Entire Papilla Preservation Technique with Enamel Matrix Proteins and Allogenic Bone Substitutes for the Treatment of Isolated Intrabony Defects: A 3-Year Follow-Up of a Prospective Case Series

Abstract

Background: This study aimed to assess the effectiveness of a modified entire papilla preservation technique (MEPPT) for treating isolated intrabony defects in patients with stage III periodontitis. Material and Methods: Fifteen patients with 15 interdental intrabony defects were treated with a MEPPT using enamel matrix derivative and allogenic bone. Their probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), keratinized tissue width (KTW), defect depth (DD), full-mouth plaque score (FMPS), full mouth bleeding score (FMBS), radiographic images (radiographic angles, BF and LDF) and intrasurgical parameters were assessed at baseline and 3 years postsurgery. Standardized measurements were taken to evaluate the defect characteristics and treatment outcomes. Results: At 3 years, significant improvements from baseline were maintained. Probing pocket depth (PPD) decreased from 7.03 ± 1.61 mm to 3.33 ± 0.89 mm (p < 0.0001), clinical attachment level (CAL) improved to 3.08 ± 1.16 mm (p < 0.001) and defect depth (DD) decreased from 4.59 ± 1.24 mm to 0.38 ± 0.31 mm (p < 0.001). The changes in gingival recession and keratinized tissue were not statistically significant. The results demonstrate sustained clinical stability over a 3-year period. Conclusions: Within the limitations of this study, the findings suggest that the modified entire papilla preservation technique (MEPPT) in conjunction with enamel matrix proteins and allogenic bone grafting is an effective approach for the treatment of intrabony defects, leading to statistically significant and sustained clinical improvements over a 3-year period. The study protocol was registered in ClinicalTrials.gov ID NCT05029089.

Keywords: allogenic bone; enamel matrix protein; intrabony defect; modified entire papilla preservation technique; periodontitis.

Figure 1

Diagrams illustrating the EPPT. (a) Intrabony defect affecting the maxillary left canine. (b) Flap design with a single vertical incision on the buccal side along with two sulcular incisions. (c) Elevation of the buccal flap. (d) Primary closure of the vertical incision using simple interrupted sutures and a sling suture at the neighboring tooth.

Figure 2

Representative case 1. (a) Baseline radiographic view. (b) Baseline clinical measurements. (c) A single vertical incision was made at the distal aspect of the mandibular left canine. (d) The flap was elevated, and the interdental tunnel was created by carefully dissecting beneath the papilla adjacent to the defect. (e,f) A clinical view of the intrabony defect after debridement. (g) the primary closure of the surgical area with interrupted sutures over the vertical incision and single sling suture. (h,i) Clinical and radiographic views at 6 months postsurgery. (j,k) Clinical and radiographic views 3 years after the surgery.

Figure 2

Representative case 1. (a) Baseline radiographic view. (b) Baseline clinical measurements. (c) A single vertical incision was made at the distal aspect of the mandibular left canine. (d) The flap was elevated, and the interdental tunnel was created by carefully dissecting beneath the papilla adjacent to the defect. (e,f) A clinical view of the intrabony defect after debridement. (g) the primary closure of the surgical area with interrupted sutures over the vertical incision and single sling suture. (h,i) Clinical and radiographic views at 6 months postsurgery. (j,k) Clinical and radiographic views 3 years after the surgery.