Ten-Year Results Following Treatment of Intrabony Defects With an Enamel Matrix Protein Derivative Combined With Either a Natural Bone Mineral or a β-Tricalcium Phosphate

Abstract

AIM: The purpose of the present study was to evaluate the ten year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or a beta-tricalcium phosphate (beta-TCP). METHODS: Twenty-two patients with advanced chronic periodontitis, displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + beta-TCP. Clinical evaluation was performed at baseline, at one and at ten years. The following parameters were evaluated: Plaque Index (PI), Bleeding on Probing (BOP), Probing Depth (PD), Gingival Recession (GR) and Clinical Attachment Level (CAL). The primary oucome variable was CAL. RESULTS: The defects treated with EMD + NBM demonstrated mean CAL change from 8.9 +/- 1.5 mm to 5.3 +/- 0.9 mm (p<0.001) and to 5.8 +/- 1.1 mm (p<0.001) at 1 and 10 years, respectively. The sites treated with EMD + beta-TCP showed a mean CAL change from 9.1 +/- 1.6 to 5.4 +/- 1.1 mm (p< 0.001) at 1 year and 6.1 +/- 1.4 mm (p<0.001) at 10 years. At 10 years, 2 defects in the EMD + NBM group have lost 2 mm while 2 other defects have lost 1 mm of the CAL gained at 1 year. In the EMD + beta-TCP group 3 defects have lost 2 mm while 2 other defects have lost 1 mm of the CAL gained at 1 year. Compared to baseline, at 10 years, a CAL gain of >/= 3 mm was measured in 64% (i.e. in 7 out of 11) of the defects in the EMD + NBM group and in 82% (i.e. in 9 out of 11) of the defects in the EMD + beta-TCP group.No statistical significant differences were found between the 1 and 10 year values in any of the two groups. Between the treatment groups no statistically significant differences in any of the investigated parameters were observed at 1 and at 10 years. CONCLUSION: Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + beta-TCP can be maintained over a period of 10 years.