Minimially Invasive Surgery Comined With Regenerative Biomaterials In Treating Intra-bony Defects:a Meta-analysis

Background: With people's awareness of oral health,the percentage of adult orthodontics in orthodontic field increased year by year.However,most adults have periodontitis,and some severe cases are unable to accept orthodontic treatment without special periodontal therapy.For these patients,how to inhibit the progress of periodontitis as well as to promote periodontal regeneration will make orthodontic therapy possible.Nowadays,minimally invasive surgery(MIS)has been widespread applied in the field of periodontal regeneration,and it brings great benefits to those patients to improve their periodontal conditions.Also,numerous publications have evaluated the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects.However,it is unclear if it is necessary to use these biomaterials in MIS.Thus,we conducted a Meta-analysis of randomized controlled trials in patients with intra-bony defects to compare the clinical outcomes of MIS with regenerative biomaterials for MIS alone.Methods: The authors retrieved English publications on relevant studies from Cochrane CENTRAL,Pub Med,Medline,Embase,Clinical Evidence,and Clinical Trails.gov(up to June 30,2015).Through these databases,we selected RCT studies on comparing the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects.The main clinical outcomes were the reduction of probing pocket depths(PPDs),gain of clinical attachment level(CAL),recession of gingival margin(REC)and radiographic bone fill.Review Manager 5.2(Cochrane Collaboration,Oxford,England)was used to calculate the heterogeneity and mean differences,and 95% confidence interval of the main clinical outcomes.Results: In total,464 studies in the literature were identified but only four were ultimately feasible.The results showed no significant difference regarding CAL gain(P = 0.32)and PPD reduction(P = 0.40)as well as REC increase(P = 0.81)and radiographic bone fill(P = 0.64)between the MIS plus biomaterials group and the MIS alone group.Conclusions: The Meta-analysis suggested no significant difference in treatment of intra-bony defects between the MIS plus biomaterials group and the MIS alone group,indicating that it is important to take costs and benefits into consideration when a decision is made about a therapeutic approach.There needs to be an in-depth exploration of the induction of intrinsic tissue healing of MIS without biomaterials to achieve optimal outcomes.