Abstract
BackgroundProper wound healing after regenerative surgical procedures is an essential issue for clinical success. Guided tissue regeneration (GTR) and application of enamel matrix derivatives (EMD) are common means to regenerate periodontal tissues. Both methods bear considerable advantages due to their special characteristics, but also go along with certain disadvantages. Today, there is no consensus in the literature whether GTR or EMD show better results regarding early wound healing, which is considered a crucial stage in periodontal regeneration. Therefore, the aim of the present systematic review was to compare the early wound healing after regenerative periodontal surgery with either EMD or GTR treatment.MethodsAn electronic literature search in PubMed was performed to identify randomized clinical trials (RCTs) or clinical trials (CTs) comparing regenerative surgery employing EMD and/or GTR in patients with chronic periodontitis. Among the finally included studies, a qualitative and quantitative data extraction regarding early wound healing parameters was performed. Primary outcome parameters were early wound healing index (EWH), flap dehiscence, membrane exposure, suppuration and abscess formation during the first 6 weeks. As secondary parameters, swelling and allergic reactions were assessed.ResultsSeven studies reporting 220 intrabony periodontal defects in 199 patients were analysed.Flap dehiscence was observed in two studies in 12% of the GTR treated sites and in 10.3% of those treated with EMD. Membrane exposure was evaluated in five studies and was registered in the 28.8% of the defects, while no dehiscence was reported on the EMD group. Swelling was reported only in one study in 8/16 GTR sites and 7/16 EMD sites. Due to considerable heterogeneity of parameters no meta-analysis was possible.ConclusionsDue to considerable heterogeneity of the published studies a clear beneficial effect of the EMD on the early wound healing outcomes after surgical treatment of periodontal intrabony defects cannot be confirmed.Standardized RCT studies are needed in order to allow for proper comparison of early wound healing after both types of surgical approaches.
Highlights
Proper wound healing after regenerative surgical procedures is an essential issue for clinical success
Treatment of periodontitis aims on one hand at preventing further disease progression by minimizing inflammation by active therapy and – on the other hand - at supporting patients in maintaining a healthy periodontium [2]
After an adequate healing period, surgical approaches may be indicated to eliminate residual pockets and to create a gingival morphology that allows for efficient plaque control [2]
Summary
Proper wound healing after regenerative surgical procedures is an essential issue for clinical success. Guided tissue regeneration (GTR) and application of enamel matrix derivatives (EMD) are common means to regenerate periodontal tissues Both methods bear considerable advantages due to their special characteristics, and go along with certain disadvantages. Supra and subgingival instrumentation is performed as the core step in order to mechanically remove biofilms and mineralized deposits [8, 9] The latter may be supported by topically or systemically applied pharmacotherapy [10]. Lost tissues might get regenerated by special surgical methods if anatomy and patient characteristics allow for it [11] It is the aim of such interventions to rebuild each of the tooth-supporting structures, including root cementum, periodontal ligament, and alveolar bone, that were lost due to periodontal inflammation [12, 13]
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