A Clinical Study of Connective Tissue Graft and Enamel Matrix Derivative in the Treatment of Intrabony Periodontal Defects

NCT ID: NCT07233733

Last Updated: 2025-11-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

17 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-06-01

Study Completion Date

2025-08-01

Brief Summary

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This clinical study aims to evaluate the effectiveness of periodontal regenerative surgery using the connective tissue graft (CTG) wall technique combined with enamel matrix derivative (EMD) in patients who have intrabony periodontal defects. The purpose is to determine whether this combined approach can enhance both bone regeneration and soft-tissue stability compared with the patient's initial condition.

Eligible participants will receive periodontal surgery in which a connective tissue graft and enamel matrix derivative are applied to the defect site. The study will monitor clinical improvements such as attachment gain, reduction in pocket depth, bone fill observed on cone-beam computed tomography (CBCT), and stability of the gingival margin and soft-tissue thickness. Clinical parameters (probing depth and attachment level) are recorded at baseline, 3 months, and 6 months. Gingival and hygiene parameters (recession, gingival thickness, plaque, and bleeding scores) are assessed at baseline, 1 month, 3 months, and 6 months. Radiographic bone outcomes are measured at baseline and 6 months, and early wound healing is assessed at 1 and 2 weeks.

The main goal is to assess whether CTG + EMD treatment provides predictable periodontal regeneration, improved tissue stability, and better esthetic outcomes for patients with periodontitis.

Detailed Description

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This is a prospective, single-group interventional clinical trial conducted at the University of Medicine and Pharmacy at Ho Chi Minh City to evaluate the effectiveness of the connective tissue graft (CTG) wall technique combined with enamel matrix derivative (EMD, Emdogain®, Straumann) in the regenerative treatment of intrabony periodontal defects. The study included 17 patients diagnosed with stage III-IV periodontitis who presented with radiographically confirmed intrabony defects suitable for regenerative therapy.

All participants received treatment following a standardized periodontal surgical protocol. After local anesthesia, a split-thickness vestibular releasing flap was prepared to allow coronal advancement, with external reflection of the papilla at the defect site. Thorough degranulation and root surface debridement were performed using ultrasonic and hand instruments. The root surface was conditioned with 24% EDTA gel for 2 minutes, rinsed with saline, and then enamel matrix derivative was applied onto the root surface and into the defect. A palatal connective tissue graft harvested using the four-incision technique was de-epithelialized, trimmed to span the papillae, and sutured to the buccal flap to form a stable soft-tissue wall. The flap was coronally advanced and secured with horizontal mattress and interrupted sutures to achieve tension-free primary closure.

Clinical and radiographic outcomes are evaluated at multiple time points.

Clinical parameters: probing pocket depth (PPD) and clinical attachment level (CAL) at baseline, 3 months, and 6 months.

Soft-tissue and hygiene parameters: gingival recession (buccal and interproximal), gingival thickness, full-mouth plaque score (FMPS), and full-mouth bleeding score (FMBS) at baseline, 1, 3, and 6 months.

Radiographic parameters: infrabony defect depth, buccal bone dehiscence, suprabony component, and defect angle measured on cone-beam computed tomography (CBCT) at baseline and 6 months.

Early wound healing: assessed at 1 and 2 weeks using the Early Healing Index (EHI).

The study was conducted at the Department of Periodontology, University of Medicine and Pharmacy at Ho Chi Minh City, between June 2024 and August 2025. The protocol was reviewed and approved by the Institutional Review Board of the University of Medicine and Pharmacy at Ho Chi Minh City (Approval No. 716/HĐĐĐ-ĐHYD, dated June 13, 2024). All participants provided written informed consent before enrollment.

Conditions

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Periodontal Diseases Regeneration

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

This is a single-arm interventional clinical trial in which all enrolled patients receive periodontal regenerative surgery using the connective tissue graft wall technique combined with enamel matrix derivative (Emdogain®). The model was selected to evaluate clinical and radiographic outcomes of this specific surgical approach without a comparator group
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Outcome assessors were blinded to the surgical intervention. Examiners responsible for clinical and radiographic measurements were not involved in the surgical procedures and were unaware of the treatment allocation, ensuring unbiased data collection

Study Groups

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Connective Tissue Wall + Enamel Matrix Derivative

Periodontal regenerative surgery using a connective tissue graft (CTG) "soft-tissue wall" combined with enamel matrix derivative (EMD, Emdogain®) under a minimally invasive flap design.

Group Type EXPERIMENTAL

Connective Tissue Graft (CTG) Wall Technique

Intervention Type PROCEDURE

After flap elevation and thorough degranulation/root debridement, a palatal connective tissue graft is harvested with the four-incision technique, de-epithelialized, and adapted to the buccal flap to create a stable soft-tissue wall.

Minimally Invasive Flap Design

Intervention Type PROCEDURE

Split-thickness vestibular releasing flap with external papilla reflection to allow coronal advancement and preserve blood supply.

Root Surface Preparation and Debridement

Intervention Type PROCEDURE

Thorough degranulation and root surface debridement using ultrasonic and hand instruments; intraoperative recording of defect depth and morphology.

Growth Factor Application (EDTA + EMD)

Intervention Type BIOLOGICAL

Conditioning of the root surface with 24% EDTA gel for 2 minutes, rinsing, followed by application of enamel matrix derivative (EMD; Emdogain®) to the root surface and into the intrabony defect.

Suturing Technique

Intervention Type PROCEDURE

Combination of horizontal mattress and interrupted sutures to achieve tension-free primary closure.

Amoxicillin/Clavulanate Potassium 875 MG-125 MG Oral Tablet

Intervention Type DRUG

875/125 mg orally, twice daily for 5 days, prescribed as postoperative antibiotic therapy.

Ibuprofen (Advil)

Intervention Type DRUG

400 mg orally, three times daily for 5 days, prescribed for postoperative pain and inflammation control.

chlorhexidine mouthrinse

Intervention Type DRUG

0.12% solution, twice daily for 2 weeks, prescribed for chemical plaque control.

Interventions

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Connective Tissue Graft (CTG) Wall Technique

After flap elevation and thorough degranulation/root debridement, a palatal connective tissue graft is harvested with the four-incision technique, de-epithelialized, and adapted to the buccal flap to create a stable soft-tissue wall.

Intervention Type PROCEDURE

Minimally Invasive Flap Design

Split-thickness vestibular releasing flap with external papilla reflection to allow coronal advancement and preserve blood supply.

Intervention Type PROCEDURE

Root Surface Preparation and Debridement

Thorough degranulation and root surface debridement using ultrasonic and hand instruments; intraoperative recording of defect depth and morphology.

Intervention Type PROCEDURE

Growth Factor Application (EDTA + EMD)

Conditioning of the root surface with 24% EDTA gel for 2 minutes, rinsing, followed by application of enamel matrix derivative (EMD; Emdogain®) to the root surface and into the intrabony defect.

Intervention Type BIOLOGICAL

Suturing Technique

Combination of horizontal mattress and interrupted sutures to achieve tension-free primary closure.

Intervention Type PROCEDURE

Amoxicillin/Clavulanate Potassium 875 MG-125 MG Oral Tablet

875/125 mg orally, twice daily for 5 days, prescribed as postoperative antibiotic therapy.

Intervention Type DRUG

Ibuprofen (Advil)

400 mg orally, three times daily for 5 days, prescribed for postoperative pain and inflammation control.

Intervention Type DRUG

chlorhexidine mouthrinse

0.12% solution, twice daily for 2 weeks, prescribed for chemical plaque control.

Intervention Type DRUG

Other Intervention Names

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Connective Tissue Graft Wall Technique

Eligibility Criteria

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Inclusion Criteria

* Adults ≥18 years old who can provide written informed consent.
* Diagnosis of stage III-IV periodontitis (2017 World Workshop).
* Completed initial non-surgical periodontal therapy with good plaque control.
* Full-mouth plaque score (FMPS) ≤20% and full-mouth bleeding score (FMBS) ≤20%.
* Presence of ≥1 intrabony periodontal defect with an intrabony component ≥3 mm, confirmed clinically and radiographically.
* Probing pocket depth (PPD) at the study site ≥6 mm.

Exclusion Criteria

* Systemic conditions or medications that could affect periodontal healing (e.g., diabetes mellitus, immunodeficiency, bisphosphonates, corticosteroids, immunosuppressants).
* Current smokers or former heavy smokers.
* Pregnancy or lactation.
* Teeth with untreated endodontic lesions or non-vital status; furcation involvement class II-III.
* Untreated occlusal trauma or tooth mobility grade II-III.
* Third molars.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Medicine and Pharmacy at Ho Chi Minh City

OTHER

Sponsor Role collaborator

Phạm Đình Thiên Khải

OTHER

Sponsor Role lead

Responsible Party

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Phạm Đình Thiên Khải

Resident Doctor in Periodontology, Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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University of Medicine and Pharmacy at Ho Chi Minh City - Faculty of Odonto-Stomatology

Ho Chi Minh City, Ho Chi Minh City, Vietnam

Site Status

Countries

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Vietnam

Other Identifiers

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258/2025/HĐ-ĐHYD

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

No. 716/HĐĐĐ-ĐHYD

Identifier Type: -

Identifier Source: org_study_id

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