A Comparison Between Enamel Matrix Derivative and a Bioabsorbable Membrane to Enhance Healing Around Transmucosal Immediate Post‐Extraction Implants

Abstract

This clinical report compares the use of an enamel matrix derivative (EMD) and bioabsorbable barrier membrane to enhance healing following the immediate placement of transmucosal implants into extraction sockets. Thirty-two adult patients scheduled for tooth replacement with dental implants agreed to participate. Following the insertion of a transmucosal implant into the extraction site, the subjects were assigned to one of two treatment alternatives of the remaining bone defects around the implants: 1) the residual bone defects were filled with EMD (EMD group) or 2) the residual bone defects were covered with a bioabsorbable membrane (membrane group). Flaps were then coronally positioned around implant cover screws. Patients followed weekly maintenance recalls for the first 6 weeks and then monthly recalls until the final prosthetic restoration was completed (after 6 months). The treatment outcome was evaluated after 12 months by the use of clinical variables. The null hypothesis of no treatment group differences was tested by the use of analysis of variance (ANOVA). At a 12-month follow-up, all of the implants were completely osseointegrated and successfully functioning, showing a success rate of 100%. The membrane group showed a significantly lower mean probing attachment level than the EMD group at proximal (0.60 mm, standard deviation (SD) 0.37 versus 1.19 mm, SD 1.10), buccal (0.80 mm, SD 0.79 versus 1.77 mm, SD 1.16), and lingual sites (0.44 mm, SD 0.52 versus 1.48 mm, SD 1.46). The difference was statistically significant at all sites (P < 0.05). With respect to the position of the soft tissue margin around the implant shoulder, the membrane group showed a consistently higher value than the EMD group at, respectively, proximal (1.30 mm, SD 2.37 versus 1.16 mm, SD 1.0), buccal (0.90 mm, SD 1.29 versus 0.22 mm, SD 1.47), and lingual sites (1.12 mm, SD 1.10 versus 0.55 mm, SD 1.42). The membrane group obtained more favorable results in terms of both the probing attachment level and peri-implant position of soft tissues compared to the EMD group. The use of a bioabsorbable membrane around immediately placed transmucosal implants enhanced soft and hard tissue healing and might be an advisable treatment choice particularly in areas with high esthetic demands.