Clinical Guidelines of the Italian Society of Periodontology for the Reconstructive Surgical Treatment of Angular Bony Defects in Periodontal Patients

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The purpose of these clinical guidelines, commissioned by the Italian Society of Periodontology and compiled with the tools and instructions of the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration, was to determine, in terms of efficacy, complications, and patient opinions, the most appropriate surgical techniques for periodontal patients with infrabony defects ≥3 mm.


Results published in the literature concerning open flap debridement (OFD), guided tissue regeneration (GTR) using a bioabsorbable or nonresorbable membrane, regeneration of periodontal tissues using enamel matrix derivative (EMD), and bone or bone substitute grafts were searched (electronically and manually) and compared. The following variables were analyzed: number of teeth lost, variation in clinical attachment level (CAL gain), variation in probing depth (PD reduction), variation in gingival recession, variation in bony defect depth (bone gain), complications, and the functional and esthetic satisfaction of the patients. Literature searches were performed selecting randomized clinical trials (RCTs) and systematic reviews (SRs) of RCTs published through December 31, 2006 with ≥1 year of follow-up. The full text of the selected SRs and RCTs were analyzed using checklists for qualitative evaluation according to the Scottish Intercollegiate Guidelines Network (SIGN) method.


For the drafting of these guidelines, it was decided to accept the results of two SRs that compared OFD versus GTR, OFD versus EMD, and GTR versus EMD. With regard to efficacy, GTR and EMD can yield better results than OFD in terms of CAL gain (1.22 mm [P value <0.0001] and 1.20 mm [P value <0.0001], respectively), reduction of PD (1.21 mm [P = 0.0004] and 0.77 mm [P = 0.0001], respectively), and bone gain (1.39 and 1.08 mm, respectively) after ≥1 year of follow-up. The available data are insufficient for an evaluation of bone or bone substitute grafts. The data in the literature are also insufficient for answering questions about complications and patient opinions.


The evidence reported in the literature indicates that it is advisable to treat infrabony defects ≥3 mm by OFD, GTR, and EMD. Further studies on these topics should be encouraged. There is a need for well-conducted RCTs that report data on complications and patient opinions. J Periodontol 2008; 79:2219-2232.

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