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.
BACKGROUND: Combined regenerative approaches have been used for treating advanced osseous lesions around teeth. The aim of combining treatments is to enhance both clinical predictability and regenerative outcome compared to a monotherapeutic approach. This case series from a private practice reports on the clinical efficacy of an enamel matrix derivative (EMD) combined with either demineralized freeze-dried bone allograft (DFDBA) or freeze-dried bone allograft (FDBA) in the treatment of advanced infrabony lesions. The advanced lesions were veneered by a rapidly formed absorbable polymer barrier of poly(DL-lactide) to enhance graft containment. METHODS: A total of 22 consecutive 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 received DFDBA-EMD (n = 10) and the other received FDBA-EMD (n = 12). Patients followed a stringent postoperative protocol and were evaluated 6 months postsurgery. Clinical outcomes were assessed by changes in clinical attachment level (CAL) and probing depth (PD) from pretreatment. Surgical re-entry of several 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 FDBA-EMD groups, respectively, 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 +/- 1.0 mm for DFDBA-EMD and FDBA-EMD groups, respectively; with corresponding PD decreased to 3.0 +/- 0.8 mm and 3.2 +/- 1.0 mm. Relative improvements in CAL for the DFDBA-EMD and DFDBA-EMD groups were 49.1% +/- 11.0% and 57.3% +/- 9.4%, respectively (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 DFDBA or FDBA. In this limited case series, a trend was observed towards greater improvement in clinical attachment level gain in advanced 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 versus FDBA in combination with EMD.