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Effect of Flap Design for Enamel Matrix Derivative Application in Intraosseous Defects
L Trombelli1,2, A Simonelli1, A Quaranta3
1Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy.
JDR Clinical and Translational Research
|June 20, 2020
Summary
Single-flap variants (SFVs) optimize enamel matrix derivative (EMD) regenerative outcomes for periodontal intraosseous defects. Combining EMD with grafts yields substantial results with SFVs and conservative double flaps, but papilla preservation variants show higher probing depths.
Area of Science:
- Periodontology
- Regenerative Dentistry
- Oral Surgery
Background:
- Periodontal intraosseous defects pose significant clinical challenges.
- Enamel matrix derivative (EMD) is a biologic agent used in periodontal regeneration.
- Optimizing surgical and nonsurgical approaches with EMD is crucial for treatment success.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of different procedures combined with EMD for intraosseous defects.
- To establish a hierarchy of surgical and nonsurgical applications of EMD for periodontal regeneration.
- To compare outcomes for EMD alone versus EMD combined with graft materials.
Main Methods:
- Systematic literature search of Medline, Scopus, and Cochrane databases.
- Network meta-analysis of 42 selected studies on EMD application in various flap designs (modified Widman, PPVs, minimally invasive, SFVs) and nonsurgical approaches.
- Evaluation of clinical, radiographic, and patient-centered outcomes at 6-12 months.
Main Results:
- Single-flap variants (SFVs) demonstrated the best regenerative outcomes with EMD alone (3.93 mm CAL gain, 3.35 mm intrabony defect reduction).
- For EMD + graft, regenerative outcomes showed limited differences among surgical procedures.
- Papilla preservation variants (PPVs) were associated with the highest residual probing depths for both EMD and EMD + graft.
Conclusions:
- Single-flap variants (SFVs) appear to optimize regenerative outcomes when using EMD for periodontal intraosseous defects.
- Combining EMD with grafts provides substantial regenerative outcomes with SFVs and conservative double flaps (PPVs, minimally invasive variants).
- Clinicians can utilize these findings to select the most effective EMD-based treatment for intraosseous defects.
