Periodontal regeneration compared with access flap surgery in human intra-bony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs
J Clin Periodontol 2017; 44: 58–66
Aim: Compare the long-term outcomes and costs of three treatment modalities in intra-bony defects. Materials and Methods: Forty-five intra-bony defects in 45 patients had been randomly allocated to receive: modified papilla preservation technique with titaniumreinforced expanded-polytetrafluoroethylene (ePTFE) membranes (MPPT Tit, N = 15); access flap with expanded-PTFE membranes (Flap-ePTFE, N = 15) and access flap alone (Flap, N = 15). Supportive periodontal care (SPC) was provided monthly for 1 year, then every 3 months for 20 years. Periodontal therapy was delivered to sites showing recurrences. Results: Forty-one patients complied with SPC. Four subjects were lost to follow-up. Clinical attachment-level differences between 1 and 20 years were 0.1 0.3 mm (p = 0.58) in the MPPT Tit; 0.5 0.1 mm (p = 0.003) in the Flap-ePTFE and 1.7 0.4 mm (p < 0.001) in the Flap. At 20 years, sites treated with Flap showed greater attachment loss compared to MPPT Tit (1.4 0.4 mm; p = 0.008) and to Flap-ePTFE (1.1 0.4 mm; p = 0.03). Flap group lost two treated teeth. Five episodes of recurrences occurred in the MPPT Tit, six in the Flap-ePTFE and fifteen in the Flap group. Residual pocket depth at 1-year was significantly correlated with the number of recurrences (p = 0.002). Sites treated with flap had greater OR for recurrences and higher costs of re-intervention than regenerated sites over a 20-year follow-up period with SPC.