Non-surgical Treatment in Periodontal Regeneration Studies: A Systematic Review

Objective:  Periodontal regenerative surgery has been shown to be effective in obtaining clinical and radiographic gains in intrabony defects. However, recent evidence suggests that also non-surgical periodontal therapy (NSPT) can result in clinical and radiographic gains in such defects.  The aim of this systematic review was to assess the study design of studies on periodontal regeneration, with respect to the provision of NSPT before surgery. Method:  A systematic search of the literature was conducted by three reviewers for studies on periodontal regeneration. Initially, 3310 potentially eligible articles were identified. Following first-stage screening of titles, 476 articles qualified for abstract screening and 344 for full-text screening. Result:  A total of 340 studies were included in the review. Six per cent of studies did not include NSPT in the study protocol before regenerative surgery, while 15% of studies did not report this aspect. Seventy-nine per cent of studies reported that non-surgical subgingival debridement was performed before periodontal surgery (2 weeks to 6 months before surgery according to the different studies). However, no papers reported clinical and radiographic data before and after NSPT, prior to periodontal surgery. Conclusion:  This review highlights the lack of information on non-surgical periodontal therapy prior to periodontal regenerative surgery. Given the recent evidence on the healing of infrabony defects following NSPT, this review calls for a revision of the current study design of periodontal regenerative surgery.