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      Terapia Periodontal Mediante Proteínas Derivadas del Esmalte y Aloinjerto Óseo Translated title: Periodontal Therapy by Enamel Matrix-derived Protein and Bone Allograft

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          Abstract

          Se describe el tratamiento periodontal en un defecto óseo situado mesial a la pieza 2.3 y distal a la pieza 2.2, mediante la terapia combinada de derivado de la matriz del esmalte (DME) y aloinjerto óseo mineralizado. Se valoró la zona afectada y se planeo su abordaje quirúrgico para la terapia combinada. Seis meses después del tratamiento se observó una reducción significativa en la profundidad al sondeo y ganancia en los niveles de inserción, así como el relleno óseo del defecto en la evaluación radiográfica. Los resultados reafirman la efectividad del DME y el aloinjerto óseo mineralizado en la terapia regenerativa periodontal.

          Translated abstract

          We describe the periodontal treatment in a bone defect located mesial to the 2.3 tooth, using combination therapy of enamel matrix derivate (EMD) and mineralized bone allograft. We evaluated the affected area and planned their surgical approach to combination therapy. Six months after treatment it showed a significant reduction in probing depth and gain in attachment levels and bone filling of the defect in the radiographic evaluation. These results confirm the effectiveness of the EMD and the mineralized bone allograft in periodontal regenerative therapy.

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          Most cited references27

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          Development of a classification system for periodontal diseases and conditions.

          Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. In addition, such systems give clinicians a way to organize the health care needs of their patients. The last time scientists and clinicians in the field of periodontology and related areas agreed upon a classification system for periodontal diseases was in 1989 at the World Workshop in Clinical Periodontics. Subsequently, a simpler classification was agreed upon at the 1st European Workshop in Periodontology. These classification systems have been widely used by clinicians and research scientists throughout the world. Unfortunately, the 1989 classification had many shortcomings including: 1) considerable overlap in disease categories, 2) absence of a gingival disease component, 3) inappropriate emphasis on age of onset of disease and rates of progression, and 4) inadequate or unclear classification criteria. The 1993 European classification lacked the detail necessary for adequate characterization of the broad spectrum of periodontal diseases encountered in clinical practice. The need for a revised classification system for periodontal diseases was emphasized during the 1996 World Workshop in Periodontics. In 1997 the American Academy of Periodontology responded to this need and formed a committee to plan and organize an international workshop to revise the classification system for periodontal diseases. The proceedings in this volume are the result of this reclassification effort. The process involved development by the Organizing Committee of an outline for a new classification and identification of individuals to write state-of-the-science reviews for each of the items on the outline. The reviewers were encouraged to depart from the preliminary outline if there were data to support any modifications. On October 30-November 2, 1999, the International Workshop for a Classification of Periodontal Diseases and Conditions was held and a new classification was agreed upon (Fig. 1). This paper summarizes how the new classification for periodontal diseases and conditions presented in this volume differs from the classification system developed at the 1989 World Workshop in Clinical Periodontics. In addition, an analysis of the rationale is provided for each of the modifications and changes.
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            Enamel matrix, cementum development and regeneration.

            Studies during the last 20 years have indicated that enamel-related proteins are involved in the formation of cementum. In the present article, this relation is further explored. Attention is called to the fact that coronal acellular extrinsic fiber cementum is formed on the enamel surface in a number of species. The composition of the enamel matrix proteins and the expression of these proteins during root formation are briefly reviewed. The dominating constituent of the enamel matrix, amelogenin, is shown by means of immunohistochemistry to be expressed in human teeth during root formation. Amelogenin was also found to be present in Tomes' granular layer of human teeth. When mesenchymal cells of the dental follicle were exposed to the enamel matrix a non-cellular hard tissue matrix was formed at the enamel surface. Application of porcine enamel matrix in experimental cavities in the roots of incisors of monkeys induced formation of acellular cementum that was well attached to the dentin. In control cavities without enamel matrix, a cellular, poorly attached hard tissue was formed. The present studies provide additional support to the idea that enamel matrix proteins are involved in the formation of acellular cementum and also that they have the potential to induce regeneration of the same type of cementum.
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              Enamel matrix proteins in the regenerative therapy of deep intrabony defects.

              This prospective multicentre randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix proteins (EMD). 172 patients with advanced chronic periodontitis were recruited in 12 centers in 7 countries. All patients had at least one intrabony defect of > or =3mm. Heavy smokers (> or =20 cigarettes/day) were excluded. The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure. After debridement, roots were conditioned for 2 min with a gel containing 24% EDTA. EMD was applied in the test subjects, and omitted in the controls. Postsurgically, a strict plaque control protocol was followed. At baseline and 1 year following the interventions, clinical attachment levels (CAL), pocket probing depths (PPD), recession (REC), full-mouth plaque scores and full-mouth bleeding scores were assessed. A total of 166 patients were available for the 1-year follow-up. At baseline, 86 test and 86 control patients presented with similar subject and defect characteristics. On average, the test defects gained 3.1+/-1.5 mm of CAL, while the control defects yielded a significantly lower CAL gain of 2.5+/-1.5 mm. Pocket reduction was also significantly higher in the test group (3.9+/-1.7 mm) when compared to the controls (3.3+/-1.7 mm). A multivariate analysis indicated that the treatment, the clinical centers, cigarette smoking, baseline PPD, and defect corticalisation significantly influenced CAL gains. A frequency distribution analysis of the studied outcomes indicated that EMD increased the predictability of clinically significant results (CAL gains > or =4 mm) and decreased the probability of obtaining negligible or no gains in CAL (CAL gains <2 mm). The results of this trial indicated that regenerative periodontal surgery with EMD offers an additional benefit in terms of CAL gains, PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone.
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                Author and article information

                Journal
                ijodontos
                International journal of odontostomatology
                Int. J. Odontostomat.
                Universidad de La Frontera. Facultad de Medicina (Temuco, , Chile )
                0718-381X
                December 2011
                : 5
                : 3
                : 279-286
                Affiliations
                [03] orgnameUniversidad de La Frontera orgdiv1Facultad de Medicina orgdiv2Departamento de Odontología Integral Chile
                [01] orgnameUniversidad Autónoma de Nuevo León orgdiv1Programa de Magister en Ciencias Odontológicas con Especialidad en Periodoncia México
                [02] orgnameUniversidad de La Frontera orgdiv1Programa de Magister en Odontología Chile
                Article
                S0718-381X2011000300012 S0718-381X(11)00500312
                10.4067/S0718-381X2011000300012
                08967050-ea88-4b37-a0a7-7f1539c9c1d3

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 12 October 2011
                : 28 October 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 8
                Product

                SciELO Chile


                aloinjerto óseo,proteins of enamel matrix,allograft bone,periodontal regeneration,proteínas de la matriz del esmalte,regeneración periodontal

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