ODONTOLOGY. PERIODONTOLOGY / ODONTOLOGIE.
PARODONTOLOGIE
PERIODONTAL TISSUE REGENERATION BY ENAMEL
MATRIX DERIVATIVES (EMDOGAIN TS), COMPOSITE
MATRIX AND ACCESS FLAP
REGENERAREA TESUTURILOR PARODONTALE CU
AJUTORUL DERIVAŢILOR MATRICEI AMELARE
(EMDOGAIN TS), MATRICEI COMPOZIT ŞI A LAMBOULUI DE
ACCES
1Assistent, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Faculty of Dental Medicine, Periodontology Dept
2Lecturer,University of Medicine and Pharmacy "Victor Babeş" Timişoara, Faculty of Dental Medicine, Periodontology Dept.
3Professor., University of Medicine and Pharmacy "Victor Babeş" Timişoara, Faculty of Dental Medicine, Periodontology Dept
ABSTRACT
Periodontal regenerative techniques use a variety of
filling materials, among these EmdogainTS and the
composite matrix (CM). The present study presents
clinical and radiographic results of the treatment of
intrabony defects achieved by 3 therapeutical methods:
Emdogain TS, composite matrix and access flap.
Material and method. 83 healthy, non-smoking
patients affected by moderate or severe periodontitis, were
included in this study. The patients were divided into 3
groups: the first group treated by Emdogain TS, the
second group by composite matrix (CM), the third one by
access flap alone.
Periodontal examination (at baseline and 6 months
after surgery) evaluated the following clinical parameters:
probing depth (PD), clinical attachment level (CAL),
gingival recession (GR), plaque index (PI), bleeding on
probing (BOP).
Results. The modification of these parameters were
more significant for the group treated by Emdogain TS
than the one treated by composite matrix. On the other
hand, the results for these 2 groups were significantly
better than the results obtained for the group treated by
access flap (AF) alone.
Conclusions. The treatment of intrabony defects
using regenerative materials or access flap alone lead to a
significant decrease of PD and an obvious gain of CAL.
Keywords : COMPOSITE MATRIX (CM), EMDOGAINTS,
PERIODONTAL REGENERATION
INTRODUCTION
“True periodontal regeneration” after
periodontal corective surgery leads to the regain of
supportive tissues affected by periodontal disease.
These tissues include new acellular cementum, a
newly formed periodontal ligament with
functionally oriented collagen fibers and new
alveolar bone attached to the periodontal ligament.
Despite the existing histologic evidences from
Bowers et al. (1) about the regeneration that occurs
after surgical treatment, a true, complete
regeneration, is still difficult to achieve (2, 3).
The present study aims to evaluate the clinical
efficiency of 3 methods used in the treatment of
66
D. Onisei1, S.I. Stratul2, Doina Onisei3
REZUMAT
Tehnicile de regenerare parodontală utilizează o varietate
de materiale de adiţie osoasă, printre care se numără
Emdogain TS şi matricea compozit (MC). Studiul de faţă
prezintă rezultate clinice şi radiologice ale tratamentului
defectelor parodontale cu ajutorul a 3 metode terapeutice:
Emdogain TS, matrice compozit şi lambou de acces.
Material şi metodă. Studiul a cuprins un număr de 83
pacienţi sănătoşi, nefumători, cu diagnosticul de parodontită
medie sau avansată. Pacienţii au fost împărţiţi în 3 grupuri
distincte: un grup tratat cu Emdogain TS, altul tratat cu
ajutorul matricei compozit (MC), la al treilea grup realizându-
se lambouri de acces, fără inserarea vreunui material de
regenerare osoasă. Examinarea parodontală a evaluat, atât în
stadiul iniţial, cât şi la 6 luni postoperator, urm atorii parametrii
clinici: adâncimea de sondaj a pungilor parodontale (AS),
nivelul de ataşament clinic (NAC), retracţia gingivală (RG),
indicele de placă (IP), indicele de sângerare la sondaj (SS).
Rezultate. Modificările parametrilor urmăriţi s-au
dovedit a fi mai importante în cazul Emdogain TS decât în
cazul matricei compozit, în special în ceea ce priveşte
câştigul de NAC. La rândul lor, rezultatele la aceste 2
grupuri au fost superioare celor obţinute la grupul tratat
prin tehnica lamboului de acces.
Concluzii. Tratamentul defectelor intraosoase cu
ajutorul materialelor de regenerare utilizate, cât şi prin
intermediul lamboului de acces, duce la o reducere
semnificativă a AS şi un câştig evident de NAC.
Cuvinte cheie : MATRICE COMPOZIT (MC),
EMDOGAINTS, REGENERARE PARODONTALĂ
INTRODUCERE
“Regenerarea parodontală adevărată” în urma
terapiei parodontale corectoare duce la recâştigarea
ţesuturilor de susţinere afectate de boala
parodontală. Aceste ţesuturi includ cement nou
acelular ataşat suprafeţei dentinare subiacente, un
nou ligament parodontal cu fibre de colagen
orientate funcţional ce se inseră la nivelul
neocementului, precum şi os alveolar neoformat
ataşat ligamentului parodontal. Cu toate că există
dovezi histologice convingătoare în clasicele studii
ale lui Bowers et al. (1) asupra regenerării ce apare
în urma unei intervenţii chirurgicale, o regenerare
adevarată, completă şi previzibilă, este încă greu de
 ODONTOLOGY. PERIODONTOLOGY / ODONTOLOGIE. PARODONTOLOGIE
intrabony periodontal defects: EmdogainTS,
composite matrix (CM) and access flap.
The composite matrix (CM) is a romanian
product, with dimensions of 15x20 mm, 25x25 mm
or 20x30 mm. It contains despecificated and
reticulated collagen (20 - 40%) and
biovitroceramics PAW1 (60 - 80%). It has a very
good biocompatibility, barrier effect and
resorbability and it is easy to use. CM is mainly
utilized in the surgical treatment of periodontitis,
implant coverage, filling of dental alveolas
following tooth extractions, treatment of apical
lesions and augmentation of the alveolar crest.
EmdogainTS is a new product based on
Emdogain – material for bone regeneration which
contains enamel matrix proteins extracted from the
developing embryonal enamel of young pigs (6
months). EmdogainTS contains EmdogainGel and
PerioGlas (a bioactive glass in granulary form).
MATERIAL AND METHOD
83 healthy, non-smoking pacients (36 female, 47
male), aged 23 - 67, were included in this study.
The pacients were diagnosed with moderate or
severe periodontitis, with a total of 427 intrabony
defects of at least 4mm. All pacients underwent
initial periodontal therapy (SRP accordind to the
Fdis concept by Quirynen, oral hygiene
instructions, occlusal adjustment where it was
necessary).
The evaluation was made on 3 different groups
: one group using EmdogainTS, the second using
composite matrix (CM) and the third one where
the access flap technique was applied.
The clinical parameters evaluated in this study
were the following: probing depth (PD), clinical
attachment level (CAL), gingival recession (GR),
plaque index (PI) and bleeding on probing (BOP).
At baseline, these parameters were determined on
the day of surgery. The reevaluation of these
parameters was made at 6 months after surgery.
The surgical procedure was performed using local
anesthesia with Ubistesin 4%. Intrasulcular incisions
with reflection of full thickness flaps were utilized, in
some cases combined with vertical incisions.
Debridement and root planing were accomplished
with hand instruments and ultrasonic scalers. After
the application of the grafts, primary soft tissue
closing was obtained utilizing 4.0 and 5.0 silk sutures.
Patients were given antiinflammatory and pain
medication (Nurofen, Ibuprofen), antibiotics
(amoxiciline) and clorhexidine digluconate (Plak
Out, Dentaton). The patients were informed not to
brush the surgical sites for 14 days, until the
sutures were removed. Postoperative appointments
were carried out at 7 days, 14 days, 30 days, 3
MEDICINA STOMATOLOGICĂ, vol. 10, nr. 1, 2006 / JOURNAL OF ROMANIAN DENTISTRY, vol. 10, issue 1, 2006
obţinut (2, 3).
Studiul de faţă îşi propune să evalueze eficienţa
clinică a 3 metode utilizate în tratamentul defectelor
intraosoase parodontale: Emdogain TS, matrice
compozit (MC) şi lambou de acces.
Matricea compozit (MC) este un produs
autohton ce se prezintă sub formă cvadrangulară,
cu dimensiuni de 15 x 20mm, 25 x 25mm sau 20 x
30mm. Este alcatuită din colagen tip despecificat şi
reticulat (20 - 40%) şi biovitroceramica PAW1 (60 -
80%). Prezintă o foarte bună biocompatibilitate,
efect de barieră şi resorbţie corespunzatoare, este
maleabilă şi uşor de utilizat. MC este utilizată în
special în tratamentul chirurgical al parodontitelor,
acoperirea implantelor, umplerea alveolelor dentare
postextracţionale, tratamentul leziunilor periapicale
sau augmentarea crestei alveolare.
EmdogainTS este o varianta mai nouă a
produsului Emdogain – material de regenerare
osoasă ce conţine proteine ale matricei amelare
extrase din smalţul embrionar în dezvoltare al
porcilor tineri (6 luni). EmdogainTS conţine pe
lângă Emdogain Gel şi o cantitate de PerioGlas, o
sticlă bioactiva (grefă aloplastică) sub forma de
granule.
MATERIAL SI METODA
În acest studiu au fost incluşi 83 pacienţi (36
femei, 47 bărbaţi) sănătoşi, nefumători, cu vârsta de
23 - 67 ani, ce au prezentat 427 defecte intraosoase
de cel puţin 4mm. Pacienţii au fost diagnosticaţi cu
parodontită medie sau avansată. Toţi pacienţii au
beneficiat în prealabil de terapie iniţială ce a cuprins
scaling şi rootplaning după conceptul Fdis
(Quirynen), instrucţia igienei orale şi şlefuiri
ocluzale acolo unde a fost necesar.
Evaluarea a fost efectuată pe 3 grupuri distincte:
un grup la care s-a folosit EmdogainTS (EMD TS),
altul la care s-a utilizat matrice compozit (MC),
respectiv un grup la care s-a aplicat tehnica
lamboului de acces (AF).
Parametrii clinici urmăriţi în acest studiu au fost:
adâncimea de sondaj (AS), nivelul ataşamentului
clinic (NAC), retracţia gingivală (RG), indicele de
placă (IP) şi indicele de sângerare la sondaj (SS). În
stadiul iniţial, aceşti parametri au fost determinaţi în
ziua intervenţiei chirurgicale. Reevaluarea
parametrilor clinici a fost realizată la 6 luni
postoperator.
Procedeul chirurgical s-a desfăşurat folosind
anestezie locală cu Ubistesin 4%. S-au realizat
incizii intrasulculare ce au evidenţiat lambouri
muco-periostale, în unele cazuri s-au utilizat incizii
verticale de degajare. Debridarea şi netezirea
radiculară au fost obţinute cu ajutorul
instrumentelor de mână şi scalerelor ultrasonice. În
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months and 6 months. At each pop-up visit, the urma aplicării materialelor de adiţie osoasă s-au
surgical area was debrided and further oral hygiene realizat suturi cu fire de mătase 4-0 şi 5-0.
instructions were given. Pacienţilor li s-a administrat o medicaţie
Statistical analysis antiinflamatorie şi analgezica (Nurofen, Ibuprofen),
The following tests were used for data analysis : antibiotica (amoxicilină) şi antiseptică (digluconat
nonparametric χ2 test, Kruskal-Wallis test, Mann- de clorhexidina - Plak Out, Dentaton). Pacienţii au
Whitney test and bivariate correlations. All tests were fost informaţi să nu practice periajul dentar in
bilateral, the level of significance was set at p<0,05. zonele tratate timp de 14 zile, cand au fost
îndepărtate şi firele de sutura. Postoperator,
RESULTS pacientii au fost chemaţi la control la 7 zile, 14 zile,
All pacients were reexamined at 6 months after 30 zile, 3 luni şi 6 luni. La fiecare control zonele
surgery. Clinical evaluation of postsurgical healing instrumentate au fost debridate, iar pacienţilor li s-
revealed an excellent soft tissue response, with no au dat indicatii referitoare la păstrarea unei igiene
adverse effects or complications reported. All orale corespunzătoare.
pacients demonstrated good plaque control. Analiza statistica
Being a parallel study, the results are presented S-au utilizat testele nonparametrice χ2, testul
comparatively between the treated groups. Kruskal-Wallis, testul Mann-Whitney şi corelaţiile
The first comparison was made between the bivariate. Toate testele statistice au fost bilaterale,
group treated by EmdogainTS (EMD TS) and the valoarea p<0,05 fiind considerată semnificativă din
one by access flap (AF). punct de vedere statistic.
PD, GR and CAL changes are presented in
table 1, while PI and BOP changes are summarized REZULTATE
in table 2. Toţi pacienţii au fost reexaminaţi la 6 luni
postoperator. Evaluarea clinică a vindecării a
Tratament Iniţial 6 luni Diferenţă Semnificaţie relevat un răspuns foarte bun al ţesuturilor
AS parodontale, fără apariţia de efecte adverse sau
AF 8,61±1,3 5,86±1,94 2,75±1,67 P<0,0001 complicaţii. Pacienţii au prezentat un control bun al
1
EMD TS 8,32±2,0 3,60±1,26 4,72±2,03 P<0,0001 plăcii.
1 p<0,0001 Fiind un studiu paralel, rezultatele obţinute sunt
RG redate comparativ la câte două grupuri în parte.
AF 1,71±1,4 2,50±1,67 0,79±0,79 P<0,0001 Într-o primă etapă sunt comparate rezultatele
9
EMD TS 0,68±1,1 1,60±1,73 0,92±1,32 P=0,002 obţinute la grupul tratat cu EmdogainTS cu cel
1 n.s. tratat prin lambou de acces.
NAC Modificările AS, RG şi a NAC sunt redate în
AF 10,32±2, 8,36±2,79 1,96±1,67 P<0,0001 tab. 1, cele ale indicelui de placă (IP) şi a sângerării
0
EMD TS 9,00±2,3 5,20±2,06 3,80±2,25 P<0,0001 la sondaj (SS) în tab. 2.
3 p=0,003
Tabel 1. AS, RG şi NAC în stadiul iniţial şi după 6 luni NAC AF EMD TS
pentru grupurile tratate cu AF (n=28) şi EMD TS (n=25) câştig Nr % Nr %
PD, GR and CAL at baseline and after 6 months for the groups ( -2 ) 1 3,57 - -
treated by AF and EMD TS 0 5 17,86 1 4
1 4 14,29 2 8
EMD TS AF
2 7 25,00 5 20
IP 3 7 25,00 4 16
Iniţial 0,54±0,32 0,72±0,48 4 3 10,71 5 20
6 luni 0,24±0,14 0,25±0,14 5 - - 3 12
SS 6 1 3,57 2 8
Iniţial 53,38±22,58 56,82±18,47 7 - - 2 8
6 luni 25,04±6,89 25,25±6,93 10 - - 1 4
Tabel 2. IP şi SS in stadiul iniţial şi după 6 luni la Tabel 3. Câştigul de NAC la grupurile tratate cu AF si
grupurile tratate cu EMD TS si AF EMD TS
PI and BOP at baseline and after 6 months for the groups treated CAL gain for the groups treated by AF and EMD TS
by EMD TS and AF
There were significantly better results for the Observăm rezultate superioare la grupul tratat cu
EmdogainTS group compared to the AF group, EMD TS faţă de AF, atât în ceea ce priveşte
regarding PD reduction (4.72+/-2.03 mm for the reducerea AS (4,72+/-2,03 mm la grupul EMD TS

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EMD TS group and 2.75+/-1.67 mm for the AF
group) and CAL gain (3.80+/-2.25 mm for EMD
TS and 1.96+/-1.67 mm for AF).
GR between the 2 groups after 6 months
remained statistically non-significant. PI and BOP
were significantly reduced after 6 months in both
groups, but the difference between their values
remained non-significant (0.24+/-0.14 compared
to 0.25+/-0.14 for PI and 25.04+/-6.89 compared
to 25.25+/-6.93 for BOP).
CAL gain during these 6 months related to the
number of defects and the percentual calculation
are synthesized in table 3.
CAL changes during the study for both groups
are presented in fig. 1.
The results between the group treated by CM
and the group treated by AF were compared in the
same way (tables 4 - 6, fig. 2).
faţă de 2,75+/-1,67 mm la grupul AF), cât şi în cazul
câştigului de NAC (3,80+/-2,25 mm la EMD TS faţă
de 1,96+/-1,67 mm la AF). Pentru RG, diferenţa
valorilor dintre grupuri la 6 luni a ramas nesemni-
ficativă statistic. IP, respectiv SS, au prezentat reduceri
semnificative la ambele grupuri tratate în decurs de 6
luni, diferenţa dintre valorile acestora obţinute la
sfârşitul studiului nefiind însă semnificativă (0,24+/-
0,14 faţă de 0,25+/-0,14 pentru IP respectiv 25,04+/-
6,89 faţă de 25,25+/-6,93 pentru SS).
Câştigul de NAC în decurs de 6 luni raportat la
numărul de defecte, precum şi exprimarea
procentuală a acestora, se evidenţiază în tabelul 3.
Modificările NAC de-a lungul studiului pentru
tratamentul cu EmdogainTS, respectiv AF, sunt
prezentate în fig.1.
În mod similar s-au comparat rezultatele dintre
terapia cu matrice compozit (MC) şi tehnica
lamboului de acces (tabelele 4 - 6, fig. 2).

Fig. 1. NAC iniţial şi după 6 luni la grupurile tratate cu Fig. 2. NAC iniţial şi după 6 luni la grupurile tratate cu
AF si EMD TS. AF şi MC
CAL at baseline and after 6 months for the groups treated by CAL at baseline and after 6 months for the groups treated by AF
AF and EMD TS and CM

Tratament Iniţial 6 luni Diferenţă Semnificaţie NAC câştig AF MC

(mm) Nr % Nr %
AS
AF 8,61±1,31 5,86±1,94 2,75±1,67 P<0,0001 -2 1 3,57 - -
MC 8,00±1,76 4,70±1,80 3,30±0,75 p<0,0001 0 5 17,86 - -
p=0,03 1 4 14,29 6 20,00
RG 2 7 25,00 10 33,33
AF 1,71±1,49 2,50±1,67 0,79±0,79 P<0,0001 3 7 25,00 10 33,33
MC 2,07±1,98 2,97±2,59 0,90±0,88 p<0,0001 4 3 10,71 4 13,33
n.s. 5 - - - -
NAC 6 1 3,57 - -
AF 10,32±2,07 8,36±2,79 1,96±1,67 P<0,0001 7 - - - -
MC 10,07±3,60 7,67±4,10 2,40±0,97 p<0,0001 10 - - - -
n.s.
Tabel 4. AS, RG şi NAC în stadiul iniţial şi după 6 luni Tabel 5. Câştigul de NAC la grupurile tratate cu AF şi
pentru grupurile tratate cu AF(n=28) şi MC (n=30) MC
PD, GR and CAL at baseline and after 6 months for the groups CAL gain for the groups treated by AF and CM
treated by AF and CM
Although the initial values of PD, CAL and GR Deşi valorile iniţiale ale AS, NAC şi RG au fost
were very similar, the differences became significant sensibil egale, diferenţele la 6 luni sunt
after 6 months in both groups (p<0,0001). There was semnificative în cazul ambelor grupuri (p<0,0001).
a significant PD reduction in the CM group Constatăm o reducere semnificativă a AS la grupul
compared to the AF group (a mean difference of 0,55 MC faţă de grupul AF (diferenţa medie de 0,55
mm). For CAL and GR, the differences remained mm), pentru NAC şi RG diferenţele rămânând

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statistically non-significant. PI and BOP decreased nesemnificative statistic. IP şi SS s-au redus şi ele
significantly at 6 months compared to baseline in semnificativ la 6 luni faţă de stadiul iniţial la ambele
both groups, but there were no significant differences grupuri, diferenţele după 6 luni între cele două
between the 2 groups at 6 months postoperative. grupuri fiind însă nesemnificative.

MC AF Tratament Iniţial 6 luni Diferenţă Semnificaţie

IP AS
Iniţial 0,58±0,49 0,72±0,48 MC 8,00±1,76 4,70±1,80 3,30±0,75 p<0,0001
6 luni 0,24±0,15 0,25±0,14 EMD TS 8,32±2,01 3,60±1,26 4,72±2,03 p<0,0001
SS P=0,006
Iniţial 61,16±15,46 56,82±18,47 RG
6 luni 26,67±6,10 25,25±6,93
MC 2,07±1,98 2,97±2,59 0,90±0,88 p<0,0001
Tabel 6. IP şi SS în stadiul iniţial şi după 6 luni la EMD TS 0,68±1,11 1,60±1,73 0,92±1,32 p=0,002
grupurile tratate cu MC şi AF.
PI and BOP at baseline and after 6 months for the groups treated n.s.
by CM and AF NAC
MC 10,07±3,6 7,67±4,10 2,40±0,97 p<0,0001
EMD TS MC 0
EMD TS 9,00±2,33 5,20±2,06 3,80±2,25 p<0,0001
IP
p<0,01
Iniţial 0,54±0,32 0,58±0,49
6 luni 0,24±0,14 0,24±0,15 Tabel 7. AS, RG şi NAC în stadiul iniţial şi după 6 luni
pentru grupurile tratate cu MC (n=30) şi EMD TS
SS
Iniţial 53,38±22,58 61,16±15,46 (n=25)
PD, GR and CAL at baseline and after 6 months for the groups
6 luni 25,04±6,89 26,67±6,10
treated by CM and EMD TS
Tabel 8. IP şi SS in stadiul iniţial şi după 6 luni la
grupurile tratate cu EMD TS si MC
NAC câştig MC EMD TS
PI and BOP at baseline and after 6 months for the groups treated
(mm)
by EMD TS and CM Nr % Nr %
-2 - - - -
0 - - 1 4
1 6 20,00 2 8
2 10 33,33 5 20
3 10 33,33 4 16
4 4 13,33 5 20
5 - - 3 12
6 - - 2 8
7 - - 2 8
10 - - 1 4
Fig. 3. NAC iniţial şi după 6 luni pentru grupurile Tabel 9. Câştigul de NAC la grupurile tratate cu MC şi
tratate cu MC şi EMD TS EMD TS
CAL at baseline and after 6 months for the groups treated by CAL gain for the groups treated by CM and EMD TS
CM and EMD TS
The most interesting comparison was between Cea mai interesanta comparaţie a fost cea dintre
the groups treated by EmdogainTS and CM, grupurile tratate cu EmdogainTS, respectiv matrice
respectively. The results are summarized in tables 7 compozit (MC). Rezultatele obţinute sunt
- 9 and fig. 3. sintetizate în tabelele 7 - 9 şi grafic în fig. 3.
There were significant changes at 6 months În ceea ce priveşte parametrii clinici, la ambele
compared to baseline for all parameters. PD grupuri se observă o diferenţă semnificativă la 6
reduction and CAL gain were more significant for luni faţă de stadiul iniţial. Reducerea AS şi câştigul
the EMD TS group than the CM group (4,72+/- de NAC au fost semnificativ mai mari la grupul
2,03 mm compared to 3,30+/-0,75 mm for PD EMD TS faţă de MC (4,72+/-2,03 mm faţă de
and 3,80+/-2,25 mm compared to 2,40+/-0,97 3,30+/-0,75 mm pentru AS şi 3,80+/-2,25 mm
mm for CAL). The difference for GR was faţă de 2,40+/-0,97 mm pentru NAC). Diferenţa în
statistically non-significant (0,92+/-1,32 mm cazul RG a fost statistic nesemnificativa (0,92+/-
compared to 0,90+/-0,88 mm). As in the previous 1,32 mm faţă de 0,90+/-0,88 mm). Ca şi în cazurile
cases, PI and BOP were significantly reduced after anterioare, IP şi SS s-au redus semnificativ după 6
6 months in both groups, but the difference luni la ambele grupuri, dar diferenţa dintre valorile

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between the values in both groups at 6 months are
statistically non-significant. CAL gain in the EMD
TS group exceeded 4 mm in 8 cases (32% of the
defects), with a maximum gain of 10mm measured
in 1 treated defect (4%). From the 30 defects
treated by CM, only 4 defects (13,33%) revealed a
maximum gain of 4 mm.
DISCUSSION
The results of the present study showed that the
chosen methods (EMD TS, CM, AF) were
effective in significantly improving the clinical
parameters. A more significant reduction of PD
and a higher gain of CAL was observed in the
EMD TS group. Both periodontal regeneration
treatments (EMD TS, CM) had a significantly
better outcome than the surgical therapy by access
flap alone.
The fact that new bone formation was not
detected radiographically in all cases that revealed a
CAL gain, can be explained by the relatively short
period of time that didn’t permit sufficient
maturation of the newly formed bone. The results
of some histologic studies reveal that new
attachment formation is not necessary related with
the formation of new alveolar bone (4, 5, 6).
The results obtained from this study are similar
to other studies made in humans, utilizing the same
therapeutical procedures (7, 8, 9, 10). These results
are sustained by histological findings on animals
(11, 12) that indicate the formation of a new
periodontal supporting apparatus using these
periodontal regenerative techniques (13, 14, 15).
CONCLUSIONS
 The procedures used in this study proved to be
efficient in the treatment of intrabony
periodontal defects.
 The clinical parameters showed statistically
significant changes compared to baseline.
 The treatment of intrabony defects by the
regenerative materials, as well as the access flap
alone, leads to a significant PD reduction and
an obvious CAL gain.
BIBLIOGRAPHY
1. Bowers G, Chadroff B, Carnevale R, Mellonig J, Corio R,
Emerson J, Stevens M, Romberg E. Histologic evaluation
of new attachment apparatus formation in humans. Part I-
III. J Periodontol, 1989; 60; 664-693.
2. Cortellini P, Pini Prato G, Tonetti MS. Periodontal
regeneration of human intrabony defects with
bioresorbable membranes. A controlled clinical trial. J
Periodontol, 1996; 67; 217-223.
3. Heard RH, Mellonig JT, Brunsvold MA, Lasho DJ,
Meffert RM, Cochran DL. Clinical evaluation of wound
MEDICINA STOMATOLOGICĂ, vol. 10, nr. 1, 2006 / JOURNAL OF ROMANIAN DENTISTRY, vol. 10, issue 1, 2006
la 6 luni între grupuri sunt nesemnificative statistic.
Câştigul de NAC în cadrul grupului EMD TS a
depăşit în 8 cazuri (32% din defecte) valoarea de 4
mm, cu un maxim de 10 mm măsurat la 1 defect
tratat (4%). Din cele 30 defecte tratate cu MC, doar
4 dintre acestea (13,33%) au prezentat un câştig
maxim de 4 mm.
DISCUTII
Rezultatele studiului de faţă ne arată că
tratamentul defectelor intraosoase cu ajutorul
materialelor de regenerare utilizate (EMD TS, MC),
cât şi prin intermediul AF, duce la o îmbunătăţire
semnificativă a parametrilor urmăriţi. Reducerea
semnificativă a AS şi un câştig evident de NAC au
fost mai pregnante la grupul EMD TS, ambele
tratamente de regenerare parodontală (EMD TS,
MC) fiind net superioare faţă de terapia chirurgicală
prin lambou de acces.
Faptul că formarea de tesut dur osos nu a fost
detectată radiografic în toate cazurile în care s-a
măsurat un caştig de NAC poate fi explicat prin
perioada relativ scurtă de monitorizare care nu a
permis maturarea suficientă a ţesutului osos
neoformat. Rezultatele unor studii histologice
demonstrează totodată faptul că formarea unui nou
aparat de ataşament nu e neapărat corelată cu
formarea de nou os alveolar (4, 5, 6).
Rezultatele obţinute în acest studiu sunt similare
altor studii efectuate pe subiecţi umani folosind
aceleaşi metode terapeutice (7, 8, 9, 10). Aceste
rezultate sunt susţinute si de rezultate histologice pe
animale (11, 12) care indică faptul ca procedeele de
regenerare utilizate duc la formarea unui nou aparat
de susţinere parodontal (13, 14, 15).
CONCLUZII
1. Procedeele folosite s-au dovedit a fi eficiente în
tratamentul defectelor intraosoase
2. Parametrii clinici urmăriţi au prezentat
modificări semnificative faţă de stadiul iniţial
3. Tratamentul defectelor intraosoase cu ajutorul
materialelor de regenerare utilizate, cât şi prin
intermediul lamboului de acces, duce la o
reducere semnificativă a AS şi un câştig evident
de NAC.
9. Mellonig JT. Enamel matrix derivative for periodontal
reconstructive surgery: Technique and clinical and
histologic case report. Int J Periodontics & Restorative
Dent, 1999; 19; 9-19.
10. Parashis A, Tsiklakis K. Clinical and radiographic findings
following application of enamel matrix derivative in the
treatment of intrabony defects. A series of case reports. J
Clin Periodontol, 2000; 27; 705-713.
11. Sculean A, Donos N, Brecx M, Reich E, Karring T.
Treatment of intrabony defects with enamel matrix
71
 ODONTOLOGY. PERIODONTOLOGY / ODONTOLOGIE. PARODONTOLOGIE

healing following multiple exposures to enamel matrix
protein derivative in the treatment of intrabony
periodontal defects. J Periodontol, 2000; 71; 1715-1721.
4. Parodi R, Liuzzo G, Patrucco P, et al. Use of Emdogain in
the treatment of deep intrabony defects: 12-month clinical
results. Histologic and radiographic evaluation. J
Periodontics & Restorative Dent, 2000; 20; 584-595.
5. Sculean A, Chiantella GC, Windisch P, Donos N. Clinical
and histologic evaluation of treatment of intrabony defects
with an enamel matrix protein derivative (Emdogain). Int J
Periodontics & Restorative Dent, 2000c; 20; 375-381.
6. Yukna RA, Mellonig JT. Histologic evaluation of
periodontal healing in humans following regenerative
therapy with enamel matrix derivative. A 10-case series. J
Periodontol, 2000; 71; 752-759.
7. Heden G. A case report study of 72 consecutive
Emdogain-treated intrabony periodontal defects: Clinical
and radiographic findings after 1 year. Int J Periodontics &
Restorative Dent, 2000; 20; 126-139.
8. Heijl L, Heden G, Svärdström G, Östgren A. Enamel
matrix derivative (Emdogain) in the treatment of
intrabony periodontal defects. J Clin Periodontol, 1997;
24; 705-714.
proteins and guided tissue regeneration. An experimental
study in monkeys. J Clin Periodontol, 2000b; 27; 466-472.
12. Sculean A, Donos N, Brecx M, Reich E, Karring T.
Healing of recession-type defects following treatment with
enamel matrix proteins or guided tissue regeneration. A
pilot study in monkeys. Journal de Parodontologie &
d’Implantologie Orale, 2000a; 19; 19-31.
13. Sculean A, Donos N, Blaes A, Lauermann M, Reich E,
Brecx M. Comparison of enamel matrix proteins and
bioabsorbable membranes in the treatment of intrabony
periodontal defects. A split-mouth study. J Periodontol,
1999b; 70; 255-262.
14. Tonetti MS, Cortellini P, Lang NP, Suvan JE, Adriaens P,
Dubravec D, Fonzar A, Fourmousis I, Rasperini G, Rossi
R, Silvestri M, Topoll H, Wallkamm B, Zybutz M. Clinical
outcomes following treatment of human intrabony defects
with GTR/bone replacement material or access flap alone.
A multicenter randomized controlled clinical trial. J Clin
Periodontol, 2004; 31; 770-776.
15. Wilson TG. Periodontal regeneration enhanced: clinical
applications of enamel matrix proteins. Quintessence
Publishing Co. Inc., 1999

ACTUALITĂŢI / NEWS
EFFECTIVENESS OF 4 PULPOTOMY TECHNIQUES—RANDOMIZED CONTROLLED TRIAL
K.C. Huth1, E. Paschos1, N. Hajek-Al-Khatar1, R. Hollweck2, A. Crispin3, R. Hickel1 M. Folwaczny1
1 Department of Restorative Dentistry & Periodontology, Dental School, Ludwig-Maximilians-University, Goethestrasse 70, 80336

Munich, Germany; 2 Institute for Medical Statistics & Epidemiology, Klinikum rechts der Isar, Technical University, Munich, Germany; and 3
Department of Medical Informatics, Biometry & Epidemiology, Ludwig-Maximilians-University, Munich, Germany

Pulpotomy is the accepted therapy for the management of cariously exposed pulps in symptom-free primary molars; however, evidence
is lacking about the most appropriate technique. The aim of this study was to compare the relative effectiveness of the Er:YAG laser,
calcium hydroxide, and ferric sulfate techniques with that of dilute formocresol in retaining such molars symptom-free. Two hundred
primary molars in 107 healthy children were included and randomly allocated to one of the techniques. The treated teeth were blindly re-
evaluated after 6, 12, 18, and 24 months. Descriptive data analysis and logistic regression analysis, accounting for each patient’s effect
by a generalized estimating equation (GEE), were used. After 24 months, the following total and clinical success rates were determined
(%): formocresol 85 (96), laser 78 (93), calcium hydroxide 53 (87), and ferric sulfate 86 (100). Only calcium hydroxide performed
significantly worse than formocresol (p = 0.001, odds ratio = 5.6, 95% confidence interval 2.0–15.5). In conclusion, calcium
hydroxide is less appropriate for pulpotomies than is formocresol.
Key words: pulpotomy • primary molars • RCT
(J Dent Res 84(12):1144-1148, 2005)

Ioana Rudnic

LOW-FLUORIDE DENTIFRICE AND GASTROINTESTINAL FLUORIDE ABSORPTION AFTER MEALS

J.A. Cury, F.S. Del Fiol, L.M.A. Tenuta P.L. Rosalen
Faculty of Dentistry of Piracicaba, UNICAMP, Av. Limeira 901, 13414-903, Piracicaba, SP, Brazil

A low-fluoride (F) dentifrice has been recommended to reduce the risk of dental fluorosis, but its anti-caries efficacy is questionable
compared with that of conventional dentrifices (1000–1100 µg F/g). The tested hypothesis was that conventional dentifrices might be
safe if used soon after meals, since food interferes with F absorption. In a crossover, double-blind study, 11 volunteers ingested a
dentifrice slurry containing 0 (placebo), 550 (low F), or 1100 µg F/g in 3 gastric content situations: on fasting, or 15 min after
breakfast or lunch. F was analyzed in saliva and 24-hour urine samples. The conventional dentifrice ingested after lunch resulted in
only 10% higher F absorption than the low-F ingested on fasting. Analysis of the data suggests that the risk of fluorosis could be
reduced by the use of either a low-F dentifrice or a conventional dentifrice, if toothbrushing occurred soon after meals.
Key words: fluoride • dentifrice • absorption • saliva • food
(J Dent Res 84(12):1133-1137, 2005)

Gianina Iovan

72