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Use of enamel matrix derivatives and autogenous bone graft combination in the treatment of periodontal intrabony defects

Year 2013, Volume: 3 Issue: 1, 48 - 54, 30.01.2014

Abstract

Objective: Enamel matrix derivatives (EMD) are the purified form of the acidic extract related to embryonic period that contain amelogenin type proteins and have stimulation effect on cementum, periodontal ligament and bone formation. Autogenous bone graft (ABG) is the only bone graft that is originated intra- or extra-orally from patients and accepted as the gold standard since it contains osteoblasts and osteoprogenitor cells. In this case report, the treatment of two periodontal defects of a 43 year-old systemically healthy male patient with chronic periodontitis was presented. 

Methods: The defects had probing depths of 11 mm and 8 mm and were treated by the use of EMD combined with ABG. Before and 8 months after the periodontal flap surgery, full mouth plaque index, gingival index, bleeding on probing, on defects sites; probing deth, relative attachment level, gingival recession were measured and intrabony defect fill percentage was calculated on the standardized radiographs. 

Results: At the end of 8 months, parallel with clinical healing, changes in plaque index, gingival index and bleeding on probing were 0.18±0.13, 0.05±0.03 and 3.78% respectively. Probing depth reductions of defect #1 and #2 were 8 mm and 5 mm, attachment gains were 5 mm and 3 mm, respectively. Percentage of bone fill in #1 and #2 intrabony defects were calculated as 89% and 53%, respectively. 

Conclusions: Clinical and radiographical findings of this report suggest that treatment of deep intrabony periodontal defects in chronic periodontitis patient by the use of EMD and ABG combination provides favourable clinical healing without any complication.


Key words: Enamel matrix derivatives, autogenous bone graft, periodontal flap surgery

References

  • Page RC, Offenbacher S, Schroeder HE, Seymour GJ, Kornman KS. Advances in the pathogenesis of periodontitis: summary of developments, clinical implications and future directions. Periodontol 2000. 1997;14:216-248.
  • Caton JG, Greenstein G. Factors related to periodontal regeneration. Periodontol 2000. 1993;1:9-15.
  • Cochran DL, Wozney JM. Biological mediators for periodontal regeneration. Periodontol 2000. 1999;19:40-58.
  • Palmer RM, Cortellini P. Periodontal tissue engineering and regeneration: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol. 2008;35:83-86.
  • Kao RT, Murakami S, Beirne OR. The use of biologic mediators and tissue engineering in dentistry. Periodontol 2000. 2009;50:127-153.
  • Hammarstrom L, Heijl L, Gestrelius S. Periodontal regeneration in a buccal dehiscence model in monkeys after application of enamel matrix proteins. J Clin Periodontol. 1997;24:669-677.
  • Yilmaz S, Cakar G, Yildirim B, Sculean A. Healing of two and three wall intrabony periodontal defects following treatment with an enamel matrix derivative combined with autogenous bone. J Clin Periodontol. 2010;37:544-550.
  • Lekovic V, Camargo PM, Weinlaender M, Nedic M, Aleksic Z, Kenney EB. A comparison between enamel matrix proteins used alone or in combination with bovine porous bone mineral in the treatment of intrabony periodontal defects in humans. J Periodontol. 2000;71:1110-1116.
  • Velasquez-Plata D, Scheyer ET, Mellonig JT. Clinical comparison of an enamel matrix derivative used alone or in combination with a bovine-derived xenograft for the treatment of periodontal osseous defects in humans. J Periodontol. 2002;73:433-440.
  • Becker W, Becker BE. Periodontal regeneration: a contemporary re-evaluation. Periodontol 2000. 1999;19:104-114.
  • Barrington EP, Nevins M. Diagnosing periodontal diseases. J Am Dent Assoc. 1990;121:460-464.
  • Greenstein G. Advances in periodontal disease diagnosis. Int J Periodontics Restorative Dent. 1990;10:350-375.
  • Yilmaz S, Kuru B, Altuna-Kirac E. Enamel matrix proteins in the treatment of periodontal sites with horizontal type of bone loss. J Clin Periodontol. 2003;30:197-206.
  • Zetterstrom O, Andersson C, Eriksson L, Fredriksson A, Friskopp J, Heden G, et al. Clinical safety of enamel matrix derivative (EMDOGAIN) in the treatment of periodontal defects. J Clin Periodontol. 1997;24:697-704.
  • Heard RH, Mellonig JT, Brunsvold MA, Lasho DJ, Meffert RM, Cochran DL. Clinical evaluation of wound healing following multiple exposures to enamel matrix protein derivative in the treatment of intrabony periodontal defects. J Periodontol. 2000;71:1715-1721.
  • Heijl L, Heden G, Svardstrom G, Ostgren A. Enamel matrix derivative (EMDOGAIN) in the treatment of intrabony periodontal defects. J Clin Periodontol. 1997;24:705-714.
  • Clark DC, Chin Quee T, Bergeron MJ, Chan EC, Lautar-Lemay C, de Gruchy K. Reliability of attachment level measurements using the cementoenamel junction and a plastic stent. J Periodontol. 1987;58:115-118.
  • Guida L, Annunziata M, Belardo S, Farina R, Scabbia A, Trombelli L. Effect of autogenous cortical bone particulate in conjunction with enamel matrix derivative in the treatment of periodontal intraosseous defects. J Periodontol. 2007;78:231-238.
  • Trombelli L, Annunziata M, Belardo S, Farina R, Scabbia A, Guida L. Autogenous bone graft in conjunction with enamel matrix derivative in the treatment of deep periodontal intra-osseous defects: a report of 13 consecutively treated patients. J Clin Periodontol. 2006;33:69-75.
  • Cortellini P, Pini Prato G, Tonetti MS. Periodontal regeneration of human infrabony defects. I. Clinical measures. J Periodontol. 1993;64:254-260.
  • Gottlow J. Guided tissue regeneration using bioresorbable and non-resorbable devices: initial healing and long-term results. J Periodontol. 1993;64:1157-1165.
  • Parodi R, Santarelli GA, Gasparetto B. Treatment of intrabony pockets with Emdogain: results at 36 months. Int J Periodontics Restorative Dent. 2004;24:57-63.
  • Pontoriero R, Wennstrom J, Lindhe J. The use of barrier membranes and enamel matrix proteins in the treatment of angular bone defects. A prospective controlled clinical study. J Clin Periodontol. 1999;26:833-840.
  • Wikesjo UM, Selvig KA. Periodontal wound healing and regeneration. Periodontol 2000. 1999;19:21-39.

Periodontal kemik içi defektlerin tedavisinde mine matriks proteini ve otojen kemik grefti kombinasyonu kullanımı

Year 2013, Volume: 3 Issue: 1, 48 - 54, 30.01.2014

Abstract

Amaç: Mine matriks türevleri (MMT), embriyonik döneme ait amelogenin proteinlerini içeren asidik ekstrenin saflaştırılmış şeklidir ve sement, periodontal ligament ve alveol kemiği oluşumu üzerine stimüle edici etkisi bulunmaktadır. Otojen kemik grefti (OKG), bireyin kendisinden elde edilen canlı osteoblast ve osteoprogenitör hücreler içermesi sebebiyle altın standart kabul edilen tek kemik greftidir. Bu olguda, kronik periodontitis tanısı konmuş ve başlangıç periodontal tedavisi tamamlanmış sistemik olarak sağlıklı 43 yaşındaki erkek hastada iki periodontal defektin tedavisi sunulmaktadır. 

Yöntemler: Sondalama derinliği 11 mm ve 8 mm olan iki adet kemik içi periodontal defekte MMT ve OKG kombinasyonu uygulandı. Periodontal flep operasyonundan önce ve 8 ay sonra tüm ağız plak indeks, gingival indeks, sondalamada kanama, defekt bölgelerinde sondalama derinliği, rölatif ataşman seviyesi, rölatif dişeti kenarı seviyesi ölçüldü ve standart radyografiler üzerinde kemik içi defekt dolum yüzdesi hesaplandı.

Bulgular: Sekizinci ayın sonunda ortalama plak indeks, gingival indeks ve sondalamada kanama değerlerinde sırasıyla 0.18±0.13, 0.05±0.03 ve %3.78 azalmaya, 1 ve 2 nolu defektlerde sondalama derinliği değerlerinde sırasıyla 8 mm ve 5 mm azalmaya ek olarak sırasıyla 5 mm ve 3 mm ataşman kazancı elde edilerek klinik iyileşmenin sağlandığı gözlendi. Standart radyografilerin değerlendirilmesi sonucunda defekt dolumu 1 ve 2 nolu defektler için sırasıyla %89 ve %53 olarak hesaplandı. 

Sonuç: Bu olgu sunumunun 8. ayda elde edilen klinik ve radyografik sonuçları, kronik periodontitisli hastadaki derin kemik içi periodontal defektlerin tedavisinde MMT+OKG kombine kullanımının herhangi bir komplikasyon gelişmeksizin olumlu düzeyde iyileşme sağladığını ortaya koymaktadır.


Anahtar Kelimeler : Mine matriks türevleri, otojen kemik grefti, periodontal flep operasyonu

References

  • Page RC, Offenbacher S, Schroeder HE, Seymour GJ, Kornman KS. Advances in the pathogenesis of periodontitis: summary of developments, clinical implications and future directions. Periodontol 2000. 1997;14:216-248.
  • Caton JG, Greenstein G. Factors related to periodontal regeneration. Periodontol 2000. 1993;1:9-15.
  • Cochran DL, Wozney JM. Biological mediators for periodontal regeneration. Periodontol 2000. 1999;19:40-58.
  • Palmer RM, Cortellini P. Periodontal tissue engineering and regeneration: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol. 2008;35:83-86.
  • Kao RT, Murakami S, Beirne OR. The use of biologic mediators and tissue engineering in dentistry. Periodontol 2000. 2009;50:127-153.
  • Hammarstrom L, Heijl L, Gestrelius S. Periodontal regeneration in a buccal dehiscence model in monkeys after application of enamel matrix proteins. J Clin Periodontol. 1997;24:669-677.
  • Yilmaz S, Cakar G, Yildirim B, Sculean A. Healing of two and three wall intrabony periodontal defects following treatment with an enamel matrix derivative combined with autogenous bone. J Clin Periodontol. 2010;37:544-550.
  • Lekovic V, Camargo PM, Weinlaender M, Nedic M, Aleksic Z, Kenney EB. A comparison between enamel matrix proteins used alone or in combination with bovine porous bone mineral in the treatment of intrabony periodontal defects in humans. J Periodontol. 2000;71:1110-1116.
  • Velasquez-Plata D, Scheyer ET, Mellonig JT. Clinical comparison of an enamel matrix derivative used alone or in combination with a bovine-derived xenograft for the treatment of periodontal osseous defects in humans. J Periodontol. 2002;73:433-440.
  • Becker W, Becker BE. Periodontal regeneration: a contemporary re-evaluation. Periodontol 2000. 1999;19:104-114.
  • Barrington EP, Nevins M. Diagnosing periodontal diseases. J Am Dent Assoc. 1990;121:460-464.
  • Greenstein G. Advances in periodontal disease diagnosis. Int J Periodontics Restorative Dent. 1990;10:350-375.
  • Yilmaz S, Kuru B, Altuna-Kirac E. Enamel matrix proteins in the treatment of periodontal sites with horizontal type of bone loss. J Clin Periodontol. 2003;30:197-206.
  • Zetterstrom O, Andersson C, Eriksson L, Fredriksson A, Friskopp J, Heden G, et al. Clinical safety of enamel matrix derivative (EMDOGAIN) in the treatment of periodontal defects. J Clin Periodontol. 1997;24:697-704.
  • Heard RH, Mellonig JT, Brunsvold MA, Lasho DJ, Meffert RM, Cochran DL. Clinical evaluation of wound healing following multiple exposures to enamel matrix protein derivative in the treatment of intrabony periodontal defects. J Periodontol. 2000;71:1715-1721.
  • Heijl L, Heden G, Svardstrom G, Ostgren A. Enamel matrix derivative (EMDOGAIN) in the treatment of intrabony periodontal defects. J Clin Periodontol. 1997;24:705-714.
  • Clark DC, Chin Quee T, Bergeron MJ, Chan EC, Lautar-Lemay C, de Gruchy K. Reliability of attachment level measurements using the cementoenamel junction and a plastic stent. J Periodontol. 1987;58:115-118.
  • Guida L, Annunziata M, Belardo S, Farina R, Scabbia A, Trombelli L. Effect of autogenous cortical bone particulate in conjunction with enamel matrix derivative in the treatment of periodontal intraosseous defects. J Periodontol. 2007;78:231-238.
  • Trombelli L, Annunziata M, Belardo S, Farina R, Scabbia A, Guida L. Autogenous bone graft in conjunction with enamel matrix derivative in the treatment of deep periodontal intra-osseous defects: a report of 13 consecutively treated patients. J Clin Periodontol. 2006;33:69-75.
  • Cortellini P, Pini Prato G, Tonetti MS. Periodontal regeneration of human infrabony defects. I. Clinical measures. J Periodontol. 1993;64:254-260.
  • Gottlow J. Guided tissue regeneration using bioresorbable and non-resorbable devices: initial healing and long-term results. J Periodontol. 1993;64:1157-1165.
  • Parodi R, Santarelli GA, Gasparetto B. Treatment of intrabony pockets with Emdogain: results at 36 months. Int J Periodontics Restorative Dent. 2004;24:57-63.
  • Pontoriero R, Wennstrom J, Lindhe J. The use of barrier membranes and enamel matrix proteins in the treatment of angular bone defects. A prospective controlled clinical study. J Clin Periodontol. 1999;26:833-840.
  • Wikesjo UM, Selvig KA. Periodontal wound healing and regeneration. Periodontol 2000. 1999;19:21-39.
There are 24 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Ömer Birkan Ağralı

Bahar Kuru This is me

Leyla Kuru This is me

Publication Date January 30, 2014
Submission Date January 30, 2014
Published in Issue Year 2013 Volume: 3 Issue: 1

Cite

APA Ağralı, Ö. B., Kuru, B., & Kuru, L. (2014). Periodontal kemik içi defektlerin tedavisinde mine matriks proteini ve otojen kemik grefti kombinasyonu kullanımı. Clinical and Experimental Health Sciences, 3(1), 48-54.
AMA Ağralı ÖB, Kuru B, Kuru L. Periodontal kemik içi defektlerin tedavisinde mine matriks proteini ve otojen kemik grefti kombinasyonu kullanımı. Clinical and Experimental Health Sciences. February 2014;3(1):48-54.
Chicago Ağralı, Ömer Birkan, Bahar Kuru, and Leyla Kuru. “Periodontal Kemik içi Defektlerin Tedavisinde Mine Matriks Proteini Ve Otojen Kemik Grefti Kombinasyonu kullanımı”. Clinical and Experimental Health Sciences 3, no. 1 (February 2014): 48-54.
EndNote Ağralı ÖB, Kuru B, Kuru L (February 1, 2014) Periodontal kemik içi defektlerin tedavisinde mine matriks proteini ve otojen kemik grefti kombinasyonu kullanımı. Clinical and Experimental Health Sciences 3 1 48–54.
IEEE Ö. B. Ağralı, B. Kuru, and L. Kuru, “Periodontal kemik içi defektlerin tedavisinde mine matriks proteini ve otojen kemik grefti kombinasyonu kullanımı”, Clinical and Experimental Health Sciences, vol. 3, no. 1, pp. 48–54, 2014.
ISNAD Ağralı, Ömer Birkan et al. “Periodontal Kemik içi Defektlerin Tedavisinde Mine Matriks Proteini Ve Otojen Kemik Grefti Kombinasyonu kullanımı”. Clinical and Experimental Health Sciences 3/1 (February 2014), 48-54.
JAMA Ağralı ÖB, Kuru B, Kuru L. Periodontal kemik içi defektlerin tedavisinde mine matriks proteini ve otojen kemik grefti kombinasyonu kullanımı. Clinical and Experimental Health Sciences. 2014;3:48–54.
MLA Ağralı, Ömer Birkan et al. “Periodontal Kemik içi Defektlerin Tedavisinde Mine Matriks Proteini Ve Otojen Kemik Grefti Kombinasyonu kullanımı”. Clinical and Experimental Health Sciences, vol. 3, no. 1, 2014, pp. 48-54.
Vancouver Ağralı ÖB, Kuru B, Kuru L. Periodontal kemik içi defektlerin tedavisinde mine matriks proteini ve otojen kemik grefti kombinasyonu kullanımı. Clinical and Experimental Health Sciences. 2014;3(1):48-54.

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