title: Periodontal regeneration with or without limited orthodontics for the treatment of 2- or 3-wall infrabony defects.
abstract: BACKGROUND
  Limited orthodontics are shown to be effective in the correction of infrabony defects. Studies have also demonstrated the efficacy of using enamel matrix derivative (EMD) with demineralized freeze-dried bone allograft (DFDBA) to treat infrabony defects. This study aims to compare the clinical efficacy of limited orthodontics combined with EMD/DFDBA in the treatment of 2- or 3-wall infrabony defects.
  
  
  METHODS
  A randomized, parallel clinical trial was conducted in a private periodontal practice (Tokyo, Japan) between April 2004 and October 2008. Treatment period was 1 year with a 1-year follow-up. Forty-seven randomized patients, mean age of 53 ± 10.7 years, were allocated into two intervention groups: ortho/EMD/DFDBA (n = 24) and EMD/DFDBA (n = 23). Each patient had either a 2- or 3-wall infrabony defect of ≥6 mm deep. Probing depth and clinical attachment level were measured at baseline and 1 year. The primary outcome measure was absolute change in probing depth and clinical attachment level from baseline to 1-year follow-up. The secondary outcome measure was absolute change in open probing attachment level gain and percentage defect resolution from baseline to 6-month reentry surgery. Infrabony defects were surgically treated with EMD and DFDBA 4 weeks before application of orthodontic extrusive forces. Reentry surgeries were performed at 6 months after initial surgery.
  
  
  RESULTS
  Forty-seven patients were analyzed. Both treatment groups showed a significant improvement from baseline with no significant difference between the groups except for the 2-wall defects. The ortho/EMD/DFDBA group had statistically significant open probing attachment level gain (95% confidence level, 3.18 to 4.36; P = 0.036) compared to the EMD/DFDBA group (95% confidence level, 2.26 to 3.24) in 2-wall defects.
  
  
  CONCLUSIONS
  Although both treatment modalities were effective in managing 2- or 3-wall infrabony defects, limited orthodontics provided an additional benefit to EMD/DFDBA in 2-wall defects.
authors.affiliation: Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA. oshigeki@spn1.speednet.ne.jp
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ogihara
authors.forename: Hom-Lay
authors.initials: HL
authors.lastname: Wang
mesh_terms: D016301:Alveolar Bone Loss / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D055113:Chronic Periodontitis / Q000601:surgery; D003131:Combined Modality Therapy; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D050793:Orthodontic Extrusion / Q000295:instrumentation / Q000379:methods*; D017622:Periodontal Attachment Loss / Q000601:surgery; D010514:Periodontal Pocket / Q000601:surgery; D013524:Surgical Flaps; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D003746:Dental Enamel Proteins; C109069:enamel matrix proteins