RESULTS

Patient and Defect Characteristics at Baseline (Table 1)

FMPS and FMBS were 10.2% ± 2.7% and 7.9% ± 2.8%, respectively. On average, CAL was 10.2 ± 2.4 mm and PD 8.9 ± 1.8 mm. The radiographic defect angle was 29° ± 5.9°. The CEJ-BD distance was 11.2 ± 2.7 mm and the intrabony component of the defects (INFRA) was 6.6 ± 1.7 mm.

Selection of Surgical Flap

The simplified papilla preservation flap was used in 15 sites, the modified papilla preservation technique was selected in 18 cases, and the remaining seven sites were accessed with a crestal incision (Table 2).

Regenerative Material

Non-resorbable titanium reinforced ePTFE barrier membranes were used in 12 cases (Table 2). Defect angles ranged from 27° to 42° (average 32.4 ± 4.3°), and eight of the selected defects had a 1-wall intrabony subcomponent of 1 to 3 mm (average 1-wall component of the 12 sites was 1.4 ± 1.2 mm). Ten of the 11 defects treated with bioabsorbable membranes supported with a graft presented a 1-wall subcomponent of 1 to 5 mm (average 1.8 ± 1.3 mm); defect angles in this group ranged from 21° to 45° (average 31.4 ± 7°). Bioabsorbable barriers were used in seven sites presenting with a prevalent 2- and 3-wall morphology and narrow defect angles, ranging from 20° to 28° (average 24.1 ± 3.7°). EMD was applied to 10 defects with a prevalent 3-wall component; defect angle in this group ranged from 19° to 31° (average 26.5° ± 4.3°).

Primary Flap Closure

In all treated sites primary closure was obtained at completion of the surgical procedure. At the 1-week follow-up, when sutures were removed, two sites, both accessed with SPPF, presented with a small interdental wound dehiscence: one was treated with a bioabsorbable membrane and filler, the other with EMD (Table 3). At week 2, two additional small wound dehiscences were detected: one accessed with MPPT and treated with a bioabsorbable membrane and filler, the other accessed with SPPF and treated with a bioabsorbable barrier alone. All the other sites (90%) remained closed during the early healing phase.

One-Year Clinical Outcomes (all treated sites)

The 40 patients presented at the 1-year follow up visit with FMPS and FMBS of 7.5% ± 2.4% (range 2.3% to 14.3%) and 5.3% ± 2% (range 2.3% to 11.6%), respectively (Table 4).

The 1-year CAL was 4.1 ± 1.7 mm with a clinical attachment gain of 6 ± 1.8 mm (range 4 to 11 mm). Differences in CAL between baseline and 1 year were clinically and statistically highly significant (P <0.0001). No sites gained less than 4 mm of CAL; 77.5% gained 5 mm or more, and 40% more than 6 mm (Table 5). The 1-year CAL% was 92.1% ± 12% with a range of 71.4% to 116.7%. CAL% reached 100% of the baseline intrabony component of the defect in 19 (47.5%) sites.
Residual probing depths were 2.7 ± 0.6 mm, with an average reduction of 6.1 ± 1.9 mm (Table 4). Differences between baseline and 1-year PD were clinically and statistically highly significant (P <0.0001). Only four sites showed a residual PD of 4 mm; all the other sites had a PD of ≤3 mm (Table 6).

A minimal, statistically insignificant (P = 0.3657) increase of −0.1 ± 0.7 mm in gingival recession between baseline and 1 year was recorded (Table 4).

One-Year Clinical Outcomes (treatment group)

The 12 sites treated with titanium reinforced ePTFE membranes had an average intrabony component of 7.2 ± 2.1 mm and resulted in a 1-year CAL gain of 6.8 ± 2.2 mm (range 4 to 11 mm). The CAL% was 94.7 ± 13.4 (range 71.4 to 114.3). Residual pockets measured on average 2.3 ± 0.5 mm (range 2 to 3 mm), and the increase in gingival recession between baseline and 1 year was −0.2 ± 0.4 mm.

The 11 cases treated with a combination therapy (bioabsorbable barrier and filler) had an intrabony component of 6.1 ± 1.8 and showed a 1-year CAL gain of 5.4 ± 1.7 mm (range 4 to 9 mm), with a CAL% of 88.2% ± 9.6% (range 77.8% to 100%). Residual PD of 2.6 ± 0.7 mm (range 2 to 4 mm) and a decrease of 0.3 ± 0.5 mm in gingival recession were recorded.
The seven sites treated with bioabsorbable barriers presented with an intrabony component of 6.6 ± 1.0 and resulted in 5.9 ± 1.2 mm of CAL gain (range 4 to 7 mm) with a CAL% of 88.9% ± 11.5% (range 71.4% to 100%). All sites presented at 1 year with residual PD of 3 mm, and the increase in gingival recession after treatment amounted to −0.1 ± 1.1 mm.

The 10 sites treated with EMD had an intrabony component of 6.2 ± 1.5 and gained on average 5.9 ± 1.5 mm of CAL (range 4 to 8 mm). The CAL% was 95.4% ± 12.9% (range 80% to 116.7%). Residual PD at 1 year was 3.1 ± 0.7 mm (range 2 to 4 mm), and the increase in gingival recession was −0.2 ± 0.8 mm.