Abstract
Previous systematic reviews 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. Cochrane Central Register of Controlled Trials, Medline/PubMed, Lilacs, Embase and Web of Science electronic databases were searched up to August 2013 for randomized clinical trials.Eligible outcomes were changes in probing depth (PD), clinical attachment level (CAL),gingival recession (GR) and bone changes (BC). Studies with follow-up of 12 months showed differences of 0.97 mm (CI95% 0.52 - 1.43) and 1.19 mm (CI95% 0.77 - 1.60) for PD and CAL, respectively, favorable for EMDP. Studies with follow-up ≥ 24 months presented advantages of 1.11 mm (CI95% 0.74 -1.48) for CAL and 0.83 mm (CI95% 0.19 -1.48) for PD,with use of EMDP. Considering the quality of studies, those with low risk of bias showed lower difference between groups, presenting 0.8 mm (CI95% 0.24-1.36) for CAL, favorable for EMDP and without differences for PS (0.51 mm, CI95% -0.21 - 1.23). In conclusion, follow-up time (< or > 2 years) and the risk of bias influence the results of treatment with EMDP in IPD.
Highlights
Destructive periodontal diseases are of multifactorial nature, with the subgingival biofilm being the main etiologic agent [1]
probing depth (PD) and clinical attachment level (CAL) were evaluated in all the studies, gingival recession (GR) was evaluated in eight studies
Information obtained by means of periodontal probing, radiographs and re-entry procedures are limited in determining the quality, quantity and nature of the newly formed supporting tissues [42]
Summary
Destructive periodontal diseases are of multifactorial nature, with the subgingival biofilm being the main etiologic agent [1] From this standpoint, the core approach for its therapy is to disorganize and disperse biofilm by mechanical means and, in some situations, with adjunct chemical agents [2]. Periodontal regeneration presupposes formation of periodontal ligament with collagen fibers inserted in new cementum and new alveolar bone [6,7,8]. With this purpose, diverse regenerative procedures have been developed and are available, such as guided tissue regeneration (GTR), associated or not with bone grafts or alloplastic materials [3,9,10,11]. In an endeavor to provide mimicking of what occurs during root development, an enamel matrix derivative of porcine origin has been used in an attempt to regenerate previously lost periodontal structures [13,14,15,16,17]
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