Adjunctive use of enamel matrix derivatives to porcine‐derived xenograft for the treatment of one‐wall intrabony defects: Two‐year longitudinal results of a randomized controlled clinical trial

Abstract

Background The purpose of this study was to evaluate the potential advantages of adjunctive use of enamel matrix protein derivative (EMD) in combination with demineralized porcine bone matrix (DPBM) for the treatment of one‐wall intrabony defects in the molar regions, in comparison with the use of DPBM alone, through a randomized controlled clinical trial. Methods Forty‐two participants were randomly assigned to two groups: one where DPBM with the adjunctive use of EMD (test group, n = 20) was applied and the other without EMD (control group, n = 22). Changes in the clinical and radiographic parameters from baseline at 6, 12, and 24 months were measured (probing pocket depth, clinical attachment loss, defect depth, and defect width). Postoperative discomfort (severity/duration of pain and swelling) and early soft tissue wound healing (dehiscence/fenestration, persistent swelling, spontaneous bleeding, and ulceration) were also assessed. Results Both treatment modalities, with and without EMD, resulted in significant improvement of clinical and radiographic outcomes without any severe adverse events. However, no statistically significant differences in any of the measured parameters were found when the two groups were compared. Early wound healing outcomes and the severity of swelling did not differ between the groups, but the severity of pain ( P = 0.046), duration ( P = 0.033), and swelling ( P = 0.022) were significantly lower in the test group. Conclusions DPBM has been verified for biocompatibility and can be used as a scaffold to enhance the clinical and radiographic outcomes of periodontal regeneration of one‐wall intrabony defects. In particular, the adjunctive use of EMD significantly reduced the postoperative discomfort.

Effectiveness of porcine-derived xenograft with enamel matrix derivative for periodontal regenerative treatment of intrabony defects associated with a fixed dental prosthesis: a 2-year follow-up retrospective study

“…When the patients of this study were limited to 2- and 3-wall intrabony defects, the baseline PPD was 7.0±1.2 mm and CAL was 7.3±1.1 mm, respectively. In a recent randomized controlled clinical trial, which was only limited to 1-wall intrabony defects, the baseline PPD was reported to be 7.3±0.6 mm and CAL was 7.8±0.6 mm [ 17 ]. When the patients of this study were likewise limited to 1-wall intrabony defects, the baseline PPD was 7.6±0.7 mm and CAL was 8.0±0.8 mm, respectively.…”

“…EMD is expected not only to enhance periodontal regeneration through new cementum formation and connective tissue attachment but also to promote soft tissue wound healing and reduce patients' subjective discomfort [ 16 17 22 ]. In an attempt to achieve periodontal regeneration without the adjunctive use of barrier membranes, EMD has become an acceptable treatment option in most periodontal practices [ 23 24 ].…”

The recent advances in scaffolds for integrated periodontal regeneration

“…Scaffolds used for the regeneration of periodontal tissues can provide a contact guidance that enables timely migration of cells into periodontal defects, followed by promoted regeneration [ 26 ]. To further facilitate cell migration and tissue ingrowth, various bioactive cues including growth factors (GFs) and cytokines have also been delivered with the scaffolds [ [27] , [28] , [29] ]. To our best knowledge, however, there has been no experimental data strongly suggesting scaffold-mediated periodontal healing as fast as GTR.…”

“… [ 27 ] Demineralized porcine bone matrix (DPBM) Enamel matrix derivatives (EMD) Randomized clinical trial; group1: DPBM with EMD, group 2: DPBM only 24 months 42 Although both groups showed clinically and radiographically significant improvement, there were no statistically significant differences between 2 groups. [ 28 ] …”

“…The aforementioned clinical studies are mostly focused on AB regeneration [ 27 , 28 , 81 ]. Given the complexity of periodontium as an integrated multi-tissue unit, it is expected to be more challenging for clinical translation of regenerative strategies for periodontium as compared to approaches focused on AB healing.…”