Supracrestal soft tissue preservation with enamel matrix proteins in treatment of deep intrabony defects.
OBJECTIVE
The purpose of the present study was to investigate the effectiveness of a regenerative procedure based on supracrestal soft tissue preservation in association with enamel matrix proteins (EMP) in the treatment of deep intrabony defects.


METHODS
The subjects included 35 consecutively treated patients, 23 females and 12 males, aged 28-61 years, 11 of whom were smokers. Patients presented with at least one intrabony defect with probing pocket depth > or = 6 mm and a radiographic depth of the defect > or = 4 mm at the initial visit. Immediately before surgery and 9-12 months after surgery, Local Plaque Score (LPS), Local Bleeding Score (LBS), probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (REC), and radiographic depth of the defect (DEPTH) were recorded.


RESULTS
Thirty-one (88.6%) defects were LPS-negative presurgery, while 29 (82.9%) defects presented with no plaque postsurgery. The prevalence of LBS-positive defects shifted from 94.3% presurgery to 8.4% postsurgery (p < 0.0000). PPD was 8.9 mm before surgery, and decreased to 3.5 mm postsurgery (p < 0.0000). CAL varied from 10.1 mm presurgery to 5.4 mm postsurgery (p < 0.0000), with an average improvement (gain) of 4.7 +/- 1.7 mm. Twenty-six (74.3%) defects presented a gain of least 4 mm. Regression analysis showed a positive correlation between CAL gain as a dependent variable, and presurgery PPD and amount of supracrestal soft tissues as predictors. DEPTH improvement (gain) was 3.9 +/- 1.8 mm, which represented 65% of defect fill. Twenty (57.1%) defects presented a DEPTH gain of at least 4 mm. DEPTH gain was significantly correlated to presurgery PPD (p < 0.000). No significant differences were found between smokers and non-smokers in terms of CAL and DEPTH gain.


CONCLUSIONS
Results from the present study indicated that the regenerative procedure based on supracrestal soft tissue preservation and EMP application leads to clinically and statistically significant improvement of hard and soft tissue conditions of deep intrabony defects.
Trombelli
Leonardo
L
Research Centre for the Study of Periodontal Diseases, University of Ferrara, Ferrara, Italy.
Bottega
Sabrina
S
Zucchelli
Giovanni
G
D000328:Adult; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000704:Analysis of Variance; D018786:Bone Substitutes / Q000627:therapeutic use*; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D003774:Dental Plaque Index; D005260:Female; D005500:Follow-Up Studies; D005889:Gingival Recession / Q000473:pathology / Q000601:surgery; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000473:pathology / Q000601:surgery; D010510:Periodontal Diseases / Q000473:pathology / Q000601:surgery*; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000473:pathology / Q000601:surgery; D011859:Radiography; D012044:Regression Analysis; D012907:Smoking; D013223:Statistics as Topic; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing
D018786:Bone Substitutes; D003746:Dental Enamel Proteins; C109069:enamel matrix proteins