Flap Operation with Enamel Matrix Proteins

Objectives: Healing after periodontal therapy is a defect healing. Several attempts have been made to improve the outcome after periodontal therapy. The aim of this study was to compare the results of open flap operation with and without the use of enamel matrix derivative. Methods: In 23 volunteers, 18 women and 5 men, mean age 44.6±10.3 years, with moderate and severe periodontitis 42 teeth were treated by open flap operation with enamel matrix derivative (Emdogain®, Biora, Malmö, Sweden, EMD). 25 teeth were treated by open flap operation (OF). A standardized treatment protocol was used. Clinical examination for attachment level (AL, mm) and probing pocket depth (PPD, mm) was executed at six sites per tooth (mesiobuccal-mb, buccal-b, distobuccal-db, mesiolingual-ml, lingual-l, distolingual-dl) at baseline (0) and after 12 months (1). The U- and Wilcoxon tests were used for statistical analysis. Results: The results for AL were as follows- EMD-0: mb-5.0, b-2.9, db-5.3, ml-4.5, l-3.5, dl-5.0; EMD-1: mb- 3.8, b-2.8, db-3.9, ml- 3.5, l- 3.0, dl- 3.8; OF-0: mb-3.9, b-3.3, db-4.6, ml-4.4, l-3.8, dl-4.9; OF-1: mb-4.1, b-3.6, db-5.0, ml-4.6, l-3.7, dl-5.0. The results for PPD were as follows- EMD-0: mb-5.2, b-2.4, db-5.4, ml-4.9, l-3.4, dl-5.2; EMD-1: mb-3.0, b-1.7, db-3.1, ml-2.8, l-2.1, dl-2.9; OF-0: mb-3.8, b-3.1, db-4.5, ml-4.0, l-3.6, dl-4.7; OF-1: mb-3.6, b-3.0, db-4.4, ml-4.1, l-3.7, dl-4.8. Significant improvements of AL and PPD were seen only in the EMD-group at 5 of 6 sites (p<0.001-0.002). Significant differences between the groups after 12 months were found at 5 of 6 sites for PPD (p<0.001-0.015) and at one site for AL (p=0.04). Conclusion: Within the limits of this study it can be concluded that the enamel matrix derivative has a beneficial effect in the treatment of periodontitis by flap operation.