ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Adding EDTA Root Conditioning Does Not Increase Likelihood Of Greater Clinical Attachment Gain Following Enamel Matrix Derivative (EMD) Treatment Of Periodontal Intrabony Defects
Clinical Question In chronic periodontitis patients with intrabony defects, does EDTA root conditioning prior to EMD treatment result in greater gain of clinical attachment than EMD treatment alone?
Clinical Bottom Line No statistically significant differences were noted with regards to probing depth(PD) reduction or clinical attachment level (CAL) gain in intrabony defects treated with open flap debridement/EDTA root conditioning/EMD vs. defects treated with open flap debridement/EMD with no EDTA root conditioning. Patients treated with EDTA + EMD and those treated with EMD alone both achieved >60% mean radiographic defect resolution. Positive clinical outcomes after EDTA root conditioning/EMD or EMD alone are most likely due to properties of EMD, with no additional benefit from EDTA root conditioning.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16805678Sculean / 200624 healthy adult humansRandomized Controlled Trial
Key resultsPatients experienced statistically and clinically significant reduction in probing depth and gain in clinical attachment level following treatment of intrabony defects with open flap debridement and either EDTA/EMD [PD reduction from 9.3 +/- 1mm to 4.0 +/- 0.9mm (P<0.001), and CAL gain from 10.8 +/- 2.2mm to 7.1 +/- 2.8mm(p<0.001)]or EMD alone (PD reduction from 9.3 +/- 1.2mm to 4.2 +/-0.9mm (P<0.001), CAL gain from 11.0 +/- 1.7mm to 7.3 +/- 1.6mm (p<0.001)]. No statistically significant difference in outcomes between treatment groups.
#2) 16579710Parashis / 200628 adult humans Case-Control Study
Key resultsAll patients experienced significant probing depth reduction and clinical attachment level gain one year post-operatively following treatment of 2- or 3- wall intrabony defects with EDTA/EMD or EMD alone. Both groups had >60% mean radiographic defect resolution. No significant differences between two treatment groups.
Evidence Search "Edetic Acid"[Mesh] AND "enamel matrix proteins"[Supplementary Concept] AND "intrabony defects"[All Fields] AND "humans"[MeSH Terms]
Comments on
The Evidence
The RCT (Sculean, et al) was double-blind, adequate follow-up was performed, minimal dropout rate observed, with no competing interests. However, increasing the population from 24 patients would have resulted in greater strength of collected evidence. The Case-Control study (Parashis, et al) did not include evidence of being double-blinded, and power analysis was conducted only for clinical attachment level, not for probing depth. Patient populations between treatment groups were dissimilar from the start (age, sex, smoking history), decreasing strength of collected evidence.
Applicability These results can be applied to a wide variety of patients suffering from isolated periodontal intrabony defects. All patients were chronic periodontitis patients. In the Sculean study, patients were non-smokers, mean age 41 +/- 11.5 years, with at least one intrabony defect with PD at least 6mm. Patients included in the Parashis study included 8 smokers and 20 non-smokers, aged 37-67, exhibiting 2- or 3- walled intrabony defects at least 4mm deep and 2mm wide. Clinical outcomes obtained following surgery on relatively healthy patients; effects of systemic disease did not play a role in these particular studies.
Specialty/Discipline (Periodontics)
Keywords Intrabony defects, enamel matrix protein, clinical attachment level
ID# 2116
Date of submission: 09/16/2011spacer
E-mail johnsonsf@livemail.uthscsa.edu
Author Shannan Johnson
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author e-mail finlaysonr@uthscsa.edu
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