Periodontal regeneration with enamel matrix derivative and decortication: A retrospective analysis of one year clinical and radiographic outcomes

Background: Intrabony periodontal defects present a clinical challenge. Decortication, also called intramarrow penetration (IMP), intended to stimulate angiogenesis and to enhance the healing environment, has demonstrated benefits in bone augmentation but remains insufficiently investigated in periodontal regenerative procedures, especially in combination with enamel matrix derivative (EMD). Methods: This retrospective cohort study included patients treated with EMD alone (control group) or with EMD combined with IMP (test group). The primary outcome was clinical attachment level (CAL) gain at 12 months. Secondary outcomes included probing pocket depth (PPD), gingival recession (REC), keratinized tissue width (KTW), and radiographic parameters such as defect depth (rDD), defect width (rDW), and defect angle (rANG). Linear regression with generalized estimating equations (GEE) was used to account for clustering, with Bonferroni correction for multiple comparisons. The significance was set at α = 0.05. Results: A total of 29 patients (39 teeth) were included. Both groups exhibited statistically significant improvements in clinical and radiographic parameters between baseline and 12 months (p < 0.05). In the test group, the mean PPD decreased by 3.86 ± 1.73 mm, the CAL gain was 3.18 ± 1.30 mm, and the REC increased by 0.68 ± 1.21 mm; radiographically, rDD and rDW were significantly reduced, whereas rANG did not change significantly. Similarly, in the control group, PPD decreased by 3.47 ± 1.33 mm, CAL gain was 2.82 ± 1.29 mm, REC increased by 0.65 ± 1.00 mm, and significant reductions in rDD and rDW were observed. No statistically significant differences were found between the two groups for any parameter at 12 months (p > 0.05). Conclusions: The adjunctive use of IMP did not significantly enhance the clinical or radiographic outcomes achieved with EMD alone. However, the comparable outcomes achieved in more challenging baseline conditions indicate that the technique merits further investigation in future randomized controlled studies.