Radiographic angle width as predictor of clinical outcomes following regenerative periodontal therapy with enamel matrix derivative. A retrospective cohort study with a mean follow-up of at least 10 years.

OBJECTIVES: To assess the association between the baseline radiographic defect angle and the long-term clinical outcomes following periodontal regenerative therapy with Enamel Matrix Derivative (EMD).

METHOD AND MATERIALS: Baseline peri-apical radiographs obtained from a cohort of patients treated with periodontal regenerative therapy were digitized and the radiographic angle width between the root surface and the bony wall of the adjacent intraosseous defect was calculated and reported in degrees (°). Changes in pocket probing depth (PD) and clinical attachment level (CAL) were assessed and reported in mm. Clinical outcomes were evaluated at baseline (T0), 6 months following therapy (T1) and at the latest follow-up (T2).

RESULTS: Thirty-eight defects in 26 patients enrolled in supportive periodontal care for a mean period of 10.4 years (range: 8.0 - 15.5 years) were available for analysis. The mean PD change between T0 and T2 was 2.33 ± 1.66 mm at teeth with a defect angle width < 20° and 0.86 ± 1.66 mm at teeth with a defect angle width > 30° (p = 0.021). When the baseline radiographic angle width was < 20° the probability of obtaining a CAL gain > 3 mm was 1.5x higher (95% CI: 0.19 - 13.8) at T1 and 2.5x higher (95% CI: 0.40 - 15.6) at T2 compared with defects with a radiographic angle width > 30°.

CONCLUSION: Within their limitations, these results indicate that pre-therapeutic measurement of the radiographic defect angle width might provide relevant information on the short/long-term clinical outcomes following regenerative periodontal therapy with EMD.