Comparison of enamel matrix proteins and bioabsorbable membranes in the treatment of intrabony periodontal defects. A split-mouth study.
BACKGROUND
Enamel matrix proteins (EMP) have recently been introduced as a new modality for regenerative periodontal treatment. However, limited information is available concerning the comparison of the treatment of intrabony periodontal defects with enamel matrix proteins and other regenerative treatment alternatives.


METHODS
The aim of the present controlled clinical trial was to compare the treatment of deep intrabony periodontal defects with EMP to that with guided tissue regeneration (GTR) with bioabsorbable membranes. Sixteen patients, each of whom displayed one pair of intrabony defects located contralaterally in the same jaw, were randomly treated with EMP or with a bioabsorbable membrane. Prior to surgery and 8 months later the following parameters were evaluated by a blinded examiner: Plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). Antibiotics (amoxicillin and metronidazole) were given during the first 10 days after surgery. No statistical significant differences in any of the investigated parameters between the 2 groups were observed at baseline.


RESULTS
No serious adverse events (e.g., allergic reactions or abscesses) after any of the treatments were noted during the entire observation period. Membrane exposure occurred in 7 out of the 16 GTR treated sites. Clinical examination was performed again 8 months postoperatively. Sites treated with EMP demonstrated a reduction of PD from 8.1+/-1.7 mm to 4.3+/-1.2 mm (P <0.001) and a change in CAL from 10.3+/-1.8 mm to 7.2+/-1.2 mm (P <0.001). The sites treated with GTR showed a reduction of PD from 8.3+/-1.7 mm to 4.3+/-0.7 mm (P <0.001) and a change of CAL from 10.1+/-1.9 mm to 7.1+/-1.7 mm (P <0.001). Both treatment procedures led to significant improvements of PD and CAL. However, no statistically significant differences in any of the investigated parameters were observed between the test and control group.


CONCLUSIONS
It may be concluded that both therapies led to shortterm improvements of the investigated clinical parameters. Further studies of much higher power are needed to support equivalence.
Sculean
A
A
Department of Periodontology and Conservative Dentistry, University of the Saarland, Homburg, Germany. zmkascu@krzsun.med-rz.uni-sb.de
Donos
N
N
Blaes
A
A
Lauermann
M
M
Reich
E
E
Brecx
M
M
D020341:Absorbable Implants; D016301:Alveolar Bone Loss / Q000601:surgery*; D000658:Amoxicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D003774:Dental Plaque Index; D005260:Female; D005500:Follow-Up Studies; D005884:Gingival Hemorrhage / Q000473:pathology / Q000601:surgery; D005889:Gingival Recession / Q000473:pathology / Q000601:surgery; D016557:Guided Tissue Regeneration, Periodontal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008795:Metronidazole / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D017622:Periodontal Attachment Loss / Q000473:pathology / Q000601:surgery; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000473:pathology / Q000601:surgery; D016037:Single-Blind Method; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D003746:Dental Enamel Proteins; D008567:Membranes, Artificial; D010406:Penicillins; D008795:Metronidazole; D000658:Amoxicillin