TREATMENT OF INTRABONY DEFECTS BY DIFFERENT SURGICAL-PROCEDURES - A LITERATURE-REVIEW

THIS ARTICLE REVIEWS STUDIES presented during the last 20 years on the surgical treatment of intrabony defects. Treatments include open flap debridement alone (OFD); OFD plus demineralized freeze-dried bone all ograft (DFDBA), freeze-dried bone allografts (FDBA), or autogenous bon e; and guided tissue regeneration (GTR). The review includes only stud ies that presented baseline and final data on probing depths, intrabon y defect depths as measured during surgery, clinical attachment level (CAL) gain, and/or bone fill. Some reports were case studies and some controlled studies comparing different treatments. In order to assess what can be accomplished in terms of pocket reduction, clinical attach ment level gain, and bone fill with the various treatment modalities, data from studies of each treatment category were pooled for meta-anal ysis in which the data from and power of each study were weighted acco rding to the number of defects treated. In addition, where there were data for each individual defect treated, these were used for simple re gression analysis evaluating the influence of intrabony defect depth o n treatment outcome in terms of CAL gain and bone fill. This was done in an effort to assess some predictability of the outcome of the vario us treatments. OFD alone resulted in limited pocket reduction, CAL gai n averaged 1.5 mm and bone fill 1.1 mm. Bone fill, but not CAL gain, c orrelated significantly to the depth of the defect (R = 0.3; P < 0.001 ), but the regression coefficient was only 0.25. OFD plus bone graft r esulted in limited pocket reduction. CAL gain and bone fill averaged 2 .1 mm. Bone fill showed a somewhat stronger correlation to defect dept h than following OFD alone (R = 0.43; P < 0.001) with a regression coe fficient of 0.37. GTR resulted in significant pocket reduction. CAL ga in of4.2 mm, and bone fill averaging 3.2 mm. CAL gain and bone fill co rrelated significantly (P < 0.001) to defect depth (R = 0.52 and 0.53 respectively) with the largest regression coefficients (0.54 and 0.58 respectively) among the three treatment modalities. By comparing outco mes following the various treatments it became obvious that to benefit from GTR procedures, the intrabony defect has to be at least 4 mm dee p.