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

2007-10-01 / 5. szám

228

FOGORVOSI SZEMLE ■ 100. évf. 5. sz. 2007.

terquartile interval (1.5 mm, 3.5 mm) at test sites compared with 1.8 mm (1.0 mm, 2.8 mm) at control sites. The frequency of complete furcation closure was 8/45 (test) and 3/45 (control); partial closure, 27/45 in both groups; no change: 9/45 and 11/45, respectively. Deterioration was observed in 1/45 and 4/45 sites, respectively. The frequency of no pain at 1 week postsurgery was 62%, and no swelling 44% at test sites, and 12% and 6% at the control sites, respectively. It was concluded that there was a significantly greater reduction in horizontal furcation depth and a comparatively lower incidence of postoperative pain/swelling following EMD compared to GTR therapy.

Conclusions

Based on the presented evidence the following conclusions can be drawn:

a. 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.

b. 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.

c. Treatment of intrabony defects with a combination of EMD + GTR does not seem to additionally improve the results compared to treatment with EMD or GTR alone.

d. 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. However, further studies are needed in order to definitively clarify the possible advantage of a combination therapy of EMD and bone grafts/bone substitutes in relation to the single therapies.

e. 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.

f. Application of EMD may enhance periodontal regeneration in mandibular Class II furcations. The clinical results are comparable to those obtained following GTR.

References

1. Hammarström L: Enamel matrix, cementum development and regeneration. J Clin Periodontol 1997; 24: 658-668.

2. Slavkin HC, Boyde A: Cementum: An epithelial secretory product? J Dent Res 1975; 53: 157 (abstr. 409).

3. Slavkin HC: Towards a cellular and molecular understanding of periodontics: Cementogenesis revisited. J Periodontol 1976; 47: 249-255.

4. Brookes SJ, Robinson C, Kirkham J, Bonass WA: Biochemistry and molecular biology of amelogenin proteins of developing dental enamel. Arch Oral Biol 1995; 40: 1-4.

5. Gestrelius S, Andersson C, Johansson AC, Persson E, Brodin A, Rydhag L, Hammarström L: Formulation of enamel matrix derivative surface coating. Kinetics and cell colonization. J Clin Periodontol 1997; 24: 678-684.

6. Maycock J., Wood SR, Brookes SJ, Shore RC, Robinson C, Kirkham J : Characterization of a porcine amelogenin preparation, EMDOGAIN, a biologic treatment treatment for periodontal disease. Connect Tissue Res 2002; 43: 472-476.

7. World Workshop in periodontology: The American Academy of Periodontology. Ann Periodontol 1996; 1: 618-670.

8. Gestrelius S, Andersson C, Lidström D, Hammarström L, Sommerman M: In vitro studies on periodontal ligament cells and enamel matrix derivative. J Clin Periodontol 1997; 24: 685-692.

[ 9. Haase HR, Bartold PM: Enamel matrix derivative induces matrix j synthesis by cultured human periodontal fibroblast cells. J Periodontol 2001; 72: 341-348.

10. Hoang AM, Oates TW, Cochran DL: In vitro wound healing responses to enamel matrix derivative. J Periodontol 2000; 71: 1270- 1277.

11 .Hoang AM, Klebe RJ.SteffensenB, Ryu OH, Simmer JP, Cochran DL: Amelogenin is a cell adhesion protein. J Dent Res 2002; 81: 497- 500.

12. LyngstadaasSP, Lundberg E, EkdahlH, Andersson C, Gestrelius S: Autocrine growth factors in human periodontal ligament cells cultured on enamel matrix derivative. J Clin Periodontol 2001 ; 28: 181-188.

I 13. Okubo K, Kobayashi M, TakiguchiT, TakadaT, Ohazama A, Okamatsu Y,

J Hasegawa K: Participation of endogenous IGF-I and TGF-beta 1 with enamel matrix derivative-stimulated cell growth in human periodontal ligament cells. J Periodont Res 2003; 38, 1-9.

14. Palioto DB, Coletta RD, Graner E, Joly JC, de Lima AF: The influence of enamel matrix derivative associated with insulin-like growth factor-l on periodontal ligament fibroblasts. J Periodontol 2004; 75: 498-504.

15. Kawase T, Okuda K, Momose M, Kato Y, Yoshie H, Burns DM: Enamel matrix derivative (EMDOGAIN) rapidly stimulates phosphorylation of the MAP kinase family and nuclear accumulation of smad2 in both oral epithelial and fibroblastic human cells. J Periodont Res 2001 ; 36, 367-376.

16. Kawase T, Okuda K, Yoshie H, Burns DM: Anti-TGF-beta antibody blocksenamelmatrixderivative-inducedupregulationofp21WAF1/cip1 and prevents its inhibition of human oral epithelial cell proliferation. J Periodont Res 2002; 37, 255-262.

17. Suzuki S, NaganoT, Yamakoshi Y, Gomi K, AraiT, FukaeM, KatagiriT, Oida S: Enamel matrix derivative gel stimulates signal transduction of BMP and TGF-ß. J Dent Res 2005; 84: 510-514.

18. Takayama T, Suzuki N, Narukawa M, Tokunaga T, Otsuka K, Ito K: Enamel matrix derivative stimulates core binding factor alpha1/Runtrelated transcription factor-2 expression via activation of Smad in C2C12 cells. J Periodontol 2005; 76: 244-249.

19. Keila S, Nemcovsky CE, Moses O, Artzi Z, Weinreb M: In vitro effects of enamel matrix proteins on rat bone marrow cells and gingival fibroblasts. J Dent Res 2004; 83: 134-138.

20. Ohyama M, Suzuki N, Yamaguchi Y, Maeno M, Otsuka K, Ito K: Effect of enamel matrix derivative on the differentiation of C2C12 cells. J Periodontol 2002; 73: 543-550.

21. Van der Pauw MT, Van Den Bos T, Everts V, Beertsen W: Enamel matrix-derived protein stimulates attachment of periodontal ligament fibrablast and enhances alkaline phosphatase activity and transforming growth factor ß1 release of periodontal ligament and gingival fibroblasts. J Periodontol 2000; 71: 31-43.

22. Cattaneo V, Rota C, Silvestri M, Piacentini C, Forlino A, Gallanti A, Rasperini G, Cetta G: Effect of enamel matrix derivative on