The efficacy of biologic factors on the surgical therapy of periodontal suprabony defects: A systematic review and network meta-analysis of randomized clinical trials

Objectives: This systematic review investigated the efficacy of biologic factors in the surgical treatment of periodontal suprabony defects. Materials and Methods: Three databases were searched to identify RCTs comparing open-flap debridement (OFD) combined with biologic factors only, or combined with bone substitute, and/or barriers to the same intervention without biologics or OFD in terms of probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain, and number of pockets closed. Risk of bias was performed according to RoB 2. Pairwise meta-analyses and frequentist network meta-analyses by using random-effects models were performed. GRADE was employed to assess the certainty of evidence. Results: Ten studies reporting on 253 subjects were included. Overall, adding biologics to OFD leads to a significant improvement in post-treatment PPD and CAL at 9–12 months, with enamel matrix derivative (EMD) having the highest probability of being the best biologic for changes in PPD (−1.91 mm, 95% CI: −3.02, −0.81) and CAL (−2.24 mm, 95% CI: −2.68, −1.79) at a low level of evidence. Conclusion: The addition of biologics provides an adjunctive benefit in post-treatment PPD and CAL. However, data should be interpreted with caution due to the heterogeneity of studies, limited data available, risk of bias, and low/moderate evidence.