Enamel matrix proteins in the treatment of intra-bony defects. A prospective 24-month clinical trial. Enamel matrix proteins and guided tissue regeneration with titanium-reinforced expanded polytetrafluoroethylene membranes in the treatment of infrabony defects: a comparative controlled clinical trial. Five years clinical results following treatment of human intra-bony defects with an enamel matrix derivative: A randomized controlled trial Enamel matrix proteins in the regenerative therapy of deep intrabony defects. Enamel matrix proteins and bovine porous bone mineral in the treatment of intrabony defects: a comparative controlled clinical trial. Effect of enamel matrix proteins on the treatment of intrabony defects: a split-mouth randomized controlled trial study. Treatment of infrabony defects with or without enamel matrix proteins: a 24-month follow-up randomized pilot study. A comparative study utilizing open flap debridement with and without enamel matrix derivative in the treatment of periodontal intrabony defects: a 12-month re-entry study. Comparison of treatments of infrabony defects with enamel matrix derivative, guided tissue regeneration with a nonresorbable membrane and Widman modified flap. A pilot study. Evaluation of efficacy of enamel matrix derivative in the treatment of intrabony defects: a 24-month multicenter study. A clinical study evaluating the treatment of supra-alveolar-type defects with access flap surgery with and without an enamel matrix protein derivative: a pilot study. Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. Treatment of intrabony defects with enamel matrix proteins and guided tissue regeneration. A prospective controlled clinical study. A comparison between enamel matrix proteins used alone or in combination with bovine porous bone mineral in the treatment of intrabony periodontal defects in humans. Healing of human intrabony defects following regenerative periodontal therapy with an enamel matrix protein derivative alone or combined with a bioactive glass. A controlled clinical study. Clinical comparison of an enamel matrix derivative used alone or in combination with a bovine-derived xenograft for the treatment of periodontal osseous defects in humans. Enamel matrix derivative and low-level laser therapy in the treatment of intra-bony defects: a randomized placebo-controlled clinical trial.
BACKGROUND A growing flow of recent evidence indicates enamel matrix derivative ( EMD , Emdogain ) as a useful tool for the regeneration of periodontal tissues . This prospect i ve clinical study aim ed to evaluate the efficacy of EMD combined with surgical treatment of periodontal intra-bony defects , as compared with surgery alone , up to 24 months of follow-up . METHODS Twenty-four intra-bony defects were treated in 24 patients in a single clinical centre . Each defect had intra-bony depth ( IBD ) > or = 4 mm and probing pocket depth ( PPD ) > or = 6 mm . Patients were r and omly assigned to either test or control group . Plaque index ( PI ) , gingival index ( GI ) , PPD and periodontal attachment level ( PAL ) were assessed at baseline pre-surgical examination at the site to be treated . Full mouth plaque score ( FMPS ) and full mouth bleeding score ( FMBS ) were also evaluated . Twelve patients were treated by simplified papilla preservation flap technique ( control group ) , while 12 patients were treated with the same surgical technique plus EMD after ethylenediamine tetraacetic acid root conditioning ( test group ) . Any probing at the involved sites was avoided in the first year post-surgery . Radiographs were taken at baseline , 12 and 24 months after surgery using customized bite blocks . Intra-bony defect depth ( IBD ) and angle ( IBA ) were measured from X-rays by a computer-aided technique . At 12 and 24 months post-surgery , FMPS , FMBS , PI , GI , PPD , PAL and radiographic IBD and IBA were assessed . The difference between each follow-up and baseline , and between groups at each follow-up was evaluated for the above parameters by st and ard statistical methods . RESULTS In both groups , clinical and radiographic parameters were improved at either 12 or 24 months when compared with baseline . The test group displayed better outcomes when compared with the control group for IBD , PPD , and PAL gain at 12 months , and only for PAL and IBD gain at 24 months . No adverse event related to the use of EMD was reported . CONCLUSIONS The surgical procedure used in the present study , aim ing for maximum preservation of the regenerative potential of periodontal tissues , showed per se excellent results . The use of EMD as an adjunct to periodontal surgery in the treatment of angular defects possibly enhances periodontal regeneration rate BACKGROUND Several studies have documented the clinical efficacy of guided tissue regeneration ( GTR ) with non-resorbable exp and ed polytetrafluoroethylene ( ePTFE ) membranes and enamel matrix proteins ( EMP ) in the treatment of infrabony defects . The objective of this controlled clinical study was to compare the clinical outcomes of 3 surgical modalities in the treatment of deep interproximal infrabony defects . METHODS Ninety ( 90 ) defects in 90 healthy subjects affected by chronic periodontitis were assigned to 1 of 3 treatment groups by blocking to prognostic variables . The test group was treated with the application of EMP and the simplified papilla preservation ( SPP ) technique ; the second group was treated with titanium-reinforced ePFTE membranes and the SPP technique ; and the third group was treated with the SPP technique used as access flap control procedure . No differences were observed in terms of baseline oral hygiene and defect characteristics among the 3 groups , indicating that the blocking approach was effective . A stringent infection control program was adopted for 1 year . RESULTS The 1-year results indicated that : 1 ) all treatment modalities result ed in clinical ly significant improvements in clinical attachment levels ( CAL ) and reduction in probing depth ( PD ) ; 2 ) a statistically significant treatment effect was demonstrated comparing the EMP test , the membrane control , and the flap control groups in terms of CAL gains ; 3 ) both the EMP test and the membrane control groups showed significant CAL gains compared to the flap control group ; 4 ) a statistically significantly greater amount of CAL gain was demonstrated in GTR-treated compared to EMP-treated patients ; 5 ) deeper residual probing depths but smaller increases in gingival recession were demonstrated following EMP therapy ; and 6 ) smoking habits reduced the clinical outcomes of both regenerative procedures . CONCLUSIONS The use of a regenerative procedure is indicated in the treatment of deep vertical bony defects since both the regenerative techniques ( GTR and EMD ) in the present study result ed in clinical ly and statistically significant improvements in clinical parameters compared to the access flap procedure . The use of EMP can be helpful in esthetically-sensitive sites and in reducing patient morbidity Abstract Introduction . Emdogain ® represents an extracellular matrix derivative that controls and promotes periodontal regeneration . Several studies have demonstrated that the treatment of periodontal defects with Emdogain ® leads to improvements in clinical parameters . However , long-time clinical trials establishing clinical usefulness of Emdogain ® are scarce . Therefore , the present r and omized split mouth , controlled study was undertaken to evaluate the effectiveness of Emdogain ® as an adjunct to open flap debridement for the treatment of intra-bony defects over a period of 5 years . Material s and methods . The study population consisted of 15 chronic periodontitis patients with bilateral interproximal osseous defects . The test group was treated by open flap debridement with EDTA 24 % ( PrefGel ® ) followed by enamel matrix derivative ( Emdogain ® ) . The control group was treated by open flap debridement with EDTA 24 % ( PrefGel ® ) . Results . After 1 and 5 years , both the test and control groups showed significant mean PPD reduction . A greater reduction in mean Probing Pocket Depth ( PPD ) was observed in the test group ( 3.84 ± 1.05 ) as compared to the control group ( 1.92 ± 0.35 ) . The mean Clinical Attachment Level ( CAL ) gain of 3.18 ± 0.87 mm was observed in the test group , while the control group displayed mean CAL gain of 1.60 ± 0.54 mm . The observed differences were found to be statistically significant in both the groups ( p < 0.05 ) . Percentage bone fill was significantly increased at 12 months post-surgery in test group ( 66.66 ± 7.8 % ) as compared to control group ( 31.71 ± 4.1 % ) . Conclusion . The treatment with Emdogain result ed in a significantly higher CAL gain and PPD reduction in comparison with OFD and PrefGel ® AIM This prospect i ve multicentre r and omized controlled clinical trial was design ed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix proteins ( EMD ) . MATERIAL AND METHODS 172 patients with advanced chronic periodontitis were recruited in 12 centers in 7 countries . All patients had at least one intrabony defect of > or = 3 mm . Heavy smokers ( > or = 20 cigarettes/day ) were excluded . The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure . After debridement , roots were conditioned for 2 min with a gel containing 24 % EDTA . EMD was applied in the test subjects , and omitted in the controls . Postsurgically , a strict plaque control protocol was followed . At baseline and 1 year following the interventions , clinical attachment levels ( CAL ) , pocket probing depths ( PPD ) , recession ( REC ) , full-mouth plaque scores and full-mouth bleeding scores were assessed . A total of 166 patients were available for the 1-year follow-up . RESULTS At baseline , 86 test and 86 control patients presented with similar subject and defect characteristics . On average , the test defects gained 3.1+/-1.5 mm of CAL , while the control defects yielded a significantly lower CAL gain of 2.5+/-1.5 mm . Pocket reduction was also significantly higher in the test group ( 3.9+/-1.7 mm ) when compared to the controls ( 3.3+/-1.7 mm ) . A multivariate analysis indicated that the treatment , the clinical centers , cigarette smoking , baseline PPD , and defect corticalisation significantly influenced CAL gains . A frequency distribution analysis of the studied outcomes indicated that EMD increased the predictability of clinical ly significant results ( CAL gains > or = 4 mm ) and decreased the probability of obtaining negligible or no gains in CAL ( CAL gains < 2 mm ) . CONCLUSIONS The results of this trial indicated that regenerative periodontal surgery with EMD offers an additional benefit in terms of CAL gains , PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone BACKGROUND Various clinical studies have demonstrated that applying commercially available enamel matrix proteins ( EMP ) on the instrumented root surface during access flap surgery promotes clinical ly significant gains of clinical attachment and bone in intrabony defects . The aim of the present controlled clinical trial was to evaluate the adjunctive effect of filling the intrabony lesion with bovine porous bone mineral ( BPBM ) to a simplified papilla preservation ( SPP ) flap and EMP surgical procedure . METHODS Sixty deep interproximal intrabony lesions in 60 patients with chronic periodontitis were treated with the SPP flap and EMP . In the 30 test defects , the intrabony component was filled with BPBM particles previously reconstituted with the EMP gel . A stringent infection control program was adopted for 1 year . The clinical and radiographical reevaluation was made 1 year after surgery . RESULTS Both techniques result ed in clinical ly and statistically significant improvements between baseline and 1 year , in terms of clinical attachment level ( CAL ) gain , probing depth ( PD ) reduction , and radiographic bone fill ; however , the BPBM test treatment showed statistically significantly greater CAL ( 5.8 + /- 1.1 versus 4.9 + /- 1.0 ) and radiographic bone ( DEPTH ) level gains ( 5.3 + /- 1.1 versus 4.3 + /- 1.5 ) , and less increase in gingival recession ( 0.4 + /- 0.6 versus 0.9 + /- 0.5 ) than the control surgical procedure . CONCLUSION The present study data supported the hypothesis that the adjunctive use of BPBM in grafting intrabony defects has the ability to improve clinical and radiographical outcomes achievable with EMP alone The objective of this split-mouth , double-blind , r and omized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement ( OFD ) combined or not with enamel matrix proteins ( EMP ) .  Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth ( PPD ) > or = 5 mm . All individuals received instructions regarding oral hygiene and were su bmi tted to scaling and root planing . Each participant received the two treatment modalities : test sites were treated with OFD and EMP , and control sites received only OFD . After 6 months , a significant reduction was observed in PPD for the EMP group ( from 6.42 + /- 1.08 mm to 2.67 + /- 1.15 mm ) and for the OFD group ( from 6.08 + /- 1.00 mm to 2.00 + /- 0.95 mm ) ( p < 0.0001 ) , but with no significant difference between groups ( p = 0.13 ) . A significant gain in relative attachment level ( RAL ) was observed in both groups ( EMP : from 13.42 + /- 1.88 mm to 10.75 + /- 2.26 mm , p < 0.001 ; OFD : from 12.42 + /- 1.98 mm to 10.58 + /- 2.23 mm , p = 0.013 ) , but with no significant difference between groups ( p = 0.85 ) . Gingival recession ( GR ) was higher in the EMP group ( from 1.08 + /- 1.50 mm to 2.33 + /- 1.43 mm ; p = 0.0009 ) than in the OFD group ( from 0.66 + /- 1.15 mm to 1.16 + /- 1.33 mm ; p = 0.16 ) , but this difference was not significant ( p = 0.06 ) . In conclusion , the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone OBJECTIVE To evaluate a comparison of open-flap debridement ( OFD ) with or without the use of enamel matrix proteins ( EMP ) for the treatment of infrabony defects . METHOD AND MATERIAL S Ten volunteers ( 38 infrabony defects ) were r and omized to receive OFD+EMP ( test site ) and OFD ( control site ) . Clinical outcomes included mean changes in Plaque Index , Gingival Index , probing pocket depth ( PPD ) , relative attachment level ( RAL ) , gingival recession , width of keratinized tissue , and dental mobility at baseline and at 24 months . RESULTS A significant reduction of 4.21+/-0.97 mm was observed in PPD for the OFD+EMP group ( from 6.30+/-0.99 mm to 2.09+/-0.97 mm ) and of 3.28+/-1.23 mm for the OFD group ( from 6.13+/-0.88 mm to 2.85+/-1.42 mm ) ( P<.001 ) . The reduction in PPD was statistically significantly greater for OFD+EMP compared to OFD ( P=.03 ) . The mean RAL decreased from 13.26+/-1.88 mm to 7.57+/-2.05 mm for the OFD+EMP group ( a gain of 5.69+/-1.96 mm ) and from 13.37+/-1.71 mm to 8.13+/-1.34 mm ( P<.001 ) for the OFD group ( a gain of 5.24+/-1.55 mm ) . Gingival recession was higher in the OFD+EMP group than in the OFD group . The mean keratinized tissue significantly decreased from 4.41+/-1.39 mm to 3.63+/-1.54 mm for OFD flap group ( P<.01 ) . CONCLUSION Both treatment modalities were efficient in improving RAL and PPD . Within groups , there was a significant reduction in keratinized tissue for OFD and a significant postoperative recession for the OFD + EMP group . Infrabony defects treated with OFD + EMP showed significantly more PPD reduction when compared to OFD BACKGROUND Previous studies have demonstrated that enamel matrix derivative ( EMD ) has the ability to improve clinical parameters when used to treat intraosseous defects . The purpose of the present study was to compare at 12 months postsurgery sites treated with open flap debridement ( OFD ) alone to those treated with OFD and EMD . METHODS Twenty-three subjects with at least 2 intrabony defects were chosen . Fifty-three defects received EMD in conjunction with OFD .  Thirty-one defects in these same 23 subjects were treated with OFD alone . Stents were fabricated to serve as fixed reference points . Re-entries were performed at least 1 year after initial surgery . Soft tissue measurements were recorded prior to initial surgery and prior to re-entry for gingival ( GI ) and plaque ( PI ) indices , probing depth ( PD ) , gingival margin position , and clinical attachment level ( CAL ) . Hard tissue measurements were recorded during the initial and re-entry surgery for level of crestal bone and depth of defect . Statistical analysis was conducted using the method of generalized estimating equations to determine changes in GI , PI , PD , CAL , fill of the osseous defect , and crestal resorption . Percent of defect fill was also calculated . RESULTS In all categories , treatment with EMD ( test ) was superior to treatment without EMD ( control ) . Average PI and GI were not significantly different either initially or prior to re-entry . The average PD reduction was 2.7 mm greater with EMD than controls . The average CAL gains were 1.5 mm greater , and the average fill of osseous defect 2.4 mm greater with EMD than controls . The average percent of defect fill after adjusting for crestal bone loss was more than 3 times greater for EMD versus control-treated sites ( 74 % defect fill with EMD versus 23 % defect fill for control sites ) . CONCLUSIONS This study indicates that treatment of periodontal intraosseous defects with EMD is clinical ly superior to treatment without EMD ( open flap debridement ) in every parameter evaluated . Re-entry data demonstrate that percent fill of osseous defects treated with EMD compares favorably with the treatment results utilizing bone grafts or membrane barriers , according to published literature BACKGROUND , AIMS The purpose of the present study was to compare the efficacy of 3 different surgical procedures in the treatment of infrabony defects :  guided tissue regeneration ( GTR ) with non-resorbable membranes , Widman modified flap ( WMF ) and enamel matrix derivative ( EMD ) . METHOD 30 patients with an infrabony component > or = 4 mm were selected . 10 were treated with exp and ed polytetrafluorethylene ( ePTFE ( Gore - Tex W. L. Gore and Associates , Flagstaff , AZ , USA ) ) membranes , 10 with WMF and 10 with enamel matrix derivatives ( Emdogain ( U Biora AB Malm , Sweden ) ) . The efficacy of each treatment modality was investigated through regression analysis . Probing attachment level ( PAL ) gain , probing depth ( PD ) reduction and gingival recession ( REC ) variation were analyzed . RESULTS Both Emdogain ( enamel matrix derivative ) and ePTFE treatment show significant better results as compared to the WMF procedure in which there were no significant changes in PAL gain and PD reduction at baseline and 1 year after surgery . CONCLUSIONS Results from our analysis suggest that there is no statistically significant difference in PAL gain between GTR and EMD . The clinical outcomes of this pilot study may be of little significance , considering the small number of patients , but it has provided an important base for a controlled clinical trial ( with a larger number of patients ) which is currently in progress The aim of this prospect i ve multicenter controlled clinical study was to evaluate the efficacy of Emdogain ( Biora ) , an enamel matrix derivative ( EMD ) , when combined with surgical treatment of periodontal angular defects , as compared to surgery alone , for up to 24 months of follow-up . The study was performed at six Italian universities and 11 private practice s. Patients with one- , two- , or three-wall angular defects were enrolled if intrabony defect depth ( IBD ) was 4 mm or more and probing pocket depth ( PPD ) was at least 6 mm . They were r and omly allocated to either test or control groups . The test group was treated by the simplified papilla preservation ( SPP ) flap plus Emdogain after root conditioning with ethylenediaminetetraacetic acid . The control group was treated by SPP alone .  Plaque Index , Gingival Index , PPD , and periodontal attachment level ( PAL ) at surgical sites were assessed at the presurgical examination ( baseline ) . IBD was measured intraoperatively after debridement . IBD was also evaluated with a computer-aided technique , from periapical radiographs . Plaque Index , Gingival Index , PPD , PAL , and IBD were assessed at 12 and 24 months postsurgery . Data were further divided in two subgroups according to baseline IBD ( 6 mm or less and more than 6 mm ) . The differences between each follow-up and baseline , and between groups at each follow-up , for the above parameters were evaluated by st and ard statistical methods . One hundred fifty-three patients were recruited , accounting for 195 intrabony defects : 83 patients ( 108 defects ) and 70 patients ( 87 defects ) were allocated to the test and control groups , respectively . All parameters were improved at both 12 and 24 months , compared to baseline in both groups . In the test group , IBD , PPD , and PAL at 12 months were significantly better than these parameters in the control group . The test subgroup with IBD of more than 6 mm at baseline displayed a better outcome when compared to the 6 mm or less IBD subgroup . No significant adverse events related to the use of Emdogain were reported . The use of EMD as an adjunct to periodontal surgery in the treatment of angular defects significantly enhanced the rate and degree of periodontal regeneration . The control group also displayed significant tissue regeneration , but at a slower rate compared to the Emdogain group . The surgical procedure itself , with its goal of maximum preservation of the regenerative potential of periodontal tissues , proved to be effective in the treatment of periodontal angular defects . Pockets with IBD greater than 6 mm showed major improvement when treated with Emdogain AIM There is evidence that regenerative treatment of intra-bony and m and ibular class II furcation defects with access flap and an application of an enamel matrix protein derivative ( EMD ) can result in a clinical benefit compared with access flap alone . The aim of this pilot study was to check if the results of access flap surgery in suprabony defects are improved by additional application of EMD . MATERIAL AND METHODS Thirty-nine adult subjects with supra-alveolar-type defects were r and omly assigned to a test ( n=25 ) and a control group ( n=14 ) . Seventy teeth were treated with EMD ; 28 teeth were treated by access flap .  Probing depth ( PD ) , clinical attachment level and bleeding on probing were evaluated at baseline and after 12 months . RESULTS PD of the operated teeth was improved in both groups ( p<0.001 to p=0.041 ) but always better in the test group . The attachment gain was 2.72+/-1.80 mm at sites with an initial PD > or=7 mm in the test group and 0.78+/-0.62 mm in the control group ( p=0.004 ) . In the test group the mean attachment gain was 0.97+/-0.92 mm ( p<0.001 ) ; the mean reduction of PD was 1.55+/-0.90 mm ( p<0.001 ) . CONCLUSIONS The data suggest a significant clinical benefit of supplementary application of EMD during surgical treatment of periodontitis of supra-alveolar pockets , especially in deeper pockets OBJECTIVES Application of the guided tissue regeneration ( GTR ) principle and utilization of enamel matrix derivative ( EMD ) have both been shown to result in periodontal regeneration . While clinical investigations have demonstrated that the use of a microsurgical concept in combination with the GTR technique positively affects the percentage of primary closure and the amount of tissue preservation , no such information is available for EMD-treated periodontal defects . It was the aim of the present investigation to assess the clinical effect of the microsurgical access flap and EMD treatment with an emphasis on the evaluation of early wound healing . MATERIAL AND METHODS Eleven patients displaying at least one pair of intrabony periodontal defects with an intrabony component of > or =3 mm participated in the study . At baseline and at 6 and 12 months after surgery , the following clinical parameters were assessed by a blinded examiner : oral hygiene status ( API ) , gingival inflammation ( BOP ) , probing pocket depth ( PPD ) , clinical attachment level ( CAL ) and gingival recession ( GR ) . Defects were r and omly assigned to test or control treatment , which both consisted of a microsurgical access flap procedure design ed for maximum tissue preservation . The exposed root surfaces of the test sites were conditioned with a 24 % EDTA gel followed by EMD ( Emdogain(R ) ) application . Primary flap closure was achieved by a 2-layered suturing technique . Postoperative healing was evaluated by a newly introduced early wound-healing index ( EHI ) at 1 and 2 weeks after surgery . RESULTS Both test and control treatment result ed in a statistically significant mean CAL gain of 2.8 and 2.0 mm at 6 months , and 3.6 and 1.7 mm at 12 months , respectively ( p<0.05 ) . Differences in CAL gain between the two treatment modalities were statistically significant at both time points ( p<0.05 ) . Additional GR values after 12 months averaged 0.3 and 0.4 mm for test and control sites , respectively , and did not reach statistical significance ( p > or = 0.05 ) . Two weeks after surgery , primary closure was maintained in 89 % of the test sites and in 96 % of the control sites . CONCLUSION Both treatment modalities using the microsurgical flap procedure result ed in a high percentage of primary flap closure and maximum tissue preservation . In terms of PPD reduction and CAL gain , the combination with EMD application appeared to be superior to the microsurgical access flap alone BACKGROUND Utilisation of enamel matrix proteins ( EMD ) and application of the guided tissue regeneration principle ( GTR ) are treatment modalities which both have been shown to result in periodontal regeneration . However , it is yet unknown whether the combination of EMD and GTR may additionally favor the regeneration process . AIM The aim of the present controlled study was to evaluate clinical ly the treatment effect of EMD , GTR , combination of EMD and GTR , and flap surgery ( control ) on intrabony defects . MATERIAL AND METHODS 56 patients each of whom displaying one intrabony defect of a depth of at least 6 mm were r and omly treated with one of the treatment modalities . Prior to surgery and at one year after , the following parameters were evaluated by a blinded examiner : Plaque index ( PlI ) , gingival index ( GI ) , bleeding on probing ( BOP ) , probing pocket depth ( PPD ) , gingival recession ( GR ) and clinical attachment level ( CAL ) . No statistical significant differences between the four groups were observed at baseline for any of the investigated parameters . RESULTS At 1 year after therapy , the sites treated with EMD demonstrated a mean PPD reduction of 4.1 + /- 1.7 mm and a mean CAL gain of 3.4 + /- 1.5 mm ( p<0.001 ) . The sites treated with GTR showed a mean PPD reduction of 4.2 + /- 1.9 mm and a mean CAL gain of 3.1 + /- 1.5 mm ( p<0.001 ) . The sites treated with the combined treatment showed a mean PPD reduction of 4.3 + /- 1.4 mm and a mean CAL gain of 3.4 + /- 1.1 mm ( p<0.001 ) . In the control group , the mean PPD reduction was 3.7 + /- 1.4 mm ( p<0.001 ) and the mean CAL gain measured 1.7 + /- 1.5 mm ( p<0.01 ) . All 4 treatments led to statistically significant PPD reduction and CAL gain . All three regenerative treatments led to higher CAL gain than the control treatment ( p<0.05 ) . No statistical significant differences in PPD reduction and CAL gain were observed between the three regenerative treatments . CONCLUSION It may be concluded that ( a ) all 3 regenerative treatment modalities may lead to higher CAL gain than the control one , and ( b ) the combined treatment does not seem to improve the outcome of the regenerative procedure BACKGROUND It has been shown that clinical improvement of intrabony periodontal defects can be achieved with the use of enamel matrix proteins ( EMPs ) or by grafting with bovine porous bone mineral ( BPBM ) . There is no report on the potential synergistic effect of EMPs and BPBM in periodontal regenerative therapy . The purpose of this study was to compare the clinical effectiveness of EMPs used alone or in combination with BPBM in the treatment of periodontal intrabony defects in humans . METHODS Twenty-one paired intrabony defects were surgically treated using a split-mouth design . Intrabony defects were treated either with enamel matrix proteins ( EMP group ) or with enamel matrix proteins combined with bovine porous bone mineral ( EMP/BPBM group ) . Re-entry surgeries were performed at 6 months . RESULTS Preoperative probing depths , attachment levels , and transoperative bone measurements were similar for the EMP and EMP/BPBM groups . Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the EMP/BPBM group ( 3.43 + /- 1.32 mm on buccal sites and 3.36 + /- 1.35 mm on lingual sites ) when compared to the EMP group ( 1.91 + /- 1.42 mm on buccal sites and 1.85 + /- 1.38 mm on lingual sites ) . The EMP/BPBM group also presented with significantly more attachment gain ( 3.13 + /- 1.41 mm on buccal sites and 3.11 + /- 1.39 mm on lingual sites ) than the EMP group ( 1.72 + /- 1.33 mm on buccal sites and 1.75 + /- 1.37 mm on lingual sites ) . Surgical re-entry of the treated defects revealed a significantly greater amount of defect fill in favor of the EMP/BPBM group ( 3.82 + /- 1.43 mm on buccal sites and 3.74 + /- 1.38 mm on lingual sites ) as compared to the EMP group ( 1.33 + /1.17 mm on buccal sites and 1.41 + /- 1.19 mm on lingual sites ) . CONCLUSIONS The results of this study indicate that BPBM has the ability to augment the effects of EMPs in reducing probing depth , improving clinical attachment levels , and promoting defect fill when compared to presurgical levels AIM The purpose of the present study was to compare clinical ly the treatment of deep intrabony defects with a combination of an enamel matrix protein derivative ( EMD ) and a bioactive glass ( BG ) to EMD alone . METHODS Thirty patients ( 16 females and 14 males ) suffering from advanced marginal periodontitis were included in this prospect i ve , controlled parallel design multicenter study . In each of the patients , one intrabony defect was r and omly treated with either EMD+BG ( test ) or with EMD alone ( control ) . Clinical measurements were recorded at baseline and at 1 year following therapy . RESULTS No differences in any of the investigated parameters were observed at baseline between the two groups . Healing was uneventful in all patients . At 1 year after therapy , the test group showed a reduction in mean probing depth ( PD ) from 8.5+/-1.1 to 4.4+/-1.2 mm ( p<0.001 ) and a change in mean clinical attachment level ( CAL ) from 10.4+/-1.5 to 7.1+/-1.5 mm ( p<0.0001 ) . In the control group , the mean PD was reduced from 8.5+/-1.5 to 4.0+/-1.6 mm ( p<0.001 ) and the mean CAL changed from 10.2+/-2.1 to 6.3+/-2.2 mm ( p<0.01 ) . In the test group , 12 sites ( 80 % ) gained at least 3 mm or more of CAL , whereas in the control group a CAL gain of 3 mm or more was measured at 13 sites ( 87 % ) . No statistically significant differences in terms of PD reduction and CAL gain were found between the test and the control treatment . CONCLUSIONS Within the limits of the present study it can be concluded that : ( i ) at 1 year after surgery , both therapies result ed in significant PD reductions and CAL gains , and ( ii ) the combination of EMD+BG does not seem to additionally improve the clinical results BACKGROUND The combination of bone replacement graft material s has been suggested for the treatment of periodontal osseous defects . The purpose of this study was to evaluate the effectiveness of enamel matrix derivative ( EMD ) combined with a bovine-derived xenograft ( BDX ) as compared to EMD alone in the treatment of intraosseous defects in patients with moderate to advanced periodontitis . METHODS Sixteen adult patients with at least 2 intrabony defects were entered in this split-mouth design study . Defects were treated with EMD alone or EMD + BDX . Reentries were performed 6 to 8 months after initial surgery . The following soft and hard tissue measurements were recorded prior to initial surgery and at reentry : probing depth ( PD ) , gingival margin location , clinical attachment level ( CAL ) , depth of defect , and crestal bone level . Statistical analyses were performed to determine changes in PD , CAL , fill of osseous defect , and crestal resorption . Percentages of bone fill ( % BF ) and defect resolution ( % DR ) were also calculated . RESULTS The most significant results were that gingival recession was greater for the group treated with EMD alone ( 0.8 + /- 0.8 mm ) compared to EMD + BDX ( 0.3 + /- 0.6 mm ) ( P = 0.04 ) and bone fill was greater for EMD + BDX ( 4.0 + /- 0.8 mm ) compared to EMD alone ( 3.1 + /- 1.0 mm ) ( P = 0.02 ) . The measures for PD reduction , attachment level gain , crestal resorption , % BF , and % DR did not present a statistically significant difference ( P > 0.10 ) . CONCLUSIONS This study evaluated the performance of EMD + BDX and EMD alone . The results demonstrated that a significant improvement in clinical parameters was observed . When comparing both modalities , a statistically significant difference was only found for gingival recession and bone fill , yielding a more favorable outcome towards the combined approach AIM The aim of this study was to evaluate the immediate post-operative pain , wound healing and clinical results after the application of an enamel matrix protein derivative ( EMD ) alone or combined with a low-level laser therapy ( LLLT ) for the treatment of deep intra-bony defects . MATERIAL AND METHODS This study was an intra-individual longitudinal test of 12 months ' duration conducted using a blinded , split-mouth , placebo-controlled and r and omized design . In 22 periodontitis patients , one intra-bony defect was r and omly treated with EMD+LLLT , while EMD alone was applied to the contra-lateral defect site . LLLT was used both intra- and post-operatively . Clinical measurements were performed by a blinded periodontist at the time of surgery , in the first week and in the first , second , sixth and 12th month . Visual analogue scale ( VAS ) scores were recorded for pain assessment . RESULTS The results have shown that the treatment of intra-bony defects with EMD alone or EMD+LLLT leads to probing depth reduction and attachment-level gain . In addition , EMD+LLLT had result ed in less gingival recession ( p<0.05 ) , less swelling ( p<0.001 ) and less VAS scores ( p<0.02 ) compared with EMD alone . CONCLUSION This study shows that EMD is an effective , safe and predictable bio material for periodontal regeneration and LLLT may improve the effects of EMD by reducing post-operative complications
In conclusion , follow-up time ( < or > 2 years ) and the risk of bias influence the results of treatment with EMDP in IPD
Previous systematic review s have demonstrated better results with enamel matrix derivative proteins ( EMDP ) as compared with open flap debridement ( OFD ) for the management of infrabony periodontal defects ( IPD ) .
The aim of this study was to determine whether these differences vary according to the follow-up and quality of the studies .