Histologic evaluation of periodontal healing in humans following regenerative therapy with enamel matrix derivative. A 10-case series.
BACKGROUND
Enamel matrix derivative (EMD) has been developed as a stimulus of periodontal regeneration. Human histology following its use has not been evaluated on pathologically altered root surfaces.


METHODS
Ten intrabony defects in 8 patients were evaluated at 2 centers. Teeth with advanced adult periodontitis that were treatment planned for extraction were treated with sulcular incisions; full-thickness flap reflection; debridement of granulomatous tissue from the defect; placement of a notch in the root at the apical extent of calculus; mechanical root planing; conditioning with citric acid; application of EMD; wound closure with sutures; and placement of a periodontal dressing. Biweekly to monthly recalls were made until removal of small block section biopsies at about 6 months. The biopsies were fixed, decalcified, step-serial sectioned at 6 microns to 8 microns, and stained with hematoxylin and eosin or Masson's trichrome.


RESULTS
Histologic evaluation of the region coronal to the base of the calculus notch showed evidence of regeneration (new cementum, new bone, and new periodontal ligament) in 3 specimens, new attachment (connective tissue attachment/adhesion only) in 3 specimens, and a long junctional epithelium in 4 specimens. No evidence of root resorption, ankylosis, or untoward inflammation was seen.


CONCLUSIONS
The results of this study fulfill the proof of principle that use of EMD can result in periodontal regeneration on previously diseased root surfaces in humans, but on an inconsistent basis.
Yukna
R A
RA
Department of Periodontics, Louisiana State University School of Dentistry, New Orleans 70119, USA.
Mellonig
J T
JT
D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000188:drug therapy* / Q000601:surgery; D001861:Bone Regeneration / Q000187:drug effects; D003739:Dental Cementum / Q000187:drug effects; D003746:Dental Enamel Proteins / Q000494:pharmacology / Q000627:therapeutic use*; D004846:Epithelial Attachment / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000188:drug therapy* / Q000601:surgery; D010513:Periodontal Ligament / Q000187:drug effects; D010519:Periodontium / Q000187:drug effects*; D012038:Regeneration / Q000187:drug effects*; D014092:Tooth Root / Q000187:drug effects*; D016896:Treatment Outcome
D003746:Dental Enamel Proteins; C109069:enamel matrix proteins