Bone Grafting Materials Used in treatment of Periodontal Intrabony and Furcation Defects: A Systematic Review of Clinical, Radiographic, and Patient-Centered Outcomes

Abstract

Aim To compare the clinical effectiveness, radiographic bone fill, safety, and patient-reported outcomes of autografts, allografts, xenografts, and alloplasts used in the regenerative treatment of periodontal intrabony and furcation defects. Methods A systematic search of PubMed, Cochrane CENTRAL, and Web of Science (1990–2025) identified 47 eligible studies (31 randomized controlled trials and 16 prospective cohort studies) involving 1,247 defects. Primary outcomes included probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain, and radiographic bone fill. Secondary outcomes were postoperative pain, graft-related complications, and patient satisfaction in terms of functional improvement. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Results Autografts achieved the highest mean bone fill (62.3%; 95% CI: 58.2–66.4) but were associated with donor-site morbidity and greater postoperative pain. Allografts, particularly when combined with enamel matrix derivative, demonstrated comparable bone fill (58.7%; 95% CI: 55.1–62.3) without the need for a second surgical site. Xenografts showed lower bone fill (53.1%; 95% CI: 49.8–56.4) but provided superior long-term volume stability due to slower resorption. Alloplasts performed favorably in contained two- and three-wall defects but exhibited particle migration in approximately 8% of one-wall defects. Patient-reported discomfort was lowest with xenografts and alloplasts. Smoking adversely affected regenerative outcomes, reducing bone fill by 18–25% across all graft types. Conclusions No graft material demonstrated universal superiority. Autografts remain the benchmark for extensive defects in nonsmokers, while allografts combined with enamel matrix derivative offer a favorable balance between efficacy and morbidity. Xenografts provide predictable volume maintenance, and alloplasts represent a cost-effective option for contained defects in selected patients.