The use of barrier membranes and enamel matrix proteins in the treatment of angular bone defects - A prospective controlled clinical study

In the present prospective clinical trial, the effect of various regenerati ve 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 per iodontal tissue destruction; (ii) presence of 2 similar, contralateral, ang ular bone defects (experimental sites) located in either the maxilla or the mandible; (iii) the defect site must exhibit a probing pocket depth (PPD) of greater than or equal to 6 mm, a probing attachment level (PAL) of great er than or equal to 7 mm, and a depth of the intrabony component of greater than or equal to 3 mm. All subjects had a good oral hygiene standard, 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 s oft tissue recession) of the selected experimental sites were obtained 6 mo nths after the completion of basic therapy. The 40 subjects were randomly d ivided into 4 treatment groups including 10 subjects each: 3 membrane group s and one Emdogain(R) group. 1 h before surgery, the patients were given 3 g of Amoxicillin. No other antibiotics were prescribed. The test and contro l sites were treated during the same surgical session. Full thickness flaps were elevated and the exposed root surfaces were planed. Membrane placemen t. The root surface was rinsed with saline. A barrier membrane (Guidor(R) o r Resolut(R) or Periodontal (e-PTFE) material(R)) was positioned to cover t he 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. E mdogain(R) placement: The exposed root surfaces at both the test and contro l sites were, during a 2-min period, conditioned with a 24% EDTA gel. Emdog ain(R) was applied to the exposed root surface of the test site. In the con trol site, the vehicle, the PCA gel, was used as placebo control. The flaps were closed and sutured to obtain a complete coverage of the intrabony def ect. Results: Re-examinations, which were performed 12 months after surgery, dis closed that regenerative therapy, including either the use of barrier membr anes or application of enamel matrix proteins to an instrumented root surfa ce in an angular, intrabony defect, enhanced outcome variables such as prob ing pocket depth and probing attachment gain. It was furthermore demonstrat ed 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 eff ective in terms of PPD reduction and PAL gain, and superior to open flap cu rretage alone.