The Application of Enamel Matrix Protein Derivative (Emdogain®) in Regenerative Periodontal Therapy: Which Applications are Evidence Based?

Cilj je regenerativnog liječenja parodonta ponovno uspostaviti izgubljenu građu parodonta (t.j. obnova korijenskoga cementa, parodontnoga ligamenta i alveolarne kosti). Rezultati temeljnih istraživanja upućuju na važnu ulogu proteinskog derivata matriksa cakline (enamel matrix protein derivative, EMD) u cijeljenju oštećenja parodonta. Histološki rezultati pokusa na životinjama i izvješća o slučajevima u ljudi, pokazuju da se primjenom EMD-a pospješuje obnova parodonta. Štoviπe, klinička istraživanja upućuju na zaključak da se primjenom EMD-a pozitivno utječe na cijeljenje parodontnih rana u čovjeka. Cilj je ovoga preglednog rada, na osnovi postojećih podataka iznijeti koje su kliničke indikacije za regenerativnu primjenu EMD-a.The goal of regenerative periodontal therapy is the reconstitution of the lost periodontal structures (i.e. the new formation of root cementum, periodontal ligament and alveolar bone). Results from basic research have pointed to the important role of the enamel matrix protein derivative (EMD) in periodontal wound healing. Histological results of experiments in animals and of human case reports have shown that treatment with EMD promotes periodontal regeneration. Moreover, clinical studies have indicated that treatment with EMD positively influences periodontal wound healing in humans. The goal of the current overview is to present, based on the existing evidence, the clinical indications for regenerative therapy with EMD

Effect of EDTA root conditioning on the healing of intrabony defects treated with an enamel matrix protein derivative.

Contains fulltext : 49580.pdf (publisher's version ) (Open Access)BACKGROUND: Regenerative periodontal therapy with an enamel matrix protein derivative (EMD) has been shown to promote regeneration in intrabony periodontal defects. However, in most clinical studies, root surface conditioning with EDTA was performed in conjunction with the application of EMD, and, therefore, it cannot be excluded that the results may also be attributable to the effect of the root conditioning procedure. The purpose of this study was to determine the effect of root conditioning on the healing of intrabony defects treated with EMD. METHODS: Twenty-four patients, each of whom exhibited one deep intrabony defect, were randomly treated with either open flap debridement (OFD) followed by root surface conditioning with EDTA and application of EMD (OFD+EDTA+EMD) or with OFD and application of EMD only (OFD+EMD). The following parameters were recorded at baseline and at 1 year: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). RESULTS: No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the OFD+EDTA+EMD group showed a reduction in mean PD from 9.3+/-1.3 mm to 4.0+/-0.9 mm (P<0.001), and mean CAL changed from 10.8+/-2.2 mm to 7.1+/-2.8 mm (P<0.001). In the OFD+EMD group, mean PD was reduced from 9.3+/-1.2 mm to 4.2+/-0.9 mm (P<0.001), and a change in mean CAL from 11.0+/-1.7 mm to 7.3+/-1.6 mm (P<0.001). There were no significant differences in any of the investigated parameters between the two groups. CONCLUSION: In intrabony defects, regenerative surgery including OFD+EDTA+EMD failed to show statistically significant differences in terms of PD reduction and CAL gain compared to treatment with OFD+EMD

Healing of intrabony defects following treatment with an oily calcium hydroxide suspension (Osteoinductal). A controlled clinical study.

Contains fulltext : 50104.pdf (publisher's version ) (Closed access)The purpose of the present clinical study was to evaluate the healing of deep intrabony defects following the application of an oily calcium hydroxide suspension (OCHS). Thirty patients suffering from chronic periodontitis, each of whom displayed one intrabony defect, were randomly treated with access flap surgery (AFS) and the application of OCHS (test) or with AFS alone (control). The following clinical parameters were recorded at baseline and at 6 months after therapy: plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession, and clinical attachment level (CAL). No differences in any of the investigated parameters were observed at baseline between the two groups. At 6 months after therapy, the test group showed a reduction in mean PD from 7.7+/-1.5 to 2.9+/-0.9 mm (P<0.001) and a change in mean CAL from 9.6+/-2.1 to 5.5+/-2.5 mm (P<0.001). In the control group, the mean PD was reduced from 6.9+/-0.9 to 3.7+/-0.9 mm (P<0.001) and the mean CAL changed from 8.5+/-2.5 to 6.4+/-2.7 mm (P<0.001). OCHS resulted in statistically significant higher PD reductions (P<0.01) and CAL gains (P<0.05) than AFS alone. Within the limits of the present study, it can be concluded that: (1) at 6 months after surgery both therapies resulted in statistically significant PD reductions and CAL gains and (2) treatment with OCHS resulted in statistically significant higher CAL gains than treatment with AFS alone