A clinical comparison of a bovine-derived xenograft used alone and in combination with enamel matrix derivative for the treatment of periodontal osseous defects in humans

Background: Enamel matrix protein derivative (EMD) and particulate anorganic cancellous bovine-derived bone xenograft (BDX) have both shown favorable clinical results in reducing intrabony periodontal defects as compared to open flap debridement alone. These materials have shown results comparable to those obtained with guided tissue regeneration, The primary aim of the present study was to evaluate the effectiveness of EMD combined with BDX as compared to BDX alone, with a secondary aim to compare the treatment outcomes of the 2 modalities. Methods: Seventeen patients with paired intrabony defects and probing depths measuring greater than or equal to5 mm who were being treated for chronic periodontitis were selected for this controlled, blinded, split-mouth study. Following non-surgical periodontal therapy, sites were randomly selected to receive either a combination of EMD and BDX (test group) or BDX alone (positive control group). Baseline and 6-month surgical reentry measurements were taken by a calibrated examiner blinded to the treatment. A paired Student t test was utilized to evaluate differences between baseline and post-treatment and between the treatment groups. Results: Favorable clinical outcomes for both hard and soft tissue measurements were achieved for both treatment groups when compared to baseline (P <0.001). There was no statistically significant difference for any of the measured clinical parameters. Probing depth reduction for the test group and control group was 4.2 +/- 1.1 mm and 3.9 +/- 1.3 mm, respectively (P >0.8). Mean gain in clinical attachment levels for the test and control groups was 3.8 +/- 0.9 mm and 3.7 +/- 1.5 mm, respectively (P >0.6). Hard tissue measurements obtained at surgical reentry were used to calculate the bone fill (BF) and percent bone fill (%BF). The BF was 3.2 +/- 1.4 mm and 3.0 +/- 1.2 mm (P >0.6), and the %BF was 63.3 +/- 16.3% and 67.0 +/- 19.0% (P >0.4) for the EMD + BDX and BDX groups, respectively. Conclusions: In summary, both the particulate anorganic cancellous bovine-derived bone xenograft used alone and in combination with enamel matrix derivative are effective for the treatment of human intrabony periodontal lesions.