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Notes: Objectives: Current literature is ambivalent on the use of barrier membranes for regeneration of intraosseous defects. One of the reasons for unpredictable results may be related to infection before, during and after the surgical procedure. Therefore, the purpose of the present controlled study was to evaluate both the use of membranes (MEM) and antibiotics (AB), separately and in combination.Methods: In all, 25 patients with two intraosseous periodontal defects each were randomized in two groups: AB+ group receiving systemic antibiotics (n = 13) and AB– group without antibiotics (n = 12). After raising flaps and after debridement, both defects in each patient were covered by a bioresorbable membrane (MEM+). However, just before suturing the flaps in a coronal position, the membrane over one of the two defects was removed at random (MEM–). This protocol resulted in four groups of defects: (i) MEM– AB–; (ii) MEM+ AB–; (iii) MEM– AB+ ; (iv) MEM+ AB+. Patients were monitored clinically and microbiologically for 1 year. Data were analyzed in repeated measures ancova's and adjusted means for clinical variables were obtained from the final statistical model.Results:  Reduction in probing pocket depth (PPD) at 12 months postoperatively varied between 2.54 and 3.06 mm between the four treatment modalities, but overall no main effect of MEM or AB was found. Gains in probing attachment level (PAL) at 12 months postoperatively varied between 0.56 and 1.96 mm for the 4 treatments. In the overall analysis for PAL, no main effect of MEM or AB was found. Gains in probing bone level (PBL) 12 months postoperatively ranged from 1.39 to 2.09 mm between the treatment groups. Again, overall, no main effects of MEM or AB were found for PBL. Explorative statistical analyses indicated that smoking and not MEM or AB is a determining factor for gain in PBL (P = 0.0009). Nonsmokers were estimated to gain 2.04 mm PBL compared to 0.52 mm in smokers. The prevalence of several periodontal pathogens, at the day of surgery or postoperatively, and specific defect characteristics, were not determining factors for gain in PAL and PBL.Conclusions:  Neither the application of barrier membranes nor the use of systemic antibiotics showed an additional effect over control on both soft and hard tissue measurements in the treatment of intraosseous defects. In contrast, smoking was a determining factor severely limiting gain in PBL in surgical procedures aimed at regeneration of intraosseous defects.

Notes: Objectives: The aim of the present study was to examine, by clinical means and as patient perception of post-operative events, the effect of Emdogain® (enamel matrix derivative (EMD)) on the healing of soft-tissue wounds following periodontal surgery in comparison to flap surgeries without application of EMD.Material and Methods: For this study, 22 subjects (nine female and 13 male) who were scheduled for periodontal flap surgery were selected. The mean age for all patients was 49.9 (SD 8.7) years (range, 32–67). Six women and five men were assigned to the test group and three women and eight men were assigned to the control group. All subjects were scheduled, after re-evaluation of the periodontal status 8 weeks after initial treatment, to undergo surgery of the soft tissues, because of existing of probing pocket depth (5 mm or more), on at least three teeth. At random, 11 patients were assigned to control treatment and 11 patients were placed in the test group. All underwent one periodontal flap surgery for the purpose of this study. A modified Widman flap was performed. Patients in the test group received an application of EMD underneath the mucoperiostal flaps and onto the exposed root surfaces. Clinical measurements were taken at four different points in time, at the time of surgery, 1, 4 and 8 weeks after surgery. All subjects filled out a questionnaire every day for the first 7 days following surgery to evaluate post-operative complaints.Results: Of all parameters evaluated none showed a significant difference between the control and EMD groups, except for gingival swelling at the 1-week assessment, where the EMD group exhibited a higher swelling score. The questionnaire revealed that complaints of oozing of blood from the wound was twice more prevalent 1 day post-surgery in the control (n=6) as in the EMD group (n=3).Conclusion: This study shows that the early woundhealing of periodontal flap-surgeries in those sites treated with Emdogain® is not different from control sites.