Enamel Matrix Derivative, Alone or Associated With a Synthetic Bone Substitute, in the Treatment of 1‐ to 2‐Wall Periodontal Defects

Abstract

In this study, we compare the effects of enamel matrix derivative (EMD) associated with a hydroxyapatite and β-tricalcium phosphate (HA/β-TCP) implant to EMD alone and to open-flap debridement (OFD) when surgically treating 1- to 2-wall intrabony defects. Thirty-four patients, exhibiting ≥3 intraosseous defects in different quadrants, were each treated by OFD, EMD, or EMD + HA/β-TCP in each defect. At baseline and 12 and 24 months, a complete clinical and radiographic examination was done. Pre-therapy and post-therapy clinical (probing depth [PD], clinical attachment level [CAL], and gingival recession [GR]) and radiographic (defect bone level [DBL] and radiographic bone gain [RBG]) parameters for the different treatments were compared. After 12 and 24 months, almost all the clinical and radiographic parameters showed significant changes from baseline within each group (P <0.001). Differences in PD, CAL, and DBL scores were also seen among the three groups at the 12- and 24-month visits (P <0.001). At 12 and 24 months after treatment, the EMD + HA/β-TCP group showed significantly greater PD reduction (4.00 ± 0.42 mm; 4.25 ± 0.63 mm), CAL gain (3.47 ± 0.65 mm; 3.63 ± 0.91 mm), and RBG (3.17 ± 0.69 mm; 3.35 ± 0.80 mm) and less GR increase (0.56 ± 0.37 mm; 0.63 ± 0.42 mm) compared with the OFD and EMD groups (P <0.05). Our data support the hypothesis that the adjunct of an HA/β-TCP composite implant with EMD may improve the clinical and radiographic outcomes of the surgical treatment of unfavorable intrabony defects.