Effect of Flap Design for Enamel Matrix Derivative Application in Intraosseous Defects

2020 ◽  
pp. 238008442093473
Author(s):  
L. Trombelli ◽  
A. Simonelli ◽  
A. Quaranta ◽  
Y.K. Tu ◽  
H. Li ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Meta Analysis ◽  
Enamel Matrix Derivative ◽  
Surgical Approaches ◽  
Enamel Matrix ◽  
Minimally Invasive Surgical ◽  
Probing Depth ◽  
Preservation Technique ◽  
Matrix Derivative

Objective: To systematically review the literature addressing the focused question: What is the effectiveness of different surgical and nonsurgical procedures combined with enamel matrix derivative (EMD) on clinical, radiographic, and patient-centered outcomes in intraosseous defects? Methods: Electronic (Medline, Scopus, and Cochrane databases) and hand literature searches were performed for studies including at least 1 treatment arm where EMD had been applied according to 1 of the following procedures: modified Widman flap; papilla preservation variants (PPVs), including papilla preservation technique, modified papilla preservation technique, and simplified papilla preservation technique; minimally invasive variants, including minimally invasive surgical approach and minimally invasive surgical technique; single-flap variants (SFVs), including single-flap approach and modified minimally invasive surgical technique; or nonsurgical application (flapless approach). Data from 42 selected articles were used to perform a network meta-analysis, and a hierarchy of surgical and nonsurgical applications of EMD was built separately for EMD and EMD + graft based on 6- to 12-mo clinical and radiographic outcomes. Results: Among surgical approaches, EMD was associated with best regenerative outcomes when applied through SFVs, with a mean clinical attachment level gain of 3.93 mm and a reduction in the intrabony component of the defect of 3.35 mm. For EMD + graft, limited differences in regenerative outcomes were observed among surgical procedures. PPVs were associated with the highest residual probing depth for EMD (4.08 mm) and EMD + graft (4.32 mm). Conclusions: In the treatment of periodontal intraosseous defects, 1) SFVs appear to optimize the regenerative outcomes of EMD; 2) substantial regenerative outcomes can be obtained with SFVs and conservative double flaps (i.e., PPVs and minimally invasive variants) when EMD is combined with a graft; and 3) residual probing depth was higher following PPVs for EMD and EMD + graft. Knowledge Transfer Statement: The results of the present systematic review and meta-analysis can be used by clinicians to identify the most effective surgical or nonsurgical procedure to treat an intraosseous defect with EMD or EMD + graft. The main findings indicate that when EMD application is indicated, surgical access based on a single flap seems the most appropriate to optimize clinical outcomes. The application of EMD + graft can be effectively combined with single flaps and conservative double flaps.

scholarly journals The role of surgical flap design (minimally invasive flap vs. extended flap with papilla preservation) on the healing of intrabony defects treated with an enamel matrix derivative: a 12-month two-center randomized controlled clinical trial

2021 ◽  
Author(s):  
Peter Windisch ◽  
Vincenzo Iorio-Siciliano ◽  
Daniel Palkovics ◽  
Luca Ramaglia ◽  
Andrea Blasi ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Test Group ◽  
Enamel Matrix Derivative ◽  
Control Group ◽  
Enamel Matrix ◽  
Intrabony Defects ◽  
Minimally Invasive Surgical ◽  
And Control ◽  
Matrix Derivative

Abstract Objectives Minimally invasive flap designs have been introduced to enhance blood clot stability and support wound healing. Limited data appear to suggest, that in intrabony defects, better clinical outcomes can be achieved by means of minimally invasive flap compared to more extended flaps. The aim of this study was to evaluate the healing of intrabony defects treated with either minimally invasive surgical flaps or with modified or simplified papilla preservation techniques in conjunction with the application of an enamel matrix derivative (EMD). Materials and methods Forty-seven subjects were randomly assigned to either test (N = 23) or control (N = 24) procedures. In the test group, the intrabony defects were accessed by means of either minimally invasive surgical technique (MIST) or modified minimally invasive surgical technique (M-MIST) according to the defect localization while the defects in the control group were treated with either the modified or simplified papilla preservation (MPP) or the simplified papilla preservation technique (SPP). EMD was used as regenerative material in all defects. The following clinical parameters were recorded at baseline and after 12 months: full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depths (PD), clinical attachment level (CAL), and gingival recession (GR). Early healing index (EHI) score was assessed in both groups 1 week following the surgery. CAL gain was set as primary outcome. Results After 12 months follow-up, the CAL gain was 4.09 ± 1.68 mm in test group and 3.79 ± 1.67 mm in control group, while the PD reduction was 4.52 ± 1.34 mm and 4.04 ± 1.62 mm for test and control sites. In both groups, a minimal GR increase (0.35 ± 1.11 mm and 0.25 ± 1.03 mm) was noted. No residual PDs ≥ 6 mm were recorded in both groups. CAL gains of 4–5 mm were achieved in 30.4% and in 29.2% of test and control group, respectively. Moreover, CAL gains ≥ 6 mm were recorded in 21.7% of experimental sites and in 20.8% of control sites. No statistically significant differences in any of the evaluated parameters were found between the test and control procedures (P > 0.05). After 1 week post-surgery, a statistically significant difference (P < 0.05) between the groups was found in terms of EHI score. Conclusions Within the limits of this pilot RCT, the results have failed to show any differences in the measured parameters following treatment of intrabony defects with EMD, irrespective of the employed surgical technique. Clinical relevance In intrabony defects, the application of EMD in conjunction with either MIST/M-MIST or M-PPT/SPPT resulted in substantial clinical improvements.

scholarly journals Regeneration of deep intrabony periodontal defects with enamel matrix derivative: A case report

2021 ◽  
Vol 6 (1) ◽  
pp. 001-005
Author(s):  
P Lopes Otão ◽  
P Mascarenhas
Keyword(s):  
Enamel Matrix Derivative ◽  
Enamel Matrix ◽  
Periodontal Health ◽  
Minimally Invasive Surgical ◽  
Supportive Periodontal Therapy ◽  
The Aesthetic ◽  
One Year ◽  
The One ◽  
Radiographic Changes ◽  
Matrix Derivative

A clinical case of treatment of two severe intrabony defects on the aesthetic zone is reported and followed for one year. The biomaterial of choice was enamel matrix derivative (Emdogain®; Straumann™) alone with a preservation papilla flap and a minimally invasive surgical technique. After surgical treatment, the patient was kept in a supportive periodontal therapy programme with 6-month interval between appointments. In the one year after surgery appointment, clinical and radiographic changes were observed, showing periodontal health and stability.

scholarly journals Lesões em áreas de furca: fatores etiológicos, diagnóstico e tratamento

2020 ◽  
Vol 9 (6) ◽  
pp. 635-640
Author(s):  
Ariana Larissa de Moura Rodrigues ◽  
Ana Carolina de Sá Gomes Cruz Souza ◽  
Jéssica Gomes Alcoforado de Melo ◽  
Diego Moura Soares
Keyword(s):  
Systematic Review ◽  
Clinical Trial ◽  
Meta Analysis ◽  
Class Ii ◽  
Periodontal Treatment ◽  
Enamel Matrix Derivative ◽  
Enamel Matrix ◽  
Furcation Defects ◽  
Furcation Involvement ◽  
Matrix Derivative

As lesões de furca ocorrem quando a doença periodontal atinge a área de bifurcação dos dentes multirradiculares causando a destruição óssea e perda de inserção no espaço inter-radicular. Existem diversos fatores etiológicos que influenciam no aparecimento dessas lesões e até os dias de hoje o tratamento desse tipo de injúria ainda é um desafio na clínica odontológica. O objetivo deste artigo foi listar, através de uma revisão da literatura, os fatores que influenciam na etiologia da lesão de furca, bem como o seu diagnóstico, prognóstico e tratamento. Fatores como características morfológicas do dente e raiz e deficiência no controle do biofilme, que podem contribuir para o seu aparecimento. Além de diversos tipos de procedimentos e técnicas têm sido propostas para o tratamento das lesões de furca, seja mais ou menos conservadores. Descritores: Defeitos da Furca; Diagnóstico; Doenças Periodontais. 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Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective 24-month randomized clinical trial. J Clin Periodontol; 2010;37(12):1100-109. Hoffmann T, Richter S, Meyle J, Gonzales JR, Heinz B, Arjomand M et al. A randomized clinical multicentre trial comparing enamel matrix derivative and membrane treatment of buccal class II furcation involvement in mandibular molars. Part III: patient factors and treatment outcome. J Clin Periodontol. 2006;33(8):575-83.

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