Abstract
ObjectivesEnamel matrix derivative (EMD) has proven to enhance periodontal regeneration; however, its effect is mainly restricted to the soft periodontal tissues. Therefore, to stimulate not only the soft tissues, but also the hard tissues, in this study EMD is combined with an injectable calcium phosphate cement (CaP; bone graft material). The aim was to evaluate histologically the healing of a macroporous CaP in combination with EMD.Materials and methodsIntrabony, three-wall periodontal defects (2 × 2 × 1.7 mm) were created mesial of the first upper molar in 15 rats (30 defects). Defects were randomly treated according to one of the three following strategies: EMD, calcium phosphate cement and EMD, or left empty. The animals were killed after 12 weeks, and retrieved samples were processed for histology and histomorphometry.ResultsEmpty defects showed a reparative type of healing without periodontal ligament or bone regeneration. As measured with on a histological grading scale for periodontal regeneration, the experimental groups (EMD and CaP/EMD) scored equally, both threefold higher compared with empty defects. However, most bone formation was measured in the CaP/EMD group; addition of CAP to EMD significantly enhanced bone formation with 50 % compared with EMD alone.ConclusionsWithin the limits of this animal study, the adjunctive use of EMD in combination with an injectable cement, although it did not affect epithelial downgrowth, appeared to be a promising treatment modality for regeneration of bone and ligament tissues in the periodontium.Clinical relevanceThe adjunctive use of EMD in combination with an injectable cement appears to be a promising treatment modality for regeneration of the bone and ligament tissues in the periodontium.
Highlights
Periodontal disease leads to tissue destruction, such as epithelial downgrowth and thereby loss of root cementum, periodontal ligament (PDL), and alveolar bone
Lost root cementum, PDL, and alveolar bone, should be regenerated. Such regeneration is sometimes partially obtained with the use of enamel matrix derivative (EMD; Emdogain®, Straumann, Basel, Switzerland) or guided tissue regeneration (GTR) [2]
The exact composition of EMD is not disclosed and the responsible reactive molecules are not yet identified, but EMD is thought to contain at least amelogenins, which are dissolved in the carrier propylene glycol alginate
Summary
Periodontal disease leads to tissue destruction, such as epithelial downgrowth and thereby loss of root cementum, periodontal ligament (PDL), and alveolar bone. The most predictable treatment is scaling and rootplaning of the root surfaces, possibly in combination with surgery. As a drawback, this treatment results only in arresting inflammation, preventing or slowing down further attachment loss. Lost root cementum, PDL, and alveolar bone, should be regenerated. Such regeneration is sometimes partially obtained with the use of enamel matrix derivative (EMD; Emdogain®, Straumann, Basel, Switzerland) or guided tissue regeneration (GTR) [2]. A recent rat study using an intrabony defect showed less gingival recession, a
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