Periodontal regeneration with or without limited orthodontics for the treatment of 2- or 3-wall infrabony defects.

BACKGROUND Limited orthodontics are shown to be effective in the correction of infrabony defects. Studies have also demonstrated the efficacy of using enamel matrix derivative (EMD) with demineralized freeze-dried bone allograft (DFDBA) to treat infrabony defects. This study aims to compare the clinical efficacy of limited orthodontics combined with EMD/DFDBA in the treatment of 2- or 3-wall infrabony defects. METHODS A randomized, parallel clinical trial was conducted in a private periodontal practice (Tokyo, Japan) between April 2004 and October 2008. Treatment period was 1 year with a 1-year follow-up. Forty-seven randomized patients, mean age of 53 ± 10.7 years, were allocated into two intervention groups: ortho/EMD/DFDBA (n = 24) and EMD/DFDBA (n = 23). Each patient had either a 2- or 3-wall infrabony defect of ≥6 mm deep. Probing depth and clinical attachment level were measured at baseline and 1 year. The primary outcome measure was absolute change in probing depth and clinical attachment level from baseline to 1-year follow-up. The secondary outcome measure was absolute change in open probing attachment level gain and percentage defect resolution from baseline to 6-month reentry surgery. Infrabony defects were surgically treated with EMD and DFDBA 4 weeks before application of orthodontic extrusive forces. Reentry surgeries were performed at 6 months after initial surgery. RESULTS Forty-seven patients were analyzed. Both treatment groups showed a significant improvement from baseline with no significant difference between the groups except for the 2-wall defects. The ortho/EMD/DFDBA group had statistically significant open probing attachment level gain (95% confidence level, 3.18 to 4.36; P = 0.036) compared to the EMD/DFDBA group (95% confidence level, 2.26 to 3.24) in 2-wall defects. CONCLUSION Although both treatment modalities were effective in managing 2- or 3-wall infrabony defects, limited orthodontics provided an additional benefit to EMD/DFDBA in 2-wall defects.