A Bayesian network meta-analysis on comparisons of enamel matrix derivatives, guided tissue regeneration and their combination therapies

Department of Periodontology, Leeds Dental Institute, University of Leeds, UK.
Journal Of Clinical Periodontology (Impact Factor: 4.01). 03/2012; 39(3):303-14. DOI: 10.1111/j.1600-051X.2011.01844.x
Source: PubMed


Guided tissue regeneration (GTR) and enamel matrix derivatives (EMD) are two popular regenerative treatments for periodontal infrabony lesions. Both have been used in conjunction with other regenerative materials. We conducted a Bayesian network meta-analysis of randomized controlled trials on treatment effects of GTR, EMD and their combination therapies.
A systematic literature search was conducted using the Medline, EMBASE, LILACS and CENTRAL databases up to and including June 2011. Treatment outcomes were changes in probing pocket depth (PPD), clinical attachment level (CAL) and infrabony defect depth. Different types of bone grafts were treated as one group and so were barrier membranes.
A total of 53 studies were included in this review, and we found small differences between regenerative therapies which were non-significant statistically and clinically. GTR and GTR-related combination therapies achieved greater PPD reduction than EMD and EMD-related combination therapies. Combination therapies achieved slightly greater CAL gain than the use of EMD or GTR alone. GTR with BG achieved greatest defect fill.
Combination therapies performed better than single therapies, but the additional benefits were small. Bayesian network meta-analysis is a promising technique to compare multiple treatments. Further analysis of methodological characteristics will be required prior to clinical recommendations.

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Available from: Leandro Chambrone, May 27, 2015
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    • "Traditional meta-analysis undertakes pair-wise comparisons between treatments, but when the number of available treatments is large, pair-wise comparisons may be inefficient or not feasible [25] [26] [27] [28]. Network meta-analysis is a methodology for direct and indirect statistical comparisons between different treatments and had been used in dental research [25] [26] [29]. The aim of this study is to undertake a systematic review and network meta-analyses, comparing the clinical and radiographic outcomes in primary molar pulpotomy amongst different dressing materials. "
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    ABSTRACT: Objective Pulpotomy is a common procedure to treat asymptomatic reversible pulpitis in primary molars. The aim of this study is to undertake a systematic review and a network meta-analysis to compare the clinical and radiographic outcomes of different pulpotomy procedures in primary molars. Data: Three authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion. Sources: An electronic literature search was performed within MEDLINE (via PubMed), ScienceDirect, Web of Science, Cochrane, and ClinicalKey databases until December 2012. Medications for pulpotomy including formocresol, ferric sulfate, calcium hydroxide, and mineral trioxide aggregate (MTA), and laser pulpotomy are compared using Bayesian network meta-analyses. The outcome is the odds ratio for clinical and radiographic failure including premature tooth loss at 12 and 24 months after treatments amongst different treatment procedures. >37 studies were included in the systematic review, and 22 of them in the final network meta-analyses. After 18-24 months, in terms of treatment failure, the odds ratio for calcium hydroxide vs formocresol was 1.94 [95% credible interval (CI): 1.11, 3.25]; 3.88 (95% CI: 1.37, 8.61) for lasers vs formocresol; 2.16 (95% CI: 1.12, 4.31) for calcium hydroxide vs ferric sulfate; 3.73 (95% CI: 1.27, 11.67) for lasers vs ferric sulfate; 0.47 (95% CI: 0.26, 0.83) for MTA vs calcium hydroxide; 3.76 (95% CI: 1.39, 10.08) for lasers vs MTA. Conclusions After 18-24 months, formocresol, ferric sulfate, and MTA showed significantly better clinical and radiographic outcomes than calcium hydroxide and laser therapies in primary molar pulpotomies. Clinical significance: The network meta-analyses showed that MTA is the first choice for primary molar pulpotomies. However, if treatment cost is an issue, especially when the treated primary molars are going to be replaced by permanent teeth, ferric sulfate may be the choice.
    Full-text · Article · Sep 2014 · Journal of dentistry
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    • "Periodontitis is a chronic infectious disease, leading to periodontal tissue inflammation, attachment loss, alveolar bone resorption, and eventually tooth loss [1]. To date, several therapies, such as mechanical and chemical root conditioning, implantation of autografts, allografts and alloplastic materials, growth factors, guided tissue regeneration, and various combinations of these approaches, have been used in clinical practice with the aim of achieving true periodontal regeneration [2]–[5]. However, the clinical results vary widely and are often unpredictable. "
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    ABSTRACT: Background We derived mesenchymal stem cells (MSCs) from rat induced pluripotent stem cells (iPSCs) and transduced them with tumor necrosis factor alpha-stimulated gene-6 (TSG-6), to test whether TSG-6 overexpression would boost the therapeutic effects of iPSC-derived MSCs in experimental periodontitis. Methods A total of 30 female Sprague-Dawley (SD) rats were randomly divided into four groups: healthy control group (Group-N, n = 5), untreated periodontitis group (Group-P, n = 5), iPS-MSCs-treated and iPSC-MSCs/TSG-6-treated periodontitis groups (Group-P1 and P2, n = 10 per group). Experimental periodontitis was established by ligature and infection with Porphyromonas gingivalis around the maxillae first molar bilaterally. MSC-like cells were generated from rat iPSCs, and transducted with TSG-6. iPSC-MSCs or iPSC-MSCs/TSG-6 were administrated to rats in Group-P1 or P2 intravenously and topically, once a week for three weeks. Blood samples were obtained one week post-injection for the analysis of serum pro-inflammatory cytokines. All animals were killed 3 months post-treatment; maxillae were then dissected for histological analysis, tartrate-resistant acid phosphatase (TRAP) staining, and morphological analysis of alveolar bone loss. Results Administration of iPSC-MSC/TSG-6 significantly decreased serum levels of IL-1β and TNF-α in the Group-P2 rats (65.78 pg/ml and 0.56 pg/ml) compared with those in Group-P (168.31 pg/ml and 1.15 pg/ml respectively) (p<0.05). Both alveolar bone loss and the number of TRAP-positive osteoclasts showed a significant decrease in rats that received iPSC-MSC/TSG-6 treatment compared to untreated rats in Group-P (p<0.05), Conclusions We demonstrated that overexpression of TSG-6 in rat iPSC-derived MSCs were capable of decreasing inflammation in experimental periodontitis and inhibiting alveolar bone resorption. This may potentially serve as an alternative stem-cell-based approach in the treatment and regeneration of periodontal tissues.
    Full-text · Article · Jun 2014 · PLoS ONE
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    • "The ultimate goal of periodontal therapy is however the regeneration of the tooth’s supporting structures lost due to periodontal disease and should result in formation of new root cementum, periodontal ligament and bone [6]. Treatment with barrier membranes alone or in combination with different grafting materials, the use of biologic active substances such as enamel matrix proteins or growth factors have been shown to promote periodontal regeneration and to significantly improve the clinical outcomes evidenced by probing depth reduction, clinical attachment gain and defect fill [7]. A few of the materials have been described to act antimicrobial, e.g., enamel matrix derivatives inhibit the growth of P. gingivalis[8]. "
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    ABSTRACT: Findings from animal and human studies have indicated that an oily calcium hydroxide suspension (OCHS) may improve early wound healing in the treatment of periodontitis. Calcium hydroxide as the main component is well known for its antimicrobial activity, however at present the effect of OCHS on the influence of periodontal wound healing/regeneration is still very limited. The purpose of this in vitro study was to investigate the effect of OCHS on periodontopathogenic bacteria as well as on the attachment and proliferation of osteoblasts and periodontal ligament fibroblasts. Human alveolar osteoblasts (HAO) and periodontal ligament (PDL) fibroblasts were cultured on 3 concentrations of OCHS (2.5, 5 and 7.5 mg). Adhesion and proliferation were counted up to 48 h and mineralization was assayed after 1 and 2 weeks. Furthermore potential growth inhibitory activity on microorganisms associated with periodontal disease (e.g. Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans) as well as the influence of periodontopathogens and OCHS on the HAO and PDL fibroblasts counts were determined. More than a 2-fold increase in adherent HAO cells was observed at 4 h following application of OCHS when compared to the control group (p = 0.007 for 2.5 mg). Proliferation of HAO cells at 48 h was stimulated by moderate concentrations (2.5 mg; 5 mg) of OCHS (each p < 0.001), whereas a high concentration (7.5 mg) of OCHS was inhibitory (p = 0.009). Mineralization was observed only for HAO cells treated with OCHS. OCHS did not exert any positive effect on attachment or proliferation of PDL fibroblasts. Although OCHS did not have an antibacterial effect, it did positively influence attachment and proliferation of HAO cells and PDL fibroblasts in the presence of periodontopathogens. The present data suggests that OCHS promotes osteoblast attachment, proliferation and mineralization in a concentration-dependent manner and results are maintained in the presence of periodontal pathogens.
    Full-text · Article · Jan 2014 · BMC Oral Health
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