Clinical comparison of an enamel matrix derivative used alone or in combination with a bovine-derived xenograft for the treatment of periodontal osseous defects in humans.
BACKGROUND
The combination of bone replacement graft materials has been suggested for the treatment of periodontal osseous defects. The purpose of this study was to evaluate the effectiveness of enamel matrix derivative (EMD) combined with a bovine-derived xenograft (BDX) as compared to EMD alone in the treatment of intraosseous defects in patients with moderate to advanced periodontitis.


METHODS
Sixteen adult patients with at least 2 intrabony defects were entered in this split-mouth design study. Defects were treated with EMD alone or EMD + BDX. Reentries were performed 6 to 8 months after initial surgery. The following soft and hard tissue measurements were recorded prior to initial surgery and at reentry: probing depth (PD), gingival margin location, clinical attachment level (CAL), depth of defect, and crestal bone level. Statistical analyses were performed to determine changes in PD, CAL, fill of osseous defect, and crestal resorption. Percentages of bone fill (%BF) and defect resolution (%DR) were also calculated.


RESULTS
The most significant results were that gingival recession was greater for the group treated with EMD alone (0.8 +/- 0.8 mm) compared to EMD + BDX (0.3 +/- 0.6 mm) (P = 0.04) and bone fill was greater for EMD + BDX (4.0 +/- 0.8 mm) compared to EMD alone (3.1 +/- 1.0 mm) (P = 0.02). The measures for PD reduction, attachment level gain, crestal resorption, %BF, and %DR did not present a statistically significant difference (P > 0.10).


CONCLUSIONS
This study evaluated the performance of EMD + BDX and EMD alone. The results demonstrated that a significant improvement in clinical parameters was observed. When comparing both modalities, a statistically significant difference was only found for gingival recession and bone fill, yielding a more favorable outcome towards the combined approach.
Velasquez-Plata
Diega
D
Department of Periodontics, The University of Texas Health Science Center at San Antonio, USA.
Scheyer
E Todd
ET
Mellonig
James T
JT
D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000601:surgery*; D000539:Alveolar Process / Q000473:pathology; D000818:Animals; D001857:Bone Matrix / Q000637:transplantation*; D001861:Bone Regeneration; D001862:Bone Resorption / Q000473:pathology; D018786:Bone Substitutes / Q000627:therapeutic use*; D002417:Cattle; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005889:Gingival Recession / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000627:therapeutic use*; D017622:Periodontal Attachment Loss / Q000601:surgery; D010514:Periodontal Pocket / Q000601:surgery; D010518:Periodontitis / Q000601:surgery; D016037:Single-Blind Method; D013223:Statistics as Topic; D014183:Transplantation, Heterologous; D016896:Treatment Outcome
C077540:Bio-Oss; D018786:Bone Substitutes; D003746:Dental Enamel Proteins; D008903:Minerals; C109069:enamel matrix proteins