Apical approach in periodontal reconstructive surgery with enamel matrix derivate and enamel matrix derivate plus bone substitutes: a randomized, controlled clinical trial

• Published in: Clinical oral investigations 2022-03, Vol.26 (3), p.2793-2805
• Main Authors: Moreno Rodríguez, Jose Antonio, Ortiz Ruiz, Antonio José
• Format: Article
• Language: English
• Subjects: Alveolar Bone Loss - surgery; Bone Substitutes - therapeutic use; Dental Enamel Proteins - pharmacology; Dental Enamel Proteins - therapeutic use; Dentistry; Follow-Up Studies; Gingival Recession - drug therapy; Gingival Recession - surgery; Guided Tissue Regeneration, Periodontal - methods; Humans; Medicine; Original; Original Article; Periodontal Attachment Loss - drug therapy; Periodontal Attachment Loss - surgery; Reconstructive Surgical Procedures; Treatment Outcome
• ISSN: 1432-6981; 1436-3771
• DOI: 10.1007/s00784-021-04256-1

Objectives This parallel, randomized controlled clinical trial evaluated the influence of bone substitutes (BS) on the efficacy of the non-incised papillae surgical approach (NIPSA) with enamel matrix derivate (EMD) in resolving deep, isolated, combined non-contained intrabony and supra-alveolar periodontal defects, preserving the soft tissue. Material and methods Twenty-four patients were randomized to treatment with NIPSA and EMD or NIPSA plus EMD and BS. Bleeding on probing (BoP), interproximal clinical attachment level (CAL), interproximal probing depth (PD), recession (REC), location of the tip of the papilla (TP), and width of the keratinized tissue (KT) were evaluated before surgery and at 1 year post-surgery (primary outcomes). Wound closure was assessed at 1 week post‐surgery, and supra‐alveolar attachment gain (SUPRA-AG) was recorded at 1 year post‐surgery. Results At 1 week, 87.5% of cases registered complete wound closure and there were no cases of necrosis, without differences between groups ( p  > .05) . At 1 year, all cases showed negative BoP. A significant PD reduction (NIPSA + EMD 8.25 ± 2.70 mm vs. NIPSA + EMD + BS 6.83 ± 0.81 mm) and CAL gain (NIPSA + EMD 8.33 ± 2.74 mm vs. NIPSA + EMD + BS 7.08 ± 2.68 mm) were observed ( p   .05). The residual PD was  .05; KT: 0.00 ± 0.43 mm vs. 0.08 ± 0.67 mm, p  > .05). There were improvements in the papilla in both groups (TP: NIPSA + EMD 0.33 ± 0.49 mm vs. NIPSA + EMD + BS 0.45 ± 0.52 mm, p  > .05), which was only significant in the NIPSA EMD + BS group (0.45 ± 0.52 mm; p   .05). Conclusions NIPSA and EMD with or without BS seem to be a valid surgical approach in the treatment of isolated, deep non-contained periodontal defects. In our study, both treatments resulted in significant PD reduction and CAL gain, that extended in the supra-alveolar component, without differences with the use of BS. Both treatments resulted in soft tissue preservation. However, the a