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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.
Journal of Periodontology 01/2013; · 2.60 Impact Factor
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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 (β-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 + β-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 + β-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 + β-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 + β-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 + β-TCP can be maintained over a period of 10 years.
Journal of Periodontology 08/2012; · 2.60 Impact Factor
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ABSTRACT: The aim of this double-blind, controlled crossover study was to evaluate the influence of food preservatives on in situ dental biofilm growth. Twenty-four volunteers wore appliances with six specimens each of bovine enamel to build up intra-oral biofilms. During three test cycles, the subjects had to put one half of the appliance twice a day in one of the assigned active solutions (0.1% benzoate, BA; 0.1% sorbate, SA or 0.2% chlorhexidine, CHX) and the other into NaCl. After 5 days, the developed biofilms were stained with two fluorescent dyes to visualise vital (green) and dead bacteria (red). Biofilms were scanned by confocal laser scanning microscopy and biofilm thickness (BT) and bacterial vitality (BV%) were calculated. After a washout period of 7 days, a new test cycle was started. The use of SA, BA and CHX resulted in a significantly reduced BT and BV compared to NaCl (p<0.001). Differences between SA and BA were not significant (p>0.05) for both parameters, while CHX showed significantly lower values. Both preservatives showed antibacterial and plaque-inhibiting properties, but not to the extent of CHX. The biofilm model enabled the examination of undisturbed oral biofilm formation influenced by antibacterial components under clinical conditions.
Clinical Oral Investigations 03/2008; 12(3):203-8. · 2.36 Impact Factor
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ABSTRACT: The goal of regenerative periodontal therapy is the reconstitution of the lost periodontal structures (i. e. the new formation of root cementum, periodontal ligament and alveolar bone). Results from basic research have pointed to the important role of an enamel matrix protein derivative (EMD) in periodontal wound healing. Histological results from experiments in animals and from human case reports have shown that treatment with EMD promotes periodontal regeneration. Moreover, clinical studies have indicated that treatment with EMD positively influences periodontal wound healing in humans. The goal of the current overview is to present the clinical indications for regenerative therapy with EMD based on the existing evidence.
Schweizer Monatsschrift für Zahnmedizin = Revue mensuelle suisse d'odonto-stomatologie = Rivista mensile svizzera di odontologia e stomatologia / SSO 02/2007; 117(6):598-606.
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ABSTRACT: Treatments with either an enamel matrix protein derivative (EMD) or guided tissue regeneration (GTR) have been shown to promote periodontal regeneration. However, until recently, only limited data have been available on the long-term clinical results following these regenerative techniques. Therefore, the aim of this study was to present the 8-year results of a prospective, controlled, split-mouth clinical study evaluating the treatment of intrabony defects with EMD or GTR.
Ten patients, each of whom displayed one pair of intrabony defects located contralaterally in the same jaw, were randomly treated with EMD or with GTR by means of bioabsorbable membranes. The following clinical parameters were evaluated at baseline and at 1 and 8 years after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). The primary outcome variable was CAL. No statistically significant differences between the groups were found at baseline.
The sites treated with EMD demonstrated a mean CAL change from 9.5 +/- 1.2 mm to 6.3 +/- 1.3 mm (P <0.001) and 6.7 +/- 1.6 mm (P <0.001) at 1 and 8 years, respectively. No statistically significant differences were found between the 1- and 8-year results. Sites treated with GTR showed a mean CAL change from 9.7 +/- 1.3 mm to 6.7 +/- 0.9 mm (P <0.001) at 1 year and 6.8 +/- 1.2 mm (P <0.001) at 8 years. The CAL change between 1 and 8 years did not present statistically significant differences. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and at 8 years. However, the study does not have the statistical power to rule out the possibility of a difference between the two groups.
Within their limits, the present results indicate the following: 1) the clinical improvements obtained following treatment with EMD or GTR can be maintained over a period of 8 years; and 2) further studies of much higher power need to be performed to support equivalence.
Journal of Periodontology 11/2006; 77(11):1879-86. · 2.60 Impact Factor
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ABSTRACT: The purpose of the present study was to compare the healing of deep intrabony defects following treatment with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or beta-tricalcium phosphate (beta-TCP).
Twenty-four patients with advanced periodontal disease, each of whom displayed one intrabony defect, were randomly treated with a combination of either EMD + NBM or EMD + beta-TCP. Clinical evaluation was performed at baseline and 1 year following therapy.
No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the sites treated with EMD + NBM showed a reduction in mean probing depth (PD) from 7.9 +/- 1.0 mm to 3.2 +/- 0.6 mm and a change in mean clinical attachment level (CAL) from 8.8 +/- 1.1 mm to 4.5 +/- 0.6 mm (P < 0.001). In the group treated with EMD + beta-TCP, the mean PD was reduced from 7.8 +/- 1.2 mm to 3.2 +/- 0.9 mm, and the mean CAL changed from 8.8 +/- 1.2 mm to 4.7 +/- 1.2 mm (P < 0.001). In both groups, all sites gained at least 3 mm of CAL. CAL gains of 4 or 5 mm were measured in the majority of the cases (75%), irrespective of treatment modality. No statistically significant differences in terms of PD reductions and CAL gains were observed between the two groups.
Within the limits of the present study, both therapies resulted in significant PD reductions and CAL gains 1 year after surgery.
Journal of Periodontology 12/2005; 76(12):2236-43. · 2.60 Impact Factor
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ABSTRACT: The aim of the present study was to evaluate and compare the desensitizing effects of an Er:YAG laser (KEY II(R), KaVo, Germany) and Dentin Protector (Vivadent, Germany) on cervically exposed hypersensitive dentine.
A group of 30 patients showing a total of 104 contralateral pairs of hypersensitive and caries-free teeth was selected and randomly allocated in a split-mouth design to either (1) Er:YAG laser (80 mJ/pulse, 3 Hz), or (2) the application of Dentin Protector (polyurethane-isocyanate 22.5%; methylenechloride 77.5%) whereat one pair served as an untreated control in each patient. The degree of sensitivity to a thermal stimulus was determined qualitatively with an evaporative stimulus defined as a 3-s air blast at a distance of 2 mm from each site to be tested. A qualitative registration of the degree of discomfort was determined according to an arbitrary pain scale in 4 degrees. Recordings were assessed before treatment, immediately after, 1 week, 2 and 6 months after treatment by 1 blinded examiner.
Both treatment forms resulted in significant improvements of discomfort immediately after and 1 week post treatment. After 2 months, the discomfort in the Dentin Protector(R) group increased up to 65% of the baseline score and even up to 90% after 6 months, whereas the effect of the laser remained at the same level that was achieved immediately after treatment. The differences immediately after, 1 week, 2 and 6 months post treatment between both groups were statistically high significant (p< or =0.001; respectively). Compared to the untreated control group, both treatment forms resulted in a significant reduction of discomfort at each follow-up examination.
It was concluded that desensitizing of hypersensitive dentine with an Er:YAG laser is effective and the maintenance of the positive result was more prolonged than with Dentin Protector.
Journal Of Clinical Periodontology 03/2002; 29(3):211-5. · 3.00 Impact Factor
