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Clinical, Radiographic and Patient-Centred Outcomes of MINST Versus MIST With Enamel Matrix Derivative in Class II
Georgios S Chatzopoulos1, Eleftherios G Kaklamanos1,2,3, Ioannis Vouros1
1Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Minimally invasive non-surgical therapy (MINST) with enamel matrix derivative (EMD) demonstrated comparable clinical and radiographic outcomes to minimally invasive surgical technique (MIST) for mandibular furcation defects. MINST showed improved short-term patient-reported outcomes during early healing.
Area of Science:
- Periodontal regenerative therapy
- Minimally invasive dental procedures
- Enamel matrix derivative application
Background:
- Mandibular Class II furcation defects present complex treatment challenges.
- Minimally invasive surgical techniques (MIST) aim to reduce surgical trauma.
- Enamel matrix derivative (EMD) is used to promote periodontal regeneration.
Purpose of the Study:
- To compare the non-inferiority of minimally invasive non-surgical therapy (MINST) with EMD against MIST + EMD in treating mandibular Grade II furcation defects.
- To assess clinical and radiographic outcomes, including probing pocket depth (PPD), clinical attachment level (CAL), and bone loss/gain.
- To evaluate patient-reported outcome measures (PROMs) for both treatment modalities.
Main Methods:
- A randomized controlled trial (RCT) adhering to CONSORT guidelines was conducted with 40 patients.
- Patients were randomized to either MINST (n=20) or MIST (n=20) with EMD application.
- Clinical parameters (PPD, CAL, gingival recession) and radiographic bone levels (CBCT) were assessed at baseline and 9 months. PROMs (VAS, OHIP-14) were collected longitudinally.
Main Results:
- MINST was found to be non-inferior to MIST for the primary outcome of PPD reduction at 9 months (p=0.025).
- Statistical non-inferiority was achieved for gingival recession and vertical bone gain against a 1.0 mm margin.
- Non-inferiority was not formally established for CAL or horizontal bone gain. MINST showed significantly better short-term PROMs (2 weeks) for root hypersensitivity and quality of life.
Conclusions:
- MINST with EMD offers generally comparable clinical and radiographic outcomes to MIST for mandibular Class II furcation defects.
- While non-inferiority was met for PPD, gingival recession, and vertical bone gain, it was not confirmed for CAL or horizontal bone gain.
- MINST provided superior short-term patient-reported benefits during the initial healing period.
