Ten-Year Results Following Treatment of Intrabony Defects With an Enamel Matrix Protein Derivative Combined With Either a Natural Bone Mineral or a β-Tricalcium Phosphate

Background: The purpose of the present study is to evaluate the 10-year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or beta-tricalcium phosphate (beta-TCP). Methods: Twenty-two patients with advanced chronic periodontitis and displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + beta-TCP. Clinical evaluations were performed at baseline and at 1 and 10 years. The following parameters were evaluated: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. Results: The defects treated with EMD + NBM demonstrated a mean CAL change from 8.9 +/- 1.5 mm to 5.3 +/- 0.9 mm (P < 0.001) and to 5.8 +/- 1.1 mm (P < 0.001) at 1 and 10 years, respectively. The sites treated with EMD + beta-TCP showed a mean CAL change from 9.1 +/- 1.6 mm to 5.4 +/- 1.1 mm (P < 0.001) at 1 year and 6.1 +/- 1.4 mm (P < 0.001) at 10 years. At 10 years two defects in the EMD + NBM group had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. In the EMD + beta-TCP group three defects had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. Compared with baseline, at 10 years, a CAL gain of >= 3 mm was measured in 64% (i.e., seven of 11) of the defects in the EMD + NBM group and in 82% (i.e., nine of 11) of the defects in the EMD + beta-TCP group. No statistically significant differences were found between the 1- and 10-year values in either of the two groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and 10 years. Conclusion: Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + beta-TCP can be maintained over a period of 10 years.