{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T18:03:04Z","timestamp":1785088984082,"version":"3.55.0"},"reference-count":65,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004687","name":"Universidad de Murcia","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004687","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Oral Invest"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>This parallel, randomized controlled clinical trial evaluated the influence of bone substitutes (BS) on the efficacy of the non-incised papillae surgical approach (NIPSA) with enamel matrix derivate (EMD) in resolving deep, isolated, combined non-contained intrabony and supra-alveolar periodontal defects, preserving the soft tissue.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Material and methods<\/jats:title>\n                <jats:p>Twenty-four patients were randomized to treatment with NIPSA and EMD or NIPSA plus EMD and BS. Bleeding on probing (BoP), interproximal clinical attachment level (CAL), interproximal probing depth (PD), recession (REC), location of the tip of the papilla (TP), and width of the keratinized tissue (KT) were evaluated before surgery and at 1\u00a0year post-surgery (primary outcomes). Wound closure was assessed at 1\u00a0week post\u2010surgery, and supra\u2010alveolar attachment gain (SUPRA-AG) was recorded at 1\u00a0year post\u2010surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>At 1\u00a0week, 87.5% of cases registered complete wound closure and there were no cases of necrosis, without differences between groups (<jats:italic>p<\/jats:italic>\u2009&gt;\u2009.05)<jats:bold>.<\/jats:bold> At 1\u00a0year, all cases showed negative BoP. A significant PD reduction (NIPSA\u2009+\u2009EMD 8.25\u2009\u00b1\u20092.70\u00a0mm vs. NIPSA\u2009+\u2009EMD\u2009+\u2009BS 6.83\u2009\u00b1\u20090.81\u00a0mm) and CAL gain (NIPSA\u2009+\u2009EMD 8.33\u2009\u00b1\u20092.74\u00a0mm vs. NIPSA\u2009+\u2009EMD\u2009+\u2009BS 7.08\u2009\u00b1\u20092.68\u00a0mm) were observed (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) in both groups, without significant between-group differences (<jats:italic>p<\/jats:italic>\u2009&gt;\u2009.05). The residual PD was\u2009&lt;\u20095\u00a0mm in all defects (NIPSA\u2009+\u2009EMD 2.50\u2009\u00b1\u20090.67\u00a0mm vs. NIPSA\u2009+\u2009EMD\u2009+\u2009BS 2.67\u2009\u00b1\u20090.78\u00a0mm). Soft tissues were preserved without significant between-group differences (REC: NIPSA\u2009+\u2009EMD 0.25\u2009\u00b1\u20090.45\u00a0mm vs. NIPSA\u2009+\u2009EMD\u2009+\u2009BS 0.17\u2009\u00b1\u20090.58\u00a0mm, <jats:italic>p<\/jats:italic>\u2009&gt;\u2009.05; KT: 0.00\u2009\u00b1\u20090.43\u00a0mm vs. 0.08\u2009\u00b1\u20090.67\u00a0mm, <jats:italic>p<\/jats:italic>\u2009&gt;\u2009.05). There were improvements in the papilla in both groups (TP: NIPSA\u2009+\u2009EMD 0.33\u2009\u00b1\u20090.49\u00a0mm vs. NIPSA\u2009+\u2009EMD\u2009+\u2009BS 0.45\u2009\u00b1\u20090.52\u00a0mm, <jats:italic>p<\/jats:italic>\u2009&gt;\u2009.05), which was only significant in the NIPSA EMD\u2009+\u2009BS group (0.45\u2009\u00b1\u20090.52\u00a0mm; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05). In both groups, CAL gain was recorded in the supra-alveolar component, showing full resolution of the intrabony component of the defect in all cases (SUPRA-AG: NIPSA\u2009+\u2009EMD 1.83\u2009\u00b1\u20091.11\u00a0mm vs. NIPSA\u2009+\u2009EMD\u2009+\u2009BS 2.00\u2009\u00b1\u20091.76\u00a0mm, <jats:italic>p<\/jats:italic>\u2009&gt;\u2009.05).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>NIPSA and EMD with or without BS seem to be a valid surgical approach in the treatment of isolated, deep non-contained periodontal defects. In our study, both treatments resulted in significant PD reduction and CAL gain, that extended in the supra-alveolar component, without differences with the use of BS. Both treatments resulted in soft tissue preservation. However, the addition of BS may improve interdental papillary tissue.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Clinical relevance\n<\/jats:title>\n                <jats:p>NIPSA, with or without bone substitutes, resulted in significant periodontal improvement, with soft tissue preservation in isolated, deep non-contained periodontal defects. The application of bone substitutes may provide interproximal soft tissue gain.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Clinical trial registration<\/jats:title>\n                <jats:p>Clinicaltrials.gov: NCT04712630.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00784-021-04256-1","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T23:13:38Z","timestamp":1637190818000},"page":"2793-2805","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Apical approach in periodontal reconstructive surgery with enamel matrix derivate and enamel matrix derivate plus bone substitutes: a randomized, controlled clinical trial"],"prefix":"10.1007","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0284-3496","authenticated-orcid":false,"given":"Jose Antonio","family":"Moreno Rodr\u00edguez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Jos\u00e9","family":"Ortiz Ruiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,17]]},"reference":[{"key":"4256_CR1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/prd.12153","volume":"76","author":"DD Bosshardt","year":"2018","unstructured":"Bosshardt DD (2018) The periodontal pocket: pathogenesis, histopathology and consequences. 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