Enamel Matrix Derivative in Intrabony Defects: Prognostic Parameters of Clinical and Radiographic Treatment Outcomes

Abstract

The purpose of this retrospective case series study is to identify possible preoperative parameters that could predict postoperative probing depth (PD), clinical attachment level (CAL) gain, or radiographic defect resolution in intrabony defects treated with enamel matrix derivative (EMD). Sixty-one chronic periodontitis patients, each contributing a 2- or 3-wall intrabony defect treated with EMD, were included. Clinical parameters recorded included the following: PD; CAL; gingival margin position; supracrestal soft tissue (SST); surgical distances of cemento-enamel junction (CEJ) to bone crest (CEJ-BC), CEJ to base of the defect (CEJ-BD), and BC to BD (BC-BD); and depth of 2- and 3-wall components. Radiographic parameters recorded included the following: CEJ-BC, CEJ-BD, BC-BD distances, and radiographic defect angle. Postoperative assessments were performed at 12 months. The probability of postoperative PD >4 mm increased 1.6-fold (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.2 to 2.3) with each 1-mm baseline PD increase. Baseline PD and surgical CEJ-BD were statistically significant predictors of CAL gain; the greater the baseline PD (OR = 0.5; 95% CI = 0.3 to 0.8) and bone loss (OR = 0.6; 95% CI = 0.3 to 0.9), the less likely that postoperative CAL gain was ≤3 mm. Smoking and SST were significantly associated with defect resolution; failure to achieve ≥65% defect resolution was six-fold greater for smokers (OR = 6.5; 95% CI = 1.7 to 24.5) and almost double (OR = 1.7; 95% CI = 1.1 to 2.8) for each millimeter of SST increase. In EMD-treated intrabony defects, baseline PD predicts both CAL gain and postoperative PD. Smoking and SST are predictors of defect resolution.