Froum S J, Weinberg M A, Rosenberg E, Tarnow D
Department of Implant Dentistry, New York University, College of Dentistry, NY, USA.
J Periodontol. 2001 Jan;72(1):25-34. doi: 10.1902/jop.2001.72.1.25.
Previous studies have demonstrated that enamel matrix derivative (EMD) has the ability to improve clinical parameters when used to treat intraosseous defects. The purpose of the present study was to compare at 12 months postsurgery sites treated with open flap debridement (OFD) alone to those treated with OFD and EMD.
Twenty-three subjects with at least 2 intrabony defects were chosen. Fifty-three defects received EMD in conjunction with OFD. Thirty-one defects in these same 23 subjects were treated with OFD alone. Stents were fabricated to serve as fixed reference points. Re-entries were performed at least 1 year after initial surgery. Soft tissue measurements were recorded prior to initial surgery and prior to re-entry for gingival (GI) and plaque (PI) indices, probing depth (PD), gingival margin position, and clinical attachment level (CAL). Hard tissue measurements were recorded during the initial and re-entry surgery for level of crestal bone and depth of defect. Statistical analysis was conducted using the method of generalized estimating equations to determine changes in GI, PI, PD, CAL, fill of the osseous defect, and crestal resorption. Percent of defect fill was also calculated.
In all categories, treatment with EMD (test) was superior to treatment without EMD (control). Average PI and GI were not significantly different either initially or prior to re-entry. The average PD reduction was 2.7 mm greater with EMD than controls. The average CAL gains were 1.5 mm greater, and the average fill of osseous defect 2.4 mm greater with EMD than controls. The average percent of defect fill after adjusting for crestal bone loss was more than 3 times greater for EMD versus control-treated sites (74% defect fill with EMD versus 23% defect fill for control sites).
This study indicates that treatment of periodontal intraosseous defects with EMD is clinically superior to treatment without EMD (open flap debridement) in every parameter evaluated. Re-entry data demonstrate that percent fill of osseous defects treated with EMD compares favorably with the treatment results utilizing bone grafts or membrane barriers, according to published literature.
以往研究表明，牙釉质基质衍生物（EMD）用于治疗骨内缺损时具有改善临床参数的能力。本研究的目的是比较术后12个月时，单纯翻瓣清创术（OFD）治疗的部位与OFD联合EMD治疗的部位。
选取23名至少有2处骨内缺损的受试者。53处缺损接受了OFD联合EMD治疗。这23名受试者中的31处缺损仅接受了OFD治疗。制作支架作为固定参考点。在初次手术后至少1年进行再次手术。在初次手术前和再次手术前记录软组织测量数据，包括牙龈指数（GI）、菌斑指数（PI）、探诊深度（PD）、牙龈边缘位置和临床附着水平（CAL）。在初次手术和再次手术期间记录硬组织测量数据，包括嵴顶骨水平和缺损深度。使用广义估计方程法进行统计分析，以确定GI、PI、PD、CAL、骨缺损填充情况和嵴吸收的变化。还计算了缺损填充百分比。
在所有类别中，EMD治疗组（试验组）优于未使用EMD的治疗组（对照组）。初始时或再次手术前，平均PI和GI无显著差异。EMD组的平均PD减少量比对照组多2.7毫米。EMD组的平均CAL增加量多1.5毫米，骨缺损的平均填充量比对照组多2.4毫米。调整嵴骨吸收后，EMD治疗部位的平均缺损填充百分比比对照组多3倍以上（EMD组缺损填充率为74%，对照组为23%）。
本研究表明，在评估的每个参数中，用EMD治疗牙周骨内缺损在临床上优于未使用EMD的治疗（翻瓣清创术）。再次手术数据表明,根据已发表的文献，用EMD治疗的骨缺损填充百分比与使用骨移植或膜屏障的治疗结果相比具有优势。
