Treatment of intrabony defects using guided tissue regeneration or enamel matrix derivative: a 3-year prospective randomized clinical study.
BACKGROUND
The aim of this randomized, controlled, prospective clinical study was to compare guided tissue regeneration (GTR) to enamel matrix derivative (EMD) for the treatment of intrabony defects in patients with chronic advanced periodontitis.


METHODS
Forty (39 evaluable) 3-wall intrabony defects, each with a depth > or = 4 mm measured from the crest of the bony defect, were treated in 40 subjects with advanced chronic periodontitis. Regeneration of angular bone defects was induced using non-resorbable membranes (GTR group; n = 20) or EMD (EMD group; evaluable n = 19). Clinical parameters, including probing depth (PD), clinical attachment level (CAL), gingival recession, radiographic measurement of the defect depth, plaque index, and bleeding on probing, were measured at baseline and at 12 and 36 months following surgery.


RESULTS
Twelve months after surgery, sites treated with GTR demonstrated a mean CAL gain of 2.5 +/- 1.2 mm and a mean reduction in PD of 3.5 +/- 1.2 mm compared to baseline. The corresponding outcomes at 36 months were 2.0 +/- 1.1 mm (CAL) and 3.2 +/- 1.1 mm (PD). Sites treated with EMD demonstrated a mean CAL gain of 2.9 +/- 1.4 mm and a mean reduction in PD of 3.5 +/- 1.4 mm at 12 months, with a mean CAL gain of 2.4 +/- 1.2 mm and a mean PD reduction of 3.1 +/- 1.4 mm at 36 months. The differences in PD reduction and CAL gain were statistically significant between the groups and for each time point compared to baseline. Attachment loss was seen in both groups between the 12- and 36-month observations. Measured radiographic bone fill was 57.0% +/- 21% at 12 months and 53.7% +/- 14.3% at 36 months in the GTR group compared to 50.5% +/- 19% at 12 months and 58.8% +/- 14.9% at 36 months in the EMD group.


CONCLUSIONS
The treatment of intrabony defects in patients with chronic advanced periodontitis using GTR or EMD led to significantly improved clinical parameters. Tests of statistical significance demonstrated better results with EMD, although the absolute differences between treatment modalities was small. Further studies with a larger number of treated defects are necessary to verify these findings.
Crea
Alessandro
A
Division of Periodontology, Catholic University of Sacred Heart, Rome, Italy.
Dassatti
Leonardo
L
Hoffmann
Oliver
O
Zafiropoulos
Gregory-George
GG
Deli
Giorgio
G
D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000601:surgery*; D000539:Alveolar Process / Q000000981:diagnostic imaging / Q000473:pathology; D001861:Bone Regeneration / Q000502:physiology; D055113:Chronic Periodontitis / Q000601:surgery; D003646:Debridement; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D003774:Dental Plaque Index; D012534:Dental Scaling; D005260:Female; D005500:Follow-Up Studies; D005884:Gingival Hemorrhage / Q000601:surgery; D005889:Gingival Recession / Q000601:surgery; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000601:surgery; D010514:Periodontal Pocket / Q000601:surgery; D011446:Prospective Studies; D011859:Radiography; D016037:Single-Blind Method; D016896:Treatment Outcome
D003746:Dental Enamel Proteins; D008567:Membranes, Artificial; C109069:enamel matrix proteins