Volume 3 • Issue 4. 1000185 J Interdiscipl Med Dent Sci ISSN: 2376-032X JIMDS, an open access journal Research Article Open Access Fernandes et al., J Interdiscipl Med Dent Sci 2015, 3:4 DOI: 10.4172/2376-032X.1000185 Research Article Open Access JBR Journal of Interdisciplinary Medicine and Dental Science *Corresponding author: Márcio Fernando de Moraes Grisi, Associate Professor, Department of Oral Surgery and Periodontology, Ribeirão Preto School of Dentistry, University of São Paulo, Avenida do Café - s/n, 14040-904, Ribeirão Preto, SP, Brazil, Tel: +55-16-602-3981; Fax: +55-16-3602-4788; E-mail: mgrisi@forp.usp.br Received: July 20, 2015; Accepted: Aujgust 13, 2015; Published: Aujgust 18, 2015 Citation: Fernandes PG, Zotarelli Filho IJ, Apolinário Vieira GH, Novaes Jr AB, Scombatti de Souza SL, et al. (2015) Periodontal Intrabony Defects and the Treatment with Enamel Matrix Derivative and a Synthetic Bone Substitute in Humans: A Clinical and Radiographic Case Series. J Interdiscipl Med Dent Sci 3: 185. doi: 10.4172/2376-032X.1000185 Copyright: © 2015 Fernandes PG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Periodontal Intrabony Defects and the Treatment with Enamel Matrix Derivative and a Synthetic Bone Substitute in Humans: A Clinical and Radiographic Case Series Patricia Garani Fernandes 1,2 , Idiberto José Zotarelli Filho 3 , Gustavo Henrique Apolinário Vieira 1 , Arthur B. Novaes Jr 1 , Sergio Luís Scombatti de Souza 4 , Mario Taba Jr 4 , Daniela Bazan Palioto 4 and Márcio Fernando de Moraes Grisi 4 * 1 Department of Periodontology, University of São Paulo, Brazil 2 Unorp - University Center North Paulista, São José do Rio Preto, Brazil 3 Unipos - Post graduate and continuing education, Brazil 4 Department of Oral Surgery and Periodontology, University of São Paulo, Brazil Keywords: Biocompatible materials; Bone grafing; Hydroxyapatite; Enamel matrix derivative; Periodontal intrabony defects Introduction Te intrabony defects are considered the main consequence of periodontal disease, presenting itself as a challenge to the clinician. Tese represent locations that, if untreated, are at an increased risk for disease progression. Although resection surgery has been used a treatment option to their elimination, the treatment of choice is periodontal regeneration [1]. Reports of guided tissue regeneration (GTR) as a periodontal procedure appeared more than 20 years ago [2,3]. Te rationale behind this therapy is to achieve regeneration of tooth supporting structures, or cementum, periodontal ligament and alveolar bone. Tis is diferent from conventional periodontal surgery that achieves healing by repair. Another way to approach periodontal regeneration is to mimic the process that occurs during development of periodontal tissues [1,3-6]. Afer the discovery of the presence of a layer of enamel matrix between the peripheral dentin and cementum under development, along with the ability of this protein to induce the formation of acellular cementum, periodontal ligament, and alveolar bone, provided the fundamental concept for use tissue derivatives of enamel matrix in periodontal regenerative therapies. Te results of several clinical studies indicated that topical application on the root surface of the enamel matrix proteins commercially available (EMD, Straumann, Basel, Switzerland) during access fap surgery promoted clinically signifcant gains in clinical attachment and bone formation in intrabony defects. Moreover, prospective, controlled clinical trials have shown that these benefts are signifcantly greater than those obtained by the access alone. Te formation of new attachment afer treatment Abstract Objective: The aim of this study was to analyze by clinical and radiographic parameters the use of enamel matrix derivative (EMD) with or without a synthetic bone substitute (Bone Ceramic) in the treatment of periodontal intrabony defects in humans. Methods: Nine patients and eighteen defects in need of treatment for periodontal intrabony defects were selected and assigned to the treatment with EMD or EMD plus Bone Ceramic assessing clinical and radiographic measurements. Results: At one year, mean probing depth (PD) reduction demonstrated improvements in all groups when compared to the baseline (P<0.01). At 1 year PD reduction ≥ 2mm was measured in 57% of the defects (i.e., in 4 of the 7) when EMD + BC was used; in 36% of the defects (i.e., 4 of the 11) when EMD was used. There were no statistically signifcant differences when standardized radiographic subtractions were compared radiographic. Conclusion: In conclusion, results from the present cases series confrm that a regenerative procedure based on EMD plus Bone Ceramic had better results in defect fll, although there was a variation in the numbers of defects. of intrabony periodontal defects with EMD has been demonstrated in both experimental animals and humans [7-11]. Combination of bone grafs with EMD has the potential to result in a synergistic efect of both materials. Tis assumption is based on the fact that two distinct procedures for resolution of the wound may occur together in a given vertical bone defect: while the graf material can act as an osteoconductive material, also acting in the space maintenance defect, the EMD can work at the root level, promoting new cementum and new formation of the attachment apparatus [8,12-14]. Standardized intra-oral radiographs provide an acceptable diagnostic test for the evaluation and monitoring of periodontal bone status. By measuring distances between anatomical landmarks (e.g., cemento-enamel junction [CEJ], alveolar ridge), the extent of bone loss and by comparison of these measures over time, changes in bone level can be assessed. Moreover digital radiographs are shown to be useful for clinical correlation between clinical attachment and bone fll in furcation defects and intrabony defects [15]. J B R J o u r n a l o f I n t e r d i s c i p li n a r y M e d i c i n e a n d D e n t a l S c i e n c e ISSN: 2376-032X