Treatment of infrabony defects with or without enamel matrix proteins: a 24-month follow-up randomized pilot study. A comparative study utilizing open flap debridement with and without enamel matrix derivative in the treatment of periodontal intrabony defects: a 12-month re-entry study. Five years clinical results following treatment of human intra-bony defects with an enamel matrix derivative: A randomized controlled trial Effect of enamel matrix proteins on the treatment of intrabony defects: a split-mouth randomized controlled trial study. Combination use of bovine porous bone mineral, enamel matrix proteins, and a bioabsorbable membrane in intrabony periodontal defects in humans. Comparison of treatments of infrabony defects with enamel matrix derivative, guided tissue regeneration with a nonresorbable membrane and Widman modified flap. A pilot study. Enamel matrix proteins and guided tissue regeneration with titanium-reinforced expanded polytetrafluoroethylene membranes in the treatment of infrabony defects: a comparative controlled clinical trial. Treatment of infrabony periodontal defects using a resorbable biopolymer of hyaluronic acid: a randomized clinical trial. Evaluation of efficacy of enamel matrix derivative in the treatment of intrabony defects: a 24-month multicenter study. A clinical study evaluating the treatment of supra-alveolar-type defects with access flap surgery with and without an enamel matrix protein derivative: a pilot study. Enamel matrix proteins in the regenerative therapy of deep intrabony defects. Microsurgical access flap in conjunction with enamel matrix derivative for the treatment of intra-bony defects: a controlled clinical trial. The efficacy of enamel matrix derivative (Emdogain) for the treatment of deep infrabony periodontal defects: a placebo-controlled randomised clinical trial. Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. Periodontal tissue alterations following Emdogain treatment of periodontal sites with angular bone defects. A series of case reports. Enamel matrix derivative in the treatment of human intrabony osseous defects. Guided tissue regeneration procedure with bioresorbable membranes versus conventional flap surgery in the treatment of infrabony periodontal defects. The use of barrier membranes and enamel matrix proteins in the treatment of angular bone defects. A prospective controlled clinical study. Enamel matrix proteins in the treatment of intra-bony defects. A prospective 24-month clinical trial. Enamel matrix proteins and bovine porous bone mineral in the treatment of intrabony defects: a comparative controlled clinical trial. The effect of systematic plaque control on bone regeneration in infrabony pockets. A retrospective case series comparing the use of demineralized freeze-dried bone allograft and freeze-dried bone allograft combined with enamel matrix derivative for the treatment of advanced osseous lesions. The effect of postsurgical antibiotics on the healing of intrabony defects following treatment with enamel matrix proteins.
OBJECTIVE To evaluate a comparison of open-flap debridement ( OFD ) with or without the use of enamel matrix proteins ( EMP ) for the treatment of infrabony defects . METHOD AND MATERIAL S Ten volunteers ( 38 infrabony defects ) were r and omized to receive OFD+EMP ( test site ) and OFD ( control site ) . Clinical outcomes included mean changes in Plaque Index , Gingival Index , probing pocket depth ( PPD ) , relative attachment level ( RAL ) , gingival recession , width of keratinized tissue , and dental mobility at baseline and at 24 months . RESULTS A significant reduction of 4.21+/-0.97 mm was observed in PPD for the OFD+EMP group ( from 6.30+/-0.99 mm to 2.09+/-0.97 mm ) and of 3.28+/-1.23 mm for the OFD group ( from 6.13+/-0.88 mm to 2.85+/-1.42 mm ) ( P<.001 ) . The reduction in PPD was statistically significantly greater for OFD+EMP compared to OFD ( P=.03 ) . The mean RAL decreased from 13.26+/-1.88 mm to 7.57+/-2.05 mm for the OFD+EMP group ( a gain of 5.69+/-1.96 mm ) and from 13.37+/-1.71 mm to 8.13+/-1.34 mm ( P<.001 ) for the OFD group ( a gain of 5.24+/-1.55 mm ) . Gingival recession was higher in the OFD+EMP group than in the OFD group . The mean keratinized tissue significantly decreased from 4.41+/-1.39 mm to 3.63+/-1.54 mm for OFD flap group ( P<.01 ) . CONCLUSION Both treatment modalities were efficient in improving RAL and PPD . Within groups , there was a significant reduction in keratinized tissue for OFD and a significant postoperative recession for the OFD + EMP group . Infrabony defects treated with OFD + EMP showed significantly more PPD reduction when compared to OFD BACKGROUND Previous studies have demonstrated that enamel matrix derivative ( EMD ) has the ability to improve clinical parameters when used to treat intraosseous defects . The purpose of the present study was to compare at 12 months postsurgery sites treated with open flap debridement ( OFD ) alone to those treated with OFD and EMD . METHODS Twenty-three subjects with at least 2 intrabony defects were chosen . Fifty-three defects received EMD in conjunction with OFD .  Thirty-one defects in these same 23 subjects were treated with OFD alone . Stents were fabricated to serve as fixed reference points . Re-entries were performed at least 1 year after initial surgery . Soft tissue measurements were recorded prior to initial surgery and prior to re-entry for gingival ( GI ) and plaque ( PI ) indices , probing depth ( PD ) , gingival margin position , and clinical attachment level ( CAL ) . Hard tissue measurements were recorded during the initial and re-entry surgery for level of crestal bone and depth of defect . Statistical analysis was conducted using the method of generalized estimating equations to determine changes in GI , PI , PD , CAL , fill of the osseous defect , and crestal resorption . Percent of defect fill was also calculated . RESULTS In all categories , treatment with EMD ( test ) was superior to treatment without EMD ( control ) . Average PI and GI were not significantly different either initially or prior to re-entry . The average PD reduction was 2.7 mm greater with EMD than controls . The average CAL gains were 1.5 mm greater , and the average fill of osseous defect 2.4 mm greater with EMD than controls . The average percent of defect fill after adjusting for crestal bone loss was more than 3 times greater for EMD versus control-treated sites ( 74 % defect fill with EMD versus 23 % defect fill for control sites ) . CONCLUSIONS This study indicates that treatment of periodontal intraosseous defects with EMD is clinical ly superior to treatment without EMD ( open flap debridement ) in every parameter evaluated . Re-entry data demonstrate that percent fill of osseous defects treated with EMD compares favorably with the treatment results utilizing bone grafts or membrane barriers , according to published literature Abstract Introduction . Emdogain ® represents an extracellular matrix derivative that controls and promotes periodontal regeneration . Several studies have demonstrated that the treatment of periodontal defects with Emdogain ® leads to improvements in clinical parameters . However , long-time clinical trials establishing clinical usefulness of Emdogain ® are scarce . Therefore , the present r and omized split mouth , controlled study was undertaken to evaluate the effectiveness of Emdogain ® as an adjunct to open flap debridement for the treatment of intra-bony defects over a period of 5 years . Material s and methods . The study population consisted of 15 chronic periodontitis patients with bilateral interproximal osseous defects . The test group was treated by open flap debridement with EDTA 24 % ( PrefGel ® ) followed by enamel matrix derivative ( Emdogain ® ) . The control group was treated by open flap debridement with EDTA 24 % ( PrefGel ® ) . Results . After 1 and 5 years , both the test and control groups showed significant mean PPD reduction . A greater reduction in mean Probing Pocket Depth ( PPD ) was observed in the test group ( 3.84 ± 1.05 ) as compared to the control group ( 1.92 ± 0.35 ) . The mean Clinical Attachment Level ( CAL ) gain of 3.18 ± 0.87 mm was observed in the test group , while the control group displayed mean CAL gain of 1.60 ± 0.54 mm . The observed differences were found to be statistically significant in both the groups ( p < 0.05 ) . Percentage bone fill was significantly increased at 12 months post-surgery in test group ( 66.66 ± 7.8 % ) as compared to control group ( 31.71 ± 4.1 % ) . Conclusion . The treatment with Emdogain result ed in a significantly higher CAL gain and PPD reduction in comparison with OFD and PrefGel ® The objective of this split-mouth , double-blind , r and omized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement ( OFD ) combined or not with enamel matrix proteins ( EMP ) .  Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth ( PPD ) > or = 5 mm . All individuals received instructions regarding oral hygiene and were su bmi tted to scaling and root planing . Each participant received the two treatment modalities : test sites were treated with OFD and EMP , and control sites received only OFD . After 6 months , a significant reduction was observed in PPD for the EMP group ( from 6.42 + /- 1.08 mm to 2.67 + /- 1.15 mm ) and for the OFD group ( from 6.08 + /- 1.00 mm to 2.00 + /- 0.95 mm ) ( p < 0.0001 ) , but with no significant difference between groups ( p = 0.13 ) . A significant gain in relative attachment level ( RAL ) was observed in both groups ( EMP : from 13.42 + /- 1.88 mm to 10.75 + /- 2.26 mm , p < 0.001 ; OFD : from 12.42 + /- 1.98 mm to 10.58 + /- 2.23 mm , p = 0.013 ) , but with no significant difference between groups ( p = 0.85 ) . Gingival recession ( GR ) was higher in the EMP group ( from 1.08 + /- 1.50 mm to 2.33 + /- 1.43 mm ; p = 0.0009 ) than in the OFD group ( from 0.66 + /- 1.15 mm to 1.16 + /- 1.33 mm ; p = 0.16 ) , but this difference was not significant ( p = 0.06 ) . In conclusion , the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone BACKGROUND The purpose of this study was to evaluate the effectiveness of a combination of enamel matrix proteins ( EMP ) , bovine porous bone mineral ( BPBM ) , and a bioabsorbable membrane for guided tissue regeneration ( GTR ) as regenerative therapy for intrabony defects in humans and compare it to an open flap debridement ( OFD ) technique . METHODS Using a split-mouth design , 18 pairs of intrabony defects were treated and surgically reentered 6 months after the initial surgery . Experimental sites were treated with EMP , grafted with BPBM , and received a collagen/polylactic acid membrane for GTR . Control sites were treated with OFD . The primary outcomes evaluated in the study included probing depth resolution , clinical attachment gain , and bony defect fill . RESULTS Preoperative probing depths , attachment levels , and intraoperative bone measurements were similar for the experimental and control groups . Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the experimental group ( 4.95+/-1.52 mm on buccal sites and 4.74+/-1.47 mm on lingual sites ) when compared to the control group ( 2.83+/-0.83 mm on buccal sites and 2.90+/-0.91 mm on lingual sites ) . The experimental sites also presented with significantly more attachment gain ( 3.89+/-1.16 mm on buccal sites and 3.78+/-1.14 mm on lingual sites ) than the control sites ( 1.52+/-0.83 mm on buccal sites and 1.48+/-0.78 mm on lingual sites ) . Surgical reentry of the treated defects revealed a significantly greater amount of defect fill in favor of the experimental group ( 4.76+/-1.36 mm on buccal sites and 4.81+/-1.37 mm on lingual sites ) as compared to the control group ( 1.78+/-0.92 mm on buccal sites and 1.67+/-0.90 mm on lingual sites ) . CONCLUSIONS The results of this study indicate that a combination technique including BPBM , EMP , and GTR results in better clinical resolution of intrabony defects than treatment with OFD . Differences observed were both statistically and clinical ly significant . The exact role of each of the 3 technique components in achieving the clinical improvement observed in this study remains to be determined BACKGROUND , AIMS The purpose of the present study was to compare the efficacy of 3 different surgical procedures in the treatment of infrabony defects :  guided tissue regeneration ( GTR ) with non-resorbable membranes , Widman modified flap ( WMF ) and enamel matrix derivative ( EMD ) . METHOD 30 patients with an infrabony component > or = 4 mm were selected . 10 were treated with exp and ed polytetrafluorethylene ( ePTFE ( Gore - Tex W. L. Gore and Associates , Flagstaff , AZ , USA ) ) membranes , 10 with WMF and 10 with enamel matrix derivatives ( Emdogain ( U Biora AB Malm , Sweden ) ) . The efficacy of each treatment modality was investigated through regression analysis . Probing attachment level ( PAL ) gain , probing depth ( PD ) reduction and gingival recession ( REC ) variation were analyzed . RESULTS Both Emdogain ( enamel matrix derivative ) and ePTFE treatment show significant better results as compared to the WMF procedure in which there were no significant changes in PAL gain and PD reduction at baseline and 1 year after surgery . CONCLUSIONS Results from our analysis suggest that there is no statistically significant difference in PAL gain between GTR and EMD . The clinical outcomes of this pilot study may be of little significance , considering the small number of patients , but it has provided an important base for a controlled clinical trial ( with a larger number of patients ) which is currently in progress BACKGROUND Several studies have documented the clinical efficacy of guided tissue regeneration ( GTR ) with non-resorbable exp and ed polytetrafluoroethylene ( ePTFE ) membranes and enamel matrix proteins ( EMP ) in the treatment of infrabony defects . The objective of this controlled clinical study was to compare the clinical outcomes of 3 surgical modalities in the treatment of deep interproximal infrabony defects . METHODS Ninety ( 90 ) defects in 90 healthy subjects affected by chronic periodontitis were assigned to 1 of 3 treatment groups by blocking to prognostic variables . The test group was treated with the application of EMP and the simplified papilla preservation ( SPP ) technique ; the second group was treated with titanium-reinforced ePFTE membranes and the SPP technique ; and the third group was treated with the SPP technique used as access flap control procedure . No differences were observed in terms of baseline oral hygiene and defect characteristics among the 3 groups , indicating that the blocking approach was effective . A stringent infection control program was adopted for 1 year . RESULTS The 1-year results indicated that : 1 ) all treatment modalities result ed in clinical ly significant improvements in clinical attachment levels ( CAL ) and reduction in probing depth ( PD ) ; 2 ) a statistically significant treatment effect was demonstrated comparing the EMP test , the membrane control , and the flap control groups in terms of CAL gains ; 3 ) both the EMP test and the membrane control groups showed significant CAL gains compared to the flap control group ; 4 ) a statistically significantly greater amount of CAL gain was demonstrated in GTR-treated compared to EMP-treated patients ; 5 ) deeper residual probing depths but smaller increases in gingival recession were demonstrated following EMP therapy ; and 6 ) smoking habits reduced the clinical outcomes of both regenerative procedures . CONCLUSIONS The use of a regenerative procedure is indicated in the treatment of deep vertical bony defects since both the regenerative techniques ( GTR and EMD ) in the present study result ed in clinical ly and statistically significant improvements in clinical parameters compared to the access flap procedure . The use of EMP can be helpful in esthetically-sensitive sites and in reducing patient morbidity OBJECTIVE This r and omized clinical study examined the use of hyaluronic acid to treat infrabony periodontal defects over a period of 24 months . METHOD AND MATERIAL S Forty subjects with a two-wall infrabony defect ( probing depth [ PD ] > = 7 mm ; clinical attachment level [ CAL ] > = 7 mm ) were selected . The defects were r and omly divided into two groups : sites treated with hyaluronic acid ( test group ) and those treated with open flap debridement ( control group ) . RESULTS The 12- and 24-month evaluations were based on clinical and radiographic parameters . The primary outcome variable was CAL . Test defects shows a mean CAL gain of 1.9 ± 1.8 mm , while the control defects yielded a significantly lower gain of 1.1 ± 0.7 mm . PD reduction was also significantly higher in the test group ( 1.6 ± 1.2 mm ) than in the control group ( 0.8 ± 0.5 mm ) . Frequency distribution analysis of the study outcomes indicated that hyaluronic acid increased the predictability of clinical ly significant results ( CAL gains > = 2 mm and PD reduction > = 2 mm ) in the test group compared with the controls . CONCLUSIONS The treatment of infrabony defects with hyaluronic acid offered an additional benefit in terms of CAL gain , PD reduction , and predictability compared to treatment with open flap debridement The aim of this prospect i ve multicenter controlled clinical study was to evaluate the efficacy of Emdogain ( Biora ) , an enamel matrix derivative ( EMD ) , when combined with surgical treatment of periodontal angular defects , as compared to surgery alone , for up to 24 months of follow-up . The study was performed at six Italian universities and 11 private practice s. Patients with one- , two- , or three-wall angular defects were enrolled if intrabony defect depth ( IBD ) was 4 mm or more and probing pocket depth ( PPD ) was at least 6 mm . They were r and omly allocated to either test or control groups . The test group was treated by the simplified papilla preservation ( SPP ) flap plus Emdogain after root conditioning with ethylenediaminetetraacetic acid . The control group was treated by SPP alone .  Plaque Index , Gingival Index , PPD , and periodontal attachment level ( PAL ) at surgical sites were assessed at the presurgical examination ( baseline ) . IBD was measured intraoperatively after debridement . IBD was also evaluated with a computer-aided technique , from periapical radiographs . Plaque Index , Gingival Index , PPD , PAL , and IBD were assessed at 12 and 24 months postsurgery . Data were further divided in two subgroups according to baseline IBD ( 6 mm or less and more than 6 mm ) . The differences between each follow-up and baseline , and between groups at each follow-up , for the above parameters were evaluated by st and ard statistical methods . One hundred fifty-three patients were recruited , accounting for 195 intrabony defects : 83 patients ( 108 defects ) and 70 patients ( 87 defects ) were allocated to the test and control groups , respectively . All parameters were improved at both 12 and 24 months , compared to baseline in both groups . In the test group , IBD , PPD , and PAL at 12 months were significantly better than these parameters in the control group . The test subgroup with IBD of more than 6 mm at baseline displayed a better outcome when compared to the 6 mm or less IBD subgroup . No significant adverse events related to the use of Emdogain were reported . The use of EMD as an adjunct to periodontal surgery in the treatment of angular defects significantly enhanced the rate and degree of periodontal regeneration . The control group also displayed significant tissue regeneration , but at a slower rate compared to the Emdogain group . The surgical procedure itself , with its goal of maximum preservation of the regenerative potential of periodontal tissues , proved to be effective in the treatment of periodontal angular defects . Pockets with IBD greater than 6 mm showed major improvement when treated with Emdogain AIM There is evidence that regenerative treatment of intra-bony and m and ibular class II furcation defects with access flap and an application of an enamel matrix protein derivative ( EMD ) can result in a clinical benefit compared with access flap alone . The aim of this pilot study was to check if the results of access flap surgery in suprabony defects are improved by additional application of EMD . MATERIAL AND METHODS Thirty-nine adult subjects with supra-alveolar-type defects were r and omly assigned to a test ( n=25 ) and a control group ( n=14 ) . Seventy teeth were treated with EMD ; 28 teeth were treated by access flap .  Probing depth ( PD ) , clinical attachment level and bleeding on probing were evaluated at baseline and after 12 months . RESULTS PD of the operated teeth was improved in both groups ( p<0.001 to p=0.041 ) but always better in the test group . The attachment gain was 2.72+/-1.80 mm at sites with an initial PD > or=7 mm in the test group and 0.78+/-0.62 mm in the control group ( p=0.004 ) . In the test group the mean attachment gain was 0.97+/-0.92 mm ( p<0.001 ) ; the mean reduction of PD was 1.55+/-0.90 mm ( p<0.001 ) . CONCLUSIONS The data suggest a significant clinical benefit of supplementary application of EMD during surgical treatment of periodontitis of supra-alveolar pockets , especially in deeper pockets AIM This prospect i ve multicentre r and omized controlled clinical trial was design ed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix proteins ( EMD ) . MATERIAL AND METHODS 172 patients with advanced chronic periodontitis were recruited in 12 centers in 7 countries . All patients had at least one intrabony defect of > or = 3 mm . Heavy smokers ( > or = 20 cigarettes/day ) were excluded . The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure . After debridement , roots were conditioned for 2 min with a gel containing 24 % EDTA . EMD was applied in the test subjects , and omitted in the controls . Postsurgically , a strict plaque control protocol was followed . At baseline and 1 year following the interventions , clinical attachment levels ( CAL ) , pocket probing depths ( PPD ) , recession ( REC ) , full-mouth plaque scores and full-mouth bleeding scores were assessed . A total of 166 patients were available for the 1-year follow-up . RESULTS At baseline , 86 test and 86 control patients presented with similar subject and defect characteristics . On average , the test defects gained 3.1+/-1.5 mm of CAL , while the control defects yielded a significantly lower CAL gain of 2.5+/-1.5 mm . Pocket reduction was also significantly higher in the test group ( 3.9+/-1.7 mm ) when compared to the controls ( 3.3+/-1.7 mm ) . A multivariate analysis indicated that the treatment , the clinical centers , cigarette smoking , baseline PPD , and defect corticalisation significantly influenced CAL gains . A frequency distribution analysis of the studied outcomes indicated that EMD increased the predictability of clinical ly significant results ( CAL gains > or = 4 mm ) and decreased the probability of obtaining negligible or no gains in CAL ( CAL gains < 2 mm ) . CONCLUSIONS The results of this trial indicated that regenerative periodontal surgery with EMD offers an additional benefit in terms of CAL gains , PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone OBJECTIVES The aims of this controlled study were to clinical ly and radiographically evaluate the effect of a microsurgical approach for the treatment of intra-bony defects with and without an enamel matrix derivative ( EMD ) . Parts of this study population were already published by Wachtel and colleagues in 2003 . MATERIAL AND METHODS Seventy intra-bony defects were r and omly assigned to a microsurgical access flap with application of EMD ( test group ) and on the contra-lateral side to a microsurgical access flap alone ( control group ) . Clinical and radiographic parameters were assessed at baseline and after 6 and 12 months . RESULTS Both test and control treatments result ed in a statistically significant mean clinical attachment level ( CAL ) gain , probing pocket depth ( PPD ) reduction and radiographic bone fill . The test group yielded statistically significantly more CAL gain , PPD reduction and radiographic bone fill than the control group . Gingival recession increase after 12 months averaged 0.5 and 0.7 mm for the test and control groups , and did not reach statistical significance . Two weeks after surgery , primary wound closure was maintained in 91 % of the test sites and 97 % of the control sites . CONCLUSION The combination of a microsurgical access flap with EMD seems to be superior to open flap debridement in terms of PPD reduction , CAL gain and radiographic bone fill . In the test as well as the control group , primary wound closure was successfully achieved PURPOSE To evaluate the efficacy of Emdogain versus placebo ( its carrier ) for the treatment of deep infrabony defects . MATERIAL S AND METHODS Thirty patients with an infrabony defect of at least 4 mm deep and at least 2 mm wide were r and omly allocated for treatment with either Emdogain or placebo ( the Emdogain carrier ) . The treating clinician was completely blinded to the therapy provided and performed all evaluations blindly up to the third year of follow-up . Outcome measures were tooth loss , complications , post-operative healing , patient 's satisfaction with treatment and aesthetics , changes in probing attachment levels ( PAL ) , probing pocket depths ( PPD ) , gingival recessions ( REC ) and radiographic bone levels ( RAD ) . RESULTS One year after treatment , both therapies had significantly improved clinical outcome measures : placebo group PAL gain = 3.3 mm , PPD reduction = 3.9 mm , and RAD gain = 2.5 mm ; Emdogain group PAL gain = 3.4 mm , PPD reduction = 4.2 mm , and RAD gain = 2.5 mm . Both therapies induced statistically significant gingival recession ( 0.6 mm in the placebo and 0.8 mm in the Emdogain group ) . There were no statistically significant differences between groups for any of the outcomes tested . No teeth had to be extracted up to 3 years after treatment . CONCLUSIONS There does not appear to be any clinical advantage when using Emdogain over its carrier ( placebo ) in the treatment of deep and wide infrabony defects OBJECTIVES Application of the guided tissue regeneration ( GTR ) principle and utilization of enamel matrix derivative ( EMD ) have both been shown to result in periodontal regeneration . While clinical investigations have demonstrated that the use of a microsurgical concept in combination with the GTR technique positively affects the percentage of primary closure and the amount of tissue preservation , no such information is available for EMD-treated periodontal defects . It was the aim of the present investigation to assess the clinical effect of the microsurgical access flap and EMD treatment with an emphasis on the evaluation of early wound healing . MATERIAL AND METHODS Eleven patients displaying at least one pair of intrabony periodontal defects with an intrabony component of > or =3 mm participated in the study . At baseline and at 6 and 12 months after surgery , the following clinical parameters were assessed by a blinded examiner : oral hygiene status ( API ) , gingival inflammation ( BOP ) , probing pocket depth ( PPD ) , clinical attachment level ( CAL ) and gingival recession ( GR ) . Defects were r and omly assigned to test or control treatment , which both consisted of a microsurgical access flap procedure design ed for maximum tissue preservation . The exposed root surfaces of the test sites were conditioned with a 24 % EDTA gel followed by EMD ( Emdogain(R ) ) application . Primary flap closure was achieved by a 2-layered suturing technique . Postoperative healing was evaluated by a newly introduced early wound-healing index ( EHI ) at 1 and 2 weeks after surgery . RESULTS Both test and control treatment result ed in a statistically significant mean CAL gain of 2.8 and 2.0 mm at 6 months , and 3.6 and 1.7 mm at 12 months , respectively ( p<0.05 ) . Differences in CAL gain between the two treatment modalities were statistically significant at both time points ( p<0.05 ) . Additional GR values after 12 months averaged 0.3 and 0.4 mm for test and control sites , respectively , and did not reach statistical significance ( p > or = 0.05 ) . Two weeks after surgery , primary closure was maintained in 89 % of the test sites and in 96 % of the control sites . CONCLUSION Both treatment modalities using the microsurgical flap procedure result ed in a high percentage of primary flap closure and maximum tissue preservation . In terms of PPD reduction and CAL gain , the combination with EMD application appeared to be superior to the microsurgical access flap alone UNLABELLED The aim of the present study was to assess the predictability of probing attachment gain and probing pocket depth reduction following Emdogain treatment at sites with deep angular bone defects . MATERIAL AND METHODS 108 consecutively-treated periodontal patients ( mean age 55.8 years ) were included . Each subject exhibited at least 1 deep interproximal intrabony defect that could be identified as an experimental site based on the inclusion criteria : ( i ) probing pocket depth > or = 5 mm , ( ii ) probing attachment loss > or = 6 mm , ( iii ) radiographic evidence of an interproximal bone defect with a > or = 3 mm intrabony component . A total of 145 defects met the criteria for inclusion . All subjects received non-surgical periodontal therapy .  This included subgingival instrumentation in all parts of the dentition . At least 6 months after the completion of this treatment , a baseline examination was performed to characterise the experimental site . Reconstructive therapy was subsequently performed . Full-thickness periodontal flaps were elevated , and the root surface scaled and planed . No bone recontouring was performed . A gel containing 24 % EDTA was applied on the exposed root and was kept in place for 2 min . A preparation of enamel matrix proteins was applied to the root surface and adjacent defect space . The flaps were replaced and closed with sutures . The experimental sites were re-examined 12 months after reconstructive surgery . RESULTS The re-examination demonstrated that a treatment including the application of enamel matrix proteins at periodontal sites with angular defects result ed in a mean probing attachment level gain of 4.6 mm and a probing pocket depth reduction of 5.2 mm . 87 % of all sites treated exhibited a probing attachment gain of > 2 mm . One site suffered probing attachment loss . The radiographic assessment s revealed that the bone defect had been reduced in depth by 2.9 mm on average . The reduction in defect size corresponded to an average bone fill of 69 % of the original defect . In 43 % of the defects , the bone fill amounted to > or = 80 % . CONCLUSION The overall probing pocket depth reduction , probing attachment level gain , and soft tissue recession , that results following Emdogain therapy , is similar to the corresponding outcome variables following GTR BACKGROUND There is limited information available from clinical trials regarding the performance of enamel matrix derivative ( EMD ) in the treatment of periodontal intrabony defects . This r and omized , double-blind , placebo-controlled , split-mouth study was design ed to compare the clinical and radiographical effects of EMD treatment to that of placebo-controlled treatment for intrabony defects . METHODS Sixteen patients were included , each of whom had 1 or 2 pairs of intrabony defects located contralaterally in the same arch . Thirty-six intrabony defects were r and omly assigned treatment with flap surgery plus EMD or flap surgery plus placebo . At baseline and at the 12-month follow-up evaluation visit , clinical and radiographic measurements were determined . Data were statistically analyzed using the Wilcoxon-signed rank test ( alpha = 0.05 ) . RESULTS At the 12-month visit , bleeding on probing for the EMD group was 0.11 + /- 0.32 compared to the placebo group , 0.61 + /- 0.50 ( P < 0.05 ) . Probing depth reduction was greater in the EMD group ( 3.00 + /- 0.97 mm ) compared to the placebo group ( 2.22 + /- 0.81 mm ) ( P < 0.05 ) . Mean values for clinical attachment gain in the EMD and the placebo groups were 1.72 + /- 1.07 mm and 0.83 + /- 0.86 mm , respectively ( P < 0.05 ) . Vertical relative attachment gain was 38.5 + /- 22.6 % in the EMD group and 21.4 + /- 25.2 % in the placebo group ( P<0.05 ) . Radiographic bone density gain was greater in the EMD ( 20.2 + /- 16.6 % ) compared to the placebo group ( -3.94 + /- 23.3 % ) ( P<0.01 ) . CONCLUSIONS Treatment with flap surgery and EMD , compared to flap surgery with placebo , produced a significantly more favorable clinical improvement in intrabony periodontal defects AIM Cl aims are being made that clinical results of periodontal flap surgery are enhanced when membranes are employed to aid GTR in intrabony pockets . It was the aim of our study to determine whether this assumption was true for a certain bioresorbable membrane ( Guidor Matrix Barrier ) . METHOD 44 intrabony defects were treated in 16 patients . In 21 lesions , conventional flap surgery only was performed , while in 23 , similar lesion membranes were placed as an additional treatment task . Results were evaluated over a time span of 12 months . RESULTS In all surgical areas , treatment result ed in significant improvement of parameters such as attachment levels and probing depths , as well as index values for plaque and bleeding on probing . This occurred whether membranes had been used or not , without any significant differences when comparing the collective results of both treatment groups . CONCLUSIONS Placement of membranes during periodontal surgery for the enhancement of tissue regeneration in intrabony pockets is often both difficult and time consuming . In the light of our clinical results with resorbable membranes , such extra effort seems hardly warranted UNLABELLED In the present prospect i ve clinical trial , the effect of various regenerative procedures performed at sites with angular bone defects were evaluated . The main outcome variable was probing attachment alteration . MATERIAL AND METHODS 40 subjects , aged 32 - 61 years participated . They met the following inclusion criteria : ( i ) presence of generalized , advanced periodontal tissue destruction ; ( ii ) presence of 2 similar , contralateral , angular bone defects ( experimental sites ) located in either the maxilla or the m and ible ; ( iii ) the defect site must exhibit a probing pocket depth ( PPD ) of > or = 6 mm , a probing attachment level ( PAL ) of > or = 7 mm , and a depth of the intrabony component of > or = 3 mm . All subjects had a good oral hygiene st and ard , were in good general health and did not use any medication . Prior to the start of the study , all subjects received non-surgical treatment for periodontal disease .  Baseline clinical measurements ( plaque , gingivitis , PPD , PAL and soft tissue recession ) of the selected experimental sites were obtained 6 months after the completion of basic therapy . The 40 subjects were r and omly divided into 4 treatment groups including 10 subjects each : 3 membrane groups and one Emdogain group . 1 h before surgery , the patients were given 3 g of Amoxicillin . No other antibiotics were prescribed . The test and control sites were treated during the same surgical session . Full thickness flaps were elevated and the exposed root surfaces were planed . Membrane placement : The root surface was rinsed with saline . A barrier membrane ( Guidor or Resolut or Periodontal ( e-PTFE ) material ) was positioned to cover the defect and the adjacent 2 - 3 mm of bone tissue . The control treatment was identical to the test treatment with the exception of barrier placement . Emdogain placement : The exposed root surfaces at both the test and control sites were , during a 2-min period , conditioned with a 24 % EDTA gel . Emdogain was applied to the exposed root surface of the test site . In the control site , the vehicle , the PGA gel , was used as placebo control . The flaps were closed and sutured to obtain a complete coverage of the intrabony defect . RESULTS Re-examinations , which were performed 12 months after surgery , disclosed that regenerative therapy , including either the use of barrier membranes or application of enamel matrix proteins to an instrumented root surface in an angular , intrabony defect , enhanced outcome variables such as probing pocket depth and probing attachment gain . It was furthermore demonstrated that clinical improvements were better at sites with deep , than at sites with shallow , intrabony defects . CONCLUSION The 4 regenerative modalities tested appeared to be equally effective in terms of PPD reduction and PAL gain , and superior to open flap curettage alone BACKGROUND A growing flow of recent evidence indicates enamel matrix derivative ( EMD , Emdogain ) as a useful tool for the regeneration of periodontal tissues . This prospect i ve clinical study aim ed to evaluate the efficacy of EMD combined with surgical treatment of periodontal intra-bony defects , as compared with surgery alone , up to 24 months of follow-up . METHODS Twenty-four intra-bony defects were treated in 24 patients in a single clinical centre . Each defect had intra-bony depth ( IBD ) > or = 4 mm and probing pocket depth ( PPD ) > or = 6 mm . Patients were r and omly assigned to either test or control group . Plaque index ( PI ) , gingival index ( GI ) , PPD and periodontal attachment level ( PAL ) were assessed at baseline pre-surgical examination at the site to be treated . Full mouth plaque score ( FMPS ) and full mouth bleeding score ( FMBS ) were also evaluated . Twelve patients were treated by simplified papilla preservation flap technique ( control group ) , while 12 patients were treated with the same surgical technique plus EMD after ethylenediamine tetraacetic acid root conditioning ( test group ) . Any probing at the involved sites was avoided in the first year post-surgery . Radiographs were taken at baseline , 12 and 24 months after surgery using customized bite blocks . Intra-bony defect depth ( IBD ) and angle ( IBA ) were measured from X-rays by a computer-aided technique . At 12 and 24 months post-surgery , FMPS , FMBS , PI , GI , PPD , PAL and radiographic IBD and IBA were assessed . The difference between each follow-up and baseline , and between groups at each follow-up was evaluated for the above parameters by st and ard statistical methods . RESULTS In both groups , clinical and radiographic parameters were improved at either 12 or 24 months when compared with baseline . The test group displayed better outcomes when compared with the control group for IBD , PPD , and PAL gain at 12 months , and only for PAL and IBD gain at 24 months . No adverse event related to the use of EMD was reported . CONCLUSIONS The surgical procedure used in the present study , aim ing for maximum preservation of the regenerative potential of periodontal tissues , showed per se excellent results . The use of EMD as an adjunct to periodontal surgery in the treatment of angular defects possibly enhances periodontal regeneration rate BACKGROUND Various clinical studies have demonstrated that applying commercially available enamel matrix proteins ( EMP ) on the instrumented root surface during access flap surgery promotes clinical ly significant gains of clinical attachment and bone in intrabony defects . The aim of the present controlled clinical trial was to evaluate the adjunctive effect of filling the intrabony lesion with bovine porous bone mineral ( BPBM ) to a simplified papilla preservation ( SPP ) flap and EMP surgical procedure . METHODS Sixty deep interproximal intrabony lesions in 60 patients with chronic periodontitis were treated with the SPP flap and EMP . In the 30 test defects , the intrabony component was filled with BPBM particles previously reconstituted with the EMP gel . A stringent infection control program was adopted for 1 year . The clinical and radiographical reevaluation was made 1 year after surgery . RESULTS Both techniques result ed in clinical ly and statistically significant improvements between baseline and 1 year , in terms of clinical attachment level ( CAL ) gain , probing depth ( PD ) reduction , and radiographic bone fill ; however , the BPBM test treatment showed statistically significantly greater CAL ( 5.8 + /- 1.1 versus 4.9 + /- 1.0 ) and radiographic bone ( DEPTH ) level gains ( 5.3 + /- 1.1 versus 4.3 + /- 1.5 ) , and less increase in gingival recession ( 0.4 + /- 0.6 versus 0.9 + /- 0.5 ) than the control surgical procedure . CONCLUSION The present study data supported the hypothesis that the adjunctive use of BPBM in grafting intrabony defects has the ability to improve clinical and radiographical outcomes achievable with EMP alone A clinical trial was undertaken to test the hypothesis that periodontitis can be cured and that bone regeneration occurs in infrabony pockets in patients maintained on an optimal st and ard of oral hygiene . The material comprised 24 patients with advanced periodontal disease . After an initial examination , the patients were r and omly distributed into one test group and one control group . All the patients were given instruction and practice in a proper oral hygiene technique , and then subjected to periodontal surgery using the modified Widman flap procedure . Following treatment , during a 2-year period the patients of the test group were recalled once every second week for professional tooth cleaning . The control patients were recalled once every 12 months for prophylaxis . The results showed that all osseous defects of the patients of the test group were refilled with bone . The control patients , on the other h and , could not maintain a high st and ard of oral hygiene , and exhibited a progressive deterioration of the periodontal tissues during the postsurgical observation time BACKGROUND Combined regenerative approaches have been used for treating advanced osseous lesions around teeth . The aim of combining treatments is to enhance both clinical predictability and regenerative outcome compared to a monotherapeutic approach . This case series from a private practice reports on the clinical efficacy of an enamel matrix derivative ( EMD ) combined with either demineralized freeze-dried bone allograft ( DFDBA ) or freeze-dried bone allograft ( FDBA ) in the treatment of advanced infrabony lesions . The advanced lesions were veneered by a rapidly formed absorbable polymer barrier of poly(DL-lactide ) to enhance graft containment . METHODS A total of 22 consecutive patients , each contributing one infrabony lesion , are reported . After patients completed presurgical preparation , the infrabony lesions were surgically treated with a combined approach that included root surface treatment with citric acid . The two groups differed in their composite graft ; one received DFDBA-EMD ( n = 10 ) and the other received FDBA-EMD ( n = 12 ) . Patients followed a stringent postoperative protocol and were evaluated 6 months postsurgery . Clinical outcomes were assessed by changes in clinical attachment level ( CAL ) and probing depth ( PD ) from pretreatment . Surgical re-entry of several sites was possible in each group . RESULTS CAL at pretreatment measured 9.2 + /- 1.3 mm and 9.1 + /- 1.9 mm for DFDBA-EMD and FDBA-EMD groups , respectively , with corresponding PD of 8.4 + /- 1.6 mm and 8.9 + /- 2.0 mm for each group . At 6 months post-treatment , CALs were reduced to 4.7 + /- 1.3 mm and 3.8 + /- 1.0 mm for DFDBA-EMD and FDBA-EMD groups , respectively ; with corresponding PD decreased to 3.0 + /- 0.8 mm and 3.2 + /- 1.0 mm . Relative improvements in CAL for the DFDBA-EMD and DFDBA-EMD groups were 49.1 % + /- 11.0 % and 57.3 % + /- 9.4 % , respectively ( P < 0.07 ) . CONCLUSIONS This case series demonstrates the clinical benefits of using a combined therapeutic approach in which a biologic mediator ( EMD ) was combined with either DFDBA or FDBA . In this limited case series , a trend was observed towards greater improvement in clinical attachment level gain in advanced  infrabony defects when EMD was combined with FDBA as compared to DFDBA . Larger prospect i ve controlled clinical trials are needed to determine if differences exist in the relative efficacy of DFDBA versus FDBA in combination with EMD BACKGROUND Regenerative treatment with enamel matrix proteins has been shown to promote healing in intrabony defects . However , up to now various postoperative antibiotic regimens have been used in combination with enamel matrix proteins and therefore it can not be excluded that the results may also be attributable to the effect of the antibiotic treatment . The aim of this r and omized , controlled , blinded , clinical investigation was to determine the effect of postsurgical administration of antibiotics on the healing of intrabony periodontal defects treated with enamel matrix proteins . METHODS Thirty-four patients each of whom exhibited one deep intrabony defect were r and omly treated with either enamel matrix proteins plus antibiotics ( test : EMD + AB ) or with enamel matrix proteins alone ( control : EMD ) . The antibiotic regimen consisted of a combination of 3 x 375 mg amoxicillin and 3 x 250 mg metronidazole daily for 7 days . The following parameters were recorded at baseline and at 1 year by the same calibrated and blinded investigator : plaque index ( PI ) , gingival index ( GI ) , bleeding on probing ( BOP ) , probing depth ( PD ) , gingival recession ( GR ) , and clinical attachment level ( CAL ) . Power analysis to determine superiority of antibiotic treatment showed that the available sample size would yield 85 % power to detect a 1 mm difference . RESULTS No statistically significant differences in any of the investigated parameters between the 2 groups were observed at baseline . No serious adverse events such as allergic reactions or abscesses after any of the treatments were observed during the entire study period . The results have shown that in the EMD + AB group the PD decreased from 9.1 + /- 1.5 mm to 4.5 + /- 1.1 mm ( P<0.0001 ) and the CAL changed from 11.0 + /- 1.6 mm to 7.5 + /- 1.4 mm ( P<0.0001 ) . In the EMD group the PD decreased from 9.0 + /- 1.7 mm to 4.3 + /- 1.7 mm ( P < 0.0001 ) and the CAL changed from 10.6 + /- 1.6 mm to 7.3 + /- 1.5 mm ( P < 0.0001 ) . There were no significant differences in any of the investigated parameters between the 2 groups . CONCLUSIONS It can be concluded that the systemic administration of amoxicillin and metronidazole adjacent to the use of EMD for the surgical treatment of intrabony periodontal defects does not produce statistically superior PD reduction and CAL gain when compared to treatment with EMD alone . Hence , the present results do not support the routine administration of amoxicillin and metronidazole following regenerative treatment with EMD
In conclusion , follow-up time ( < or > 2 years ) and the risk of bias influence the results of treatment with EMDP in IPD
Previous systematic review s have demonstrated better results with enamel matrix derivative proteins ( EMDP ) as compared with open flap debridement ( OFD ) for the management of infrabony periodontal defects ( IPD ) .
The aim of this study was to determine whether these differences vary according to the follow-up and quality of the studies .