Introduction
tooth loss, inflammation, periodontitis, Periodontitis
DISEASE PROGRESSION, EMD, PERIODONTITIS, INFLAMMATION, PERIODONTITIS, INFLAMMATORY DISEASE, INFLAMMATORY RESPONSE
Periodontitis is a biofilm-driven inflammatory disease characterized by progressive destruction of the periodontal structures, thereby leading to tooth loss if left untreated [For more than 25 years, enamel matrix derivatives (EMD) have been in use as an adjunctive agent during surgical therapy to promote periodontal soft and hard tissue regeneration and have shown beneficial effects such as PPD reduction and CAL gain [While clinical parameters can be used to assess periodontal disease progression, the underlying inflammatory host immune response is one key aspect promoting tissue destruction [In addition to an overactivated inflammatory response, periodontitis is characterized by a dysbiotic overgrowing subgingival biofilm with increased prevalence of potential periodontal pathogens, dysregulated immune response, and tissue destruction [To the best of our knowledge, the impact of EMD application in the nonsurgical retreatment of remaining periodontal pockets on inflammatory response and subgingival biofilm has so far not been investigated in depth. Thus, the aim of the present study was to assess EMD effects on a broad range of host inflammation biomarkers and bacterial count of periodontitis associated bacteria in addition to clinical outcome in periodontitis patients presenting with residual pockets at re-evaluation. The null-hypothesis of the present study was that the use of EMD in addition to subgingival instrumentation would have no beneficial effects on the clinical outcome, inflammation, and bacterial count when compared to subgingival instrumentation alone.