Fogorvosi szemle, 2007 (100. évfolyam, 1-6. szám)

2007-10-01 / 5. szám

FOGORVOSI SZEMLE ■ 100. évf. 5. sz. 2007. 220-232.

Department of Periodontology, Radboud University Medical Center, Nijmegen, The Netherlands", Department of Periodontology, Semmelweis University of Medicine, Budapest, Hungary"

Emdogain® in Regenerative Periodontal Therapy

A Review of the Literature

DR. ANTON SCULEAN", DR. PÉTER WINDISCH”, DR. FERENC DÖRI”, DR. TIBOR KEGLEVICH“, DR. BÁLINT MOLNÁR”, DR. ISTVÁN GERA”

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 the periodontal wound healing. Histological results from animal and human studies 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. Surgical periodontal treatment of deep intrabony defects with EMD promotes periodontal regeneration. The application of EMD in the context of non-surgical periodontal therapy has failed to result in periodontal regeneration. Surgical periodontal therapy of deep intrabony defects with EMD may lead to significantly higher improvements of the clinical parameters than open flap debridement alone. The results obtained following treatment with EMD are comparable to those following treatment with GTR and can be maintained over a longer period. Treatment of intrabony defects with a combination of EMD + GTR does not seem to additionally improve the results compared to treatment with EMD alone or GTR alone. The combination of EMD and some types of bone grafts/bone substitutes may result in certain improvements in the soft and hard tissue parameters compared to treatment with EMD alone. Treatment of recession-type defects with coronally repositioned flaps and EMD may promote formation of cementum, periodontal ligament and bone, and may significantly increase the width of the keratinized tissue. Application of EMD seems to provide better long-term results than coronally repositioned flaps alone. Application of EMD may enhance periodontal regeneration in manibular Classll furcations. The clinical results are comparable to those obtained following GTR.

Key words: enamel matrix protein derivative, cementogenesis, regenerative periodontal therapy, review

Introduction

Results from basic research have indicated the role of the different types of cementum for attaching the tooth and for the reparative processes in the entire periodontium. Acellular cementum is the most important tissue for the insertion of collagen fibres and plays thereby the largest role in attaching the tooth to the alveolar socket [1], Studies of Slavkin and Boyde [2] and Slavkin [3] have shown that proteins, which are secreted during the tooth development by the Hertwig’s root sheath, play a crucial role in the formation of acellular root cementum. These proteins referred to as enamel matrix proteins (EMP) constitute the largest part of the enamel matrix [1, 4], They consist of a whole family of proteins, from which 90 % are Amelogenin, and the remaining 10% consist of prolin-rich non-Amelogenins, Tuftelin, and other serum proteins [4], It has been shown that the chemical structure of Amelogenin remained more or less constant during evolution, even among the individual animal species, exhibiting only slight differences [4]. In a series of animal experiments

on root development in rats, monkeys and pigs, it was immunohistologically demonstrated that the concentration of Amelogenin rises dramatically during tooth development [1], In addition a close connection between acellular cementum and Amelogenin exists [1]. These results have been also confirmed in investigations of human teeth, whereby some histological sections showed a thin layer of highly-mineralized enamel like tissue between dentin and root cement. This observation permits the assumption that the attachment of enamel matrix must occur on the dentin surface before the emergence of acellular cementum [1], Based on these results several in vivo experiments in animal models were conducted [1]. In an experiment the lateral incisors of two monkeys were extracted. Immediately after the extraction a standardized cavity in the root surface was created mesially and distally. The test cavities were then filled with an enamel matrix derivative (EMD), while the control cavities remained untreated. All teeth were reimplanted into their original alveoli. Histological evaluation eight weeks after reimplantation resulted in formation of acellular cementum