In most respects , all membranes and enamel matrix derivative ( EMD ) delivered better outcomes , in the range of 1 to 2 mm , than open flap debridement .
The use of any barrier type or EMD configuration was found to yield more Clinical Attachment Level ( CAL ) gain than any open flap configuration .
GTR was confirmed to be superior to open flap debridement
In a 1998 review article , Laurell and colleagues performed a meta- analysis of relevant guided tissue regeneration ( GTR ) articles over the previous 20 years ( 1 ) .
The purpose of the present research was to exp and on that work , particularly search ing for trends discriminating between bioabsorbable and non-bioabsorbable barriers , as well as the use of enamel matrix derivative , with respect to interproximal bony defects .
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.
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
In most respects , all membranes and enamel matrix derivative ( EMD ) delivered better outcomes , in the range of 1 to 2 mm , than open flap debridement .
The use of any barrier type or EMD configuration was found to yield more Clinical Attachment Level ( CAL ) gain than any open flap configuration .
GTR was confirmed to be superior to open flap debridement
In a 1998 review article , Laurell and colleagues performed a meta- analysis of relevant guided tissue regeneration ( GTR ) articles over the previous 20 years ( 1 ) .
The purpose of the present research was to exp and on that work , particularly search ing for trends discriminating between bioabsorbable and non-bioabsorbable barriers , as well as the use of enamel matrix derivative , with respect to interproximal bony defects .