Treatment of intrabony defects with EMD/SBC or EMD alone

Objectives: Comparison of the outcomes of a combination of an enamel matrix

derivative and a synthetic bone graft (EMD/SBC) with EMD alone in wide 1- or 2-wall intrabony defects.

Method: Seventy-three patients with chronic periodontitis were recruited in 5 German centers. Each patient contributed one deep (≥ 4mm) 1- or 2-wall intrabony defect. Using a microsurgical technique a modified papilla preservation flap was prepared. After debridement, defects were randomly assigned to EMD/SBC (test) or EMD (control). Assessments at baseline, 6 , and 12 months by blinded examiners included bone sounding (PBL), attachment level (AL), probing pocket depth, bleeding on probing, recession, as well as standardized radiographs (baseline and 12 months). Early-Wound-Healing, adverse effects and patients' perceptions were also recorded. Oral hygiene was reinforced throughout the study.

Results: Both treatment modalities led to significant clinical improvements. Change in PBL 6, and 12 months after surgery was 2.0±2.1 mm , 2.6±1.9 mm for test and 2.1±1.2 mm, 2.8±1.8 mm for control, respectively. An AL gain of 1.3±1.8 mm, 1.7±2.1 mm for test and 1.8±1.6 mm, 1.9±1.7 mm for control, respectively, was observed. Radiographic bone fill after 12 months was 1.8±1.9 mm for test and 1.4±1.9 mm for control, respectively. One week after surgery, primary closure was maintained in 95% of the test sites and 100% of the control sites. No differences in patients' perceptions were found.

Conclusion: Regenerative periodontal surgery with EMD with or without the additional use of a synthetic bone graft in advanced 1- or 2-wall intrabony defects led to significant clinical and radiographic improvements compared to baseline. The results of the present study could not confirm any differences in the clinical and radiographic outcomes between the two treatment modalities.