document, 56.5 KB | Table S6. Rank distributions of flap operation, EMD, GTR and the combination therapies for different treatment outcomes. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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