{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T21:34:08Z","timestamp":1789940048280,"version":"4.0.1"},"reference-count":116,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2008,12,1]],"date-time":"2008-12-01T00:00:00Z","timestamp":1228089600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Periodontology"],"published-print":{"date-parts":[[2008,12]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> The purpose of these clinical guidelines, commissioned by the Italian Society of Periodontology and compiled with the tools and instructions of the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration, was to determine, in terms of efficacy, complications, and patient opinions, the most appropriate surgical techniques for periodontal patients with infrabony defects \u22653 mm.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Results published in the literature concerning open flap debridement (OFD), guided tissue regeneration (GTR) using a bioabsorbable or non\u2010resorbable membrane, regeneration of periodontal tissues using enamel matrix derivative (EMD), and bone or bone substitute grafts were searched (electronically and manually) and compared. The following variables were analyzed: number of teeth lost, variation in clinical attachment level (CAL gain), variation in probing depth (PD reduction), variation in gingival recession, variation in bony defect depth (bone gain), complications, and the functional and esthetic satisfaction of the patients. Literature searches were performed selecting randomized clinical trials (RCTs) and systematic reviews (SRs) of RCTs published through December 31, 2006 with \u22651 year of follow\u2010up. The full text of the selected SRs and RCTs were analyzed using checklists for qualitative evaluation according to the Scottish Intercollegiate Guidelines Network (SIGN) method.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> For the drafting of these guidelines, it was decided to accept the results of two SRs that compared OFD versus GTR, OFD versus EMD, and GTR versus EMD. With regard to efficacy, GTR and EMD can yield better results than OFD in terms of CAL gain (1.22 mm [<jats:italic>P<\/jats:italic> value &lt;0.0001] and 1.20 mm [<jats:italic>P<\/jats:italic> value &lt;0.0001], respectively), reduction of PD (1.21 mm [<jats:italic>P<\/jats:italic> = 0.0004] and 0.77 mm [<jats:italic>P<\/jats:italic> = 0.0001], respectively), and bone gain (1.39 and 1.08 mm, respectively) after \u22651 year of follow\u2010up. The available data are insufficient for an evaluation of bone or bone substitute grafts. The data in the literature are also insufficient for answering questions about complications and patient opinions.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> The evidence reported in the literature indicates that it is advisable to treat infrabony defects \u22653 mm by OFD, GTR, and EMD. Further studies on these topics should be encouraged. There is a need for well\u2010conducted RCTs that report data on complications and patient opinions.<\/jats:p>","DOI":"10.1902\/jop.2008.080266","type":"journal-article","created":{"date-parts":[[2008,12,4]],"date-time":"2008-12-04T07:12:25Z","timestamp":1228374745000},"page":"2219-2232","source":"Crossref","is-referenced-by-count":37,"title":["Clinical Guidelines of the Italian Society of Periodontology for the Reconstructive Surgical Treatment of Angular Bony Defects in Periodontal Patients"],"prefix":"10.1002","volume":"79","author":[{"given":"Umberto","family":"Pagliaro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Nieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Rotundo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Cairo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranco","family":"Carnevale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Esposito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierpaolo","family":"Cortellini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanpaolo","family":"Pini\u2010Prato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,12]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"PetersonP.The World Oral Health Report 2003. Available at:http:\/\/www.who.int\/oral_health\/media\/en\/orh_report03_en.pdf. Accessed February5 2007."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1999.70.1.13"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0757.2002.290103.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1992.63.4s.322"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0906-6713.2002.03202.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051X.29.s-3.2.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1999.70.4.457"},{"key":"e_1_2_8_9_1","unstructured":"Committee on Intersociety Coordination of the Italian Dental Societies (CIC).Guidelines in Dentistry(in Italian). Promo Leader Service Florence Italy; 2003:131\u2010156."},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051X.29.s3.3.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1995.tb00828.x"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.1931.0237"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1982.tb02065.x"},{"issue":"9","key":"e_1_2_8_14_1","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1111\/j.1600-051X.1997.tb00251.x","article-title":"Periodontal regeneration with enamel matrix derivative in one human experimental defect. A case report","volume":"24","author":"Heijl L","year":"1997","journal-title":"J Clin Periodontol"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1986.57.5.286"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2003.74.9.1395"},{"key":"e_1_2_8_17_1","unstructured":"The AGREE Collaboration. Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument. Available at:http:\/\/www.agreecollaboration.org. Accessed February 5 2007."},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jebdp.2007.01.001"},{"key":"e_1_2_8_19_1","unstructured":"Scottish Intercollegiate Guidelines Network (SIGN). A guideline developers' handbook. Available athttp:\/\/www.sign.ac.uk. Accessed February 5 2007."},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1998.69.3.303"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051X.29.s3.7.x"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2002.73.11.1360"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1902\/annals.2003.8.1.193"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1902\/annals.2003.8.1.227"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1902\/annals.2003.8.1.266"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/154411130401500605"},{"key":"e_1_2_8_27_1","first-page":"CD003875","article-title":"Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects","author":"Esposito M","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_28_1","first-page":"CD001724","article-title":"Guided tissue regeneration for periodontal infra\u2010bony defects","author":"Needleman IG","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_29_1","first-page":"461","article-title":"Evaluation of efficacy of enamel matrix derivative in the treatment of intrabony defects: A 24\u2010month multicenter study","volume":"25","author":"Francetti L","year":"2005","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2005.76.8.1354"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2006.060002"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1971.42.10.648"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1976.tb01856.x"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1976.47.5.287"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1979.50.10.510"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1981.52.2.55"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1981.52.11.680"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1982.tb01230.x"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1983.54.1.1"},{"key":"e_1_2_8_40_1","first-page":"40","article-title":"Decalcified freeze\u2010dried bone allograft as an implant material in human periodontal defects","volume":"4","author":"Mellonig JT","year":"1984","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1984.tb01326.x"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1984.55.11.633"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1985.56.2.63"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1985.56.2.74"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1985.56.2.82"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1985.tb01380.x"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1985.56.9.540"},{"key":"e_1_2_8_48_1","first-page":"34","article-title":"Six month evaluation of Calcitite (hydroxyapatite ceramic) in periodontal osseous defects","volume":"6","author":"Yukna RA","year":"1986","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1986.57.4.205"},{"key":"e_1_2_8_50_1","first-page":"8","article-title":"The induction of new bone and cementum formation. V. A comparison of graft and control in sites in deep intrabony periodontal lesions","volume":"6","author":"Hiatt WH","year":"1986","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_8_51_1","first-page":"203","article-title":"6\u2010month clinical evaluation of the augmentation of intraosseous lesions with porous hydroxyapatite (Interpore 200) (in French)","volume":"6","author":"Louise F","year":"1987","journal-title":"J Parodontol"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1987.58.8.521"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1989.tb01667.x"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1989.60.10.544"},{"key":"e_1_2_8_55_1","first-page":"173","article-title":"Variations in healing of infrabony defects treated with ceramic bone\u2010grafting material observed radiographically for a period of three years","volume":"16","author":"Galgut PN","year":"1990","journal-title":"J Oral Implantol"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1990.61.6.319"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1990.61.10.633"},{"key":"e_1_2_8_58_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1990.61.12.737"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1991.62.1.44"},{"key":"e_1_2_8_60_1","first-page":"294","article-title":"Clinical response to the use of the HTR polymer implant in human intrabony lesions","volume":"12","author":"Shahmiri S","year":"1992","journal-title":"Int J Periodontics Restorative Dent"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1992.tb00685.x"},{"key":"e_1_2_8_62_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1993.64.2.103"},{"key":"e_1_2_8_63_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1993.64.2.128"},{"key":"e_1_2_8_64_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1994.65.2.177"},{"key":"e_1_2_8_65_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1995.tb01787.x"},{"key":"e_1_2_8_66_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1996.67.8.770"},{"key":"e_1_2_8_67_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1996.67.12.1301"},{"key":"e_1_2_8_68_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1997.tb00200.x"},{"key":"e_1_2_8_69_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1997.tb00205.x"},{"key":"e_1_2_8_70_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1998.69.1.47"},{"key":"e_1_2_8_71_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1998.69.2.146"},{"key":"e_1_2_8_72_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1998.69.6.655"},{"key":"e_1_2_8_73_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1998.69.6.698"},{"key":"e_1_2_8_74_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1998.69.12.1346"},{"key":"e_1_2_8_75_1","doi-asserted-by":"publisher","DOI":"10.1007\/s007840050123"},{"key":"e_1_2_8_76_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1708-8240.2000.tb00231.x"},{"key":"e_1_2_8_77_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2001.72.6.730"},{"key":"e_1_2_8_78_1","first-page":"225","article-title":"Clinical evaluation of bioactive glass in the treatment of periodontal intrabony defects","volume":"37","author":"Han J","year":"2002","journal-title":"Zhonghua Kou Qiang Yi Xue Za Zhi"},{"key":"e_1_2_8_79_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2003.74.6.899"},{"key":"e_1_2_8_80_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2003.74.9.1282"},{"key":"e_1_2_8_81_1","first-page":"101","article-title":"Comparative clinical evaluation of combination anorganic bovine\u2010derived hydroxyapatite matrix (ABM)\/cell binding peptide (P\u201015) and open flap debridement (DEBR) in human periodontal osseous defects: A 6 month pilot study","volume":"6","author":"Radhakrishnan S","year":"2004","journal-title":"J Int Acad Periodontol"},{"key":"e_1_2_8_82_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2004.00562.x"},{"key":"e_1_2_8_83_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2004.75.12.1668"},{"key":"e_1_2_8_84_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2005.00696.x"},{"key":"e_1_2_8_85_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2005.76.5.768"},{"key":"e_1_2_8_86_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2005.76.12.2205"},{"key":"e_1_2_8_87_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2005.00870.x"},{"key":"e_1_2_8_88_1","first-page":"560","article-title":"The effect of fibronectin and a bone xenograft on regenerative treatment: A feasibility study","volume":"27","author":"Camargo PM","year":"2006","journal-title":"Compend Contin Educ Dent"},{"key":"e_1_2_8_89_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2006.060029"},{"key":"e_1_2_8_90_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1990.61.12.732"},{"key":"e_1_2_8_91_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1995.66.9.797"},{"key":"e_1_2_8_92_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bdj.4808933"},{"key":"e_1_2_8_93_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1996.67.3.217"},{"key":"e_1_2_8_94_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2842.1996.tb00898.x"},{"key":"e_1_2_8_95_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1998.tb02492.x"},{"key":"e_1_2_8_96_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1998.69.11.1183"},{"key":"e_1_2_8_97_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1998.tb02402.x"},{"key":"e_1_2_8_98_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1998.69.12.1317"},{"key":"e_1_2_8_99_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051X.1997.00833.x"},{"key":"e_1_2_8_100_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051x.2000.027002120.x"},{"key":"e_1_2_8_101_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051x.2000.027008603.x"},{"key":"e_1_2_8_102_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051x.2001.028005397.x"},{"key":"e_1_2_8_103_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2001.72.12.1702"},{"key":"e_1_2_8_104_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2002.73.1.3"},{"key":"e_1_2_8_105_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051X.2002.291006.x"},{"key":"e_1_2_8_106_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1997.tb00253.x"},{"key":"e_1_2_8_107_1","first-page":"292","article-title":"EMDOGAIN in the treatment of intrabony periodontal defects","volume":"76","author":"Heijl L","year":"1997","journal-title":"J Dent Res"},{"key":"e_1_2_8_108_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2000.71.12.1821"},{"key":"e_1_2_8_109_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2000.71.12.1821"},{"key":"e_1_2_8_110_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051X.2002.290407.x"},{"key":"e_1_2_8_111_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051X.2003.10146.x"},{"key":"e_1_2_8_112_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0303-6979.2004.00437.x"},{"key":"e_1_2_8_113_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2004.75.5.726"},{"key":"e_1_2_8_114_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2004.00615.x"},{"key":"e_1_2_8_115_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2005.76.1.129"},{"key":"e_1_2_8_116_1","unstructured":"U.S. Department of Health and Human Services.Acute Pain Management: Operative or Medical Procedures and Trauma. Clinical Practice Guideline No. 1. AHCPR Publication No. 92\u20100023:107. Rockville MD: Agency for Health Care Policy and Research U.S. Department of Health and Human Services; 1993."},{"key":"e_1_2_8_117_1","unstructured":"Scottish Intercollegiate Guidelines Network. Methodology Review Group.Report on the Review of the Method of Grading Guideline Recommendations. Edinburgh: SIGN; 1999."}],"container-title":["Journal of Periodontology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1902\/jop.2008.080266","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T09:01:50Z","timestamp":1760864510000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1902\/jop.2008.080266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,12]]},"references-count":116,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2008,12]]}},"alternative-id":["10.1902\/jop.2008.080266"],"URL":"https:\/\/doi.org\/10.1902\/jop.2008.080266","archive":["Portico"],"relation":{},"ISSN":["0022-3492","1943-3670"],"issn-type":[{"value":"0022-3492","type":"print"},{"value":"1943-3670","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,12]]}}}