Clinical evaluation of wound healing following multiple exposures to enamel matrix protein derivative in the treatment of intrabony periodontal defects

Background: Multiple exposures to enamel matrix protein derivative (EMD) du ring periodontal therapy have been shown to be safe for the patient. The pu rpose of this study was to clinically determine if an altered course of wou nd healing would occur after multiple exposures to EMD in the treatment of intrabony defects. A secondary aim was to assess the efficacy of EMD in pro bing depth reduction and clinical attachment level gain. Methods: Thirty-two systemically healthy patients (18 females, 14 males, 33 to 69 years old) who were being treated for moderate to advanced periodont al disease were selected for the study. Surgical procedures involving 2 sit es were separated by at least 8 weeks, and wound healing comparisons were m ade between the first and second procedure. Patients were given a diary car d the day of surgery, which consisted of questions concerning the presence and severity of headaches, root hypersensitivity, tooth pain, swelling, and itching. Patients were also examined at postoperative visits to clinically assess wound healing and discuss responses to the questionnaire. Soft tiss ue measurements were taken the day of surgery and 6 months postoperatively to ascertain probing depth reduction (PD) and gains in clinical attachment levels (CAL). Results: The results revealed no clinically detectable reaction that could not be attributed to normal postoperative sequelae. There were no differenc es in reported symptoms between patient gender, first and second procedures , or intrabony and non-intrabony defects. Smokers were found to have a stat istically significantly higher incidence of severe symptoms in root hyperse nsitivity, tooth pain, and swelling compared to non-smokers (n = 21). The m ean probing depth reduction was 3.8 +/- 1.5 mm (2 to 9 mm), while the mean clinical attachment level gain was 2.8 +/- 1.7 mm (0 to 8 mm). Conclusions: The findings of this study demonstrate that EMD is a clinicall y safe product to use in the treatment of periodontal defects and that mult iple uses do not have a negative impact on periodontal wound healing. In ad dition, a statistically significant gain in clinical attachment and reducti on in probing depth were demonstrated.