Initial Clinical and Cone-Beam Computed Tomography (CBCT) Outcomes of Enamel Matrix Derivative-Based Regenerative Therapy in Vertical Bone Defects.

Abstract

Background and objective Enamel matrix derivatives (EMD) arebiomaterials extracted from porcine dental germs. They consistof amelogenins (90%), ameloblastine, enamelin, and amelotin. New evidence has shown that all these proteins can be absorbed onto hydroxyapatite crystals and collagen fibers on the root surface of teeth and initiate regeneration of root cementum as well as stimulate periodontal cell proliferation. Currently, the most preferred method of periodontal regenerative therapy in clinical dental practice involves EMD, thanks to its facilitated surgical protocol and the many postoperative complications associated with guided tissue regeneration. There is scarce dataregarding when the first and earliest signs of healing occur after the application of this method. Hence, this study focused on the evaluation and analysis of clinical outcomes and cone-beam CT (CBCT) results at sixmonths after the application of the EMD technique. It aimed to evaluate the efficacy of regenerative therapy with EMDin vertical bone defects six months post-surgical intervention. Material and methods The study was conducted between August 2022 and July 2023 in the Faculty of Dental Medicine, the Medical University - Varna, using the University Medical-Dental Center as a base. The study included 12 cases characterized by bilateral, trilateral, or a combination of the mentioned vertical bone defects. The participants were aged between 31 and 57 years, of both genders, with satisfactory personal oral hygiene. They were in good general condition with no established systemic diseases and gave prior written informed consent. Between the sixth and eighth weeks after the hygiene phase was completed, the patients were re-evaluated, a new periodontal status was recorded, and a CBCT examination was ordered. Three clinical (probing pocket depth, gingival margin level, andclinical attachment level) and three radiographic parameters (A, B, and C) were evaluated in areas of vertical bone defect. Six months after the regenerative therapy using EMD, the same parameters were again recorded in all patients. Finally, after statistical processing of the results, an analysis of the data was performed regarding the early effectiveness of EMD application in regenerative therapy of vertical bone defects. Results The clinical results observed at the six-month mark following regenerative therapy using EMDin vertical bone defects indicated an average reduction in probing depth of 4.50 mm, an average apical migration of the gingival margin by 0.5 mm, and an average clinical attachment level of 4.00 mm. Bone filling was noted on the CBCT, corroborated by the following parameters: A - an average decrease of 1.51 mm; B - an average decrease of 0.50 mm; and C - an average decrease of 0.24 mm. Conclusions The results of our study confirm the remarkable effectiveness of EMD as a regenerative biomaterial. Furthermore, both clinical and CBCT studies demonstrated a very good healing process at an extremely early stage after the surgical intervention.