Enamel matrix proteins and bovine porous bone mineral in the treatment of intrabony defects: A comparative controlled clinical trial

Background: Various clinical studies have demonstrated that applying commercially available enamel matrix proteins (EMP) on the instrumented root surface during access flap surgery promotes clinically significant gains of clinical attachment and bone in intrabony defects. The aim of the present controlled clinical trial was to evaluate the adjunctive effect of filling the intrabony lesion with bovine porous bone mineral (BPBM) to a simplified papilla preservation (SPP) flap and EMP surgical procedure. Methods: Sixty deep interproximal intrabony lesions in 60 patients with chronic periodontitis were treated with the SPP flap and EMP. In the 30 test defects, the intrabony component was filled with BPBM particles previously reconstituted with the EMP gel. A stringent infection control program was adopted for 1 year. The clinical and radiographical reevaluation was made 1 year after surgery. Results: Both techniques resulted in clinically and statistically significant improvements between baseline and 1 year, in terms of clinical attachment level (CAL) gain, probing depth (PD) reduction, and radiographic bone fill; however, the BPBM test treatment showed statistically significantly greater CAL (5.8 +/- 1.1 versus 4.9 +/- 1.0) and radiographic bone (DEPTH) level gains (5.3 +/- 1.1 versus 4.3 +/- 1.5), and less increase in gingival recession (0.4 +/- 0.6 versus 0.9 +/- 0.5) than the control surgical procedure. Conclusion: The present study data supported the hypothesis that the adjunctive use of BPBM in grafting intrabony defects has the ability to improve clinical and radiographical outcomes achievable with EMP alone.