Treatment of Intrabony Defects Using Equine-derived Bone Granules and Collagen Membranes: A Retrospective Study with a 13-year Follow-up

Abstract

Aim: The aim of this study is to investigate the effectiveness of a combination of an equine-derived, enzyme-treated bone graft and an equine collagen membrane to treat intrabony defects caused by periodontitis. Materials and methods: About 22 patients with a single 1-, 2-, or 3-wall intrabony defect and a probing pocket depth (PPD) of ≥5 mm, who were treated using an enzyme-deantigenated equine bone graft in addition to a collagen membrane and were followed up for at least 10 years, were retrospectively assessed. The plaque index (PI), the sulcus bleeding index (SBI), PPD, and the clinical attachment level (CAL) at each follow-up visit were compared to baseline. Results: The mean PI, SBI, PPD, and CAL were 0.22 ± 0.41, 1.86 ± 0.78, 7.86 ± 1.39 mm, and 8.84 ± 1.86 mm, respectively, at baseline, and 0.25 ± 0.44, 0.12 ± 0.32, 2.59 ± 0.50, and 4.04 ± 0.77 mm, respectively, at the last follow-up. The difference was significant for all parameters (p < 0.001) except PI (p = 0.83). The final CAL gain was 4.8 mm (49.8%). The SBI, PPD, and CAL still significantly improved at the 12-month follow-up visit but not at the 24-month follow-up visit. There were no correlations between either the number of defect walls or smoking and outcomes. In one case, a surgical re-entry at 5 years allowed a clinical evaluation, showing that intrabony defect was repaired with the newly formed bone of the patient. Conclusion: Equine bone granules in addition to an equine collagen membrane effectively and safely treated intrabony defects caused by periodontitis providing long-term results. Clinical significance: Equine-derived bone grafts have been in the market for more than 20 years. However, to the author's knowledge, no studies have reported long-term results for the use of this type of bone graft in periodontal surgery. The equine-derived bone granules used in the present study appears a promising option for treating intrabony defects due to moderate to severe periodontitis.