Five-year results evaluating the effects of platelet-rich plasma on the healing of intrabony defects treated with enamel matrix derivative and natural bone mineral

Abstract

BACKGROUND: Regenerative periodontal surgery utilizing the combination of an enamel matrix protein derivative (EMD) and a natural bone mineral (NBM) with and without addition of platelet-rich plasma (PRP) has been shown to result in substantial clinical improvements but the long-term effects of this combination are unknown. AIM: To evaluate the long-term (5 year) outcomes following regenerative surgery of deep intrabony defects with either EMD+NBM+PRP or EMD+NBM. METHODS: Twenty-four patients were included in this study. In each patient, one intrabony defect was randomly treated with either EMD+NBM+PRP or EMD+NBM. Clinical parameters were evaluated at baseline, at 1 -and 5 years after treatment. The primary outcome variable was clinical attachment level (CAL). RESULTS: The sites treated with EMD+NBM+PRP demonstrated a mean CAL change from 10.5 +/- 1.6 mm to 6.0 +/- 1.7 mm (p<0.001) and to 6.2 +/- 1.5 mm (p<0.001) at 1 and 5 years, respectively. EMD+NBM treated defects showed a mean CAL change from 10.6 +/- 1.7 mm to 6.1 +/- 1.5 mm (p< 0.001) at 1 year and 6.3 +/- 1.4 mm (p<0.001) at 5 years. At 1 year, a CAL gain of >/= 4 mm was measured in 83% (i.e. in 10 out of 12) of the defects treated with EMD + NBM + PRP and in 100% (i.e. in all 12) of the defects treated with EMD + NBM. Compared to baseline, in both groups at 5 years, a CAL gain of >/= 4 mm was measured in 75% (i.e. in 9 out of 12) of the defects. Four sites in the EMD + PRP + NBM group have lost 1 mm of the CAL gained at 1 year. In the EMD + NBM group 1 defect has lost 2 mm while 4 other defects have lost 1 mm of the CAL gained at 1 year. No statistically significant differences in any of the investigated parameters were observed between the two groups. Conclusions: Within their limits, the present results indicate that i) the clinical outcomes obtained with both treatments can be maintained up to a period of five years, and ii) the use of PRP did not appear to improve the results obtained with EMD + NBM.