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      Regeneration of the periodontium using enamel matrix derivative in combination with an injectable bone cement

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          Abstract

          Objectives

          Enamel 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 methods

          Intrabony, 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.

          Results

          Empty 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.

          Conclusions

          Within 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 relevance

          The 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.

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          Most cited references26

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          Periodontal regeneration.

          Untreated periodontal disease leads to tooth loss through destruction of the attachment apparatus and tooth-supporting structures. The goals of periodontal therapy include not only the arrest of periodontal disease progression,but also the regeneration of structures lost to disease where appropriate. Conventional surgical approaches (e.g., flap debridement) continue to offer time-tested and reliable methods to access root surfaces,reduce periodontal pockets, and attain improved periodontal form/architecture. However, these techniques offer only limited potential towards recovering tissues destroyed during earlier disease phases. Recently, surgical procedures aimed at greater and more predictable regeneration of periodontal tissues and functional attachment close to their original level have been developed, analyzed, and employed in clinical practice. This paper provides a review of the current understanding of the mechanisms, cells, and factors required for regeneration of the periodontium and of procedures used to restore periodontal tissues around natural teeth. Targeted audiences for this paper are periodontists and/or researchers with an interest in improving the predictability of regenerative procedures. This paper replaces the version published in 1993.
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            Histometric evaluation of periodontal surgery. II. Connective tissue attachment levels after four regenerative procedures.

            The present study was undertaken to determine the effect of four periodontal regenerative procedures on the connective tissue attachment level. The procedures tested were: 1) the modified Widman flap procedure, 2) the modified Widman flap procedure combined with transplantation of previously frozen autogenous red marrow and cancellous bone, 3) the modified Widman flap procedure in combination with implantation of beta tricalcium phosphate, and 4) periodic root planing and soft tissue curettage. Eight adult Rhesus monkeys, divided into four equal groups, were used. Periodontal pockets were produced around contralateral teeth in a standardized manner. In each group of animals, the pockets on one side of the jaws were subjected to one of the above-mentioned surgical treatments, while the contralateral pockets remained as unoperated controls. Three weeks before surgery, a carefully designed plaque control program was instituted and continued until the animals were sacrificed 12 months after surgery. In histologic sections, linear measurements along the root surfaces were made from the cemento-enamel junction (CEJ) to the most apical cells of the junctional epithelium (JE). These measurements from operated and unoperated sites were then compared. The data revealed that healing following the four different regenerative procedures resulted in the reformation of an epithelial lining (long junctional epithelium) along the treated root surfaces, with no new connective tissue attachment.
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              Do bone grafts or barrier membranes provide additional treatment effects for infrabony lesions treated with enamel matrix derivatives? A network meta-analysis of randomized-controlled trials.

              Network meta-analyses of randomized-controlled trials were undertaken to investigate whether enamel matrix derivatives (EMD) in conjunction with other regenerative materials yield better treatment outcomes than EMD alone in the treatment of infrabony defects > or =3 mm. A literature search was conducted using the Medline, EMBASE, LILACS and CENTRAL databases up to and including December 2008. Treatment outcomes were changes in probing pocket depth (PPD), clinical attachment level (CAL) and infrabony defect depth. Different types of bone grafts (or barrier membranes) were first treated as a group and then separately. Twenty-eight studies were included in the review. EMD plus bone grafts and EMD plus membranes attained 0.24 mm [95% high probability density (HPD) intervals: -0.38, 0.65] and 0.07 mm (95% HPD intervals: -1.26, 1.04) more PPD reduction than EMD alone, respectively. For CAL gain, EMD plus bone grafts and EMD plus membranes attained 0.46 mm (95% HPD intervals: -0.17, 0.83) and 0.15 mm (95% HPD intervals: -1.37, 0.30), respectively. When different types of bone grafts and barrier membranes were treated separately, EMD with bovine bone grafts showed greater treatment effects. There was little evidence to support the additional benefits of EMD in conjunction with other regenerative materials.
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                Author and article information

                Contributors
                +31-24-3614006 , +31-24-3614657 , j.jansen@dent.umcn.nl
                Journal
                Clin Oral Investig
                Clin Oral Investig
                Clinical Oral Investigations
                Springer-Verlag (Berlin/Heidelberg )
                1432-6981
                1436-3771
                3 May 2012
                3 May 2012
                March 2013
                : 17
                : 2
                : 411-421
                Affiliations
                [ ]Department of Biomaterials (309), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
                [ ]Department of Periodontology and Implantology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
                [ ]Department of Oral Cell Biology, Academic Center for Dentistry (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Research Institute MOVE, Amsterdam, The Netherlands
                Article
                743
                10.1007/s00784-012-0743-z
                3579465
                22552596
                675c8cf0-9c48-4746-8897-d6fe286a0554
                © The Author(s) 2012
                History
                : 4 January 2012
                : 16 April 2012
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag Berlin Heidelberg 2013

                Dentistry
                animals,calcium phosphates,periodontal diseases,guided tissue regeneration,periodontal
                Dentistry
                animals, calcium phosphates, periodontal diseases, guided tissue regeneration, periodontal

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