title: Enamel matrix protein derivative and/or synthetic bone substitute for the treatment of mandibular class II buccal furcation defects. A 12-month randomized clinical trial.
abstract: OBJECTIVE
  This study aims to clinically evaluate the treatment of mandibular class II furcation defects with enamel matrix derivative (EMD) and/or a bone substitute graft made of β-tricalcium phosphate/hydroxyapatite (βTCP/HA).
  
  
  METHODS
  Forty-one patients, presenting a mandibular class II buccal furcation defect, probing pocket depth (PPD) ≥4 mm and bleeding on probing, were included. They were randomly assigned to the groups: 1-EMD (n = 13); 2-βTCP/HA (n = 14); 3-EMD + βTCP/HA (n = 14). Plaque index (PI), gingival index (GI), relative gingival margin position (RGMP), relative vertical and horizontal attachment level (RVCAL and RHCAL), and PPD were evaluated at baseline and 6 and 12 months. The mean horizontal clinical attachment level gain was considered the primary outcome variable.
  
  
  RESULTS
  No significant intragroup differences were observed for RGMP, but significant changes were observed for RVCAL, RHCAL, and PPD for all groups (p < 0.05). After 12 months, the mean horizontal clinical attachment level gain was 2.77 ± 0.93 mm for EMD, 2.64 ± 0.93 mm for βTCP/HA, and 2.93 ± 0.83 mm for EMD + βTCP/HA, with no significant differences among the groups. At the end of the study, 85.3 % of the sites were partially closed; however, no complete closure was observed.
  
  
  CONCLUSIONS
  EMD + βTCP/HA does not provide a significant advantage when compared to the isolated approaches. All three tested treatments promote significant improvements and partial closure of class II buccal furcation defects. Based on its potential to induce periodontal regeneration, EMD may be considered an attractive option for this type of defect, but complete closure remains an unrealistic goal.
  
  
  CONCLUSIONS
  The partial closure of buccal furcation defects can be achieved after the three tested approaches. However, the combined treatment does not provide a significant benefit when compared to the isolated approaches.
authors.affiliation: Faculty of Odontology of Piracicaba, Piracicaba, São Paulo, Brazil.
authors.forename: Lucas Araujo
authors.initials: LA
authors.lastname: Queiroz
authors.affiliation: Faculty of Odontology of Piracicaba, Piracicaba, São Paulo, Brazil.
authors.forename: Mauro Pedrine
authors.initials: MP
authors.lastname: Santamaria
authors.affiliation: Faculty of Odontology of Piracicaba, Piracicaba, São Paulo, Brazil.
authors.forename: Marcio Z
authors.initials: MZ
authors.lastname: Casati
authors.affiliation: Faculty of Odontology of Piracicaba, Piracicaba, São Paulo, Brazil.
authors.forename: Karina Silverio
authors.initials: KS
authors.lastname: Ruiz
authors.affiliation: Faculty of Odontology of Piracicaba, Piracicaba, São Paulo, Brazil.
authors.forename: Francisco
authors.initials: F
authors.lastname: Nociti
authors.affiliation: Faculty of Odontology of Piracicaba, Piracicaba, São Paulo, Brazil.
authors.forename: Antonio Wilson
authors.initials: AW
authors.lastname: Sallum
authors.affiliation: Faculty of Odontology of Piracicaba, Piracicaba, São Paulo, Brazil. easallum@fop.unicamp.br.
authors.forename: Enilson A
authors.initials: EA
authors.lastname: Sallum
mesh_terms: D018786:Bone Substitutes / Q000494:pharmacology*; D003746:Dental Enamel Proteins / Q000494:pharmacology*; D003774:Dental Plaque Index; D005260:Female; D017823:Furcation Defects / Q000601:surgery*; D006801:Humans; D006882:Hydroxyapatites; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D010512:Periodontal Index; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: D018786:Bone Substitutes; C558777:BoneCeramic; D003746:Dental Enamel Proteins; D006882:Hydroxyapatites; C109069:enamel matrix proteins; C074950:hydroxyapatite-beta tricalcium phosphate
keywords: Enamel matrix protein; Furcation defects; Hydroxyapatite-beta tricalcium phosphate; Periodontal disease; Randomized controlled trial