Title For Healthy Adult Patients, Surgical Therapy for Peri-Implantitis Using Bovine Xenograft and Enamel Matrix Derivative (Emdogain) Will be More Effective in Achieving Positive Clinical Outcomes Than Emdogain Alone
Clinical Question For healthy adult patients, will surgical therapy for peri-implantitis using bovine xenograft and enamel matrix derivative (Emdogain) be more effective in achieving positive clinical outcomes than the same treatment with Emdogain alone?
Clinical Bottom Line For healthy adult patients, surgical therapy for peri-implantitis using bovine xenograft and enamel matrix derivative (Emdogain) will be more effective in achieving positive clinical outcomes than the same treatment without the use of bovine xenograft. This is supported by a randomized controlled trial and a comparative study. This treatment is within the capability of the average general dental practice and likely to be accepted by the average patient.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
15562907Gurinsky/200440 patients, 67 sites with peridontal defectsRandomized Controlled Trial
Key resultsProbing depth reduction for Emdogain and bone allograft was 3.6 +/- 0.2 mm, while Emdogain alone showed probing depth reduction of 4.0 +/- 0.3 mm. Although there was not a significant difference between the two treatments for soft tissue measurements, the combination therapy demonstrated significant improvements in bone fill, crestal resorption, and percentage of sites gaining greater than 50% and 90% bone fill as compared to Emdogain alone (P<0.001).
10960017Lekovic/200021 paired intrabony defectsComparative Study
Key resultsWhile there was not a significant difference in probing depths, attachment levels, and transoperative bone measurements, postsurgical measurements taken at 6 months yielded greater reduction in probing depths in the combination therapy group (3.43 +/- 1.32 mm on buccal sites and 3.36 +/- 1.35 mm on lingual sites). The combination therapy showed more attachment gain than the Emdogain therapy alone (3.13 +/- 1.41 mm in buccal sites and 3.11 +/- 1.39 mm in lingual sites opposed to 1.72 +/- 1.33 mm in buccal sites and 1.75 +/- 1.37 mm in lingual sites). The combination therapy also revealed a greater amount of defect fill (3.82 +/- 1.43 mm on the buccal and 3.74 +/- 1.38 mm on the lingual as opposed to 1.33 +/- 1.17 mm on the buccal and 1.41 +/- 1.19 mm on the lingual).
Evidence Search ("enamel matrix proteins"[Supplementary Concept] OR "enamel matrix proteins"[All Fields] OR "emdogain"[All Fields]) AND periodontal[All Fields] AND ("regeneration"[MeSH Terms] OR "regeneration"[All Fields])
Comments on
The Evidence
Validity: In Gurinsky's article, two groups (one treated with Emdogain and the other treated with Emdogain and bone allograft) showed a result of P<0.001. In Lekovic's study, 21 intrabony defects were treated using a split-mouth design. Patients were compliant, and there was no recall bias. The experiment was double-blinded. Perspective: The result of this regenerative treatment for peri-implantitis appears to be promising. However, more cases done in multiple practices are needed to measure the predictability of the protocol. The split-mouth design in Lekovic's study provides a very good controlled technique. These studies do not specifically address the treatment for peri-implantitis. However, the results in the studies provide significant results that would indicate positive clinical effects for treatment of peri-implantitis.
Applicability The subjects are representative of a routine patient. The treatment is feasible in a normal dental clinic. The patient is not likely to be harmed, but instead should experience benefits from this regeneration. The patient may expect to have healing at a fast rate. These promising results may help reduce chair time at the dental clinic and bring about efficient clinical outcomes.
Specialty (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Peri-implantitis, implant, emdogain, bovine xenograft
ID# 2892
Date of submission 04/10/2015
E-mail leek8@livemail.uthscsa.edu
Author Ki Lee
Co-author(s) e-mail
Faculty mentor Archie Jones, DDS
Faculty mentor e-mail jonesa@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available