The use of barrier membranes and enamel matrix proteins in the treatment of angular bone defects. A prospective controlled clinical study.
In the present prospective clinical trial, the effect of various regenerative procedures performed at sites with angular bone defects were evaluated. The main outcome variable was probing attachment alteration.


METHODS
40 subjects, aged 32-61 years participated. They met the following inclusion criteria: (i) presence of generalized, advanced periodontal tissue destruction; (ii) presence of 2 similar, contralateral, angular bone defects (experimental sites) located in either the maxilla or the mandible; (iii) the defect site must exhibit a probing pocket depth (PPD) of > or = 6 mm, a probing attachment level (PAL) of > or = 7 mm, and a depth of the intrabony component of > or = 3 mm. All subjects had a good oral hygiene standard, were in good general health and did not use any medication. Prior to the start of the study, all subjects received non-surgical treatment for periodontal disease. Baseline clinical measurements (plaque, gingivitis, PPD, PAL and soft tissue recession) of the selected experimental sites were obtained 6 months after the completion of basic therapy. The 40 subjects were randomly divided into 4 treatment groups including 10 subjects each: 3 membrane groups and one Emdogain group. 1 h before surgery, the patients were given 3 g of Amoxicillin. No other antibiotics were prescribed. The test and control sites were treated during the same surgical session. Full thickness flaps were elevated and the exposed root surfaces were planed. Membrane placement: The root surface was rinsed with saline. A barrier membrane (Guidor or Resolut or Periodontal (e-PTFE) material) was positioned to cover the defect and the adjacent 2-3 mm of bone tissue. The control treatment was identical to the test treatment with the exception of barrier placement. Emdogain placement: The exposed root surfaces at both the test and control sites were, during a 2-min period, conditioned with a 24% EDTA gel. Emdogain was applied to the exposed root surface of the test site. In the control site, the vehicle, the PGA gel, was used as placebo control. The flaps were closed and sutured to obtain a complete coverage of the intrabony defect.


RESULTS
Re-examinations, which were performed 12 months after surgery, disclosed that regenerative therapy, including either the use of barrier membranes or application of enamel matrix proteins to an instrumented root surface in an angular, intrabony defect, enhanced outcome variables such as probing pocket depth and probing attachment gain. It was furthermore demonstrated that clinical improvements were better at sites with deep, than at sites with shallow, intrabony defects.


CONCLUSIONS
The 4 regenerative modalities tested appeared to be equally effective in terms of PPD reduction and PAL gain, and superior to open flap curettage alone.
Pontoriero
R
R
Department of Periodontology, Institute of Odontology, Göteborg University, Sweden.
Wennström
J
J
Lindhe
J
J
D000328:Adult; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003131:Combined Modality Therapy; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D005260:Female; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D009067:Mouthwashes / Q000008:administration & dosage; D010510:Periodontal Diseases / Q000188:drug therapy* / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors
D003746:Dental Enamel Proteins; D008567:Membranes, Artificial; D009067:Mouthwashes; C109069:enamel matrix proteins; C010882:chlorhexidine gluconate; D002710:Chlorhexidine