human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of this study was to evaluate an allogeneic bone matrix ( ABM ) as a graft material for the treatment of periodontal osseous defects .  ABM is allogeneic demineralized freeze-dried human bone which has been processed to eliminate contaminating lipids , serum proteins , and cellular components which , when present , have the potential to reduce the osteoinductive capacity of the graft . ABM is provided in a glycerine delivery suspension which enhances graft stability and ease in placement . Paired osseous defects , ranging in depth from 3 to 12 mm , within 11 patients , were r and omized to receive ABM or demineralized freeze-dried bone allograft ( DFDBA ) .  Probing depth , clinical attachment level , bone fill , and defect resolution were determined at baseline and at the 6-month re-entry procedure . St and ardized radiographs and computer-assisted densitometric image analysis ( CADIA ) were used to assess bone density changes . Complete bone defect resolution was seen in 7 of 11 defects receiving ABM , and in 5 of 11 defects with the use of DFDBA . Mean defect fill with  ABM  was 69 % ( 33 to 100 % ) compared to 77 % ( 66 to 100 % ) with DFDBA . Soft tissue healing without clinical evidence of tissue reaction to ABM was observed . ABM and DFDBA sites exhibited similar probing depth reduction of 4.0 and 4.6 mm , respectively . In sites with initial probing depth of 7 mm or more , probing depths were reduced a mean of 5.8 mm with ABM and 6.7 mm with DFDBA ; both grafts result ed in a mean 4 mm of attachment gain . Results of radiographic analysis suggest similar density changes with each graft . These results demonstrate that both treatments were effective and that ABM may be a useful graft material in the treatment of periodontal osseous defects . J Periodontol 1995;66:1074 - 1079 The aim of the present clinical trial was to compare the long-term effect of EMDOGAIN treatment as an adjunct to modified widman flap ( MWF ) surgery with the effect of MWF and placebo treatment . The investigation was a placebo-controlled , r and omized multicenter trial involving 33 subjects with 34 paired test and control sites . The protocol required 2 interproximal sites , appropriately separated , in the same jaw with probing pocket depths > or = 6 mm and an associated intrabony defect with a depth of > or = 4 mm and a width of > or = 2 mm as measured on a radiograph . Only predominantly 1- and 2-wall defects were included .  Clinical attachment gain and radiographic bone gain were used as primary outcome variables . Assessment s were made at baseline , 8 , 16 and 36 months . Mean values for clinical attachment level gain in test and control sites at 8 months were 2.1 mm and 1.5 mm , respectively ; at 16 months , 2.3 mm and 1.7 mm , respectively ; and at 36 months 2.2 mm and 1.7 mm , respectively ; and the differences were statistically significantly different at each time point ( p < 0.01 ) . The radiographic bone level continued to increase over the 36 months at the EMDOGAIN-treated sites , while it remained close to the baseline level at the control sites . The statistically significant ( p < 0.001 ) radiographic bone gain at 36 months of 2.6 mm at EMDOGAIN-treated sites corresponded to 36 % gain of initial bone loss or 66 % defect fill . The present trial has demonstrated that topical application of EMDOGAIN onto diseased root surfaces associated with intrabony defects during MWF periodontal surgery will promote an increased gain of radiographic bone and clinical attachment compared to control ( placebo application ) surgery in the same patient . There was no evidence to indicate any clinical adverse effects from application of EMDOGAIN conjunction with periodontal surgery BACKGROUND It has been shown that clinical improvement of intrabony periodontal defects can be achieved with the use of enamel matrix proteins ( EMPs ) or by grafting with bovine porous bone mineral ( BPBM ) . There is no report on the potential synergistic effect of EMPs and BPBM in periodontal regenerative therapy . The purpose of this study was to compare the clinical effectiveness of EMPs used alone or in combination with BPBM in the treatment of periodontal intrabony defects in humans . METHODS Twenty-one paired intrabony defects were surgically treated using a split-mouth design . Intrabony defects were treated either with enamel matrix proteins ( EMP group ) or with enamel matrix proteins combined with bovine porous bone mineral ( EMP/BPBM group ) . Re-entry surgeries were performed at 6 months . RESULTS Preoperative probing depths , attachment levels , and transoperative bone measurements were similar for the EMP and EMP/BPBM groups . Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the EMP/BPBM group ( 3.43 + /- 1.32 mm on buccal sites and 3.36 + /- 1.35 mm on lingual sites ) when compared to the EMP group ( 1.91 + /- 1.42 mm on buccal sites and 1.85 + /- 1.38 mm on lingual sites ) . The EMP/BPBM group also presented with significantly more attachment gain ( 3.13 + /- 1.41 mm on buccal sites and 3.11 + /- 1.39 mm on lingual sites ) than the EMP group ( 1.72 + /- 1.33 mm on buccal sites and 1.75 + /- 1.37 mm on lingual sites ) . Surgical re-entry of the treated defects revealed a significantly greater amount of defect fill in favor of the EMP/BPBM group ( 3.82 + /- 1.43 mm on buccal sites and 3.74 + /- 1.38 mm on lingual sites ) as compared to the EMP group ( 1.33 + /1.17 mm on buccal sites and 1.41 + /- 1.19 mm on lingual sites ) . CONCLUSIONS The results of this study indicate that BPBM has the ability to augment the effects of EMPs in reducing probing depth , improving clinical attachment levels , and promoting defect fill when compared to presurgical levels As observed in previous case reports , dental rubber dam ( DRD ) can be utilized as a barrier membrane in the guided tissue regeneration ( GTR ) technique for the treatment of periodontal intrabony defects . The purpose of the present study was ( 1 ) to confirm the validity of DRD as a suitable material in regenerative procedures and ( 2 ) to compare , in a split-mouth clinical trial , the effectiveness of DRD-made membranes in the treatment of periodontal intrabony defects versus that of exp and ed polytetrafluoroethylene ( e-PTFE ) barriers .  22 systemically healthy non-smoker adult periodontitis patients ( 7 male , 15 female ) aged between 35 to 58 years were selected for the study . In each patient , a couple of 2 - 3 wall intrabony defects , located in different quadrants , were treated by a GTR technique using DRD ( test sites ) and e-PTFE ( control sites ) , respectively . Performing a strict control of the oral hygiene level and of the marginal gingival health during the whole period of study , clinical ( pocket probing depth , PPD ; probing attachment level , PAL ; gingival recession , GR ) and intrasurgical ( depth of the defect 's intraosseous component , IOC ; level of the alveolar crest , ACL ) parameters were recorded at baseline and at the 1-year re-entry procedure in each experimental site . Furthermore , the coronal level of the newly formed tissue from the base of the defect ( NFTL ) and the vertical bone gain ( VBG ) were calculated at the time of membrane removal and after the re-entry procedure respectively . Membranes were removed from both test and control sites after 5 weeks ; however , exposure of the membrane always occurred in test sites whereas it was observed in only 6 out of 22 control sites , this fact leading to an incomplete coverage of the regenerated tissue by the gingival flap in 18 out of 22 test sites . In both test and control sites , a statistically significant improvement of clinical and intrasurgical parameters occurred at the end of the study period ; however , a significantly greater improvement was observed in control sites for PAL ( + 4.0 mm versus + 3.0 mm ; p<0.05 ) and VBG ( 3.9 mm versus 2.9 mm ; p<0.05 ) although at the time of membrane removal , NFTL was similar between the experimental sites ( test : 5.8 ; control : 5.6 ; p>0.05 ) . Conversely , test sites exhibited a statistically significant greater increase in gingival recession ( + 1.9 versus + 1.2 ; p<0.05 ) and alveolar crest resorption ( -1.1 versus -0.3 , p<0.01 ) in comparison to controls . It was concluded that ( 1 ) DRD is a suitable material to be used as a barrier membrane in GTR procedures although ( 2 ) e-PTFE membranes can provide a greater improvement in PAL and VBG , probably because of the difficulty in completely covering the regenerated tissue due to the fact that the gingival tissues have undergone a consistent recession in DRD-treated sites . Further studies are needed to demonstrate if an adequate coverage of the regenerated tissue in DRD-treated sites can eliminate these differences The aim of the present study was to evaluate clinical ly and histologically the treatment of intrabony periodontal defects with a bioresorbable membrane barrier .  Fifty-two intrabony periodontal defects were treated according to the principles of guided tissue regeneration ( GTR ) with a bioresorbable membrane . Results were evaluated by assessing probing pocket depth , recession of the gingival margin , and clinical attachment level at baseline and at 1 and 2 years after therapy . Bone level changes were evaluated radiographically . The postoperative phase was uneventful in all cases . There was a mean probing pocket depth reduction from 8.4 to 3.6 mm , a mean increase of gingival margin recession from 1.5 to 3.0 mm , and a mean clinical attachment level change from 9.9 to 6.5 mm . Mean attachment gain was 3.4 mm . Two teeth scheduled for extraction were also treated with the same bioresorbable membrane . The histologic analysis 6 months after treatment revealed the formation of new connective tissue attachment and new alveolar bone in both cases . Based on the histologic findings it can be concluded that the clinical improvements following GTR with this type of bioresorbable membrane may represent , at least in part , true periodontal regeneration BACKGROUND Treatment with enamel matrix proteins ( EMD ) and guided tissue regeneration ( GTR ) with bioabsorbable membranes has been shown to promote periodontal regeneration ; however , until now , there were only limited data on the long-term clinical results following these regenerative techniques . Therefore , the aim of the present study was to present the 4-year results following treatment of intrabony defects with EMD or guided tissue regeneration ( GTR ) . METHODS Twelve patients , each displaying one pair of intrabony defects located contralaterally in the same jaw , were r and omly treated with EMD or with GTR by means of bioabsorbable membranes . The following clinical parameters were evaluated at baseline , at 1 year , and at 4 years after treatment : plaque index ( P1 ) , gingival index ( G1 ) , bleeding on probing ( BOP ) , probing depth ( PD ) , gingival recession ( GR ) , and clinical attachment level ( CAL ) . The primary outcome variable was CAL . No statistically significant differences between the groups were found at baseline . Power analysis to determine superiority of EMD treatment showed that the available sample size would yield 70 % power to detect a 1 mm difference . RESULTS The sites treated with EMD demonstrated mean CAL change from 9.8 + /- 2.0 mm to 6.4 + /- 1.6 mm ( P<0.001 ) and to 6.8 + /- 1.8 mm ( P<0.001 ) at 1 and 4 years , respectively . No statistically significant differences were found between the CAL mean at 1 and 4 years postoperatively . The sites treated with GTR showed a mean CAL change from 9.8 + /- 2.3 mm to 6.6 + /- 1.7 mm ( P<0.001 ) at 1 year and to 6.9 + /- 1.8 mm ( P<0.001 ) at 4 years . The CAL change between I and 4 years did not present statistically significant differences . No statistically significant differences in any of the investigated parameters were observed at 1 and 4 years between the treatment groups . CONCLUSIONS It was concluded that the CAL gain obtained following treatment with EMD or GTR can be maintained over a 4-year period AIM The purpose of the present multicenter clinical trial was to compare the efficacy of two different procedures in the treatment of infrabony defects :  guided tissue regeneration ( GTR ) with nonresorbable membranes and enamel matrix derivative ( EMD ) . MATERIAL AND METHODS Six centers participated in this study . Ninety-eight patients with an interproximal infrabony defect were selected . All patients were treated with an initial phase of scaling and root planing , and at the study 's baseline the selected defects presented a value of probing depth ( PD ) > or = 6 mm with an infrabony component > or = 4 mm . Forty-nine patients were treated with GTR procedures ( 
    Output:
    
agent
In most respects , all membranes and enamel matrix derivative ( EMD ) delivered better outcomes , in the range of 1 to 2 mm , than open flap debridement .
The use of any barrier type or EMD configuration was found to yield more Clinical Attachment Level ( CAL ) gain than any open flap configuration .
GTR was confirmed to be superior to open flap debridement
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of this study was to evaluate an allogeneic bone matrix ( ABM ) as a graft material for the treatment of periodontal osseous defects .  ABM is allogeneic demineralized freeze-dried human bone which has been processed to eliminate contaminating lipids , serum proteins , and cellular components which , when present , have the potential to reduce the osteoinductive capacity of the graft . ABM is provided in a glycerine delivery suspension which enhances graft stability and ease in placement . Paired osseous defects , ranging in depth from 3 to 12 mm , within 11 patients , were r and omized to receive ABM or demineralized freeze-dried bone allograft ( DFDBA ) .  Probing depth , clinical attachment level , bone fill , and defect resolution were determined at baseline and at the 6-month re-entry procedure . St and ardized radiographs and computer-assisted densitometric image analysis ( CADIA ) were used to assess bone density changes . Complete bone defect resolution was seen in 7 of 11 defects receiving ABM , and in 5 of 11 defects with the use of DFDBA . Mean defect fill with  ABM  was 69 % ( 33 to 100 % ) compared to 77 % ( 66 to 100 % ) with DFDBA . Soft tissue healing without clinical evidence of tissue reaction to ABM was observed . ABM and DFDBA sites exhibited similar probing depth reduction of 4.0 and 4.6 mm , respectively . In sites with initial probing depth of 7 mm or more , probing depths were reduced a mean of 5.8 mm with ABM and 6.7 mm with DFDBA ; both grafts result ed in a mean 4 mm of attachment gain . Results of radiographic analysis suggest similar density changes with each graft . These results demonstrate that both treatments were effective and that ABM may be a useful graft material in the treatment of periodontal osseous defects . J Periodontol 1995;66:1074 - 1079 The aim of the present clinical trial was to compare the long-term effect of EMDOGAIN treatment as an adjunct to modified widman flap ( MWF ) surgery with the effect of MWF and placebo treatment . The investigation was a placebo-controlled , r and omized multicenter trial involving 33 subjects with 34 paired test and control sites . The protocol required 2 interproximal sites , appropriately separated , in the same jaw with probing pocket depths > or = 6 mm and an associated intrabony defect with a depth of > or = 4 mm and a width of > or = 2 mm as measured on a radiograph . Only predominantly 1- and 2-wall defects were included .  Clinical attachment gain and radiographic bone gain were used as primary outcome variables . Assessment s were made at baseline , 8 , 16 and 36 months . Mean values for clinical attachment level gain in test and control sites at 8 months were 2.1 mm and 1.5 mm , respectively ; at 16 months , 2.3 mm and 1.7 mm , respectively ; and at 36 months 2.2 mm and 1.7 mm , respectively ; and the differences were statistically significantly different at each time point ( p < 0.01 ) . The radiographic bone level continued to increase over the 36 months at the EMDOGAIN-treated sites , while it remained close to the baseline level at the control sites . The statistically significant ( p < 0.001 ) radiographic bone gain at 36 months of 2.6 mm at EMDOGAIN-treated sites corresponded to 36 % gain of initial bone loss or 66 % defect fill . The present trial has demonstrated that topical application of EMDOGAIN onto diseased root surfaces associated with intrabony defects during MWF periodontal surgery will promote an increased gain of radiographic bone and clinical attachment compared to control ( placebo application ) surgery in the same patient . There was no evidence to indicate any clinical adverse effects from application of EMDOGAIN conjunction with periodontal surgery BACKGROUND It has been shown that clinical improvement of intrabony periodontal defects can be achieved with the use of enamel matrix proteins ( EMPs ) or by grafting with bovine porous bone mineral ( BPBM ) . There is no report on the potential synergistic effect of EMPs and BPBM in periodontal regenerative therapy . The purpose of this study was to compare the clinical effectiveness of EMPs used alone or in combination with BPBM in the treatment of periodontal intrabony defects in humans . METHODS Twenty-one paired intrabony defects were surgically treated using a split-mouth design . Intrabony defects were treated either with enamel matrix proteins ( EMP group ) or with enamel matrix proteins combined with bovine porous bone mineral ( EMP/BPBM group ) . Re-entry surgeries were performed at 6 months . RESULTS Preoperative probing depths , attachment levels , and transoperative bone measurements were similar for the EMP and EMP/BPBM groups . Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the EMP/BPBM group ( 3.43 + /- 1.32 mm on buccal sites and 3.36 + /- 1.35 mm on lingual sites ) when compared to the EMP group ( 1.91 + /- 1.42 mm on buccal sites and 1.85 + /- 1.38 mm on lingual sites ) . The EMP/BPBM group also presented with significantly more attachment gain ( 3.13 + /- 1.41 mm on buccal sites and 3.11 + /- 1.39 mm on lingual sites ) than the EMP group ( 1.72 + /- 1.33 mm on buccal sites and 1.75 + /- 1.37 mm on lingual sites ) . Surgical re-entry of the treated defects revealed a significantly greater amount of defect fill in favor of the EMP/BPBM group ( 3.82 + /- 1.43 mm on buccal sites and 3.74 + /- 1.38 mm on lingual sites ) as compared to the EMP group ( 1.33 + /1.17 mm on buccal sites and 1.41 + /- 1.19 mm on lingual sites ) . CONCLUSIONS The results of this study indicate that BPBM has the ability to augment the effects of EMPs in reducing probing depth , improving clinical attachment levels , and promoting defect fill when compared to presurgical levels As observed in previous case reports , dental rubber dam ( DRD ) can be utilized as a barrier membrane in the guided tissue regeneration ( GTR ) technique for the treatment of periodontal intrabony defects . The purpose of the present study was ( 1 ) to confirm the validity of DRD as a suitable material in regenerative procedures and ( 2 ) to compare , in a split-mouth clinical trial , the effectiveness of DRD-made membranes in the treatment of periodontal intrabony defects versus that of exp and ed polytetrafluoroethylene ( e-PTFE ) barriers .  22 systemically healthy non-smoker adult periodontitis patients ( 7 male , 15 female ) aged between 35 to 58 years were selected for the study . In each patient , a couple of 2 - 3 wall intrabony defects , located in different quadrants , were treated by a GTR technique using DRD ( test sites ) and e-PTFE ( control sites ) , respectively . Performing a strict control of the oral hygiene level and of the marginal gingival health during the whole period of study , clinical ( pocket probing depth , PPD ; probing attachment level , PAL ; gingival recession , GR ) and intrasurgical ( depth of the defect 's intraosseous component , IOC ; level of the alveolar crest , ACL ) parameters were recorded at baseline and at the 1-year re-entry procedure in each experimental site . Furthermore , the coronal level of the newly formed tissue from the base of the defect ( NFTL ) and the vertical bone gain ( VBG ) were calculated at the time of membrane removal and after the re-entry procedure respectively . Membranes were removed from both test and control sites after 5 weeks ; however , exposure of the membrane always occurred in test sites whereas it was observed in only 6 out of 22 control sites , this fact leading to an incomplete coverage of the regenerated tissue by the gingival flap in 18 out of 22 test sites . In both test and control sites , a statistically significant improvement of clinical and intrasurgical parameters occurred at the end of the study period ; however , a significantly greater improvement was observed in control sites for PAL ( + 4.0 mm versus + 3.0 mm ; p<0.05 ) and VBG ( 3.9 mm versus 2.9 mm ; p<0.05 ) although at the time of membrane removal , NFTL was similar between the experimental sites ( test : 5.8 ; control : 5.6 ; p>0.05 ) . Conversely , test sites exhibited a statistically significant greater increase in gingival recession ( + 1.9 versus + 1.2 ; p<0.05 ) and alveolar crest resorption ( -1.1 versus -0.3 , p<0.01 ) in comparison to controls . It was concluded that ( 1 ) DRD is a suitable material to be used as a barrier membrane in GTR procedures although ( 2 ) e-PTFE membranes can provide a greater improvement in PAL and VBG , probably because of the difficulty in completely covering the regenerated tissue due to the fact that the gingival tissues have undergone a consistent recession in DRD-treated sites . Further studies are needed to demonstrate if an adequate coverage of the regenerated tissue in DRD-treated sites can eliminate these differences The aim of the present study was to evaluate clinical ly and histologically the treatment of intrabony periodontal defects with a bioresorbable membrane barrier .  Fifty-two intrabony periodontal defects were treated according to the principles of guided tissue regeneration ( GTR ) with a bioresorbable membrane . Results were evaluated by assessing probing pocket depth , recession of the gingival margin , and clinical attachment level at baseline and at 1 and 2 years after therapy . Bone level changes were evaluated radiographically . The postoperative phase was uneventful in all cases . There was a mean probing pocket depth reduction from 8.4 to 3.6 mm , a mean increase of gingival margin recession from 1.5 to 3.0 mm , and a mean clinical attachment level change from 9.9 to 6.5 mm . Mean attachment gain was 3.4 mm . Two teeth scheduled for extraction were also treated with the same bioresorbable membrane . The histologic analysis 6 months after treatment revealed the formation of new connective tissue attachment and new alveolar bone in both cases . Based on the histologic findings it can be concluded that the clinical improvements following GTR with this type of bioresorbable membrane may represent , at least in part , true periodontal regeneration BACKGROUND Treatment with enamel matrix proteins ( EMD ) and guided tissue regeneration ( GTR ) with bioabsorbable membranes has been shown to promote periodontal regeneration ; however , until now , there were only limited data on the long-term clinical results following these regenerative techniques . Therefore , the aim of the present study was to present the 4-year results following treatment of intrabony defects with EMD or guided tissue regeneration ( GTR ) . METHODS Twelve patients , each displaying one pair of intrabony defects located contralaterally in the same jaw , were r and omly treated with EMD or with GTR by means of bioabsorbable membranes . The following clinical parameters were evaluated at baseline , at 1 year , and at 4 years after treatment : plaque index ( P1 ) , gingival index ( G1 ) , bleeding on probing ( BOP ) , probing depth ( PD ) , gingival recession ( GR ) , and clinical attachment level ( CAL ) . The primary outcome variable was CAL . No statistically significant differences between the groups were found at baseline . Power analysis to determine superiority of EMD treatment showed that the available sample size would yield 70 % power to detect a 1 mm difference . RESULTS The sites treated with EMD demonstrated mean CAL change from 9.8 + /- 2.0 mm to 6.4 + /- 1.6 mm ( P<0.001 ) and to 6.8 + /- 1.8 mm ( P<0.001 ) at 1 and 4 years , respectively . No statistically significant differences were found between the CAL mean at 1 and 4 years postoperatively . The sites treated with GTR showed a mean CAL change from 9.8 + /- 2.3 mm to 6.6 + /- 1.7 mm ( P<0.001 ) at 1 year and to 6.9 + /- 1.8 mm ( P<0.001 ) at 4 years . The CAL change between I and 4 years did not present statistically significant differences . No statistically significant differences in any of the investigated parameters were observed at 1 and 4 years between the treatment groups . CONCLUSIONS It was concluded that the CAL gain obtained following treatment with EMD or GTR can be maintained over a 4-year period AIM The purpose of the present multicenter clinical trial was to compare the efficacy of two different procedures in the treatment of infrabony defects :  guided tissue regeneration ( GTR ) with nonresorbable membranes and enamel matrix derivative ( EMD ) . MATERIAL AND METHODS Six centers participated in this study . Ninety-eight patients with an interproximal infrabony defect were selected . All patients were treated with an initial phase of scaling and root planing , and at the study 's baseline the selected defects presented a value of probing depth ( PD ) > or = 6 mm with an infrabony component > or = 4 mm . Forty-nine patients were treated with GTR procedures ( 
    Output:
    