Effect of Connective Tissue Grafts in the Regenerative Treatment of Intrabony Defects: A Systematic Review and Meta-Regression Analysis

Abstract

Aim: To assess the effect of connective tissue graft (CTG) in the treatment of periodontal intrabony defects (IDs), focusing on changes in postoperative gingival recession (GR) depth and regenerative outcomes. Methods: A systematic search was conducted across MEDLINE–PubMed, EMBASE, Cochrane CENTRAL, and Google Scholar for articles published through December 31, 2024. Randomized controlled trials (RCTs) comparing treatment outcomes in IDs treated with or without CTG were included in a meta-regression analysis. A mixed-effect linear regression model was employed to estimate the effect of CTG on postoperative GR depth, probing depth (PPD) reduction, clinical attachment level (CAL) gain, and bone fill (BF). Results: Twenty-three studies were selected, with five RCTs (176 IDs) included in the meta-regression. Of these, two RCTs compared bone graft (BG) + CTG to BG + resorbable membrane (MB), one compared periosteal vs. nonperiosteal CTG combined with BG, one compared open flap debridement (OFD) + CTG to OFD alone, and one compared BG + CTG to either OFD or MB. The use of CTG was significantly associated with a reduction in GR (mean effect size of 0.981 mm, 95% CI: 0.573 to 1.389, p = 0.001), PPD (mean effect size of 1.160 mm, 95% CI: 0.318 to 2.002, p = 0.010), as well as improvements in CAL (mean effect size of 1.105 mm, 95% CI: 0.420 to 1.790, p = 0.004) and BF (mean effect size of 1.382 mm, 95% CI: 0.595 to 2.169, p = 0.002). Conclusion: Within the limitations of the study, the use of CTG in periodontal regenerative therapy for IDs appears beneficial in reducing postoperative GR and might further enhance regenerative outcomes compared to treatments without CTG.