Emdogain is a product containing a cocktail of enamel matrix proteins. Its use can result in greater clinical improvements than access flap surgery alone in periodontal infrabony defects, although with substantial variability in results.1 Antibiotics are not routinely recommended as an adjunct to conventional periodontal surgery, so it is curious that several previous trials with Emdogain have given them to patients. The explanation probably relates to the use of antibiotics by some people as an adjunct to another periodontal regenerative approach, guided tissue regeneration (GTR). The logic might be summarised thus: (i) GTR uses barrier membranes; (ii) barrier membranes often become exposed to the mouth; and (iii) systemic antibiotics might prevent or treat bacterial colonisation of the barriers and so favour improved results. It turns out that no consistent benefits have been shown for GTR despite this line of argument.

This study was not able to show that systemic antibiotics improved the clinical results following Emdogain surgery. This does not prove equivalence, especially since the compact size of the trial did not permit small differences to be shown to be statistically significant. The use of mean values could have obscured differences, and the presentation of proportions of patients with “winning” and “losing” sites might have helped to better understand the clinical outcomes. It was however helpful to report adverse events and these included diarrhoea in five patients treated with antibiotics.

Despite some reservations, this carefully conducted study should be considered as the best available evidence. No advantage to systemic antibiotics has been demonstrated, which is reassuring since their rationale as an adjunct to this type of surgery is obscure.

Practice point

  • No advantage in using systematic antibiotics as adjunct with this type of surgery has been demonstrated.