Efficacy of Biologics for Surgical Treatment of Periodontal Suprabony Defects: A Systematic Review and Meta‐Analysis of Controlled Clinical Trials

ABSTRACT Aim Limited bone support in suprabony defects hinders predictable regeneration, but adjunctive biologics can improve results. This systematic review and meta‐analysis aimed to evaluate the clinical efficacy of adjunctive biologics combined with open flap debridement (OFD) compared with OFD alone when treating suprabony defects. Materials and Methods A systematic literature search was performed to identify controlled trials evaluating adult patients presenting horizontal periodontal defects. The primary outcome included residual probing depth (PD). Random‐effects meta‐analyses were performed; heterogeneity was assessed using I 2 statistics; risk of bias was evaluated using Cochrane RoB‐2; and evidence of quality was appraised via the GRADE framework. Results Nine studies comprising 303 patients were included. Adjunctive use of biologics—including enamel matrix derivative (EMD), platelet‐rich fibrin (PRF) and hyaluronic acid (HA)—significantly enhanced clinical outcomes compared to OFD alone, with pooled mean differences favouring EMD and PRF for both residual PD (−0.89 and −0.42 mm) and clinical attachment level (CAL) (−1.32 and −0.69 mm). While subgroup differences were observed, notably with EMD, high heterogeneity was present for CAL and PD, and evidence of certainty ranged from low to very low. Conclusion Adjunctive biologics improve clinical outcomes in suprabony periodontal defects; however, rigorous standardised trials are needed for reaching firm conclusions.