The flapless approach with and without enamel matrix derivatives for the treatment of intrabony defects: A randomized controlled clinical trial

J Clin Periodontol. 2024 Sep;51(9):1112-1121. doi: 10.1111/jcpe.14028. Epub 2024 Jun 10.

Abstract

Aim: To compare the clinical and radiographic outcomes of flapless procedure alone or in combination with enamel matrix derivatives (EMD) in the treatment of deep intrabony defects.

Materials and methods: Forty-six patients re-evaluated after non-surgical therapy were randomly assigned to the test (flapless with EMD) or control group (flapless alone). Clinical measurements were recorded pre-surgery and at 6 and 12 months after surgery, and radiographic measurements were taken pre-surgery and after 12 months.

Results: Forty-six patients completed the study. Improvements were observed in both groups at 12 months for mean clinical attachment level (CAL) gain, with significant differences between test (3.9 ± 1.1 mm) and control groups (3.0 ± 1.2) (p = .017). Probing pocket depth (PPD) reduction (4.0 ± 0.7 vs. 3.3 ± 1.4 mm) was also near to statistical significance (p = .051). Also, more sites achieved successful composite outcome measure (final PPD ≤ 4 mm and CAL gain ≥3 mm) for the regenerative treatment in the flapless + EMD group (82.6% vs. 52.2%; p = .028). In terms of radiographic outcomes, EMD yielded a greater defect bone fill than flapless treatment alone (3.0 ± 1.0 mm vs. 1.8 ± 1.5 mm; p < .001).

Conclusions: The additional application of EMD during the flapless procedure for intrabony defects slightly improved clinical and radiographic outcomes.

Clinicaltrials: gov identification number: NCT05456555.

Keywords: enamel matrix derivatives; intrabony defects; minimally invasive non‐surgical procedures; periodontal diseases; periodontal regeneration.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alveolar Bone Loss* / diagnostic imaging
  • Alveolar Bone Loss* / surgery
  • Alveolar Bone Loss* / therapy
  • Dental Enamel Proteins* / therapeutic use
  • Female
  • Guided Tissue Regeneration, Periodontal / methods
  • Humans
  • Male
  • Middle Aged
  • Treatment Outcome

Substances

  • Dental Enamel Proteins
  • enamel matrix proteins

Associated data

  • ClinicalTrials.gov/NCT05456555