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Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study.
J Clin Periodontol 2003; 30(6):496-504JC

Abstract

OBJECTIVES

Application of the guided tissue regeneration (GTR) principle and utilization of enamel matrix derivative (EMD) have both been shown to result in periodontal regeneration. While clinical investigations have demonstrated that the use of a microsurgical concept in combination with the GTR technique positively affects the percentage of primary closure and the amount of tissue preservation, no such information is available for EMD-treated periodontal defects. It was the aim of the present investigation to assess the clinical effect of the microsurgical access flap and EMD treatment with an emphasis on the evaluation of early wound healing.

MATERIAL AND METHODS

Eleven patients displaying at least one pair of intrabony periodontal defects with an intrabony component of > or =3 mm participated in the study. At baseline and at 6 and 12 months after surgery, the following clinical parameters were assessed by a blinded examiner: oral hygiene status (API), gingival inflammation (BOP), probing pocket depth (PPD), clinical attachment level (CAL) and gingival recession (GR). Defects were randomly assigned to test or control treatment, which both consisted of a microsurgical access flap procedure designed for maximum tissue preservation. The exposed root surfaces of the test sites were conditioned with a 24% EDTA gel followed by EMD (Emdogain(R)) application. Primary flap closure was achieved by a 2-layered suturing technique. Postoperative healing was evaluated by a newly introduced early wound-healing index (EHI) at 1 and 2 weeks after surgery.

RESULTS

Both test and control treatment resulted in a statistically significant mean CAL gain of 2.8 and 2.0 mm at 6 months, and 3.6 and 1.7 mm at 12 months, respectively (p<0.05). Differences in CAL gain between the two treatment modalities were statistically significant at both time points (p<0.05). Additional GR values after 12 months averaged 0.3 and 0.4 mm for test and control sites, respectively, and did not reach statistical significance (p> or =0.05). Two weeks after surgery, primary closure was maintained in 89% of the test sites and in 96% of the control sites.

CONCLUSION

Both treatment modalities using the microsurgical flap procedure resulted in a high percentage of primary flap closure and maximum tissue preservation. In terms of PPD reduction and CAL gain, the combination with EMD application appeared to be superior to the microsurgical access flap alone.

Authors+Show Affiliations

Department of Prosthodontics, Dental School, Free University of Berlin, Berlin, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

12795787

Citation

Wachtel, Hannes, et al. "Microsurgical Access Flap and Enamel Matrix Derivative for the Treatment of Periodontal Intrabony Defects: a Controlled Clinical Study." Journal of Clinical Periodontology, vol. 30, no. 6, 2003, pp. 496-504.
Wachtel H, Schenk G, Böhm S, et al. Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. J Clin Periodontol. 2003;30(6):496-504.
Wachtel, H., Schenk, G., Böhm, S., Weng, D., Zuhr, O., & Hürzeler, M. B. (2003). Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. Journal of Clinical Periodontology, 30(6), pp. 496-504.
Wachtel H, et al. Microsurgical Access Flap and Enamel Matrix Derivative for the Treatment of Periodontal Intrabony Defects: a Controlled Clinical Study. J Clin Periodontol. 2003;30(6):496-504. PubMed PMID: 12795787.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. AU - Wachtel,Hannes, AU - Schenk,Günther, AU - Böhm,Sonja, AU - Weng,Dietmar, AU - Zuhr,Otto, AU - Hürzeler,Markus B, PY - 2003/6/11/pubmed PY - 2003/9/6/medline PY - 2003/6/11/entrez SP - 496 EP - 504 JF - Journal of clinical periodontology JO - J. Clin. Periodontol. VL - 30 IS - 6 N2 - OBJECTIVES: Application of the guided tissue regeneration (GTR) principle and utilization of enamel matrix derivative (EMD) have both been shown to result in periodontal regeneration. While clinical investigations have demonstrated that the use of a microsurgical concept in combination with the GTR technique positively affects the percentage of primary closure and the amount of tissue preservation, no such information is available for EMD-treated periodontal defects. It was the aim of the present investigation to assess the clinical effect of the microsurgical access flap and EMD treatment with an emphasis on the evaluation of early wound healing. MATERIAL AND METHODS: Eleven patients displaying at least one pair of intrabony periodontal defects with an intrabony component of > or =3 mm participated in the study. At baseline and at 6 and 12 months after surgery, the following clinical parameters were assessed by a blinded examiner: oral hygiene status (API), gingival inflammation (BOP), probing pocket depth (PPD), clinical attachment level (CAL) and gingival recession (GR). Defects were randomly assigned to test or control treatment, which both consisted of a microsurgical access flap procedure designed for maximum tissue preservation. The exposed root surfaces of the test sites were conditioned with a 24% EDTA gel followed by EMD (Emdogain(R)) application. Primary flap closure was achieved by a 2-layered suturing technique. Postoperative healing was evaluated by a newly introduced early wound-healing index (EHI) at 1 and 2 weeks after surgery. RESULTS: Both test and control treatment resulted in a statistically significant mean CAL gain of 2.8 and 2.0 mm at 6 months, and 3.6 and 1.7 mm at 12 months, respectively (p<0.05). Differences in CAL gain between the two treatment modalities were statistically significant at both time points (p<0.05). Additional GR values after 12 months averaged 0.3 and 0.4 mm for test and control sites, respectively, and did not reach statistical significance (p> or =0.05). Two weeks after surgery, primary closure was maintained in 89% of the test sites and in 96% of the control sites. CONCLUSION: Both treatment modalities using the microsurgical flap procedure resulted in a high percentage of primary flap closure and maximum tissue preservation. In terms of PPD reduction and CAL gain, the combination with EMD application appeared to be superior to the microsurgical access flap alone. SN - 0303-6979 UR - https://www.unboundmedicine.com/medline/citation/12795787/Microsurgical_access_flap_and_enamel_matrix_derivative_for_the_treatment_of_periodontal_intrabony_defects:_a_controlled_clinical_study_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0303-6979&amp;date=2003&amp;volume=30&amp;issue=6&amp;spage=496 DB - PRIME DP - Unbound Medicine ER -