Enamel matrix derivative stabilizes blood clot and improves clinical healing in deep pockets after flapless periodontal therapy: A Randomized Clinical Trial

Abstract

Aim An acute phase response is induced after non‐surgical periodontal treatment (SRP). The main aim of this study was to compare acute phase (24‐hr) and medium‐term (3‐months) inflammation and clinical outcomes after SRP with or without application of enamel matrix derivative (EMD) in sites with probing pocket depth (PPD) ≥ 6 mm. Methods Thirty‐eight periodontitis‐affected subjects were randomized to SRP or SRP + EMD. Periodontal parameters were recorded at baseline and 3 months. Serum samples were collected at baseline, 1 and 90 days after treatment. Results Both treatments triggered an intense acute inflammation on day 1, which regressed to baseline values at 3 months. D‐dimer and cystatin C levels did not show sharp increases in SRP + EMD group 24 hr after treatment, compared to SRP. Significant difference between groups was observed for D‐dimer (p < 0.001). EMD application was also associated with better periodontal healing as shown by greater PPD reduction and clinical attachment level gain in sites with PPD ≥ 6 mm, and higher number of cases with no residual PPD ≥ 6 mm (p < 0.05) at 3 months. Conclusions EMD application after non‐SRP resulted in lower fibrinolysis, and better periodontal healing of deep pockets. These initial observations warrant further investigations on the potential to modulate both local and systemic outcomes of non‐SRP. NCT03544931

Effect of Flap Design for Enamel Matrix Derivative Application in Intraosseous Defects

“…The protocol for flapless EMD use adopted in the study included in the present review was based on root instrumentation/conditioning per a combination of minicurets and ultrasonic instruments with thin and delicate tips under 12.5× magnification via a gingival retractor and a microsurgical dental mirror, followed by 24% EDTA gel application (Aimetti et al 2017). It has been consistently shown that substantial CAL gain (up to 3.0 mm) can be obtained at 6 to 18 mo following treatment when nonsurgical therapy is administered according to the principles of minimal invasiveness, as in the minimally invasive nonsurgical therapy protocol (Ribeiro et al 2011; Nibali et al 2015), and 1-mm additional attachment gain may be obtained by the adjunctive use of EMD at sites with deep pockets (Graziani et al 2019). Due to the low level of evidence (1 study with 15 subjects), the results obtained with EMD alone by avoiding any incision (as in the nonsurgical approach) must be interpreted with caution.…”

Flapless application of enamel matrix derivative in periodontal retreatment: A multicentre randomized feasibility trial

“…In contrast, the non-surgical ("flapless") application of EMD as an adjunctive measure during the initial phase of periodontal therapy by root instrumentation has led to conflicting results. While several studies did not observe an added benefit of EMD (Gutierrez et al 2003;Mombelli et al 2005;Giannopoulou et al 2006;Wyganowska-Świątkowska et al, 2013), other studies reported positive effects (Wennström & Lindhe, 2002;Mellonig et al 2009;Aimetti et al 2017;Graziani et al 2019).…”

Prevention of Periodontal Pocket Formation after Mandibular Third Molar Extraction Using Dentin Autologous Graft: A Split Mouth Case Report

“…Prior to extractions, periapical radiographs of the interested third molars were taken, and the following periodontal indexes were recorded by a calibrated and blinded operator (G.S), at mesiobuccal, midbuccal, distobuccal, distolingual, midlingual, and mesiolingual sites of the bilateral mandibular second molars: plaque index (PI), bleeding on probing (BOP), gingival index (GI), clinical attachment level (CAL), and probing pocket depth (PPD) were recorded by the use of a PCP-15-UNC probe (Hu-Friedy, Leimen, Germany) ( Table 1 ) [ 19 , 20 ]. The registration of all those above-mentioned periodontal indexes was considered mandatory due to avoid invalid results caused by the shrinkage of the soft tissues during the healing.…”