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

• Autores: Paul S. Rosen, Mark A. Reynolds
• Localización: Journal of periodontology, ISSN 0022-3492, Vol. 73, Nº. 8, 2002, págs. 942-949
• Idioma: inglés
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• Resumen

  • Background: Combined regeneratbe approaches have been used for treating advanced osseous lesions around teeth. The aim of combining treatments is to enhance both clinical predictability and regeneratbe outcome compared to a monotherapeutic approach. This case series from a prioate practice reports on the clinical efficacy of an enamel matrix derioatioe (EMD) combined with either demineralized freeze-dried bone allograft (DFDBA) or freeze-dried bone allograft (FDBA) in the treatment of adoanced infrabony lesions. The aduanced lesions were veneered by a rapidly formed absorbable polymer barrier of poly (DL-lactide) to enhance graft containment.

    Methods: A total of 22 consecutiue 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 receiued DFDBA-EMD (n = 10) and the other received FDBA-EMD n = 12). Patients followed a stringent postoperatioe protocol and were eoaluated 6 months postsurgery. Clinical outcomes were assessed by changes in clinical attachment leoel (CAL) and probing depth (PO) from pretreatment. Surgical re-entry of seoeral 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 FDBAEMD groups, respectiuely, 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 .O mm for DFDBA-EMD and FDBAEMD groups, respectiuely; with corresponding PD decreased to 3.0 ± 0.8 mm and 3.2 ± 1.0 mm. Relative improoements in CAL for the DFDBA-EMD and DFDBA-EMD groups were 49.1 % ± 11.O% and 57.3% ± 9.4%, respectioely (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 DmBA or FDBA. In this limited case series, a trend was obseroed towards greater improoement in clinical attachment leoel gain in adoanced infrabony defects when EMD was combined with FDBA as compared to DFDBA. Larger prospective controlled clinical trials are needed to determine if differences exist in the relative efficacy of DFDBA uersus FDBA in combination with EMD.