Efficacy of forced eruption/enamel matrix derivative with freeze-dried bone allograft or with demineralized freeze-dried bone allograft in infrabony defects: A randomized trial.

OBJECTIVE: To determine the efficacy of enamel matrix derivative (EMD) and forced eruption alone or in combination with freeze-dried bone allograft (FDBA) or demineralized FDBA (DFDBA) when managing infrabony defects. METHOD AND MATERIALS: Seventy-four patients with an inadequate biologic width due to subgingival caries were randomly assigned to one of three intervention groups: Ortho/EMD/FDBA (OEF) (n = 25), Ortho/EMD/DFDBA (OED) (n = 24), and Ortho/EMD alone without graft material as a control (OE) (n = 25). Each patient donated an infrabony defect. The primary outcomes were absolute change in probing depth (PD) reduction and clinical attachment level (CAL) gain from baseline to 1- and 3-year follow-up. Infrabony defects were surgically treated with EMD/FDBA, EMD/DFDBA, or EMD alone 4 weeks before orthodontic extrusive force was applied to reestablish a biologic width of 2 mm. RESULTS: Seventy-four patients (OEF, n = 25; OED, n = 24; OE, n = 25) were analyzed. All groups demonstrated significant improvement in PD reduction and CAL gain from baseline. The changes at 1 year for PD were: OEF (mm, 95% CI), 4.3, 3.7 to 4.7; OED, 4.2, 3.6 to 4.9; and OE, 3.4, 3.1 to 3.7; for CAL, changes were: OEF, 4.3, 3.9 to 4.7; OED, 3.9, 3.5 to 4.4; and OE, 3.3, 3.1 to 3.5. Longer follow-ups showed similar findings. CONCLUSION: This study showed that both forced eruption/EMD/FDBA and forced eruption/EMD/DFDBA combination therapies result in greater soft tissue improvements at 1- and 3-year follow-up in addition to greater hard tissue improvements at 6-month re-entry compared with forced eruption/EMD alone.

Efficacy of enamel matrix derivative with freeze-dried bone allograft or demineralized freeze-dried bone allograft in intrabony defects: a randomized trial.

BACKGROUND: Promising clinical outcomes have been reported with the combination of enamel matrix derivative (EMD) and allograft materials. Direct comparison between EMD with a freeze-dried bone allograft (FDBA) and a demineralized FDBA (DFDBA) was evaluated in one case series study. To date, no randomized controlled trial has been reported. Therefore, a well-controlled randomized clinical trial was conducted to determine the relative efficacy of EMD/FDBA versus EMD/DFDBA when managing intrabony defects. METHODS: A randomized parallel trial was conducted in a private practice from April 2004 to October 2011. Sixty-nine patients were randomly assigned to one of three groups: EMD/FDBA (EF) intervention group (n = 23), EMD/DFDBA (ED) intervention group (n = 23), and EMD alone without graft material (E) as a negative control group (n = 23). All of the grafting material had minocycline added. Each patient had an intrabony defect. The primary outcomes were the absolute change in probing depth (PD) reduction and clinical attachment level (CAL) gain from baseline to 1- and 3-year follow-up. Intrabony defects were surgically treated with EMD/FDBA, EMD/DFDBA, or EMD alone. RESULTS: Sixty-seven patients (EF, n = 21: ED, n = 23; E, n = 23) were analyzed. All groups demonstrated significant improvement in PD reduction and CAL gain from baseline. The changes for PD were as follows (mm, 95% confidence interval [CI]): at 1 year: EF (4.4 mm, 4.0 to 4.7), ED (3.7 mm, 3.4 to 4.0), and E (control) (3.3 mm, 3.0 to 3.6); at 3 years: EF (4.4 mm, 4.1 to 4.8), ED (3.7 mm, 3.4 to 4.0), and E (3.1 mm, 2.8 to 3.4). The changes for CAL were as follows (mm, 95% CI): at 1 year: EF (4.1 mm, 3.8 to 4.5), ED (3.5 mm, 3.0 to 4.0), and E (3.0 mm, 2.5 to 3.6); at 3 years: EF (4.2 mm, 3.7 to 4.7), ED (3.6 mm, 3.1 to 4.1), and E (3.0 mm, 2.5 to 3.5). The intervention groups (EF and ED) showed better treatment outcomes than the control group at 1 and 3 years. Statistically, the two bone-graft groups were not significantly different from each other at 1 and 3 years. CONCLUSIONS: Both EMD/FDBA and EMD/DFDBA interventions resulted in greater soft tissue improvement at 1 and 3 years of follow-up compared to EMD alone. Both graft materials worked well in managing deep intrabony defects when combined with EMD.

Periodontal regeneration with or without limited orthodontics for the treatment of 2- or 3-wall infrabony defects.

BACKGROUND: Limited orthodontics are shown to be effective in the correction of infrabony defects. Studies have also demonstrated the efficacy of using enamel matrix derivative (EMD) with demineralized freeze-dried bone allograft (DFDBA) to treat infrabony defects. This study aims to compare the clinical efficacy of limited orthodontics combined with EMD/DFDBA in the treatment of 2- or 3-wall infrabony defects. METHODS: A randomized, parallel clinical trial was conducted in a private periodontal practice (Tokyo, Japan) between April 2004 and October 2008. Treatment period was 1 year with a 1-year follow-up. Forty-seven randomized patients, mean age of 53 ± 10.7 years, were allocated into two intervention groups: ortho/EMD/DFDBA (n = 24) and EMD/DFDBA (n = 23). Each patient had either a 2- or 3-wall infrabony defect of ≥6 mm deep. Probing depth and clinical attachment level were measured at baseline and 1 year. The primary outcome measure was absolute change in probing depth and clinical attachment level from baseline to 1-year follow-up. The secondary outcome measure was absolute change in open probing attachment level gain and percentage defect resolution from baseline to 6-month reentry surgery. Infrabony defects were surgically treated with EMD and DFDBA 4 weeks before application of orthodontic extrusive forces. Reentry surgeries were performed at 6 months after initial surgery. RESULTS: Forty-seven patients were analyzed. Both treatment groups showed a significant improvement from baseline with no significant difference between the groups except for the 2-wall defects. The ortho/EMD/DFDBA group had statistically significant open probing attachment level gain (95% confidence level, 3.18 to 4.36; P = 0.036) compared to the EMD/DFDBA group (95% confidence level, 2.26 to 3.24) in 2-wall defects. CONCLUSION: Although both treatment modalities were effective in managing 2- or 3-wall infrabony defects, limited orthodontics provided an additional benefit to EMD/DFDBA in 2-wall defects.

Enhancing the regenerative potential of guided tissue regeneration to treat an intrabony defect and adjacent ridge deformity by orthodontic extrusive force.

BACKGROUND: The biologic potential of the periodontal ligament (PDL) can be harnessed to solve complex clinical problems involving several dental disciplines. The purpose of this case report is to demonstrate that orthodontic extrusive force can enhance the regenerative potential of guided tissue regeneration (GTR) to eliminate an intrabony defect and augment a ridge deformity. METHODS: Regenerative therapy by open debridement with particulate anorganic cancellous bovine-derived bone xenograft (BDX), bioabsorbable membrane, and minocycline root conditioning was carried out. Eight weeks after the initial surgery, orthodontic extrusion and uprighting simultaneously were initiated. RESULTS: Radiographs and reentry documentation demonstrated that orthodontic extrusive force could enhance the regenerative potential of GTR. Consequently, the intrabony defect and alveolar ridge were successfully treated. CONCLUSION: This case report demonstrates that orthodontic-regenerative combined therapy can resolve complex clinical problems involving several dental disciplines.

Alveolar bone upper growth in furcation area using a combined orthodontic-regenerative therapy: a case report.

BACKGROUND: This case report demonstrates orthodontic and regenerative combined therapy in a 49-year-old male whose right maxillary premolar furcation had a bony defect with poor biologic width resulting from extensive subgingival caries. In these advanced interdisciplinary cases, crown lengthening with periodontal surgery alone does not solve the complex clinical problems. We believe that a combined orthodontic and periodontal regenerative combination therapy offers the best option for achieving a predictable outcome. METHODS: First, regenerative therapy by open debridement with a bioabsorbable synthetic bone graft, bioabsorbable membrane, and minocycline root conditioning was carried out. Eight weeks after initial surgery, orthodontic extrusion was initiated. RESULTS: Radiographs and reentry documentation suggest that the furcation defect associated with poor biologic width was successfully treated. CONCLUSION: This case report demonstrates that orthodontic-regenerative combined therapy can resolve complex clinical problems and enhance predictability.