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

2007-10-01 / 5. szám

225 FOGORVOSI SZEMLE ■ 100. évf. 5. sz. 2007. turn. External root resorption was observed in 2 cas­es at 6 and 24 months following treatment with EMD while no periodontal regeneration was observed, when EMD was applied in a non-surgical way into intra­­bony periodontal defects [81, 82]. Based on the avail­able evidence from human histological studies it may be concluded that the application of EMD in conjunc­tion with periodontal surgery may promote formation of new cementum, periodontal ligament and bone in intrabony and recession defects. Moreover, when ap­plied during periodontal surgery EMD can be detected on the root surfaces for a period of at least 4 weeks. Based on current knowledge, there are no histologic data from human material evaluating the regenerative potential of EMD in furcation defects. Controlled clinical studies evaluating the effect of EMD on early wound healing Several studies have attempted to evaluate the effect of EMD treatment on early wound healing [83-85]. In a double-masked, split-mouth, placebo-controlled, ran­domized study, 28 patients with moderately advanced chronic periodontitis were scaled and root planed, and the soft tissue wall of the pocket was curetted to re­move pocket epithelium and adjacent granulation tis­sue [83], All experimental sites were carefully irrigat­ed with saline. When the bleeding from the pocket had ceased, a 24% EDTA gel was applied in the sites and retained for 2 min. The sites were then thoroughly irrig­ated with saline to remove EDTA remnants. Subse­quently, left and right quadrants were randomized to subgingival application of EMD (test) or vehicle (con­trol). All sites were re-examined clinically after 1,2 and 3 weeks. In addition, a visual analogue scale (VAS) was used to score the degree of post-treatment dis­comfort. The results indicated that EMD topically ap­plied in instrumented sulci enhance the early healing of periodontal soft tissue wounds. Furthermore, at 1 week, the proportion of patients reporting a VAS score <20 was significantly higher for the EMD treated quad­rants than for controls. Another study has evaluated by clinical means and as patient perception of post­operative events, the effect of EMD on the healing of soft-tissue wounds following periodontal surgery [85], Patients scheduled for periodontal flap surgery were treated with either modified Widman flap and applica­tion of EMD (test) or with modified Widman flap alone (control). Clinical measurements were taken at four different points in time: at surgery, 1, 4 and 8 weeks after surgery. The results revealed that of all param­eters evaluated, none showed a significant difference between the control and EMD groups, except for gin­gival swelling at the 1-week assessment where the EMD group exhibited a higher swelling score. It was concluded that the early wound healing of periodontal flap-surgeries in those sites treated with EMD is not different from control sites. Based on the available data, at the current time it appears that no definitive conclusions can be drawn to what extent the additional application of EMD may ad­ditionally enhance early wound healing following con­ventional periodontal therapy. Controlled clinical studies in intrabony defects Nonsurgical periodontal therapy Two randomized, placebo controlled clinical studies have evaluated in intrabony defects the effects of EMD as adjunct to nonsurgical periodontal therapy [86, 87], Both studies have failed to show a significant benefit of using EMD during nonsurgical periodontal therapy. Surgical periodontal therapy Side effects such as incompatibility or allergic reac­tions even after repeated treatment with EMD, for ex­ample, were not reported in any published studies [88-91]. A multi-centre study (11 universities and five private practices) evaluated the potential for sensiti­zation to EMD in periodontal patients treated at least twice with at least 2 months between treatments [91]. Intrabony defects in 376 patients were treated and the second test defect was treated in a similar man­ner at least 8 weeks after the first surgery. No clini­cal adverse reactions to multiple applications of EMD were noted. The results demonstrated a lack of clinical adverse reactions following 2 separate applications of EMD. Any subjective/objective adverse reactions ex­perienced by the patient were typical complications following routine periodontal surgery and were not di­rectly related to the use of EMD. Data from controlled clinical studies have demonstrated that treatment of in­trabony defects with EMD results in a significant reduc­tion of the probing depths and gain of clinical attach­ment. Moreover, it was shown that EMD attenuated the release of TNF-a and interleukin-8 in whole blood from healthy donors challenged by lipopolysaccha­ride or peptidoglycan, while the release of interleukin- 10 was unchanged. EMD also produced a four-fold increase in the cAMP levels of peripheral blood mono­nuclear cell lysates, which in turn suggested that EMD has anti-inflammatory properties [91], A randomized, placebo controlled multicenter-study examined the effectiveness of EMD in the split-mouth procedure in 33 patients [92], The results after 36 months showed a mean CAL gain of 2.2 mm in the test group and of 1.7 mm in the control group (open flap debridement). The radiologically determined bone gain amount­ed to 2.6 mm in the test group, with a 66% fill of the bone defects. However, the control teeth did not show any bone gain. In another controlled clinical study Froum et al. [93] compared the treatment of deep in-

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