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International Poster Journal of Dentistry and Oral Medicine
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Int Poster J Dent Oral Med 9 (2007), No. 1     15. Mar. 2007

Int Poster J Dent Oral Med 2007, Vol 9 No 01, Poster 350

Early Evaluation at 6 Months of the Healing of Intrabony Defects Following Treatment with an Enamel Matrix Protein Derivative. A Controlled Clinical Study.

Language: English

Authors:
Dr. Mirona Mesaros, Dr. Bacila Adrian, Dr. Rusu Darian, Dr. Dinca Alin - Dental Clinic Dr. Stratul, Timisoara, Romania
Dr. Benta Anca - Johannes Gutenberg University, Mainz, Germany
Assist. Prof. Dr. Dr. Stefan-Ioan Stratul - Department of Periodontology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, Johannes Gutenberg University of Mainz, Germany

Date/Event/Venue:
11-14 Mai 2005
The 10th Congress of the Balkan Stomatological Society
Belgrade, Republic of Serbia

Introduction

The regenerative potential of enamel matrix protein derivatives (EMD) on human periodontium has been evaluated and validated over the last years in countless histological, clinical controlled studies and meta-analyses. The use in clinical practice, however, has shown a certain delay of the regenerative outcome as demonstrated clinically and on radiographs, which extends up to one year after the surgery, or even more, making this outcome more dependable on the post-treatment maintenance conditions.

Objectives

The purpose of the present study was to compare clinically the treatment of deep intrabony defects with an enamel matrix protein derivative (EMD) to access flap (AF) surgery, in an early evaluation at 6 months after the therapy.

Material and Methods

Twenty-five patients (12 male and 13 female), between 35-56 years old, with moderate to severe periodontitis, light- or non-smokers, and displaying a total of 32 deep intrabony defects, were treated either with EMD (Emdogain®, Straumann, Waldenburg, Switzerland) (test) or with AF alone (control). All patients underwent initial therapy one month prior to surgery. All patients were instructed and motivated to maintain a good oral hygiene level, verified by a reduction of the PI (Silness and Löe) < 1. Before surgery and six months after, the following clinical parameters were registrated: the periodontal pocket depth (PD), the gingival recession (GR) and the clinical attachment level (CAL). All measurements were performed with a rigid periodontal probe (PCP 12, Hu-Friedy), at six sites per tooth (buccal: mesiobuccal, central, distobuccal; oral: mesiooral, central, distooral).
Radiographic examination was performed using the conventional RIO technique. For each patient, the highest measured value was taken into account and the mean PD, GR and CAL were calculated. The Wilcoxon paired-samples test was used to compare the differences between baseline values and the values measured six months after and the Mann-Whitney U independent-samples test was used for comparison between the groups. Surgery was performed under local anesthesia. A full thickness flap was raised after intrasulcular incision, without using release incisions. After removal of the granulation tissue, the exposed roots underwent thorough S/RP, using ultrasonic devices and curettes. No resective surgery was performed, nor any root conditioning. Emdogain® gel was placed into the defects of the test group. The defects of the control group underwent the same surgical protocol, without any grafting procedure. Post surgical care included antibiotherapy for one week (3x500 mg Amoxycillin daily) and 0.2% Chlorhexidin (Dentaton®, Ghimas s.p.a., Casalecchio di Reno, Italy) mouth rinses, twice a day, for the following two weeks, as gentle debridement of the operated area every second week, during two months.

Results

No adverse healing response was observed. No signs of inflammation, infection, allergy or severe pain were present. Pre- and postoperative mean values of the PD, GR and CAL in the two treated groups are displayed in the table No.1 and table No.2.

Table 1. Six months clinical results of treatment of intrabony defects with Emdogain®
Patient Nr. Tooth Type Defect Type (walls) PPD (mm) PPD CAL (mm) CAL gain (mm) GR (mm) GR CEJ BD BC BD CEJ BC
Pre-operative After 6 months Diff. Pre-operative After 6 months Pre-operative After 6 months Diff.
1 21 2 6 3 3 7 6 1 1 3 2 11 6 5
2 21 2 7 4 3 9 6 3 2 2 0 11 6 5
3 14 2 8 4 4 8 4 4 0 0 0 9 6 3
4 14 2 6 3 3 6 5 1 0 2 2 9 5 4
5 25 2 8 4 4 8 6 2 0 2 2 9 4 5
6 24 1 11 5 6 11 6 5 0 1 1 12 7 5
7 22 1 7 3 4 7 7 0 0 4 4 9 4 5
8 22 1 10 3 7 10 8 2 0 5 5 10 4 6
9 27 2 8 6 2 8 6 2 0 0 0 10 9 1
10 1.1.m 2 6 3 3 8 6 2 2 3 1 9 2 7
11 1.7.m 1 8 7 1 9 8 1 1 1 0 12 9 3
12 2.5.m 1 11 6 5 11 6 5 0 0 0 11 8 3
13 3.6.m 1 8 4 4 9 6 3 1 2 1 10 7 3
14 4.3.m 2 9 3 6 9 5 4 0 2 2 11 7 4
15 2.6.m 1 7 3 4 9 5 4 2 2 0 10 7 3
16 2.3.m 1 6 3 3 7 4 3 1 1 0 8 5 3
Mean 7,88 4,00 3,88 8,50 5,88 2,63 0,63 1,88 1,25 10,06 6,00 4,06
SD 1,67 1,32 1,54 1,41 1,15 1,50 0,81 1,41 1,53 1,18 1,93 1,48

Table 2. Six months clinical results of treatment of intrabony defects with access flap surgery AF
Patient Nr. Tooth Type Defect Type (walls) PPD (mm) PPD CAL (mm) CAL gain (mm) GR (mm) GR CEJ BD BC BD CEJ BC
Pre-operative After 6 months Diff. Pre-operative After 6 months Pre-operative After 6 months Diff.
1 2.3.d 2 6 3 3 7 4 3 1 1 0 9 4 5
2 1.6.m 2 6 4 2 6 5 1 0 1 1 6 4 2
3 4.5.m 2 9 3 6 12 8 4 3 5 2 12 4 8
4 2.7.m 2 6 5 1 6 5 1 0 0 0 8 5 3
5 2.4.m 1 7 4 3 7 8 -1 0 4 4 8 5 3
6 4.8.m 1 8 3 5 8 3 5 0 0 0 9 6 3
7 3.5.m 1 6 1 5 6 1 5 0 0 0 7 4 3
8 1.7.m circ 8 3 5 10 3 7 2 0 -2 13 7 6
9 2.5.m 2 7 2 5 7 3 4 0 1 1 8 5 3
10 2.3.d 1 7 5 2 8 7 1 1 2 1 8 5 3
11 2.6.m 1 7 7 0 10 9 1 3 2 -1 12 7 5
12 3.3.m 2 7 5 2 11 10 1 4 5 1 13 6 7
13 1.7.m 2 6 4 2 6 4 2 0 0 0 8 5 3
14 1.3.m 2 12 5 7 12 6 6 0 1 1 13 8 5
15 3.7.m 2 9 4 5 9 6 3 0 2 2 9 5 4
16 3.5.d 1 6 3 3 6 4 2 0 1 1 6 4 2
Mean 7,31 3,81 3,50 8,19 5,38 2,81 0,88 1,56 0,69 9,31 5,25 4,06
SD 1,62 1,42 1,97 2,20 2,50 2,20 1,36 1,71 1,35 2,47 1,24 1,77

Table 3. Intraoperative measurements of the Emdogain(R) and access flap groups
Treatment CAL (mm) CEJ-BD (mm) CEJ-BC (mm) INTRA (mm)
AF (n=16) 5,38±2,50 9,31±2,47 4,06±1,77 5,25±1,24
EMD (n=16) 5,88±1,15 10,06±1,18 4,06±1,48 6,00±1,93

Table 4. Clinical parameters at baseline and 6 months for the
AF (n=16) and the EMD surgery groups (n=16)
Treatment Baseline 6 months Difference Significance
Probing depth
AF 7,31±1,62 3,81±1,42 3,50±1,97 p=0,001
EMD 7,88±1,67 4,00±1,32 3,88±1,54 p<0,0001
n.s.
Gingival recession
AF 0,88±1,36 1,56±1,71 0,69±1,35 n.s.
EMD 0,63±0,81 1,88±1,41 1,25±1,53 p=0,007
n.s.
Clinical attachment level
AF 8,19±2,20 5,38±2,50 2,81±2,20 p=0,001
EMD 8,50±1,41 5,88±1,15 2,63±1,50 p=0,001
n.s.

Table 5. The CAL gain related to the number
of the defects in the AF and EMD groups
CAL gain (mm) AF EMD
% %
-1 1 6,25 - -
- - 1 6,25
1 5 31,25 3 18,75
2 2 12,5 4 25
3 2 12,5 3 18,75
4 2 12,5 3 18,75
5 2 12,5 2 12,5
6 1 6,25 - -
7 1 6,25 - -


Fig.1 Case A. a) The bone defect exposed Fig.1 Case A. b) Emdogain® gel in place

Fig.1 Case A. c) Rx image before treatment Fig.1 Case A. d) Rx image at six months

Fig.2 Case B. a) The bone defect exposed

Fig.2 Case B c) Rx image at six months Fig.2 Case B b) Rx image before treatment

Conclusions

Within the limits of the present study, it can be concluded that: (i) at 6 months after surgery both therapies resulted in significant PD reductions and CAL gains, and (ii) early evaluation (at 6 months) of the treatment with EMD resulted in no higher CAL gains and PD reductions than the treatment with access flap surgery.

Abbreviations

PD - probing depth
CAL - clinical attachment level
EMD - enamel matrix protein derivative
AF - access flap


This Poster was submitted by Assist. Prof. Dr. Dr. Stefan-Ioan Stratul.

Correspondence address:
Dr.Mirona Mesaros
Dental Clinic Dr.Stratul
str.Em.Gojdu, no.5
300176 Timisoara
Romania