Apical approach in periodontal reconstructive surgery with enamel matrix derivate and enamel matrix derivate plus bone substitutes: a randomized, controlled clinical trial

Jose Antonio Moreno Rodríguez,Antonio José Ortiz Ruiz

doi:10.1007/s00784-021-04256-1

Jose Antonio Moreno Rodríguez, Antonio José Ortiz Ruiz

Open Access

https://doi.org/10.1007/s00784-021-04256-1

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Journal: Clinical Oral Investigations	Publication Date: Nov 17, 2021
Citations: 5	License type: open-access

Affiliation: University of Murcia

Abstract

ObjectivesThis parallel, randomized controlled clinical trial evaluated the influence of bone substitutes (BS) on the efficacy of the non-incised papillae surgical approach (NIPSA) with enamel matrix derivate (EMD) in resolving deep, isolated, combined non-contained intrabony and supra-alveolar periodontal defects, preserving the soft tissue.Material and methodsTwenty-four patients were randomized to treatment with NIPSA and EMD or NIPSA plus EMD and BS. Bleeding on probing (BoP), interproximal clinical attachment level (CAL), interproximal probing depth (PD), recession (REC), location of the tip of the papilla (TP), and width of the keratinized tissue (KT) were evaluated before surgery and at 1 year post-surgery (primary outcomes). Wound closure was assessed at 1 week post‐surgery, and supra‐alveolar attachment gain (SUPRA-AG) was recorded at 1 year post‐surgery.ResultsAt 1 week, 87.5% of cases registered complete wound closure and there were no cases of necrosis, without differences between groups (p > .05). At 1 year, all cases showed negative BoP. A significant PD reduction (NIPSA + EMD 8.25 ± 2.70 mm vs. NIPSA + EMD + BS 6.83 ± 0.81 mm) and CAL gain (NIPSA + EMD 8.33 ± 2.74 mm vs. NIPSA + EMD + BS 7.08 ± 2.68 mm) were observed (p < .001) in both groups, without significant between-group differences (p > .05). The residual PD was < 5 mm in all defects (NIPSA + EMD 2.50 ± 0.67 mm vs. NIPSA + EMD + BS 2.67 ± 0.78 mm). Soft tissues were preserved without significant between-group differences (REC: NIPSA + EMD 0.25 ± 0.45 mm vs. NIPSA + EMD + BS 0.17 ± 0.58 mm, p > .05; KT: 0.00 ± 0.43 mm vs. 0.08 ± 0.67 mm, p > .05). There were improvements in the papilla in both groups (TP: NIPSA + EMD 0.33 ± 0.49 mm vs. NIPSA + EMD + BS 0.45 ± 0.52 mm, p > .05), which was only significant in the NIPSA EMD + BS group (0.45 ± 0.52 mm; p < .05). In both groups, CAL gain was recorded in the supra-alveolar component, showing full resolution of the intrabony component of the defect in all cases (SUPRA-AG: NIPSA + EMD 1.83 ± 1.11 mm vs. NIPSA + EMD + BS 2.00 ± 1.76 mm, p > .05).ConclusionsNIPSA and EMD with or without BS seem to be a valid surgical approach in the treatment of isolated, deep non-contained periodontal defects. In our study, both treatments resulted in significant PD reduction and CAL gain, that extended in the supra-alveolar component, without differences with the use of BS. Both treatments resulted in soft tissue preservation. However, the addition of BS may improve interdental papillary tissue.Clinical relevanceNIPSA, with or without bone substitutes, resulted in significant periodontal improvement, with soft tissue preservation in isolated, deep non-contained periodontal defects. The application of bone substitutes may provide interproximal soft tissue gain.Clinical trial registrationClinicaltrials.gov: NCT04712630.

Highlights

Periodontal disease is a bacterial biofilm caused chronic inflammatory disease that results in destruction of periodontal tissues and their disinsertion from the root surface [1,2,3,4]
non-incised papillae surgical approach (NIPSA) and enamel matrix derivate (EMD) with or without bone substitutes (BS) seem to be a valid surgical approach in the treatment of isolated, deep non-contained periodontal defects. Both treatments resulted in significant probing depth (PD) reduction and clinical attachment level (CAL) gain, that extended in the supra-alveolar component, without differences with the use of BS
Twenty-four patients were invited to participate in the trial: 12 were treated with NIPSA EMD without BS and 12 with NIPSA EMD + BS

Summary

Introduction

Periodontal disease is a bacterial biofilm caused chronic inflammatory disease that results in destruction of periodontal tissues and their disinsertion from the root surface [1,2,3,4]. Clinical Oral Investigations coronoapically, disinserted periodontal tissues heal through epithelial apical migration of the gingival sulcus epithelium, forming the periodontal pocket [1, 5]. A periodontal lesions are configured by a periodontal pocket in the underlying bone, forming supra-alveolar or intrabony defects. There is a deep interproximal clinical attachment loss that modulates the disease evolution, prognosis, and choice of treatment [6]. After non-surgical or surgical periodontal disease treatment, residual interproximal periodontal pockets or interproximal soft tissue defects condition the maintenance of the noninflamed periodontal status [7]. The resolution of interproximal periodontal pockets associated with papilla preservation and the reconstruction of supra-alveolar type defects are the major challenge and objective in periodontal reconstructive surgical treatment [6]

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