Combination Of GTR And Bone Transplantation For Treatment Of Intrabony Defects: A Cochrane Systematic Review

ObjectiveTo systematically reviewed the evidence for efficacy of combined periodon-tal regeneration technique (CPRT) in comparison with guided tissue regeneration (GTR) for the treatment of intrabony defects, and to provide basis for the choice of the treatment plan .MethodsThe reviewer searched four electronic databases for GTR related articles with no language restrictions, and 13 journals were handsearched. With strict standardation of inclusion and exclusion, the reviewer sieved 10 randomized controlled trials ( RCTs) with at least 6 months of follow - up which compared the therapeutic effect of CPRT and GTR. The reviewer used meta - analysis to analyze the outcome of the trials. Outcome measures were : change in probing depths (PD),probing attachment level (PAL) , gingival recession (REC) , re-sorption of alveolar crest ( CEJ - AC ) ,raise of intrabony defect base ( CEJ -BD) and filling of the defect( AC - BD) on intraoral radiograph or surgical re -entry. Screening of eligible RCTs, assessment of the methodological quality according to Jadad score calculation, and data extraction were conducted by a reviewer. The reviewer extracted data by the table of Review Manager software, and used Revman4. 2 to analyze the outcome measures. A weighted treatment effect was calculated and the results were expressed as weighted mean difference (WMD) and 95% confidence interval (95% CI) for continuous outcomes.ResultsStudy characteristics and methodological qualityOf five hundred and five related articles, ten were include in this review. The group of CPRT had 171 cases and the control were 159 cases. Input the number of patients age intervention outcome and allocation concealment, Jadad score showed that six trials had 3 or above 3 scores which were high quality studies and four trials had 2 scores which were poor quality studies.Change in probing depthsThere were nine studies employed change in probing pocket depth as an outcome. No difference between CPRT and GTR controls was evident (weighted mean difference:0. 03mm,95% CI: -0. 31to0. 37 , chi - square = 2. 86, P = 0. 94,I2=0%).Change in attachment levelTen studies had change in probing attachment level as an outcome. There were no statistically significant differences for probing attachment level (weighted mean difference:0. 13mm,95%CI: -0. 17to0.44, chi - square = 7.60,P=0. 57,I2=0%).Gingival recessionThere were nine studies had gingival recession as an outcome, and these studies were homogeneous ( chi - square for heterogeneity = 5.56,P = 0.70,12 = 0% ). The result showed a limited but statistically significantly less recession for CPRT group compared with GTR control. The weighted mean difference between test and control was -0. 39mm (95%CI: -0. 61 to -0.17,test for complicating effect Z =3.51, P=0.00004).Bone dataFor the filling of the intrabony defects, there was one study used radio-graphic data, CPRT group had more filling. And four studies had surgical re -entry data as outcome, no difference between two groups was evident either ( WMD: 0.07mm,95% CI: - 0.29 toO. 43, chi - square for heterogeneity = 2. 28, P = 0.52, I2 = 0% ). There was heterogeneity between studies which had re-...