Enamel matrix derivative for the treatment of partially contained intrabony defects – a comparative study

Abstract

Background : Intrabony defects of the alveolar bone develop as a result of vertical periodontal bone resorption and are generally associated with deep periodontal pockets which persist after initial non-surgical periodontal therapy and require surgical treatment. A number of surgical techniques and biomaterials have been employed for the regenerative treatment of intrabony defects, including bone substitutes and enamel matrix derivative (EMD). Aim/Hypothesis : The aim of the study was to evaluate the use of EMD alone or in association with deproteinized bovine bone mineral (DBBM) for the treatment of partially contained intrabony defects. Material and Methods : In the present nonrandomized controlled study, a total of 29 intrabony defects of more than 4 mm belonging to 13 patients diagnosed with chronic periodontitis were included. Patients with one-walled defects, being pregnant or nursing were excluded. All surgeries were performed by one operator using the papilla preservation technique. After direct visualization of the defects, they were classified as self-contained (three-walled) and partially contained (two-walled). The former were treated with EMD alone and served as positive controls (n = 9). The latter were treated either with EMD alone (test group 1, n = 10) or combined with DBBM (test group 2, n = 10). The primary outcomes were probing depth (PD), recession (REC), clinical attachment level (CAL), radiographic depth from cemento-enamel junction (CEJ-A), depth (C-A) and width (C-B) of the intrabony defect. Clinical and radiographic evaluations were performed by one blinded operator at baseline, 6 and 12 months after surgeries. Results : At 6 months, PD, REC and CAL were respectively 2.4 ± 0.7 mm, 2.4 ± 2.2 mm and 4.8 ± 2.0 mm in the control group, 3.3 ± 1.8 mm, 2.6 ± 2.3 mm and 5.9 ± 2.6 mm in test group 1, and 3.0 ± 0.9 mm, 4.1 ± 1.3 mm, and 7.1 ± 1.2 mm in test group 2. In all groups, these parameters were significantly reduced from baseline (P < 0.05). No differences among groups were found. Radiographic parameters showed a filling of all defects. Significant differences were registered between control and test group 2 and between test group 1 and test group 2 considering CEJ-A, and between test groups considering C-A and C-B. At 12 months, PD, REC and CAL were respectively 2.3 ± 0.5 mm, 3.3 ± 2.0 mm and 5.6 ± 1.8 mm in the control group, 2.8 ± 0.8 mm, 2.3 ± 2.4 mm, and 5.0 ± 2.8 mm in test group 1, and 3.0 ± 0.7 mm, 3.9 ± 1.5 mm and 6.9 ± 1.1 mm in test group 2. Radiographic parameters registered a further decrease in all groups. No differences among groups were found in clinical and radiographic outcomes. Conclusions and Clinical Implications : EMD obtained comparable results in both self-contained and partially contained defects. Partially contained defects were successfully treated using EMD alone or in association with DBBM, despite the differences in the short-term radiographic outcomes, which can be related to the characteristics of the bone substitutes. In conclusion, EMD alone or in associat...