DOI: 10.1002/jper.23-0538 ISSN: 0022-3492

Assessment of bone defect morphology for the adjunctive use of bone grafting combined with enamel matrix derivative: A 3‐year cohort study

Takanori Matsuura, Risako Mikami, Koji Mizutani, Hidehiro Shioyama, Norio Aoyama, Tomonari Suda, Yukako Kusunoki, Kohei Takeda, Yuichi Izumi, Jun Aida, Akira Aoki, Takanori Iwata
  • Periodontics
  • General Medicine



There have been limited studies with statistically sufficient sample sizes for assessment of suitable bone defect morphology for combination therapy with enamel matrix derivative (EMD) and bone grafting. The aim of this study was to investigate the appropriate feature of intrabony defects, such as bone defect angle (DA) and the containment by bony wall, for yielding the additional benefit of bone grafting in combination with periodontal regenerative therapy using EMD.


Following periodontal regenerative therapy using EMD with or without autologous bone grafting, 282 intrabony defects of 177 participants were maintained for 3 years. Multilevel linear regression analysis was performed to evaluate the radiographic bony defect depth (RBD) reduction after adjusting for confounders.


The baseline parameters, except for the proportion of contained bony defects and tooth mobility, did not differ significantly between the groups with and without bone grafts. There was no significant difference in the improvement of clinical parameters between the groups. The 1‐ and 3‐year reduction of RBD showed significant inverse correlations with preoperative DA only in the group without bone graft. Furthermore, multivariate analysis showed a significant interaction between DA at baseline ≥40° and adjunctive bone grafting in the reduction of RBD, regardless of the number of bony walls.


Adjunctive autologous bone grafting with enamel matrix derivative might be significantly beneficial for defect depth improvement in the case of DA at baseline ≥40°.

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