Management of vertical bone defects: evidence-based clinical practice

Abstract

Objective: To identify and present high-quality scientific evidence that discusses the effectiveness and safety of interventions in the management of vertical bone defects, with an emphasis on treatments related to guided tissue regeneration and dental enamel proteins. Data sources: The search was carried out on the Cochrane Library platform until June 2024, with the inclusion of systematic reviews. Two studies were selected, focusing on the efficacy of the enamel matrix derivative Emdogain® and autologous platelet concentrates. The inclusion criteria were based on reviews that analyzed interventions for vertical bone defects, and the quality of the information was assessed according to Cochrane parameters. Data synthesis: The use of Emdogain® resulted in an average gain of 0.62 mm (95% CI 0.28 to 0.96) in the clinical insertion level compared to the minimally invasive flap technique (p<0.05 ), while guided tissue regeneration showed an average increase of 0.41 mm (95% CI 0.15 to 0.66) in gingival recessions (p=0.002). Regarding the surgical access technique for debridement, associated with autologous platelet concentrates, an average gain of 1.29 mm (95% CI 1.00 to 1.58) in probing depth was observed (p<0.001). Conclusions: Despite promising results, the low certainty of the evidence limits the clinical applicability of the interventions discussed. Therefore, the choice of treatment must consider factors such as quality of life, patient preferences and cost of the intervention, avoiding generalizations beyond the scope of the reviews analyzed.