Clinical performance of a regenerative strategy for intrabony defects: Scientific evidence and clinical experience

Background: The aim of the present study was to evaluate the clinical performance of a regenerative strategy for the treatment of deep intrabony defects. Methods: This patient cohort study involved 40 patients with one deep interdental intrabony defect each. They were treated with periodontal regeneration using four different regenerative methods (expanded polytetrafluoroethylene [ePTFE] titanium reinforced membranes, bioabsorbable membranes alone, bioabsorbable membranes with a bone replacement graft [combination], or enamel matrix derivative), according to predefined criteria and decision-making algorithms. Defects were accessed with papilla preservation flaps performed with the aid of an operating microscope and microsurgical instruments. A stringent plaque control regimen was enforced in all the patients during the 1-year observation period. Outcomes included evaluation of the complete primary closure of the interdental space (CLOSURE), gains in clinical attachment (CAL), and reductions in probing depths (PD). Results: CLOSURE was achieved in all treated defects and was maintained in 90% of cases for the entire healing period. At 1 year the observed CAL gains were 6 +/- 1.8 mm on average, corresponding to a resolution of 92.1% +/- 12% of the initial intrabony (CAL%) component of the defect. Average PD reduction was 6.1 +/- 1.9 mm and was associated with minimal increase in gingival recession (-0.1 +/- 0.7 mm). The 12 sites treated with titanium reinforced ePTFE membranes resulted in a 1-year CAL gain of 6.8 +/- 2.2 mm (CAL%: 94.7 +/- 13.4); the 11 cases treated with combination therapy showed a 1-year CAL gain of 5.4 +/- 1.7 mm (CAL%: 88.2 +/- 9.6); the seven sites treated with bioabsorbable barriers resulted in 5.9 +/- 1.2 mm of CAL gain (CAL%: 88.9 +/- 11.5); and the 10 sites treated with enamel matrix gained on average 5.9 +/- 1.5 mm of CAL (CAL%: 88.9 11.5). No significant differences were observed among the four approaches. Conclusion: The use of an evidence-based regenerative strategy resulted in clinically relevant amounts of CAL gains, shallow pockets, and minimal gingival recession with the four regenerative approaches.