Objective: To assess the clinical efficacy of regenerative periodontal surgery of intrabony defects using a combination of enamel matrix derivative (EMD) and bone graft compared with that of EMD alone. Materials and methods:The Cochrane Oral Health Group specialist trials, MEDLINE and EMBASE databases were searched for entries up to February 2014. The primary outcome was gain of clinical attachment (CAL). Weighted means and Forest plots were calculated for CAL gain, probing depth (PD) and gingival recession (REC).Results: Twelve studies reporting on 434 patients and 548 intrabony defects were selected for the analysis. Mean CAL gain amounted to 3.76 ± 1.07 mm (median 3.63 95% CI: 3.51-3.75) following treatment with a combination of EMD and bone graft and to 3.32±1.04 mm (median 3.40; 95% CI 3.28; 3.52) following treatment with EMD alone. Clinical relevance: The present findings support the use of EMD and bone grafts for the treatment of intrabony periodontal defects.3

Within the limitations of the present study, regenerative therapy using either EMD + DBBM or CM + DBBM yielded comparable clinical outcomes in deep non-contained intrabony defects after 12 months.

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At present, early MRONJ stages should be primarily treated by means of a conservative approach while more advanced stages must be carefully evaluated. Individual decisions should be made for every single case even with respect to the drug-holiday protocol.

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