title: Clinical Evaluation of an Allogeneic Bone Matrix in the Treatment of Periodontal Osseous Defects. Enamel matrix derivative (EMDOGAIN) in the treatment of intrabony periodontal defects. A comparison between enamel matrix proteins used alone or in combination with bovine porous bone mineral in the treatment of intrabony periodontal defects in humans. Expanded polytetrafluoroethylene and dental rubber dam barrier membranes in the treatment of periodontal intrabony defects. A comparative clinical trial. GTR with bioresorbable membranes in the treatment of intrabony defects: a clinical and histologic study. Treatment of intrabony defects with enamel matrix proteins or bioabsorbable membranes. A 4-year follow-up split-mouth study. Comparison of infrabony defects treated with enamel matrix derivative versus guided tissue regeneration with a nonresorbable membrane. Healing of human intrabony defects following regenerative periodontal therapy with an enamel matrix protein derivative alone or combined with a bioactive glass. A controlled clinical study. Evaluation of guided tissue regeneration in interproximal defects. (II). Membrane and bone versus membrane alone. Enamel matrix proteins and bovine porous bone mineral in the treatment of intrabony defects: a comparative controlled clinical trial. Guided tissue regeneration in conjunction with hydroxyapatite-collagen grafts for intrabony defects. A clinical and radiological evaluation. Periodontal tissue alterations following Emdogain treatment of periodontal sites with angular bone defects. A series of case reports. Periodontal regeneration of human intrabony defects with bioresorbable membranes. A controlled clinical trial. The use of 2 bioabsorbable barrier membranes in the treatment of interproximal intrabony periodontal defects. Comparison of treatments of infrabony defects with enamel matrix derivative, guided tissue regeneration with a nonresorbable membrane and Widman modified flap. A pilot study. Clinical evaluation of an enamel matrix protein derivative combined with a bioactive glass for the treatment of intrabony periodontal defects in humans. Enamel matrix proteins and guided tissue regeneration with titanium-reinforced expanded polytetrafluoroethylene membranes in the treatment of infrabony defects: a comparative controlled clinical trial. Clinical outcomes following treatment of human intrabony defects with GTR/bone replacement material or access flap alone. A multicenter randomized controlled clinical trial. Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. Platelet-rich plasma combined with a porous hydroxyapatite graft for the treatment of intrabony periodontal defects in humans: a comparative controlled clinical study. A comparative study utilizing open flap debridement with and without enamel matrix derivative in the treatment of periodontal intrabony defects: a 12-month re-entry study. Enamel matrix derivative in the treatment of human intrabony osseous defects. Effect of repeated local minocycline administration on periodontal healing following guided tissue regeneration. A controlled re-entry study on the effectiveness of bovine porous bone mineral used in combination with a collagen membrane of porcine origin in the treatment of intrabony defects in humans. Topical and systemic antimicrobial therapy in guided tissue regeneration. Treatment of intrabony defects with enamel matrix proteins and guided tissue regeneration. A prospective controlled clinical study. Combination use of bovine porous bone mineral, enamel matrix proteins, and a bioabsorbable membrane in intrabony periodontal defects in humans. Effects of pretreatment clinical parameters on bioactive glass implantation in intrabony periodontal defects. Clinical comparison of an enamel matrix derivative used alone or in combination with a bovine-derived xenograft for the treatment of periodontal osseous defects in humans. Comparison of calcium sulfate and autogenous bone graft to bioabsorbable membranes plus autogenous bone graft in the treatment of intrabony periodontal defects: a split-mouth study. A clinical evaluation of demineralized freeze-dried bone allograft in combination with tetracycline in the treatment of periodontal osseous defects. Periodontal repair in intrabony defects treated with a calcium sulfate implant and calcium sulfate barrier. Healing of human intrabony defects following treatment with enamel matrix proteins or guided tissue regeneration. Comparison of clinical, radiographic, and histometric measurements following treatment with guided tissue regeneration or enamel matrix proteins in human periodontal defects. Evaluation of a collagen membrane with and without bone grafts in treating periodontal intrabony defects. A retrospective case series comparing the use of demineralized freeze-dried bone allograft and freeze-dried bone allograft combined with enamel matrix derivative for the treatment of advanced osseous lesions. Evaluation of demineralized bone matrix paste and putty in periodontal intraosseous defects. Treatment of wide, shallow, and predominantly 1-wall intrabony defects with a bioabsorbable membrane: a randomized controlled clinical trial. Clinical evaluation of calcium sulfate in combination with demineralized freeze-dried bone allograft for the treatment of human intraosseous defects. Treatment of intrabony defects with enamel matrix proteins or barrier membranes: results from a multicenter practice-based clinical trial Clinical evaluation of demineralized freeze-dried bone allograft and enamel matrix derivative versus enamel matrix derivative alone for the treatment of periodontal osseous defects in humans. Enamel matrix proteins in the regenerative therapy of deep intrabony defects. Healing in periodontal defects treated by decalcified freeze-dried bone allografts in combination with ePTFE membranes (I). Clinical and scanning electron microscope analysis. Factors affecting the healing response of intrabony defects following guided tissue regeneration and access flap surgery. A prospective multi-center study evaluating periodontal regeneration for Class II furcation invasions and intrabony defects after treatment with a bioabsorbable barrier membrane: 1-year results. Periodontal regeneration of human intrabony defects with titanium reinforced membranes. A controlled clinical trial. Guided tissue regeneration in the treatment of human infrabony defects. Clinical, radiographical and microbiological results: a pilot study. Guided tissue regeneration in human Class II furcations and interproximal infrabony defects after using a bioabsorbable membrane barrier. Enamel matrix proteins in the treatment of intra-bony defects. A prospective 24-month clinical trial. The use of barrier membranes and enamel matrix proteins in the treatment of angular bone defects. A prospective controlled clinical study. Clinical comparison of resorbable and non-resorbable barriers for guided periodontal tissue regeneration. Healing of intra-bony defects following treatment with a composite bovine-derived xenograft (Bio-Oss Collagen) in combination with a collagen membrane (Bio-Gide PERIO). Abstracts Guided tissue regeneration in intrabony periodontal defects following treatment with two bioabsorbable membranes in combination with bovine bone mineral graft. A clinical and radiographic study.
abstract: The objective of this study was to evaluate an allogeneic bone matrix ( ABM ) as a graft material for the treatment of periodontal osseous defects .  ABM is allogeneic demineralized freeze-dried human bone which has been processed to eliminate contaminating lipids , serum proteins , and cellular components which , when present , have the potential to reduce the osteoinductive capacity of the graft . ABM is provided in a glycerine delivery suspension which enhances graft stability and ease in placement . Paired osseous defects , ranging in depth from 3 to 12 mm , within 11 patients , were r and omized to receive ABM or demineralized freeze-dried bone allograft ( DFDBA ) .  Probing depth , clinical attachment level , bone fill , and defect resolution were determined at baseline and at the 6-month re-entry procedure . St and ardized radiographs and computer-assisted densitometric image analysis ( CADIA ) were used to assess bone density changes . Complete bone defect resolution was seen in 7 of 11 defects receiving ABM , and in 5 of 11 defects with the use of DFDBA . Mean defect fill with  ABM  was 69 % ( 33 to 100 % ) compared to 77 % ( 66 to 100 % ) with DFDBA . Soft tissue healing without clinical evidence of tissue reaction to ABM was observed . ABM and DFDBA sites exhibited similar probing depth reduction of 4.0 and 4.6 mm , respectively . In sites with initial probing depth of 7 mm or more , probing depths were reduced a mean of 5.8 mm with ABM and 6.7 mm with DFDBA ; both grafts result ed in a mean 4 mm of attachment gain . Results of radiographic analysis suggest similar density changes with each graft . These results demonstrate that both treatments were effective and that ABM may be a useful graft material in the treatment of periodontal osseous defects . J Periodontol 1995;66:1074 - 1079 The aim of the present clinical trial was to compare the long-term effect of EMDOGAIN treatment as an adjunct to modified widman flap ( MWF ) surgery with the effect of MWF and placebo treatment . The investigation was a placebo-controlled , r and omized multicenter trial involving 33 subjects with 34 paired test and control sites . The protocol required 2 interproximal sites , appropriately separated , in the same jaw with probing pocket depths > or = 6 mm and an associated intrabony defect with a depth of > or = 4 mm and a width of > or = 2 mm as measured on a radiograph . Only predominantly 1- and 2-wall defects were included .  Clinical attachment gain and radiographic bone gain were used as primary outcome variables . Assessment s were made at baseline , 8 , 16 and 36 months . Mean values for clinical attachment level gain in test and control sites at 8 months were 2.1 mm and 1.5 mm , respectively ; at 16 months , 2.3 mm and 1.7 mm , respectively ; and at 36 months 2.2 mm and 1.7 mm , respectively ; and the differences were statistically significantly different at each time point ( p < 0.01 ) . The radiographic bone level continued to increase over the 36 months at the EMDOGAIN-treated sites , while it remained close to the baseline level at the control sites . The statistically significant ( p < 0.001 ) radiographic bone gain at 36 months of 2.6 mm at EMDOGAIN-treated sites corresponded to 36 % gain of initial bone loss or 66 % defect fill . The present trial has demonstrated that topical application of EMDOGAIN onto diseased root surfaces associated with intrabony defects during MWF periodontal surgery will promote an increased gain of radiographic bone and clinical attachment compared to control ( placebo application ) surgery in the same patient . There was no evidence to indicate any clinical adverse effects from application of EMDOGAIN conjunction with periodontal surgery BACKGROUND It has been shown that clinical improvement of intrabony periodontal defects can be achieved with the use of enamel matrix proteins ( EMPs ) or by grafting with bovine porous bone mineral ( BPBM ) . There is no report on the potential synergistic effect of EMPs and BPBM in periodontal regenerative therapy . The purpose of this study was to compare the clinical effectiveness of EMPs used alone or in combination with BPBM in the treatment of periodontal intrabony defects in humans . METHODS Twenty-one paired intrabony defects were surgically treated using a split-mouth design . Intrabony defects were treated either with enamel matrix proteins ( EMP group ) or with enamel matrix proteins combined with bovine porous bone mineral ( EMP/BPBM group ) . Re-entry surgeries were performed at 6 months . RESULTS Preoperative probing depths , attachment levels , and transoperative bone measurements were similar for the EMP and EMP/BPBM groups . Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the EMP/BPBM group ( 3.43 + /- 1.32 mm on buccal sites and 3.36 + /- 1.35 mm on lingual sites ) when compared to the EMP group ( 1.91 + /- 1.42 mm on buccal sites and 1.85 + /- 1.38 mm on lingual sites ) . The EMP/BPBM group also presented with significantly more attachment gain ( 3.13 + /- 1.41 mm on buccal sites and 3.11 + /- 1.39 mm on lingual sites ) than the EMP group ( 1.72 + /- 1.33 mm on buccal sites and 1.75 + /- 1.37 mm on lingual sites ) . Surgical re-entry of the treated defects revealed a significantly greater amount of defect fill in favor of the EMP/BPBM group ( 3.82 + /- 1.43 mm on buccal sites and 3.74 + /- 1.38 mm on lingual sites ) as compared to the EMP group ( 1.33 + /1.17 mm on buccal sites and 1.41 + /- 1.19 mm on lingual sites ) . CONCLUSIONS The results of this study indicate that BPBM has the ability to augment the effects of EMPs in reducing probing depth , improving clinical attachment levels , and promoting defect fill when compared to presurgical levels As observed in previous case reports , dental rubber dam ( DRD ) can be utilized as a barrier membrane in the guided tissue regeneration ( GTR ) technique for the treatment of periodontal intrabony defects . The purpose of the present study was ( 1 ) to confirm the validity of DRD as a suitable material in regenerative procedures and ( 2 ) to compare , in a split-mouth clinical trial , the effectiveness of DRD-made membranes in the treatment of periodontal intrabony defects versus that of exp and ed polytetrafluoroethylene ( e-PTFE ) barriers .  22 systemically healthy non-smoker adult periodontitis patients ( 7 male , 15 female ) aged between 35 to 58 years were selected for the study . In each patient , a couple of 2 - 3 wall intrabony defects , located in different quadrants , were treated by a GTR technique using DRD ( test sites ) and e-PTFE ( control sites ) , respectively . Performing a strict control of the oral hygiene level and of the marginal gingival health during the whole period of study , clinical ( pocket probing depth , PPD ; probing attachment level , PAL ; gingival recession , GR ) and intrasurgical ( depth of the defect 's intraosseous component , IOC ; level of the alveolar crest , ACL ) parameters were recorded at baseline and at the 1-year re-entry procedure in each experimental site . Furthermore , the coronal level of the newly formed tissue from the base of the defect ( NFTL ) and the vertical bone gain ( VBG ) were calculated at the time of membrane removal and after the re-entry procedure respectively . Membranes were removed from both test and control sites after 5 weeks ; however , exposure of the membrane always occurred in test sites whereas it was observed in only 6 out of 22 control sites , this fact leading to an incomplete coverage of the regenerated tissue by the gingival flap in 18 out of 22 test sites . In both test and control sites , a statistically significant improvement of clinical and intrasurgical parameters occurred at the end of the study period ; however , a significantly greater improvement was observed in control sites for PAL ( + 4.0 mm versus + 3.0 mm ; p<0.05 ) and VBG ( 3.9 mm versus 2.9 mm ; p<0.05 ) although at the time of membrane removal , NFTL was similar between the experimental sites ( test : 5.8 ; control : 5.6 ; p>0.05 ) . Conversely , test sites exhibited a statistically significant greater increase in gingival recession ( + 1.9 versus + 1.2 ; p<0.05 ) and alveolar crest resorption ( -1.1 versus -0.3 , p<0.01 ) in comparison to controls . It was concluded that ( 1 ) DRD is a suitable material to be used as a barrier membrane in GTR procedures although ( 2 ) e-PTFE membranes can provide a greater improvement in PAL and VBG , probably because of the difficulty in completely covering the regenerated tissue due to the fact that the gingival tissues have undergone a consistent recession in DRD-treated sites . Further studies are needed to demonstrate if an adequate coverage of the regenerated tissue in DRD-treated sites can eliminate these differences The aim of the present study was to evaluate clinical ly and histologically the treatment of intrabony periodontal defects with a bioresorbable membrane barrier .  Fifty-two intrabony periodontal defects were treated according to the principles of guided tissue regeneration ( GTR ) with a bioresorbable membrane . Results were evaluated by assessing probing pocket depth , recession of the gingival margin , and clinical attachment level at baseline and at 1 and 2 years after therapy . Bone level changes were evaluated radiographically . The postoperative phase was uneventful in all cases . There was a mean probing pocket depth reduction from 8.4 to 3.6 mm , a mean increase of gingival margin recession from 1.5 to 3.0 mm , and a mean clinical attachment level change from 9.9 to 6.5 mm . Mean attachment gain was 3.4 mm . Two teeth scheduled for extraction were also treated with the same bioresorbable membrane . The histologic analysis 6 months after treatment revealed the formation of new connective tissue attachment and new alveolar bone in both cases . Based on the histologic findings it can be concluded that the clinical improvements following GTR with this type of bioresorbable membrane may represent , at least in part , true periodontal regeneration BACKGROUND Treatment with enamel matrix proteins ( EMD ) and guided tissue regeneration ( GTR ) with bioabsorbable membranes has been shown to promote periodontal regeneration ; however , until now , there were only limited data on the long-term clinical results following these regenerative techniques . Therefore , the aim of the present study was to present the 4-year results following treatment of intrabony defects with EMD or guided tissue regeneration ( GTR ) . METHODS Twelve patients , each displaying one pair of intrabony defects located contralaterally in the same jaw , were r and omly treated with EMD or with GTR by means of bioabsorbable membranes . The following clinical parameters were evaluated at baseline , at 1 year , and at 4 years after treatment : plaque index ( P1 ) , gingival index ( G1 ) , bleeding on probing ( BOP ) , probing depth ( PD ) , gingival recession ( GR ) , and clinical attachment level ( CAL ) . The primary outcome variable was CAL . No statistically significant differences between the groups were found at baseline . Power analysis to determine superiority of EMD treatment showed that the available sample size would yield 70 % power to detect a 1 mm difference . RESULTS The sites treated with EMD demonstrated mean CAL change from 9.8 + /- 2.0 mm to 6.4 + /- 1.6 mm ( P<0.001 ) and to 6.8 + /- 1.8 mm ( P<0.001 ) at 1 and 4 years , respectively . No statistically significant differences were found between the CAL mean at 1 and 4 years postoperatively . The sites treated with GTR showed a mean CAL change from 9.8 + /- 2.3 mm to 6.6 + /- 1.7 mm ( P<0.001 ) at 1 year and to 6.9 + /- 1.8 mm ( P<0.001 ) at 4 years . The CAL change between I and 4 years did not present statistically significant differences . No statistically significant differences in any of the investigated parameters were observed at 1 and 4 years between the treatment groups . CONCLUSIONS It was concluded that the CAL gain obtained following treatment with EMD or GTR can be maintained over a 4-year period AIM The purpose of the present multicenter clinical trial was to compare the efficacy of two different procedures in the treatment of infrabony defects :  guided tissue regeneration ( GTR ) with nonresorbable membranes and enamel matrix derivative ( EMD ) . MATERIAL AND METHODS Six centers participated in this study . Ninety-eight patients with an interproximal infrabony defect were selected . All patients were treated with an initial phase of scaling and root planing , and at the study 's baseline the selected defects presented a value of probing depth ( PD ) > or = 6 mm with an infrabony component > or = 4 mm . Forty-nine patients were treated with GTR procedures ( using ePTFE membranes ( Gore-Tex W.L. Gore and Associates , Flagstaff , AZ , USA ) ) and forty-nine with EMDs ( Emdogain ( U Biora AB Malm , Sweden ) ) . The efficacy of each treatment modality was investigated through covariance analysis . RESULTS The patients were reevaluated at one year postop . Probing attachment level ( PAL ) gain and PD reduction were analyzed . In the Emdogain group the PAL before surgery ( PAL 0 ) and the PD before surgery ( PD 0 ) were respectively 9.9+/-1.4 and 8.5+/-1.6 mm . The PAL gain and the PD reduction at 1 year postsurgery were respectively 4.1+/-1.8 and 5.3+/-1.9 mm . The group of patients treated with membranes showed that PAL 0 and PD 0 were respectively 8.9+/-1.9 and 8.1+/-1.9 . The PAL gain was 4.3+/-1.9 mm and the PD reduction was 5.6+/-1.5 mm . The mean PAL gain expressed by percentage ( PAL gain/PAL 0 ) for the group treated with EMD was 41 % , while it was 48 % for the group treated with GTR . Results from our analysis suggest that there is no statistically significant difference between GTR and EMD treatments in terms of PAL gain , PD reduction and recession variation . Applying the regression model to a group of patients with a PAL 0 > or = 8 mm , we observed a better clinical outcome in terms of PAL gain ( difference of 0.3 mm ) in patients treated with the GTR procedure compared to those treated with EMD . Covariance analysis showed a strong correlation in both groups of patients between PAL gain and full mouth bleeding score , and between PAL gain and defect morphology and depth AIM The purpose of the present study was to compare clinical ly the treatment of deep intrabony defects with a combination of an enamel matrix protein derivative ( EMD ) and a bioactive glass ( BG ) to EMD alone . METHODS Thirty patients ( 16 females and 14 males ) suffering from advanced marginal periodontitis were included in this prospect i ve , controlled parallel design multicenter study . In each of the patients , one intrabony defect was r and omly treated with either EMD+BG ( test ) or with EMD alone ( control ) . Clinical measurements were recorded at baseline and at 1 year following therapy . RESULTS No differences in any of the investigated parameters were observed at baseline between the two groups . Healing was uneventful in all patients . At 1 year after therapy , the test group showed a reduction in mean probing depth ( PD ) from 8.5+/-1.1 to 4.4+/-1.2 mm ( p<0.001 ) and a change in mean clinical attachment level ( CAL ) from 10.4+/-1.5 to 7.1+/-1.5 mm ( p<0.0001 ) . In the control group , the mean PD was reduced from 8.5+/-1.5 to 4.0+/-1.6 mm ( p<0.001 ) and the mean CAL changed from 10.2+/-2.1 to 6.3+/-2.2 mm ( p<0.01 ) . In the test group , 12 sites ( 80 % ) gained at least 3 mm or more of CAL , whereas in the control group a CAL gain of 3 mm or more was measured at 13 sites ( 87 % ) . No statistically significant differences in terms of PD reduction and CAL gain were found between the test and the control treatment . CONCLUSIONS Within the limits of the present study it can be concluded that : ( i ) at 1 year after surgery , both therapies result ed in significant PD reductions and CAL gains , and ( ii ) the combination of EMD+BG does not seem to additionally improve the clinical results This study clinical ly evaluates the use of exp and ed polytetrafluoroethylene ( ePTFE ) membranes with or without the addition of decalcified freezedried bone allograft ( DFDBA ) in the treatment of interproximal intraosseous defects . 25 patients ( 26 paired defects ) diagnosed with advanced periodontitis and having at least 2 bilateral interproximal probing depths of > or = 6 mm participated in the study . After the hygiene phase , measurements were made to determine soft tissue recession , pocket depth , and clinical attachment levels . Defects from each pair were r and omly treated with either ePTFE alone ( control ) , or ePTFE+DFDBA ( experimental ) . Measurements were made during the surgery to determine crestal resorption , defect resolution and defect fill . Membranes were removed at 4 to 6 weeks . At 6 months , the soft and hard tissue measurements ( surgical reentry ) were repeated . Both groups showed statistically significant improvement when compared to baseline ( p < 0.001 ) , but no difference was determined between groups . Control sites showed a 50 % bone fill and experimental sites had 54 % bone fill . The defect resolution changes were also similar between control and experimental groups , respectively ( 80 % , 74 % ) . For this short-term study , it was concluded that either technique was beneficial for the treatment of intraosseous defects . Other studies are needed to assess the long-term stability of the improvements rendered by these treatments BACKGROUND Various clinical studies have demonstrated that applying commercially available enamel matrix proteins ( EMP ) on the instrumented root surface during access flap surgery promotes clinical ly 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 result ed in clinical ly 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 This clinical and radiological study evaluated the healing of 3 + 2 + 1 wall-combined intrabony defects treated using the guided tissue regeneration technique ( GTR ) with and without hydroxyapatite-collagen alloplastic graft material s ( HAC ) , in comparison to that of HAC alone and conventional flap surgery ( CF ) .  40 interproximal defects with probing depth > 6 mm were treated in 18 adult periodontitis patients of ages 35 - 60 years . After non-surgical therapy , the defects were r and omly grouped into 4 groups of 10 defects each . These groups were design ated : ( 1 ) exp and ed polytetrafluoroethylene membrane ( e-PTFE ) , ( 2 ) e-PTFE + HAC , ( 3 ) HAC alone and ( 4 ) CF . At 6 months , the following changes in parameters were recorded . Mean PPD reduction for each group was 5.83 , 5.85 , 3.80 and 3.17 mm respectively . PPD reduced very significantly in all groups ( p < 0.01 ) , the highest and lowest reductions in PPD being for the e-PTFE + HAC and CF group respectively . Comparison between the 4 groups showed higher PPD reduction in both membrane groups than in either of the non membrane groups ( p < 0.05 ) with the difference between the e-PTFE and CF groups being very highly significant ( p < 0.001 ) . Mean attachment gain for the 4 groups was 3.70 , 3.80 , 2.60 and 2.1 mm , respectively . Similarly attachment gain for all groups was very significant ( p < 0.01 ) and the highest and lowest attachment gains were for the e-PTFE + HAC and CF group respectively . Both membrane groups showed significantly more attachment gain than the CF group ( p < 0.05 ) . Change in probing bone level ( BL ) for the 4 groups was 1.60 , 1.90 , 1.0 and 0.65 mm respectively . Again the highest changes in BL were recorded for the e-PTFE + HAC group . Significant differences were found between both membrane groups and the CF group ( p < 0.05 ) . Radiological evaluation using st and ardized radiographs and millimeter grids showed change in radiographic bone level at the deepest point of the defect on the radiograph to be 1.50 , 1.55 , 0.85 and 0.60 mm , respectively and this was significantly higher in both membrane groups than in the CF group ( p < 0.05 ) . This study therefore found e-PTFE membranes both alone and when combined with HAC to lead to more attachment gain and bone fill than did HAC alone or CF . It found HAC combined with e-PTFE to perform better although not significantly better than e-PTFE alone UNLABELLED The aim of the present study was to assess the predictability of probing attachment gain and probing pocket depth reduction following Emdogain treatment at sites with deep angular bone defects . MATERIAL AND METHODS 108 consecutively-treated periodontal patients ( mean age 55.8 years ) were included . Each subject exhibited at least 1 deep interproximal intrabony defect that could be identified as an experimental site based on the inclusion criteria : ( i ) probing pocket depth > or = 5 mm , ( ii ) probing attachment loss > or = 6 mm , ( iii ) radiographic evidence of an interproximal bone defect with a > or = 3 mm intrabony component . A total of 145 defects met the criteria for inclusion . All subjects received non-surgical periodontal therapy .  This included subgingival instrumentation in all parts of the dentition . At least 6 months after the completion of this treatment , a baseline examination was performed to characterise the experimental site . Reconstructive therapy was subsequently performed . Full-thickness periodontal flaps were elevated , and the root surface scaled and planed . No bone recontouring was performed . A gel containing 24 % EDTA was applied on the exposed root and was kept in place for 2 min . A preparation of enamel matrix proteins was applied to the root surface and adjacent defect space . The flaps were replaced and closed with sutures . The experimental sites were re-examined 12 months after reconstructive surgery . RESULTS The re-examination demonstrated that a treatment including the application of enamel matrix proteins at periodontal sites with angular defects result ed in a mean probing attachment level gain of 4.6 mm and a probing pocket depth reduction of 5.2 mm . 87 % of all sites treated exhibited a probing attachment gain of > 2 mm . One site suffered probing attachment loss . The radiographic assessment s revealed that the bone defect had been reduced in depth by 2.9 mm on average . The reduction in defect size corresponded to an average bone fill of 69 % of the original defect . In 43 % of the defects , the bone fill amounted to > or = 80 % . CONCLUSION The overall probing pocket depth reduction , probing attachment level gain , and soft tissue recession , that results following Emdogain therapy , is similar to the corresponding outcome variables following GTR The purpose of this controlled clinical trial was to compare the clinical efficacy of 3 treatment modalities in the treatment of deep interproximal intrabony defects . Thirty-six ( 36 ) defects in 36 patients were r and omly assigned to 1 of 3 treatment groups by blocking to prognostic variables . The test was treated with bioresorbable membranes positioned coronal to the interproximal bone crest ; the second group ( membrane control ) was treated with conventional non-resorbable ( ePTFE ) barrier membranes applied coronal to the alveolar crest ; the third group ( flap Control ) was treated with an access flap procedure ( MWF ) . No differences were observed in terms of baseline oral hygiene and defect characteristics among the 3 groups , indicating that the blocking approach was effective . A stringent infection control program was enforced for 1 year . The results indicated that : 1 ) at 1 year all treatment modalities result ed in clinical ly significant improvements in clinical attachment levels ( CAL ) and reductions in probing depths ; 2 ) a statistically significant treatment effect ( P < 0.0001 , ANOVA ) was observed comparing the test ( 4.6 + /- 1.2 mm ) , the membrane control ( 5.2 + /- 1.4 mm ) , and the flap control groups ( 2.3 + /- 0.8 mm ) in terms of CAL gain ; 3 ) differences in terms of CAL gain between the test ( bioresorbable ) and the membrane control ( ePTFE ) groups were not statistically significant ( P = 0.19 , t-test ) ; 4 ) both the test and the membrane control groups gained significantly more CAL at 1 year than the MWF group ( P < 0.0001 , t-test ) . CAL gains > or = 4 mm were observed in 83.3 % of cases in both GTR groups , while CAL gains of this magnitude were not detected in the MWF group . We concluded that clinical ly significant CAL gains can be obtained with GTR procedures using both bioresorbable and non-resorbable membranes . Patients ' morbidity , however , was lower in the group treated with bioresorbable membranes BACKGROUND The use of barrier membranes in the treatment of periodontal defects is well documented . There has been an increase in the use of bioabsorbable material s which do not require a second surgical procedure for removal . However , there are little data evaluating the efficacy of bioabsorbable membranes in the treatment of intrabony defects . The purpose of this investigation was to evaluate the regenerative potential of 2 bioabsorbable barrier membranes without the use of grafting material s in the treatment of interdental intrabony defects . METHODS Twenty-three 2- or 3-walled intrabony defects were treated in 19 patients with a mean age of 50.4 years . All had completed nonsurgical treatment and a period of supportive periodontal therapy . The sites were r and omly chosen to receive a barrier membrane composed of type I bovine collagen ( 11 ) or a copolymer of polylactic acid ( PGA/PLA;12 ) . A pressure sensitive disc probe was used to evaluate the following criteria at baseline and re-entry : 1 ) occlusal surface to the apical depth of probe penetration ( OS-DP ) ; 2 ) occlusal surface to the gingival margin ( OS-GM ) ; 3 ) occlusal surface to the alveolar crest ( OS-AC ) ; and 4 ) occlusal surface to the base of the osseous defect ( OS-BD ) . Full thickness mucoperiosteal flaps were reflected to expose the surgical sites . The defects were debrided of the granulomatous tissue , the root surfaces instrumented and conditioned with 4 one-minute applications of 50 mg/ml of tetracycline . The barrier membranes were adapted to cover the defects and the flaps replaced . The postsurgical healing was uneventful and similar in both treatment modalities . RESULTS Twenty-three sites were surgically re-entered 6 months from the time of the initial surgery . The deepest probe depth for each site was used for statistical analysis . There was a mean relative attachment gain of 2.58+/-1.90 mm for the collagen , and 2.77+/-2.13 mm for the copolymer . There was a decrease in probing depth of 3.27+/-1.91 mm and 0.69+/-1.35 mm of recession for the collagen . The PGA/PLA copolymer had 3.55+/-2.47 mm reduction in probe depth and 0.78+/-1.14 mm of recession . CONCLUSIONS The data indicated the bioabsorbable collagen and copolymer membranes result ed in comparable results . A larger sample size would be necessary to determine if one membrane was superior to the other BACKGROUND , AIMS The purpose of the present study was to compare the efficacy of 3 different surgical procedures in the treatment of infrabony defects :  guided tissue regeneration ( GTR ) with non-resorbable membranes , Widman modified flap ( WMF ) and enamel matrix derivative ( EMD ) . METHOD 30 patients with an infrabony component > or = 4 mm were selected . 10 were treated with exp and ed polytetrafluorethylene ( ePTFE ( Gore - Tex W. L. Gore and Associates , Flagstaff , AZ , USA ) ) membranes , 10 with WMF and 10 with enamel matrix derivatives ( Emdogain ( U Biora AB Malm , Sweden ) ) . The efficacy of each treatment modality was investigated through regression analysis . Probing attachment level ( PAL ) gain , probing depth ( PD ) reduction and gingival recession ( REC ) variation were analyzed . RESULTS Both Emdogain ( enamel matrix derivative ) and ePTFE treatment show significant better results as compared to the WMF procedure in which there were no significant changes in PAL gain and PD reduction at baseline and 1 year after surgery . CONCLUSIONS Results from our analysis suggest that there is no statistically significant difference in PAL gain between GTR and EMD . The clinical outcomes of this pilot study may be of little significance , considering the small number of patients , but it has provided an important base for a controlled clinical trial ( with a larger number of patients ) which is currently in progress BACKGROUND The purpose of the present study was to compare the treatment of deep intrabony defects with a combination of an enamel matrix protein derivative ( EMD ) and a bioactive glass ( BG ) to BG alone . METHODS Twenty-eight patients with chronic periodontitis , each of whom displayed 1 intrabony defect , were r and omly treated with a combination of EMD and BG or with BG alone .  Soft tissue measurements were made at baseline and at 1 year following therapy . RESULTS No differences in any of the investigated parameters were observed at baseline between the 2 groups . Healing was uneventful in all patients . At 1 year after therapy , the sites treated with EMD and BG showed a reduction in mean probing depth ( PD ) from 8.07 + /- 1.14 mm to 3.92 + /- 0.73 mm and a change in mean clinical attachment level ( CAL ) from 9.64 + /- 1.59 mm to 6.42 + /- 1.08 mm ( P < 0.0001 ) . In the group treated with BG , the mean PD was reduced from 8.07 + /- 1.32 mm to 3.85 + /- 0.66 mm and the mean CAL changed from 9.78 + /- 1.71 mm to 6.71 + /- 1.89 mm ( P < 0.0001 ) . No statistically significant differences in any of the investigated parameters were observed between the test and control group . CONCLUSIONS Within the limits of the present study , it can be concluded that both therapies led to significant improvements of the investigated clinical parameters , and the combination of enamel matrix derivative and bioactive glass does not seem to additionally improve the clinical outcome of the therapy BACKGROUND Several studies have documented the clinical efficacy of guided tissue regeneration ( GTR ) with non-resorbable exp and ed polytetrafluoroethylene ( ePTFE ) membranes and enamel matrix proteins ( EMP ) in the treatment of infrabony defects . The objective of this controlled clinical study was to compare the clinical outcomes of 3 surgical modalities in the treatment of deep interproximal infrabony defects . METHODS Ninety ( 90 ) defects in 90 healthy subjects affected by chronic periodontitis were assigned to 1 of 3 treatment groups by blocking to prognostic variables . The test group was treated with the application of EMP and the simplified papilla preservation ( SPP ) technique ; the second group was treated with titanium-reinforced ePFTE membranes and the SPP technique ; and the third group was treated with the SPP technique used as access flap control procedure . No differences were observed in terms of baseline oral hygiene and defect characteristics among the 3 groups , indicating that the blocking approach was effective . A stringent infection control program was adopted for 1 year . RESULTS The 1-year results indicated that : 1 ) all treatment modalities result ed in clinical ly significant improvements in clinical attachment levels ( CAL ) and reduction in probing depth ( PD ) ; 2 ) a statistically significant treatment effect was demonstrated comparing the EMP test , the membrane control , and the flap control groups in terms of CAL gains ; 3 ) both the EMP test and the membrane control groups showed significant CAL gains compared to the flap control group ; 4 ) a statistically significantly greater amount of CAL gain was demonstrated in GTR-treated compared to EMP-treated patients ; 5 ) deeper residual probing depths but smaller increases in gingival recession were demonstrated following EMP therapy ; and 6 ) smoking habits reduced the clinical outcomes of both regenerative procedures . CONCLUSIONS The use of a regenerative procedure is indicated in the treatment of deep vertical bony defects since both the regenerative techniques ( GTR and EMD ) in the present study result ed in clinical ly and statistically significant improvements in clinical parameters compared to the access flap procedure . The use of EMP can be helpful in esthetically-sensitive sites and in reducing patient morbidity AIM This prospect i ve multicenter r and omized controlled clinical trial was design ed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of a guided tissue regeneration (GTR)/bone replacement material . MATERIAL S AND METHODS One hundred and twenty-four patients with advanced chronic periodontitis were recruited in 10 centers in seven countries . All patients had at least one intrabony defect of > or = 3 mm . The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure . After debridement , the regenerative material was applied in the test subjects , and omitted in the controls . At baseline and 1 year following the interventions , clinical attachment levels ( CALs ) , probing pocket depths ( PPDs ) , recession , full-mouth plaque scores and full-mouth bleeding scores ( FMBS ) were assessed . RESULTS One year after treatment , the test defects gained 3.3 + /- 1.7 mm of CAL , while the control defects yielded a significantly lower CAL gain of 2.5 + /- 1.5 mm . Pocket reduction was also significantly higher in the test group ( 3.7 + /- 1.8 mm ) when compared with the controls ( 3.2 + /- 1.5 mm ) . A multivariate analysis indicated that the treatment , the clinical centers , baseline PPD and baseline FMBS significantly influenced CAL gains . Odds ratios ( ORs ) of achieving above-median CAL gains were significantly improved by the test procedure ( OR = 2.6 , 95 % CI 1.2 - 5.4 ) and by starting with deeper PPD ( OR = 1.7 , 1.3 - 2.2 ) but were decreased by receiving treatment at the worst-performing clinical center ( OR = 0.9 , 0.76 - 0.99 ) . CONCLUSIONS The results of this trial indicated that regenerative periodontal surgery with a GTR/bone replacement material offers an additional benefit in terms of CAL gains , PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone OBJECTIVES Application of the guided tissue regeneration ( GTR ) principle and utilization of enamel matrix derivative ( EMD ) have both been shown to result in periodontal regeneration . While clinical investigations have demonstrated that the use of a microsurgical concept in combination with the GTR technique positively affects the percentage of primary closure and the amount of tissue preservation , no such information is available for EMD-treated periodontal defects . It was the aim of the present investigation to assess the clinical effect of the microsurgical access flap and EMD treatment with an emphasis on the evaluation of early wound healing . MATERIAL AND METHODS Eleven patients displaying at least one pair of intrabony periodontal defects with an intrabony component of > or =3 mm participated in the study . At baseline and at 6 and 12 months after surgery , the following clinical parameters were assessed by a blinded examiner : oral hygiene status ( API ) , gingival inflammation ( BOP ) , probing pocket depth ( PPD ) , clinical attachment level ( CAL ) and gingival recession ( GR ) . Defects were r and omly assigned to test or control treatment , which both consisted of a microsurgical access flap procedure design ed for maximum tissue preservation . The exposed root surfaces of the test sites were conditioned with a 24 % EDTA gel followed by EMD ( Emdogain(R ) ) application . Primary flap closure was achieved by a 2-layered suturing technique . Postoperative healing was evaluated by a newly introduced early wound-healing index ( EHI ) at 1 and 2 weeks after surgery . RESULTS Both test and control treatment result ed in a statistically significant mean CAL gain of 2.8 and 2.0 mm at 6 months , and 3.6 and 1.7 mm at 12 months , respectively ( p<0.05 ) . Differences in CAL gain between the two treatment modalities were statistically significant at both time points ( p<0.05 ) . Additional GR values after 12 months averaged 0.3 and 0.4 mm for test and control sites , respectively , and did not reach statistical significance ( p > or = 0.05 ) . Two weeks after surgery , primary closure was maintained in 89 % of the test sites and in 96 % of the control sites . CONCLUSION Both treatment modalities using the microsurgical flap procedure result ed in a high percentage of primary flap closure and maximum tissue preservation . In terms of PPD reduction and CAL gain , the combination with EMD application appeared to be superior to the microsurgical access flap alone BACKGROUND The aim of the present controlled clinical study was to compare platelet-rich plasma ( PRP ) combined with a biodegradable ceramic , porous hydroxyapatite ( HA ) with a mixture of HA and saline in the treatment of human intrabony defects . METHODS Seventy interproximal intrabony osseous defects in 70 healthy , non-smoking subjects diagnosed with chronic periodontitis were included in this study . Thirty-five subjects each were r and omly assigned to either the test group ( PRP and HA ) or control group ( HA with saline ) . Clinical and radiographic measurements were determined at baseline and the 12-month evaluation . RESULTS When compared to baseline , the 12-month results indicated that , while both treatment modalities result ed in significant changes in all clinical parameters ( gingival index , bleeding on probing , probing depth , clinical attachment level , and intrabony defect fill ; P < 0.001 ) , the test group exhibited statistically significant changes compared to the control sites in probing depth reduction : 4.7 + /- 1.6 mm versus 3.7 + /- 2.0 mm ( P < 0.05 ) ; clinical attachment gain : 3.4 + /- 1.7 mm versus 2.0 + /- 1.2 mm ( P < 0.001 ) ; and vertical relative attachment gain : 70.3 % + /- 23.4 % versus 45.5 % + /- 29.4 % ( P < 0.001 ) . CONCLUSION Treatment with a combination of PRP and HA compared to HA with saline led to a significantly more favorable clinical improvement in intrabony periodontal defects BACKGROUND 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 . METHODS 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 . RESULTS 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 ) . CONCLUSIONS This study indicates that treatment of periodontal intraosseous defects with EMD is clinical ly 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 BACKGROUND There is limited information available from clinical trials regarding the performance of enamel matrix derivative ( EMD ) in the treatment of periodontal intrabony defects . This r and omized , double-blind , placebo-controlled , split-mouth study was design ed to compare the clinical and radiographical effects of EMD treatment to that of placebo-controlled treatment for intrabony defects . METHODS Sixteen patients were included , each of whom had 1 or 2 pairs of intrabony defects located contralaterally in the same arch . Thirty-six intrabony defects were r and omly assigned treatment with flap surgery plus EMD or flap surgery plus placebo . At baseline and at the 12-month follow-up evaluation visit , clinical and radiographic measurements were determined . Data were statistically analyzed using the Wilcoxon-signed rank test ( alpha = 0.05 ) . RESULTS At the 12-month visit , bleeding on probing for the EMD group was 0.11 + /- 0.32 compared to the placebo group , 0.61 + /- 0.50 ( P < 0.05 ) . Probing depth reduction was greater in the EMD group ( 3.00 + /- 0.97 mm ) compared to the placebo group ( 2.22 + /- 0.81 mm ) ( P < 0.05 ) . Mean values for clinical attachment gain in the EMD and the placebo groups were 1.72 + /- 1.07 mm and 0.83 + /- 0.86 mm , respectively ( P < 0.05 ) . Vertical relative attachment gain was 38.5 + /- 22.6 % in the EMD group and 21.4 + /- 25.2 % in the placebo group ( P<0.05 ) . Radiographic bone density gain was greater in the EMD ( 20.2 + /- 16.6 % ) compared to the placebo group ( -3.94 + /- 23.3 % ) ( P<0.01 ) . CONCLUSIONS Treatment with flap surgery and EMD , compared to flap surgery with placebo , produced a significantly more favorable clinical improvement in intrabony periodontal defects BACKGROUND  Infection after a periodontal surgical site has been prepared for guided tissue regeneration ( GTR ) is one of the common complications that can compromise healing . The purpose of this study was to assess the effect of repeated local antimicrobial therapy following GTR for improving clinical attachment gains , and to histologically evaluate the various cell population s and bacterial contamination of the retrieved exp and ed polytetrafluoroethylene membrane ( ePTFE ) . METHODS Forty periodontal intrabony defects in 40 patients were treated by a flap procedure that included the use of  ePTFE membranes  to allow GTR . Patients were r and omly assigned to 2 treatment groups : 20 patients were treated with the ePTFE alone ( control group ) , and the other 20 were treated with the ePTFE combined with the administration of a weekly repeated local application of minocycline ointment for 8 weeks after membrane placement ( test group ) . The membranes were retrieved 6 weeks after the initial surgery and sectioned serially in a coronal-apical plane . The sections were then divided into 9 fields and examined by light microscopy for the presence of inflammatory cells and oral bacteria . Clinical measurements were taken at the time of baseline examination and at a 6-month follow-up examination after removal of the ePTFE . RESULTS At the 6-month follow-up examination , control and test groups showed significant improvement ; i.e. , reduction in the probing depth and increased clinical attachment gain compared with the values at the baseline examination . However , the mean clinical attachment gain of the test group ( 3.0+/-0.3 mm ) was significantly ( P = 0.03 ) greater than that of the control group ( 2.0+/-0.5 mm ) . Histologically , the total number of the cells of both groups was similar . In both groups , mononuclear cells were dominant and fibroblasts , neutrophils , and plasma cells were rarely encountered . There was a tendency for the number of macrophages to be somewhat higher in the control group . The total number of bacteria in the test group was significantly less than that in the control group . The number of bacteria in both control and test groups decreased toward the apical portion . CONCLUSIONS In the present study , clinical attachment gain of intrabony defects following GTR was favorable with repeated local administration of minocycline ointment . However , a complete microbial eradication was not achieved AIM The purpose of this study was to evaluate the clinical effectiveness of a bovine porous bone mineral used in combination with a porcine derived collagen membrane as a barrier in promoting periodontal regeneration in intrabony defects in humans . MATERIAL AND METHODS The study employed a split-mouth design . 22 paired intrabony defects were treated and surgically re-entered 6 months after treatment . Experimental sites were grafted with bovine porous bone mineral and received a collagen membrane for guided tissue regeneration . Control sites were treated with an open flap debridement . RESULTS Preoperative pocket depths , attachment levels and trans-operative bone measurements were similar for control and experimental sites . Post surgical measurements revealed a significantly greater reduction in pocket depth ( differences of 1.89 + /- 0.31 mm on buccal 0.88 + /- 0.27 mm on lingual measurements ) and more gain in clinical attachment ( differences of 1.51 + /- 0.33 mm on buccal and 1.50 + /- 0.35 mm on lingual measurements ) in experimental sites . Surgical reentry of the treated defects revealed a significantly greater amount of defect fill in favor of experimental sites ( differences of 2.67 + /- 0.91 mm on buccal and 2.54 + /- 0.87 mm on lingual measurements ) . CONCLUSIONS The results of this study indicate that clinical resolution of intrabony defects can be achieved using a combination of bovine porous bone mineral and an absorbable , porcine derived collagen membrane when employing a technique based on the principles of guided tissue regeneration . The nature of the attachment between the newly regenerated tissue and the root surfaces needs to be evaluated histologically to confirm the presence of new attachment BACKGROUND Bacterial contamination of membrane material negatively affects healing after guided tissue regeneration ( GTR ) procedures ; conversely , flap connective tissue integration on barrier material improves the clinical outcomes . The objective of this study was to evaluate the effect of topical application of antibiotics on : 1 ) clinical outcomes of  GTR surgical procedures using titanium reinforced exp and ed polytetrafluoroethylene ( ePTFE ) periodontal membrane ; 2 ) bacterial colonization of membrane material ; and 3 ) flap connective tissue-membrane integration . METHODS Fifty-six deep interproximal bony defects were treated with  GTR surgical procedures  using titanium reinforced ePTFE periodontal membranes . Patients were r and omly assigned to 1 of the 2 antimicrobial treatment groups : the test group received weekly topical application of 25 % metronidazole gel and the control group received systemic antibiotics ( amoxicillin plus clavulanic acid 1 g/day for 14 days ) . Clinical outcomes were assessed at 1 year ; the amount of bacterial contamination and connective tissue integration on membrane material was evaluated at time of membrane removal by means of a morphological ( SEM ) method . RESULTS No statistically significant difference was found between test and control groups in terms of clinical attachment ( CAL ) gain ( baseline CAL - 12 months CAL ; P = 0.2 ) and probing depth ( PD ) reduction ( baseline PD - 12 months PD ; P = 0.6 ) . A greater increase in gingival recession ( REC ) ( 12 months REC - baseline REC ) was found in the test group compared to the control group ( P = 0.003 ) . The SEM analysis revealed no statistically significant ( t test ) difference between test and control groups in the number of fields positive to integrated connective tissue ( P = 0.82 ) , while the number of fields positive to bacteria was statistically higher ( P < 0.001 ) in the control group . CONCLUSIONS Local antibiotic administration is more effective than systemic use in preventing membrane contamination , but it does not improve clinical outcomes due to an interference of the vehicle ( gel ) with gingival tissues which may reduce the potential benefits derived from better control of the bacterial load BACKGROUND Utilisation of enamel matrix proteins ( EMD ) and application of the guided tissue regeneration principle ( GTR ) are treatment modalities which both have been shown to result in periodontal regeneration . However , it is yet unknown whether the combination of EMD and GTR may additionally favor the regeneration process . AIM The aim of the present controlled study was to evaluate clinical ly the treatment effect of EMD , GTR , combination of EMD and GTR , and flap surgery ( control ) on intrabony defects . MATERIAL AND METHODS 56 patients each of whom displaying one intrabony defect of a depth of at least 6 mm were r and omly treated with one of the treatment modalities . Prior to surgery and at one year after , the following parameters were evaluated by a blinded examiner : Plaque index ( PlI ) , gingival index ( GI ) , bleeding on probing ( BOP ) , probing pocket depth ( PPD ) , gingival recession ( GR ) and clinical attachment level ( CAL ) . No statistical significant differences between the four groups were observed at baseline for any of the investigated parameters . RESULTS At 1 year after therapy , the sites treated with EMD demonstrated a mean PPD reduction of 4.1 + /- 1.7 mm and a mean CAL gain of 3.4 + /- 1.5 mm ( p<0.001 ) . The sites treated with GTR showed a mean PPD reduction of 4.2 + /- 1.9 mm and a mean CAL gain of 3.1 + /- 1.5 mm ( p<0.001 ) . The sites treated with the combined treatment showed a mean PPD reduction of 4.3 + /- 1.4 mm and a mean CAL gain of 3.4 + /- 1.1 mm ( p<0.001 ) . In the control group , the mean PPD reduction was 3.7 + /- 1.4 mm ( p<0.001 ) and the mean CAL gain measured 1.7 + /- 1.5 mm ( p<0.01 ) . All 4 treatments led to statistically significant PPD reduction and CAL gain . All three regenerative treatments led to higher CAL gain than the control treatment ( p<0.05 ) . No statistical significant differences in PPD reduction and CAL gain were observed between the three regenerative treatments . CONCLUSION It may be concluded that ( a ) all 3 regenerative treatment modalities may lead to higher CAL gain than the control one , and ( b ) the combined treatment does not seem to improve the outcome of the regenerative procedure BACKGROUND The purpose of this study was to evaluate the effectiveness of a combination of enamel matrix proteins ( EMP ) , bovine porous bone mineral ( BPBM ) , and a bioabsorbable membrane for guided tissue regeneration ( GTR ) as regenerative therapy for intrabony defects in humans and compare it to an open flap debridement ( OFD ) technique . METHODS Using a split-mouth design , 18 pairs of intrabony defects were treated and surgically reentered 6 months after the initial surgery . Experimental sites were treated with EMP , grafted with BPBM , and received a collagen/polylactic acid membrane for GTR . Control sites were treated with OFD . The primary outcomes evaluated in the study included probing depth resolution , clinical attachment gain , and bony defect fill . RESULTS Preoperative probing depths , attachment levels , and intraoperative bone measurements were similar for the experimental and control groups . Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the experimental group ( 4.95+/-1.52 mm on buccal sites and 4.74+/-1.47 mm on lingual sites ) when compared to the control group ( 2.83+/-0.83 mm on buccal sites and 2.90+/-0.91 mm on lingual sites ) . The experimental sites also presented with significantly more attachment gain ( 3.89+/-1.16 mm on buccal sites and 3.78+/-1.14 mm on lingual sites ) than the control sites ( 1.52+/-0.83 mm on buccal sites and 1.48+/-0.78 mm on lingual sites ) . Surgical reentry of the treated defects revealed a significantly greater amount of defect fill in favor of the experimental group ( 4.76+/-1.36 mm on buccal sites and 4.81+/-1.37 mm on lingual sites ) as compared to the control group ( 1.78+/-0.92 mm on buccal sites and 1.67+/-0.90 mm on lingual sites ) . CONCLUSIONS The results of this study indicate that a combination technique including BPBM , EMP , and GTR results in better clinical resolution of intrabony defects than treatment with OFD . Differences observed were both statistically and clinical ly significant . The exact role of each of the 3 technique components in achieving the clinical improvement observed in this study remains to be determined BACKGROUND The various methods for regeneration of periodontal tissue that have been developed can be classified into guided tissue regeneration and bone implantation . Since the implantation material s have shown both deficiencies and merits , dentists have begun exploring the bioactive glass first used in plastic surgery . This paper examines the effectiveness of this new material on periodontal intrabony defects . METHODS Clinical effects of bioactive glass implantation in intrabony periodontal defects were evaluated 6 months after surgery in 38 intrabony defects from 38 patients with chronic periodontitis . Twenty-one experimental defects received bioactive glass implantation  ( test group ) , while 17 control defects were treated with a flap procedure only ( control group ) . The criteria for comparative observation were preoperative and postoperative probing depth ( PD ) , clinical attachment level ( CAL ) , bone probing depth ( BPD ) , and gingival recession . RESULTS Reductions in PD were observed in both groups ( P<0.01 ) . The reduction in PD was significantly greater in the test group when preoperative PD exceeded 7 mm ( P<0.01 ) . Improvements in CAL were also observed in both groups ( P<0.01 ) , with the test group showing significantly greater gains ( P<0.05 ) . In those cases where preoperative CAL was less than 7 mm , there was no statistically significant difference between the two groups . Reduction in BPD was observed in both groups , with the test group showing significantly greater reduction ( P < 0.01 ) . There was no significant difference in BPD change , however , when preoperative BPD was < or = 7 mm . Significantly greater reduction of BPD in the test group was observed when intrabony defect depth was > 4 mm ( P < 0.05 ) . Significant improvements in PD , CAL , and BPD were noted in the test group when the crestal involvement exceeded 100 degrees . Correlation test between various clinical parameters indicated that greater changes in PD and CAL in the test group were observed when preoperative CAL was large ( P<0.001 ) , and greater changes in PD ( P<0.05 ) , CAL ( P<0.01 ) , and BPD ( P<0.05 ) were noted when preoperative BPD was large . Correlation between crestal involvement and CAL change was noted only in the control group ( P<0.01 ) . High correlations were observed between PD changes and CAL changes and between CAL changes and BPD changes in both groups . CONCLUSIONS Use of a bone substitute in a flap operation result ed in significantly greater improvements in CAL and BPD over flap operation alone and seemed to have positive effects in postoperative PD , CAL , and BPD in those cases with more severe preoperative CAL and BPD BACKGROUND The combination of bone replacement graft material s has been suggested for the treatment of periodontal osseous defects . The purpose of this study was to evaluate the effectiveness of enamel matrix derivative ( EMD ) combined with a bovine-derived xenograft ( BDX ) as compared to EMD alone in the treatment of intraosseous defects in patients with moderate to advanced periodontitis . METHODS Sixteen adult patients with at least 2 intrabony defects were entered in this split-mouth design study . Defects were treated with EMD alone or EMD + BDX . Reentries were performed 6 to 8 months after initial surgery . The following soft and hard tissue measurements were recorded prior to initial surgery and at reentry : probing depth ( PD ) , gingival margin location , clinical attachment level ( CAL ) , depth of defect , and crestal bone level . Statistical analyses were performed to determine changes in PD , CAL , fill of osseous defect , and crestal resorption . Percentages of bone fill ( % BF ) and defect resolution ( % DR ) were also calculated . RESULTS The most significant results were that gingival recession was greater for the group treated with EMD alone ( 0.8 + /- 0.8 mm ) compared to EMD + BDX ( 0.3 + /- 0.6 mm ) ( P = 0.04 ) and bone fill was greater for EMD + BDX ( 4.0 + /- 0.8 mm ) compared to EMD alone ( 3.1 + /- 1.0 mm ) ( P = 0.02 ) . The measures for PD reduction , attachment level gain , crestal resorption , % BF , and % DR did not present a statistically significant difference ( P > 0.10 ) . CONCLUSIONS This study evaluated the performance of EMD + BDX and EMD alone . The results demonstrated that a significant improvement in clinical parameters was observed . When comparing both modalities , a statistically significant difference was only found for gingival recession and bone fill , yielding a more favorable outcome towards the combined approach BACKGROUND Current literature shows that calcium sulfate can be used in guided tissue regeneration . Its biocompatibility and resorbability give it significant advantages in the treatment of periodontal and endodontic defects . Clinical ly guided tissue regeneration procedures have demonstrated significant positive clinical change , beyond that achieved with debridement alone , in treating intraosseous defects . The aim of the present investigation was to evaluate the clinical results obtained with autologous bone plus calcium sulfate , and to compare them with the results obtained using autologous bone plus membrane . METHODS A total of 12 patients were treated in the present investigation . A split-mouth design was utilized . Twelve 3-wall periodontal defects were treated with calcium sulfate plus autologous bone graft ( test ) and compared with 12 contra-lateral defects treated with a bioabsorbable membrane plus autologous bone graft ( control ) . Before the surgical procedure , patients were instructed about oral hygiene and scaling and root planing ( SRP ) was completed . Probing depth ( PD ) , clinical attachment level ( CAL ) , and bleeding on probing ( BOP ) were recorded at baseline and 6 months . RESULTS There were no statistical differences between test and control defects at baseline . BOP was 58 % and 50 % for control and test defects , respectively . Mean PD was 7.75+/-0.96 mm ( control ) and 8.0+/-1.28 mm ( test ) . Mean CAL was 8.58+/-1.31 mm ( control ) and 8.83+/-0.91 mm ( test ) . At 6 months , mean PD was 3.41+/-0.51 ( P = 0.0022 ) for control defects and 3.58+/-0.51 ( P = 0.0022 ) for test defects . CAL showed a mean gain of 5+/-0.85 for controls ( P = 0.0022 ) and 5.25+/-0.75 for test defects ( P = 0.0022 ) . Thus , there was a mean reduction of PD of 4.33 mm ( 56 % ) for control sites and 4.42 mm ( 55 % ) for test sites . The mean clinical attachment gain was 3.57 mm for control sites and 3.58 mm for test sites . As there were no sham-operated controls , it is not clear that the healing of these test or control-treated sites was any better than similar 3-walled defects sham operated . CONCLUSIONS Both therapies led to short-term improvement of the measured parameters ; neither was superior to the other The purpose was to evaluate the use of demineralized freeze-dried bone allograft reconstituted with 50 mg/ml tetracycline hydrochloride in the treatment of intrabony periodontal defects . Fifteen systemically healthy patients ( 12 females , 3 males ; aged 35 to 61 ) with moderate-advanced periodontitis were treated . Patients had 3 osseous defects with probing depths ( PD ) > 5 mm after initial therapy . Each site in each subject was r and omly assigned to one of the following groups : 1 ) demineralized freeze-dried bone allograft reconstituted with 50 mg/ml tetracycline ( DFDBA + TCN ) ; 2 ) demineralized freeze-dried bone allograft alone ( DFDBA ) ; or 3 ) debridement only ( D ) . Clinical measurements were taken the day of surgery , 6 months , and 1 year . St and ardized radiographs were taken at baseline and 1 year and were evaluated by computer assisted densitometric image analysis ( CADIA ) . Clinical measurements included gingival recession , PD , clinical attachment level , and mobility . Osseous defect measurements were taken at baseline and at the 1 year reentry . No adverse healing responses occurred . The results showed that all patients had a statistically significant improvement in probing depth and attachment level at 1 year . Osseous measurements showed bone fill of 2.27 mm ( 51.6 % ) for the DFDBA + TCN group , 2.20 mm ( 52.4 % ) for the DFDBA group , and 1.27 mm ( 32.8 % ) for the D group . Defect resolution was 77.3 % for the DFDBA + TCN group , 77.9 % for the DFDBA group , and 63.8 % for the D group . The mean CADIA values were 5.04 for the DFDBA + TCN group , 6.79 for the DFDBA group and 2.78 for the D group . The CADIA values did not correlate with the clinical parameters . Although the grafted groups showed greater bone fill and defect resolution , there was no statistically significant difference in any of the clinical parameters between the treatment groups . This study suggests that there is no significant benefit from reconstituting the allograft with 50 mg/ml of tetracycline hydrochloride THIS R AND OMIZED , CONTROLLED , CLINICAL STUDY was design ed to evaluate outcome following surgical implantation of an allogeneic , freeze-dried , demineralized bone matrix-calcium sulfate ( DBM+CS ) composite with a CS barrier in intrabony periodontal defects . Twenty-six patients contributing 26 deep intrabony defects completed the study . Thirteen patients received the DBM+CS implant . Thirteen patients received gingival flap surgery alone ( GFS ; control ) . Clinical outcome was assessed at 6 and 12 months postsurgery . At 12 months postsurgery , probing depth ( PD ) reduction ( mean + /-SD ) for the DBM+CS and GFS group was to 4.3+/-0.5 and 3.0+/-1.3 mm ; clinical attachment gain was to 2.9+/-0.8 and 1.7+/-1.5 mm ; and probing bone level gain was to 2.9+/-1.4 and 1.2+/-1.2 mm , respectively . There were no apparent differences between evaluations at 6 and 12 months postsurgery . Clinical improvements were significantly different from presurgery for both groups at both observation intervals ( P < 0.01 ) . There were no significant differences between groups in PD reduction and clinical attachment gain . Probing bone level gain was significantly greater in the DBM+CS group compared to controls ( P < 0.05 ) . In summary , surgical implantation of DBM+CS with a CS barrier result ed in reduced PD and improved attachment levels comparable to that achieved by gingival flap surgery alone . However , gain in probing bone levels in deep intrabony periodontal pockets assessed by clinical parameters was greater than that observed by gingival flap surgery alone . These changes were noted at both 6 and 12 months after surgery . This regenerative technique needs further biologic evaluation before being generally accepted The aim of the present study was to evaluate histologically in humans the healing of advanced intrabony defects following treatment with enamel matrix proteins ( EMD ) or guided tissue regeneration ( GTR ) .  Fourteen patients , each of them displaying 1 advanced intrabony defect around teeth scheduled for extraction were included in the study . The defects were treated r and omly either with an enamel matrix protein derivative ( Emdogain , BIORA AB , Malmö , Sweden ) or with a bioabsorbable membrane ( Resolut , Regenerative Material , W.L. Gore & Assoc . , Flagstaff , Arizona , USA ) . At baseline the mean probing pocket depth ( PPD ) in the EMD group was 11.3 + /- 1.8 mm and the mean clinical attachment level ( CAL ) 12.1 + /- 2.0 mm , whereas in the GTR group the mean PPD was 11.4 + /- 2.2 mm and the mean CAL 13.3 + /- 2.3 mm . Healing was uneventful in all cases . Neither allergic reactions against EMD or the bioabsorbable membrane , nor suppuration or abscesses were observed . The clinical results revealed at 6 months in the EMD group a mean PPD of 5.6 + /- 1.3 mm and a mean CAL of 9.1 + /- 1.5 mm . In the GTR group the mean PPD was 5.6 + /- 1.3 mm and the mean CAL 10.1 + /- 1.5 mm . The histological analysis showed in the EMD group a mean 2.6 + /- 1.0 mm of new attachment ( i.e. new cementum with inserting collagen fibers ) and a mean 0.9 + /- 1.0 mm of new bone . In this group , the formation of new attachment was not always followed by bone regeneration . In the GTR group , the mean new attachment was 2.4 + /- 1.0 mm and the mean new bone 2.1 + /- 1.0 mm . In every case treated with GTR , the formation of new attachment was followed by a varying amount of new bone . After both types of regenerative treatment the newly formed cementum displayed a predominantly cellular character . The findings of the present study indicate that the treatment of intrabony defects with enamel matrix proteins or with bioabsorbable membranes enhances the formation of a new connective tissue attachment in humans BACKGROUND The purpose of this study was to compare the clinical and radiographic parameters with the histometric findings following 2 different regenerative procedures in humans . METHODS Fourteen advanced intrabony defects at teeth scheduled for extraction were r and omly treated as follows : 8 with guided tissue regeneration ( GTR ) using bioabsorbable barriers and 6 with an enamel matrix protein derivative ( EMD ) .  St and ardized radiographs , probing depths ( PD ) , and attachment levels ( CAL ) at baseline and 6 months after therapy were evaluated and compared to the histometric measurements made following the removal of teeth and surrounding tissues 6 months after the surgery . RESULTS Significant PD reductions ( GTR : -5.62 mm ; EMD : -5.00 mm ) and CAL gains ( GTR : 3.87 mm ; EMD : 2.67 mm ) were observed in both groups . Six months after surgery , minor resorptions of the alveolar crest ( AC ) ( GTR : 0.40 mm ; EMD : 0.33 mm ) and bony gain at the bottom of the defects ( GTR : 0.47 mm ; EMD : 1.05 mm ) were observed radiographically . No statistically significant differences in the change of clinical and radiographic parameters between the GTR and EMD groups were found . Histometrically , significant amounts of new connective tissue attachment ( i.e. , cementum with inserting collagen fibers ) were observed in both groups ( GTR : 2.29 mm ; EMD : 1.81 mm ) . Bone regeneration was found to be significant only in the GTR group ( GTR : 1.93 mm ; EMD : 0.78 mm ) . However , the study lacked statistical power for determining equivalence between the groups . CONCLUSIONS Within the limitations of the present study , it may be concluded that at 6 months after GTR or enamel matrix protein derivative therapy , formation of new cementum and bone may be histometrically demonstrated . Except for the formation of new bone , no statistically significant differences between both therapies could be seen for clinical , radiographic , and histometric results 6 months after surgery The aim of this study was to compare the clinical regenerative capacity of collagen membrane with and without demineralized freeze-dried bone allografts ( DFDBA ) in treating periodontal intrabony defects . Ten systemically healthy patients with similar bilateral periodontal defects were scheduled for surgery . Each patient had at least > or = 6 mm clinical probing depth and loss of attachment at selected sites . Baseline measurements included gingival index ( GI ) , plaque index ( PI ) , gingival recession ( GR ) , clinical attachment level ( CAL ) , probing depth ( PD ) , and mobility . At the time of surgery , the defects were r and omly assigned to either test ( collagen membrane plus DFDBA ) or control group ( collagen membrane only ) . Stent to base of the defects , stent to crest bone , crest of bone to base of the defect , and width of the defects were recorded at the time of surgery and reentry . Eight patients returned after 6 months for reentry surgery . Statistical analysis with a paired t test was used to evaluate the treatment effect and comparison between test and control groups . In addition , a McNemar test was used to analyze the significance of GI , PI , and mobility at different times . The result of this study indicated that both the collagen plus DFDBA and the collagen alone treatment groups had a significant decrease of PD ( 3.4 + /- 0.4 and 3.2 + /- 0.4 mm ) , gain of CAL ( 2.3 + /- 0.5 and 2.0 + /- 0.4 mm ) , and defect fill ( 1.7 + /- 0.3 and 1.9 + /- 0.9 mm ) ( P < 0.05 ) when compared to the presurgery status . However , there was no significant difference in PD , AL , GR , defect fill , crestal bone resorption , GI , PI , or mobility between the test group and control group . No adverse tissue reaction , infection , or delayed wound healing was noted throughout the treatment in either group . This study suggests that the collagen membrane is well tolerated by the human tissues . Both treatments , either collagen membrane plus DFDBA or collagen membrane alone , promoted significant resolution of periodontal intrabony defects . The addition of a bone graft ( DFDBA ) with a collagen membrane appears to add no extra benefit to the collagen membrane treatment BACKGROUND Combined regenerative approaches have been used for treating advanced osseous lesions around teeth . The aim of combining treatments is to enhance both clinical predictability and regenerative outcome compared to a monotherapeutic approach . This case series from a private practice reports on the clinical efficacy of an enamel matrix derivative ( EMD ) combined with either demineralized freeze-dried bone allograft ( DFDBA ) or freeze-dried bone allograft ( FDBA ) in the treatment of advanced infrabony lesions . The advanced lesions were veneered by a rapidly formed absorbable polymer barrier of poly(DL-lactide ) to enhance graft containment . METHODS A total of 22 consecutive patients , each contributing one infrabony lesion , are reported . After patients completed presurgical preparation , the infrabony lesions were surgically treated with a combined approach that included root surface treatment with citric acid . The two groups differed in their composite graft ; one received DFDBA-EMD ( n = 10 ) and the other received FDBA-EMD ( n = 12 ) . Patients followed a stringent postoperative protocol and were evaluated 6 months postsurgery . Clinical outcomes were assessed by changes in clinical attachment level ( CAL ) and probing depth ( PD ) from pretreatment . Surgical re-entry of several sites was possible in each group . RESULTS CAL at pretreatment measured 9.2 + /- 1.3 mm and 9.1 + /- 1.9 mm for DFDBA-EMD and FDBA-EMD groups , respectively , with corresponding PD of 8.4 + /- 1.6 mm and 8.9 + /- 2.0 mm for each group . At 6 months post-treatment , CALs were reduced to 4.7 + /- 1.3 mm and 3.8 + /- 1.0 mm for DFDBA-EMD and FDBA-EMD groups , respectively ; with corresponding PD decreased to 3.0 + /- 0.8 mm and 3.2 + /- 1.0 mm . Relative improvements in CAL for the DFDBA-EMD and DFDBA-EMD groups were 49.1 % + /- 11.0 % and 57.3 % + /- 9.4 % , respectively ( P < 0.07 ) . CONCLUSIONS This case series demonstrates the clinical benefits of using a combined therapeutic approach in which a biologic mediator ( EMD ) was combined with either DFDBA or FDBA . In this limited case series , a trend was observed towards greater improvement in clinical attachment level gain in advanced  infrabony defects when EMD was combined with FDBA as compared to DFDBA . Larger prospect i ve controlled clinical trials are needed to determine if differences exist in the relative efficacy of DFDBA versus FDBA in combination with EMD BACKGROUND Demineralized bone matrix ( DBX ) paste and putty are particulate demineralized bone matrices in a 2 % or 4 % hyaluronate carrier , respectively . The purpose of this study was to determine the effectiveness of DBX paste and putty compared to demineralized freeze-dried bone allograft ( DFDBA ) in the treatment of human intraosseous periodontal defects . METHODS Sixty systemically healthy individuals between the ages of 31 and 71 years with at least one intraosseous periodontal defect of > or = 3 mm in depth and radiographic evidence of at least 40 % to 50 % vertical bone loss were accrued . Following initial non-surgical periodontal therapy , sites were r and omly selected to receive either DBX paste , DBX putty , or DFDBA ( control ) . Baseline and 6-month reentry soft and hard tissue parameter measurements were made by calibrated examiners . Data were analyzed within and between groups utilizing analysis of variance ( ANOVA ) and paired and unpaired Student t tests . RESULTS Probing depth reductions were significantly improved in all treatment groups with DFDBA , DBX paste , and putty patients demonstrating 2.8 mm , 3.6 mm , and 2.3 mm , respectively . Attachment level gains were significantly improved from baseline for all treatment groups with DFDBA , DBX paste , and putty , respectively , demonstrating 2.4 mm , 2.9 mm , and 1.6 mm . Bone fill was similar between all groups with DBX paste , putty , and DFDBA control groups demonstrating 2.0 mm , 2.4 mm , and 2.2 mm , respectively . All groups yielded significant improvements in percent bone fill with DFDBA , DBX paste and putty , respectively , achieving 37 % , 42.1 % , and 50 % with no significant differences between the groups . CONCLUSION In summary , demineralized bone matrix paste , demineralized bone matrix putty , and demineralized freeze-dried bone allograft all demonstrated similar favorable improvements in soft and hard tissue parameters in the treatment of human intraosseous defects BACKGROUND The regenerative therapy of non-contained intrabony defects achieves better results when bioabsorbable membranes are combined with a filling material . The purpose of the present study was to analyze clinical and radiographic effectiveness of a space-making bioabsorbable membrane in the treatment of wide and shallow intrabony defects characterized by a relevant 1-wall component . METHODS Eighteen pairs of angular bone defects were selected in 18 healthy , non-smoking patients ( age range 30 to 66 years ) . Prior to the surgical phase , patients were enrolled in a strict periodontal program including oral hygiene instructions and scaling and root planing ( presurgical full-mouth plaque score < 10 % ) . Using a split-mouth design , 18 sites were r and omly assigned to receive guided tissue regeneration ( GTR ) using a bioabsorbable membrane ( test group ) and 18 to receive open flap debridement alone ( control group ) . Clinical treatment outcome was evaluated 12 months postoperatively for changes in probing depth ( PD ) , clinical attachment level ( CAL ) , and position of gingival margin ( REC ) and radiographically for bone changes . RESULTS Open flap debridement and GTR yielded statistically significant ( P<0.0001 ) PD reduction ( 2.39+/- 0.92 mm and 3.44+/- 0.78 mm ) , CAL gain ( 1.50+/- 0.99 mm and 2.89 + /- 0.90 mm ) , increased REC ( -0.89 + /- 0.58 mm and -0.56 + /- 0.92 mm ) and bone fill ( 1.05+/- 0.94 mm and 2.13+/- 1.21 mm ) when 12-month data were compared to baseline . The differences between test and control groups were statistically significant for all parameters ( P<0.007 ) except for REC ( P=0.25 ) . CONCLUSION The use of this bioabsorbable membrane would seem to be effective in the treatment of intrabony defects with unfavorable architecture without the use of filling material BACKGROUND Medical- grade calcium sulfate ( CS ) is a biocompatible , bioabsorbable , and clinical ly versatile ceramic for use in bone repair . This study compared the clinical efficacy of a combination of calcium sulfate dihydrate , as a binder and barrier , and demineralized freeze-dried bone allograft ( DFDBA ) to polytetrafluoroethylene ( ePTFE ) and DFDBA for the treatment of human periodontal defects . METHODS Two intrabony defects were compared in each of 19 patients with chronic periodontitis . After initial preparation , full-thickness mucoperiosteal flaps were elevated , osseous defects debrided , and the roots prepared ( ultrasonic , h and curets , and tetracycline conditioning ) . Defects were r and omly treated with either a combination graft of DFDBA with CS ( 4:1 ) covered by a CS barrier or with DFDBA and fitted with an ePTFE barrier . Flaps were coronally positioned to obtain primary closure . Clinical soft tissue measurements were recorded at 6 months , and all study sites were surgically reentered for evaluation . RESULTS The mean presurgical measurements for defects r and omized to the CS and ePTFE treatments , respectively , were similar for attachment level ( AL ; 6.2 + /- 1.8 mm and 6.1 + /- 1.7 mm ) , probing depth ( PD ; 6.3 + /- 1.1 mm and 6.2 + /- 1.1 mm ) , and gingival recession ( 0.1 + /- 1.9 mm and 0.2 + /- 1.4 mm ) . Defects treated with CS or ePTFE demonstrated statistically significant ( P < or = 0.0001 ) reductions in mean PD ( 2.7 + /- 1.4 mm and 3.4 + /- 1.3 mm , respectively ) and gains in mean AL ( 1.8 + /- 1.5 mm and 1.7 + /- 1.4 mm , respectively ) . Recession increased by 0.8 + /- 1.4 mm at CS sites and 1.6 + /- 1.7 mm at ePTFE-treated sites ( P < or = 0.05 ) . Pretreatment mean defect depths were 4.1 + /- 1.0 mm and 3.7 + /- 1.0 mm for CS and ePTFE sites , respectively . Reentry evaluations revealed a mean defect fill of 2.7 + /- 1.5 mm and 2.5 + /- 0.9 mm for the CS and ePTFE sites , respectively , with a corresponding mean defect resolution of 80.3 + /- 18.7 % and 76.7 + /- 18.5 % . The CS and ePTFE sites did not differ significantly in mean defect fill or defect resolution . CONCLUSIONS The results of this study indicate that calcium sulfate , when used as a binder and barrier in combination with DFDBA , supports significant clinical improvement in intrabony defects , as evidence d by reductions in probing depth , gains in clinical attachment level , and defect fill and resolution .  Calcium sulfate represents an important alternative to non-resorbable ePTFE barriers in combination with DFDBA for the treatment of intrabony defects Abstract s on this page have been chosen and edited by Dr Trevor Watts Abstract Results were similar for both methods of regenerative periodontal treatment . BACKGROUND A recent study suggests that the addition of enamel matrix derivative to demineralized freeze-dried bone allograft may enhance osseoinduction . The purpose of this study was to evaluate the use of demineralized freeze-dried bone allograft ( DFDBA ) in combination with enamel matrix derivative ( EMD + DFDBA ) compared to enamel matrix derivative ( EMD ) alone in the treatment of human intrabony periodontal defects . METHODS Forty patients with a total of 67 sites ( intrabony defect > or = 3 mm deep ) were selected to participate in this single-masked , parallel design , r and omized , controlled clinical trial . Each subject received either EMD alone ( 34 sites ) or in combination with DFDBA ( 33 sites ) . Soft tissue measurements included probing depth ( PD ) , clinical attachment level ( CAL ) , and recession . Hard tissue measurements included defect depth , alveolar crestal resorption , and defect morphology . Following 6 months of healing , all soft tissue measurements were repeated . Forty-nine sites ( EMD + DFDBA = 26 sites , EMD alone = 23 sites ) were surgically reentered . Statistical analyses were performed using unpaired and paired Student t tests . RESULTS Analyses showed a significant improvement in soft tissue parameters for both treatment groups ( P < 0.001 ) as compared to preoperative measurements . There were no statistical differences between treatment groups . The probing depth reduction ( PDR ) for the EMD + DFDBA was 3.6 + /- 0.2 mm , while the EMD alone had a PDR of 4.0 + /- 0.3 mm . The CAL gain for the EMD + DFDBA group was 3.0 + /- 0.3 mm and 3.2 + /- 0.3 mm for the EMD alone group . The mean value for bone fill in the EMD + DFDBA group was 3.7 + /- 0.2 mm ( 74.9 % ) , while the EMD alone group demonstrated a mean bone fill of 2.6 + /- 0.4 mm ( 55.3 % ) . While there were no significant differences between the two treatments with regards to soft tissue measurements , the combination of EMD + DFDBA therapy yielded statistically significant improvements in bone fill , crestal resorption , and percentage of sites gaining greater than 50 % and 90 % bone fill when compared to EMD alone ( P < 0.001 ) . CONCLUSION The results of this study indicate that there may be an enhancement of hard tissue parameters when enamel matrix derivative is added to demineralized freeze-dried bone allograft AIM This prospect i ve multicentre r and omized controlled clinical trial was design ed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix proteins ( EMD ) . MATERIAL AND METHODS 172 patients with advanced chronic periodontitis were recruited in 12 centers in 7 countries . All patients had at least one intrabony defect of > or = 3 mm . Heavy smokers ( > or = 20 cigarettes/day ) were excluded . The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure . After debridement , roots were conditioned for 2 min with a gel containing 24 % EDTA . EMD was applied in the test subjects , and omitted in the controls . Postsurgically , a strict plaque control protocol was followed . At baseline and 1 year following the interventions , clinical attachment levels ( CAL ) , pocket probing depths ( PPD ) , recession ( REC ) , full-mouth plaque scores and full-mouth bleeding scores were assessed . A total of 166 patients were available for the 1-year follow-up . RESULTS At baseline , 86 test and 86 control patients presented with similar subject and defect characteristics . On average , the test defects gained 3.1+/-1.5 mm of CAL , while the control defects yielded a significantly lower CAL gain of 2.5+/-1.5 mm . Pocket reduction was also significantly higher in the test group ( 3.9+/-1.7 mm ) when compared to the controls ( 3.3+/-1.7 mm ) . A multivariate analysis indicated that the treatment , the clinical centers , cigarette smoking , baseline PPD , and defect corticalisation significantly influenced CAL gains . A frequency distribution analysis of the studied outcomes indicated that EMD increased the predictability of clinical ly significant results ( CAL gains > or = 4 mm ) and decreased the probability of obtaining negligible or no gains in CAL ( CAL gains < 2 mm ) . CONCLUSIONS The results of this trial indicated that regenerative periodontal surgery with EMD offers an additional benefit in terms of CAL gains , PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone This study clinical ly evaluates the use of decalcified freeze-dried bone allograft ( DFDBA ) in conjunction with an exp and ed polytetrafluoroethylene ( ePTFE ) membrane specifically design ed for the treatment of interproximal intraosseous defects . It also examines by SEM , plaque contaminated membranes retrieved from patients . 15 advanced periodontitis patients with two bilateral interproximal probing depths of > or = 6 mm participated . After hygiene phase , measurements were made to determined soft tissue recession , pocket depth , clinical attachment levels and amount of keratinized tissue . Defects from each pair were r and omly treated with ePTFE plus DFDBA ( experimental ) or DFDBA alone ( control ) . Measurements were made during the surgery to determine crestal resorption , defect resolution and defect fill . Membranes were removed at 4 to 6 weeks and analyzed by SEM . Each site was surgically reentered and measurements repeated at six months . Both groups showed clinical and statistically significant changes when compared to baseline ( P < 0.01 ) , but no difference between groups . The experimental group showed increased soft tissue recession vs control group , 0.9 versus 0.4 mm , and loss of keratinized tissue 1.6 versus 0.1 mm ( P < 0.0001 ) . Control sites showed a 58 % bone fill while experimental sites had 70 % bone fill . There were no clear patterns of microbial colonization or cell adherences in either side of the membrane . It was concluded that the presence of plaque on the membranes did not compromise the initial clinical healing during the first 4 - 6 weeks . Results suggest a beneficial effect with the use of either technique for the treatment of intraosseous defects Identification and control of significant factors determining clinical outcomes is of paramount importance to improve expected results of a variety of therapeutic procedures . The aim of this investigation was to identify , with a multivariate approach , factors associated with healing outcomes of 3 periodontal surgical procedures in deep intrabony defects . 45 patients with evidence of deep intrabony defects were r and omly assigned to 3 treatment groups : access flap ( group C ) , conventional guided tissue regeneration ( GTR ) with non-resorbable exp and ed polytetrafluoroethilene ( ePTFE ) membranes ( group B ) , and GTR with self supporting membranes combined with the modified papilla preservation technique ( group A ) . In both GTR procedures , membranes were positioned coronal to the interproxymal alveolar crest . Primary outcome variables ( i.e. , probing attachment level gains at 1 year and the amount of newly formed tissue present at membrane removal ) were explained in terms of a series of patient , defect morphology and surgical factors , using a multivariate approach . Highly significant treatment effects were observed , indicating that the 3 tested therapeutic modalities result ed in significant differences in primary outcome variables . Detailed analysis assessing the significance of the tested factors in determining the healing outcomes following each procedure was performed with a stepwise elimination approach of non-significant factors . The results indicated that : ( i ) the need to create and maintain space should be a key objective of regenerative approaches based upon the principles of guided tissue regeneration ; ( ii ) control of patient 's oral hygiene and residual periodontal infection in the oral cavity are strongly associated with clinical outcomes of both regenerative and conventional surgical procedures and should receive proper attention The purpose of this prospect i ve multi-center study was to evaluate a resorbable barrier membrane design ed for periodontal regeneration . Thirty-one Class II furcations and 30 two- and three-wall intrabony defects were treated by flap debridement and bioabsorbable barrier membrane augmentation . The efficacy of treatment was evaluated in terms of changes in vertical probing depth ( PD ) , horizontal probing depth ( HPD ) , clinical attachment levels ( CAL ) , and recession .  Five centers participated in the study . Changes in clinical parameters are reported by individual center and by the average of the centers . All patients had either one molar with a Class II furcation or an intrabony defect . Baseline data were taken on the day of surgery . Post-treatment data were collected at 6 months and 1 year . This report is based on the 1-year findings . The average initial PD for Class II furcations was 6.1 mm . At 1 year the average PD was reduced to 3.6 mm , a 2.5 mm change . These differences were clinical ly and statistically significant ( P < 0.0001 ) . There was an average gain of 2.1 mm of clinical attachment ( P < 0.0001 ) and 0.4 mm of recession ( P < 0.04 ) . There was a mean of 1.8 mm change in HPD ( P < 0.0001 ) . For intrabony defects , at 1 year there was an average PD reduction of 4.1 mm ( P < 0.0001 ) and a mean gain of CAL of 2.9 mm ( P < 0.0001 ) . At 1 year the average recession was 0.9 mm which was statistically significant . When treatment outcomes were compared between centers there were no differences for either group of treated defects . There were differences between centers when baseline PD for furcations and intrabony sites were compared . The results of this study indicate that clinical ly and statistically significant improvements in PD , CAL , and HPD occurred after treatment of Class II furcations and 2- to 3-wall intrabony defects with the bioabsorbable periodontal membrane The purpose of this controlled clinical trial was to compare the clinical efficacy of 3 treatment modalities in the treatment of deep interproximal intrabony defects . Forty-five ( 45 ) defects in 45 patients were r and omly assigned to 1 of 3 treatment groups by blocking to prognostic variables . The test group was treated with titanium reinforced membranes positioned just apical to the cemento-enamel junction and the modified papilla preservation technique ; the second group received conventional exp and ed polytetrafluoroethylene ( ePTFE ) barrier membranes applied at the alveolar crest ; the third group was treated with an access flap procedure . The groups were well balanced with respect to all prognostic variables . During the 1-year observation period , patients were subjected to a stringent infection control program including : professional tooth cleaning every week for the first 6 weeks ( all groups ) and in the 4 weeks following membrane removal ( guided tissue regeneration groups ) , then at monthly intervals ( all groups ) . The results indicated that : 1 ) all treatment modalities result ed in clinical and statistically significant improvements in clinical attachment level ( CAL ) and probing depths ( PD ) at 1 year ; 2 ) a significantly greater amount of CAL gain ( P = 0.0003 , analysis of variance ) was observed in the test group ( 5.3 + /- 2.2 mm ) with respect to both the ePTFE group ( 4.1 + /- 1.8 mm ) and the flap control group 2.5 + /- 0.8 ; 3 ) in the test group the 1 year CAL ( 4.7 + /- 1.8 mm ) was located more coronally than the baseline position of the interproximal alveolar crest ( 5.9 + /- 2 mm ; P = 0.003 , t test ) . ( ABSTRACT TRUNCATED AT 250 WORDS The aim of the study was to evaluate the clinical , radiographical and microbiological outcome after using guided tissue regeneration ( GTR ) with a bioabsorbable membrane , Resolut . Subjects with bilateral infrabony defects at single rooted teeth were selected . A total of 22 teeth , 2 in each 1 of 7 patients and 4 in 2 patients , with probing pocket depth > or = 5 mm , 3 months after scaling , participated . At baseline , assessment s of plaque and gingival indices , bleeding on probing , probing pocket depth and probing attachment level were recorded and reproducible radiographs for computer-based bone level measurements were taken . Bacterial sample s were collected to investigate the presence of periodontitis-associated bacteria , e.g. , Porphyromonas/Prevotella- and Fusobactrium-like micro-organisms . One tooth was r and omly treated with GTR and the contralateral with an open debridement procedure as a control . Clinical , radiographical and microbiological examinations were repeated 6 and 12 months postoperatively . Both procedures demonstrated a statistically significant improvement of gingival conditions , reduction of pocket depths and gain of attachment . When evaluating the differences between test and control teeth , none of the clinical parameters yielded statistical difference . Computer-based bone-level measurements showed only small differences in the majority of both test and control sites . The differences were not significant . Periodontitis-associated bacteria were present at baseline , but the appearance was not related to any specific site or patient and did not demonstrate any unwanted change in the 6- and 12-month sample s. The findings suggest that the clinical , radiographical and microbiological improvements were not significantly enhanced with the GTR therapy This study clinical ly evaluated a bioabsorbable barrier membrane design ed for periodontal regeneration . Ten Class II furcations and 12 interproximal infrabony defects were treated by flap debridement and placement of a bioabsorbable barrier membrane using the principles of guided tissue regeneration . Treatment was evaluated in terms of changes in vertical probing depth , horizontal attachment level , clinical attachment level , and recession . Baseline data were collected on the day of surgery , and outcome measurements were performed at the 1-year appointment . The mean initial probing depth for Class II furcations was 6.5 mm . At 1 year , the mean probing depth was reduced to 2.9 mm , a 3.6 mm change . These differences were clinical ly and statistically significant ( P < 0.01 ) . There was a mean gain of 2.4 mm in clinical attachment level ( P < 0.01 ) and a mean 3.4-mm change in horizontal attachment level ( P < 0.01 ) . Recession increased 1.2 mm . For interproximal infrabony defects , there was a mean probing depth reduction of 5.0 mm ( P < 0.01 ) , a mean gain of clinical attachment level of 3.8 mm ( P < 0.02 ) , and a mean increase of 1.2 mm in recession ( P < 0.04 ) . The results indicate that significant improvements occurred after treatment of Class II furcations and interproximal infrabony defects with the use of a bioabsorbable barrier membrane and guided tissue regeneration BACKGROUND A growing flow of recent evidence indicates enamel matrix derivative ( EMD , Emdogain ) as a useful tool for the regeneration of periodontal tissues . This prospect i ve clinical study aim ed to evaluate the efficacy of EMD combined with surgical treatment of periodontal intra-bony defects , as compared with surgery alone , up to 24 months of follow-up . METHODS Twenty-four intra-bony defects were treated in 24 patients in a single clinical centre . Each defect had intra-bony depth ( IBD ) > or = 4 mm and probing pocket depth ( PPD ) > or = 6 mm . Patients were r and omly assigned to either test or control group . Plaque index ( PI ) , gingival index ( GI ) , PPD and periodontal attachment level ( PAL ) were assessed at baseline pre-surgical examination at the site to be treated . Full mouth plaque score ( FMPS ) and full mouth bleeding score ( FMBS ) were also evaluated . Twelve patients were treated by simplified papilla preservation flap technique ( control group ) , while 12 patients were treated with the same surgical technique plus EMD after ethylenediamine tetraacetic acid root conditioning ( test group ) . Any probing at the involved sites was avoided in the first year post-surgery . Radiographs were taken at baseline , 12 and 24 months after surgery using customized bite blocks . Intra-bony defect depth ( IBD ) and angle ( IBA ) were measured from X-rays by a computer-aided technique . At 12 and 24 months post-surgery , FMPS , FMBS , PI , GI , PPD , PAL and radiographic IBD and IBA were assessed . The difference between each follow-up and baseline , and between groups at each follow-up was evaluated for the above parameters by st and ard statistical methods . RESULTS In both groups , clinical and radiographic parameters were improved at either 12 or 24 months when compared with baseline . The test group displayed better outcomes when compared with the control group for IBD , PPD , and PAL gain at 12 months , and only for PAL and IBD gain at 24 months . No adverse event related to the use of EMD was reported . CONCLUSIONS The surgical procedure used in the present study , aim ing for maximum preservation of the regenerative potential of periodontal tissues , showed per se excellent results . The use of EMD as an adjunct to periodontal surgery in the treatment of angular defects possibly enhances periodontal regeneration rate UNLABELLED In the present prospect i ve clinical trial , the effect of various regenerative procedures performed at sites with angular bone defects were evaluated . The main outcome variable was probing attachment alteration . MATERIAL AND METHODS 40 subjects , aged 32 - 61 years participated . They met the following inclusion criteria : ( i ) presence of generalized , advanced periodontal tissue destruction ; ( ii ) presence of 2 similar , contralateral , angular bone defects ( experimental sites ) located in either the maxilla or the m and ible ; ( iii ) the defect site must exhibit a probing pocket depth ( PPD ) of > or = 6 mm , a probing attachment level ( PAL ) of > or = 7 mm , and a depth of the intrabony component of > or = 3 mm . All subjects had a good oral hygiene st and ard , were in good general health and did not use any medication . Prior to the start of the study , all subjects received non-surgical treatment for periodontal disease .  Baseline clinical measurements ( plaque , gingivitis , PPD , PAL and soft tissue recession ) of the selected experimental sites were obtained 6 months after the completion of basic therapy . The 40 subjects were r and omly divided into 4 treatment groups including 10 subjects each : 3 membrane groups and one Emdogain group . 1 h before surgery , the patients were given 3 g of Amoxicillin . No other antibiotics were prescribed . The test and control sites were treated during the same surgical session . Full thickness flaps were elevated and the exposed root surfaces were planed . Membrane placement : The root surface was rinsed with saline . A barrier membrane ( Guidor or Resolut or Periodontal ( e-PTFE ) material ) was positioned to cover the defect and the adjacent 2 - 3 mm of bone tissue . The control treatment was identical to the test treatment with the exception of barrier placement . Emdogain placement : The exposed root surfaces at both the test and control sites were , during a 2-min period , conditioned with a 24 % EDTA gel . Emdogain was applied to the exposed root surface of the test site . In the control site , the vehicle , the PGA gel , was used as placebo control . The flaps were closed and sutured to obtain a complete coverage of the intrabony defect . RESULTS Re-examinations , which were performed 12 months after surgery , disclosed that regenerative therapy , including either the use of barrier membranes or application of enamel matrix proteins to an instrumented root surface in an angular , intrabony defect , enhanced outcome variables such as probing pocket depth and probing attachment gain . It was furthermore demonstrated that clinical improvements were better at sites with deep , than at sites with shallow , intrabony defects . CONCLUSION The 4 regenerative modalities tested appeared to be equally effective in terms of PPD reduction and PAL gain , and superior to open flap curettage alone The purpose of this study was to compare the clinical results of guided periodontal tissue regeneration ( GPTR ) using a resorbable barrier manufactured from a copolymer of polylactic and polyglycolic acids ( Resolut Regenerative Material ) with those of non-resorbable e-PTFE barrier ( Gore-Tex Periodontal Material ) .  12 subjects participated , 6 with similarly paired class II furcations and 6 with 2 similar 2 , 3-wall periodontal lesions . The resorbable and non-resorbable barriers were r and omly assigned to 1 defect in each subject . Non-resorbable barriers were removed in six weeks . Plaque index ( PlI ) , gingival index ( GI ) , probing depth ( PD ) , clinical attachment level ( CAL ) and gingival recession ( R ) were recorded at baseline , ( i.e. , immediately prior to surgery ) and at 12 months postsurgically . The clinical healing was similar and uneventful in both groups . Intrabony pockets depicted significant changes from baseline ( p < 0.05 ) for probing depth reduction and gain in clinical attachment levels . No differences were found between treatments . Class II furcations showed significant improvements from baseline ( p < or = 0.05 ) for probing depth reduction and clinical attachment gain . No differences were detected between treatments . It is concluded that the resorbable barrier tested is as effective as the nonresorbable e-PTFE barrier for the treatment of class II furcations and intrabony defects AIM The purpose of the present study was to compare clinical ly the treatment of deep intra-bony defects with a combination of a composite bovine-derived xenograft ( BDX Coll ) and a bioresorbable collagen membrane [ guided tissue regeneration ( GTR ) ] to access flap surgery only . METHODS Thirty-two patients , each of whom displayed one intra-bony defect , were treated either with BDX Coll+GTR ( test ) or with access flap surgery ( control ) . The results were evaluated at 1 year following therapy . RESULTS No differences in any of the investigated parameters were observed at baseline between the two groups . Healing was uneventful in all patients . At 1 year after therapy , the test group showed a reduction in the mean probing depth ( PD ) from 8.3+/-1.5 to 2.9+/-1.3 mm ( p<0.001 ) and a change in the mean clinical attachment level ( CAL ) from 9.4+/-1.3 to 5.3+/-1.5 mm ( p<0.0001 ) . In the control group , the mean PD was reduced from 8.0+/-1.2 to 4.4+/-1.7 mm ( p<0.001 ) and the mean CAL changed from 9.6+/-1.3 to 7.9+/-1.6 mm ( p<0.01 ) . The test treatment result ed in statistically higher PD reductions ( p < or = 0.05 ) and CAL gains ( p<0.001 ) than the control one . In the test group , all sites ( 100 % ) gained at least 3 mm of CAL . In this group , a CAL gain of 3 or 4 mm was measured at 10 sites ( 62 % ) , whereas at six sites ( 38 % ) , the CAL gain was 5 or 6 mm . In the control group , no CAL gain occurred at three sites ( 19 % ) , whereas at 10 sites ( 62 % ) , the CAL gain was only 1 or 2 mm . A CAL gain of 3 mm was measured in three defects ( 19 % ) . CONCLUSIONS Within the limits of the present study , it can be concluded that the combination of BDX Coll+GTR result ed in significantly higher CAL gains than treatment with access flap surgery alone , and thus appears to be a suitable alternative for treating intra-bony periodontal defects Abstract s on this page have been chosen and edited by Dr Trevor Watts AIM Comparison of two bioabsorbable barriers ( collagen and polylactic acid ( PLA ) membranes ) combined with a bovine bone mineral ( BBM ) graft , with an access flap procedure ( AFP ) alone for treating intrabony defects . MATERIAL AND METHODS Thirty-four subjects participated in this prospect i ve , controlled clinical trial . Baseline clinical examination ( probing depth ( PD ) , clinical attachment level ( CAL ) ) of selected sites was performed 2 months after completion of conservative treatment in conjunction with hard-tissue measurements to ascertain the depth of the defect ( cementoenamel junction to the bottom of the defects ) . After r and omly dividing patients into three groups ( two membrane groups , one control group ) , full thickness flaps were elevated and exposed root surfaces planed before filling defects with bone graft and positioning a barrier membrane covering the defect . The control group was treated identically except for the barrier and bone graft placement . Clinical treatment outcomes were finally evaluated 12 months after surgery for changes of PD and CAL . Radiographs at baseline and 12 months were compared using non-st and ardized digital radiography . RESULTS A mean reduction in PD value of 5.08 mm and mean CAL gain of 4.39 mm occurred in the collagen-BBM group . Corresponding values for the PLA-BBM group were 4.72 and 3.71 mm , while access flap procedure ( AFP ) sites produced values of 2.50 and 2.43 mm . All improvements in clinical parameters were statistically significant ( p<0.001 ) within groups for all variables . Both membranes produced statistically greater PD reduction and CAL gain compared with AFP treatment ( p<0.05 ) . Comparison between barrier groups failed to reveal any statistically significant difference in probing pocket depth reduction ( p=0.56 ) or in CAL gain ( p=0.34 ) . CONCLUSION Placement of the two barrier membranes used in the present study in combination with BBM graft significantly improved clinical and radiographic parameters of deep intrabony pockets and proved superior to access flap alone
target: In most respects , all membranes and enamel matrix derivative ( EMD ) delivered better outcomes , in the range of 1 to 2 mm , than open flap debridement .
  The use of any barrier type or EMD configuration was found to yield more Clinical Attachment Level ( CAL ) gain than any open flap configuration .
  GTR was confirmed to be superior to open flap debridement
background: In a 1998 review article , Laurell and colleagues performed a meta- analysis of relevant guided tissue regeneration ( GTR ) articles over the previous 20 years ( 1 ) .
  The purpose of the present research was to exp and on that work , particularly search ing for trends discriminating between bioabsorbable and non-bioabsorbable barriers , as well as the use of enamel matrix derivative , with respect to interproximal bony defects .