ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Resorbable and Non-Resorbable Membranes Are Both Effective in Producing Positive Clinical Outcomes Following Grafting of Intrabony Defects
Clinical Question In periodontitis patients with intrabony defects, does guided tissue regeneration (GTR) with non-resorbable or resorbable membranes result in greater clinical attachment level gain?
Clinical Bottom Line When treating intrabony defects with guided tissue regeneration, use of either resorbable or non-resorbable membranes will produce significant gains in clinical attachment level and reduction in probing depth (PD). Both techniques produce superior clinical results compared to open flap debridement alone.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19776505Parrish / 2009Adult humans with intrabony defects involved in previous clinical trialsSystematic Review
Key resultsNon-resorbable and resorbable membranes were both found to be superior to open flap debridement alone in treatment of intrabony periodontal defects (CAL gain with resorbable membranes = 2.53 mm to 3.4 mm vs. non-resorbable membranes = 2.60 to 3.34 mm vs. OFD alone = 1.81 to 2.10 mm).
#2) 9350559Caffesse / 1997Adult healthy humansRCT
Key resultsSignificant gain in clinical attachment level (CAL) and decrease in probing depth (PD) was observed when using either resorbable or non-resorbable membrane techniques, with no statistically significant difference (PD reduction resorbable membranes 3.8mm vs. non-resorbable membranes 3.7 mm; CAL gain resorbable membranes 2.3 mm vs non-resorbable membranes 3.0 mm). Class II furcations also studied, also resulting in significant positive clinical outcomes (PD reduction resorbable membrane 2.5mm vs. non-resorbable membrane 2.6 mm; CAL gain resorbable membranes 2.4 mm vs non-resorbable membrane 1.5 mm) with no statistically significant difference between membrane types (p>0.05).
Evidence Search (("Guided Tissue Regeneration, Periodontal/instrumentation"[Mesh] OR "Guided Tissue Regeneration, Periodontal/methods"[Mesh]) AND "Membranes, Artificial"[Mesh]) AND "Alveolar Bone Loss/surgery"[Mesh] AND ("humans"[MeSH Terms] AND (Randomized Controlled Trial[ptyp] OR Review[ptyp]) AND English[lang])
Comments on
The Evidence
The systematic review included 49 clinical trials, but no comments made regarding validity of each study included for review. Mean data from individual studies was included, upon which simple statistical calculations for further data analysis was made. Trials included did not have to be double blinded or randomized. The RCT study only included a small patient population (n=12), and was unclear as to whether examiners were blinded or not. Adequate follow-up and patient compliance are strengths of the study.
Applicability These findings can be applied to healthy patients experiencing either moderate furcation defects (Class II) or intrabony defects resulting from chronic periodontitis. Collected data is also beneficial in allowing clinicians to select membrane materials based on operator preference (ease of use, patient comfort, number of procedures, etc.), as no significant clinical outcomes differences were found between membrane types.
Specialty/Discipline (Periodontics)
Keywords Guided Tissue Regeneration, Intrabony Defects
ID# 2117
Date of submission: 09/15/2011spacer
E-mail johnsonsf@livemail.uthscsa.edu
Author Shannan Johnson
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author e-mail finlaysonr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Madeline Hart, Jeff Taylor (San Antonio, TX) on 11/28/2017
The TRIP database was searched on November 2017, and an article was located (PMID: 26411859) that contradicts the article discussed in this CAT. This study published by Rakmanee in 2016 is a single-blinded, randomized, controlled clinical trial with 18 patients presenting bilateral intrabony defects and aggressive periodontitis. In each patient, one side was treated with polyglycolide membrane, a resorbable membrane, and the other side was treated with access flap surgery. After 6 and 12 months, there was no statistically significant difference between sides (p>0.05) in terms of CAL and PPD. This differs from the discussed CAT where both non-resorbable and resorbable membranes were statistically significant compared to open flap debridement.
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