Clinical and radiographic comparison of minimally invasive nonsurgical and surgical approaches with enamel matrix derivatives in periodontal intrabony defects: a 3-arm randomized clinical trial.

PURPOSE: This study aimed to compare the clinical and radiographic efficacy of nonsurgical treatment with enamel matrix derivative (EMD), EMD-assisted surgical treatment, and nonsurgical treatment alone for intrabony defects. METHODS: Sixty patients with intrabony defects were randomly assigned to one of the following groups: (i) nonsurgical subgingival debridement alone (negative control [NC]), (ii) minimally invasive surgical technique (MIST) with EMD application (positive control [PC]), or (iii) nonsurgical subgingival debridement with EMD application (test group). Clinical and radiographic measurements, along with optical impressions, were obtained at baseline and during the 6-month follow-up period. RESULTS: All 60 patients completed the trial, with 20 participants in each group. The proportion of patients achieving the composite outcome (final probing pocket depth ≤4 mm and reduction in clinical attachment loss ≥3 mm) did not differ significantly among the groups (NC: 9/20; PC: 8/20; test: 11/20; P = 0.626). However, bleeding on probing was significantly lower in the test group than in the PC group at both 3 and 6 months (P=0.029 for both timepoints). Gingival recession assessed using optical impressions demonstrated mean changes from baseline of 0.24±0.27 mm, 0.51±0.56 mm, and 0.20±0.18 mm at 6 months in the NC, PC, and test groups, respectively, with significant intergroup differences over time (P=0.038). The amount of radiographic bone gain did not differ significantly among the groups (P>0.05). CONCLUSIONS: The nonsurgical application of EMD resulted in clinical and radiographic improvements comparable to those achieved with EMD-assisted MIST procedures. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0007436.