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

Background: Previous studies have demonstrated that enamel matrix derivativ e (EMD) has the ability to improve clinical parameters when used to treat i ntraosseous 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 chose n. Fifty-three defects received EMD in conjunction with OFD. Thirty-one def ects in these same 23 subjects were treated with OFD alone. Stents were fab ricated to serve as fixed reference points. Re-entries were performed at le ast 1 year after initial surgery. Soft tissue measurements were recorded pr ior to initial surgery and prior to re-entry for gingival (GI) and plaque ( PI) indices, probing depth (PD), gingival margin position, and clinical att achment level (CAL). Hard tissue measurements were recorded during the init ial and re-entry surgery for level of crestal bone and depth of defect. Sta tistical analysis was conducted using the method of generalized estimating equations to determine changes in GI, PI, PD, GAL, fill of the osseous defe ct, and crestal resorption. Percent of defect fill was also calculated. Results: In all categories, treatment with EMD (test) was superior to treat ment without EMD (control). Average PI and GI were not significantly differ ent 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 great er, and the average fill of osseous defect 2.4 mm greater with EMD than con trols. 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 intraosseou s defects with EMD is clinically superior to treatment without EMD (open fl ap debridement) in every parameter evaluated. Re-entry data demonstrate tha t percent fill of osseous defects treated with EMD compares favorably with the treatment results utilizing bone grafts or membrane barriers, according to published literature.