Can Periodontal Bone Defects Regenerate?｜證據鏈

Changes in bone support caused by periodontitis may form intrabony defects around the roots, appear flatter, or be located at a furcation. An X-ray can indicate location and depth, but a single image cannot determine whether debridement, flap surgery, or regeneration is appropriate. The dentist must also consider periodontal probing, bleeding, tooth mobility, defect boundaries, soft tissue, access for root-surface cleaning, and whether the patient can maintain the site over the long term. For intrabony defects at least 3 mm deep, a systematic review of 79 randomised trials, 3,042 patients, and 3,612 defects found that regenerative surgery produced an average of 1.34 mm more clinical attachment gain than access flap debridement, with a 95% confidence interval of 0.95–1.73 mm. However, only 10 studies were rated at low risk of bias, heterogeneity between studies was moderate to high, and the overall strength of evidence was low to moderate. The conclusion of that review is stated more definitely than this: for residual pockets with deep (≥3 mm) intrabony defects, enamel matrix derivative or guided tissue regeneration combined with papilla preservation flaps “should be considered the treatment of choice”.