Linear radiographic digital subtraction analysis of treatment of human 2 or 3-wall intrabony defects by repositioned flap associated or not with enamel derivative matrix protein

A Subtração Radiográfica Digital (SRD) vem sendo vastamente utilizada para inúmeros fins em Odontologia. Uma de suas aplicações é a avaliação do resultado radiográfico de procedimentos regenerativos. Este estudo avaliou radiograficamente defeitos infra-ósseos de 2 ou 3 paredes tratados com a proteína derivada da matriz do esmalte (PME) e/ou o retalho de espessura total reposto (RET). Foram selecionados 11 pacientes (3 ? / 8 ?) com periodontite crônica apresentando 2 ou mais defeitos. Antes da cirurgia e após 1 ano foram coletados os dados clínicos e radiográficos. Para a padronização radiográfica foi utilizado um posicionador modificado. Revelou-se os filmes numa processadora automática. As películas foram digitalizadas (500dpi/8bits) em um escaner (SprintScan 35 Plus - Polaroid). Através do programa AxioVision v 3.0 (Carl Zeiss) mediu-se as distâncias da JEC à crista óssea (CO), ao fundo do defeito (FD). Para criar uma escala milimétrica e calibrar a mensuração foi utilizada uma tela quadriculada (2 x 2 mm). As porcentagens de mudança óssea (MO) também foram calculadas. Os resultados mostraram perda da CO de 1,8 mm para PME (MO = -20,93%), revelando diferença estatística neste grupo (p<0,02), e de 0,9 mm para RET (MO = -10,71%), sem diferença entre os grupos. Observou-se maior preenchimento do FD em RET (1,1 mm; MO = 8,14%) do que em PME (-0,6 mm; MO = -3,92%), com diferença entre os grupos (p<0,01). Dentro das limitações deste estudo, conclui-se que através da análise por SRD linear o tratamento convencional de defeitos infra-ósseos humanos promoveu melhores resultados quando comparado à aplicação da PME.Digital Subtraction Radiographic (DSR) has been widely used for several purposes in Dentistry. Among them is the radiographic evaluation of the results of regenerative procedures. This study evaluated radiographically 2 and 3-wall infra-bony defects which were treated with matrix derivative enamel protein (PME) and/or repositioned flap (RET). Eleven patients (3 ? / 8 ?) with chronic periodontitis were selected, presenting 2 or more defects. Clinical and radiographic data were collected before surgery. A modified filmholder was used to take standardized radiographs. X-ray were developed using an automatic machine. The films were digitized (500dpi/8bits) with the scanner SprintScan 35 Plus (Polaroid). The software AxioVision v 3.0 (Carl Zeiss) was used to measure the distances from the JEC to the alveolar crest (CO), to the bottom of the defect (FD). A grid (2 x 2 mm) was used to establish a milimetric scale after calibration. The amount of bone changes (MO) was also calculated. Results have shown loss of bone at the CO of 1,8 mm (PME) (MO = -20,93%), showing statistic significance (p<0,02), and of 0,9 mm to RET group (MO = -10,71%). No significant differences could be observed when groups were compared. A better fill was observed in the RET group (1,1 mm; MO = 8,14%) than in the PME group (-0,6 mm; MO = -3,92%), showing statistical significance between groups (p<0,01). In conclusion, radiographic analysis has shown that conventional treatment of human intra-bony defects promotes better results when compared to the application of PME

Treatment of infrabony defects with or without enamel matrix proteins: A 24-month follow-up randomized pilot study

Objective: To evaluate a comparison of open-flap debridement (OFD) with or without the use of enamel matrix proteins (EMP) for the treatment of infrabony defects. Method and Materials: Ten volunteers (38 infrabony defects) were randomized to receive OFD + EMP (test site) and OFD (control site). Clinical outcomes included mean changes in Plaque Index, Gingival Index, probing pocket depth (PPD), relative attachment level (RAL), gingival recession, width of keratinized tissue, and dental mobility at baseline and at 24 months. Results: A significant reduction of 4.21 +/- 0.97 mm was observed in PPD for the OFD + EMP group (from 6.30 +/- 0.99 mm to 2.09 +/- 0.97 mm) and of 3.28 +/- 1.23 mm for the OFD group (from 6.13 +/- 0.88 mm to 2.85 +/- 1.42 mm) (P < .001). The reduction in PPD was statistically significantly greater for OFD + EMP compared to OFD (P = .03). The mean RAL decreased from 13.26 +/- 1.88 mm to 7.57 +/- 2.05 mm for the OFD + EMP group (a gain of 5.69 +/- 1.96 mm) and from 13.37 +/- 1.71 mm to 8.13 +/- 1.34 min (P < .001) for the OFD group (a gain of 5.24 +/- 1.55 mm). Gingival recession was higher it) the OFD + EMP group than in the OFD group. The mean keratinized tissue significantly decreased from 4.41 +/- 1.39 mm to 3.63 +/- 1.54 mm for OFD flap group (P < .01). Conclusion: Both treatment modalities were efficient in improving RAL and PPD. Within groups, there was a significant reduction in keratinized tissue for OFD and a significant postoperative recession for the OFD + EMP group. Infrabony defects treated with OFD + EMP showed significantly more PPD reduction when compared to OFD. (Quintessence Int 2010;41:125-134)State of Sao Paulo Research Foundation (FAPESP)Sao Paulo, SP, Brazil[00/12285-0

Effect of enamel matrix proteins on the treatment of intrabony defects: a split-mouth randomized controlled trial study O efeito da proteína da matriz do esmalte no tratamento de defeitos infra-ósseos: um estudo clínico controlado randomizado boca-dividida

The objective of this split-mouth, double-blind, randomized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement (OFD) combined or not with enamel matrix proteins (EMP). Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth (PPD) > 5 mm. All individuals received instructions regarding oral hygiene and were submitted to scaling and root planing. Each participant received the two treatment modalities: test sites were treated with OFD and EMP, and control sites received only OFD. After 6 months, a significant reduction was observed in PPD for the EMP group (from 6.42 ± 1.08 mm to 2.67 ± 1.15 mm) and for the OFD group (from 6.08 ± 1.00 mm to 2.00 ± 0.95 mm) (p < 0.0001), but with no significant difference between groups (p = 0.13). A significant gain in relative attachment level (RAL) was observed in both groups (EMP: from 13.42 ± 1.88 mm to 10.75 ± 2.26 mm, p < 0.001; OFD: from 12.42 ± 1.98 mm to 10.58 ± 2.23 mm, p = 0.013), but with no significant difference between groups (p = 0.85). Gingival recession (GR) was higher in the EMP group (from 1.08 ± 1.50 mm to 2.33 ± 1.43 mm; p = 0.0009) than in the OFD group (from 0.66 ± 1.15 mm to 1.16 ± 1.33 mm; p = 0.16), but this difference was not significant (p = 0.06). In conclusion, the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone.<br>O objetivo deste estudo clínico controlado, randomizado, duplo-cego, tipo boca-dividida foi comparar o efeito clínico do tratamento de defeitos infra-ósseos de 2 ou 3 paredes com retalho de espessura total (RET) associado ou não com a proteína da matriz do esmalte (PME). Treze voluntários com 1 par ou mais de defeitos infra-ósseos foram selecionados com profundidade clínica de sondagem (PCS) > 5 mm. Todos receberam instruções de higiene bucal, raspagem e alisamento radicular. Cada participante recebeu os dois tipos de tratamento: o lado teste foi tratado com RET e PME, e o lado controle recebeu somente RET. Após 6 meses, foi observada uma redução significante na PCS para o grupo PME (de 6,42 ± 1,08 mm para 2,67 ± 1,15 mm) e para o grupo RET (de 6,08 ± 1,00 mm para 2,00 ± 0,95 mm) (p < 0,0001), mas não houve diferença significante entre os grupos (p = 0,13). Um ganho significante de nível clínico de inserção relativo (NCIR) foi observado em ambos os grupos (PME: de 13,42 ± 1,88 mm para 10,75 ± 2,26 mm, p < 0,001; RET: de 12,42 ± 1,98 mm para 10,58 ± 2,23 mm, p = 0,013), mas não houve diferença significante entre os grupos (p = 0,85). A retração gengival (RG) foi maior para o grupo PME (de 1,08 ± 1,50 mm para 2,33 ± 1,43 mm; p = 0,0009) do que para o grupo RET (de 0,66 ± 1,15 mm para 1,16 ± 1,33 mm; p = 0,16), mas essa diferença não foi significante (p = 0,06). Concluiu-se que o tratamento de defeitos infra-ósseos com RET associado à PME não mostrou resultados melhores que o uso de RET sozinho