Periodontal Regeneration with Enamel Matrix Proteins
The holy grail of periodontal therapy is the regeneration of the attachment apparatus (cementum, periodontal ligament, and alveolar bone), around a previously bacteria-contaminated root surface. Reconstituting the periodontium can add longevity to the the dentition. Bone grafting with autogenous or demineralized freeze-dried bone allograft (DFDBA), and barrier membranes for guided tissue regeneration, represent great strides in regeneration therapy. Unfortunately, the predicatablily of these techniques is often lacking. A recent advance in reconstructive periodontal surgery is the application of enamel matrix proteins to a pathologically involved root surface. These proteins form acellular root cementum, the foundation needed to restore functional tooth support while preventing downgrowth of a junctional epithelium.
The enclosed pre and post op radiographs are from a case report where I was able to achieve an exciting result using Emdogain, which is an enamel matrix derivative. Prior to surgery there were considerable pocket depths on the maxillary left cuspid (#11): 9 mm. on the distal facial aspect, 9 mm. on the direct palate, and 9 mm. on the distal palatal surface of this tooth. Periodontal flap surgery using Emdogain was performed on 3/19/98 (pre-op films). As of the recall visit on 1/21/99 (post-op radiograph), the probe depths were within normal limits. As in any of the treatments for inflammatory periodontal diseases, long term success is predicated upon good personal plaque control and supportive periodontal care (maintenance).