Three-year results following regenerative periodontal surgery of advanced intrabony defects with enamel matrix derivative alone or combined with a synthetic bone graft

Abstract

Objectives: This study aims to compare the clinical outcomes of a combination of enamel matrix derivatives (EMD) and a synthetic bone graft (biphasic calcium phosphate) with EMD alone in wide and deep one- and two-wall intrabony defects 36 months after treatment.

Material and methods: Thirty patients with chronic periodontitis and one wide (≥ 2 mm) and deep (≥ 4 mm) intrabony defect had been recruited in three centres in Germany. During surgery, defects were randomly assigned to EMD/synthetic bone graft (SBG) (test) or EMD (control). Assessments at baseline, after 6, 12 and 36 months, included bone sounding, relative clinical attachment levels, probing pocket depths and recessions.

Results: After 36 months, defects in both groups were significantly improved (p < 0.001) with regard to defect fill, attachment gain and probing pocket reduction. In the EMD/SBG group, a mean defect fill of 2.6 mm (±1.7) was measured, and in the EMD group, the defect fill was 2.3 mm (±1.5). A mean gain in clinical attachment of 4.1 mm (±3.6) and 3.8 mm (±2.2) was observed in the test and in the control group, respectively. There were no statistically significant differences in any of the investigated parameters between the two treatment modalities.

Conclusions: The clinical improvements of advanced intrabony defects obtained with both regenerative modalities could be maintained over a period of 3 years. The combination of EMD with SBG did not show any advantage compared to the use of EMD alone.

Keywords: Bone replacement graft; Enamel matrix derivative; Intrabony defects; Randomized clinical trial; Regenerative periodontal therapy.