Adjunctive Enamel Matrix Derivative During Scaling and Root Planing

Objectives: Residual periodontal pockets can be treated by a repeated scaling and root palning (SRP). The aim of the present study was to verify if the adjunctive use of enamel matrix derivative (EMD) results in a better clinical outcome and in a measurable change of biomarkers in the gingival crevicular fluid (GCF).
Methods: The study was performed in a split-mouth design. Thirteen male and female volunteers (mean age 57.69 ± 8.05 years) with periodontitis and residual pockets (probing depth (PD) ≥ 4 mm and positive bleeding on probing (BOP)) were treated with SRP and EMD (test teeth) or SRP only (control teeth). PD, AL and BOP were recorded and samples of GCF were collected at baseline as well as after 6 and 12 months. The GCF-samples were analysed for IL-1β, MMP-8, IL-10 and TGF-β1. Nonparametric tests (Friedman/ Wilcoxon and Mann-Whitney-U-tests) were used for statistical analysis.
Results: PD (3.7 vs. 5.9, 4.3 vs. 5.5 mm ), AL (4.5 vs. 6.2, 4.5 vs. 5.7 mm) and BOP (0.0 vs. 100.0, 0.1 vs. 100.0 %) were significantly improved in the test and control groups (p < 0.001 - p = 0.006). The reduction of PD was significantly higher in the test group (2.2 vs. 1.2 mm, p = 0.005). The levels of IL-10 and TGF-β1 were unchanged during the study. After six months the level of IL-1β increased at the test teeth (23.7 pg/site), and the level of MMP-8 (2615 pg/site) increased at the control teeth (p = 0.015 and 0.034). At 12 months, there was no significant statistical difference of the biomarker levels vs. the controls.
Conclusions: Within the limits of the present study, the study suggests that the treatment of residual pockets after SRP by a second SRP benefits by the adjunctive use of enamel matrix derivative and results in additional pocket reduction.