The use of enamel matrix derivative in the treatment of periodontal osseous defects: a clinical decision tree based on biologic principles of regeneration.
An investigation of the periodontal literature reveals four critical factors necessary for a regenerative response in the treatment of intrabony defects. These include root preparation to remove toxins and altered cementum, space creation by the graft or membrane barrier for migration of progenitor cells, stabilization and flap coverage of the graft, and use of a membrane barrier or enamel matrix derivative (EMD). This article reviews the literature supporting this concept and presents a clinical decision tree to determine when to use EMD alone or with autogenous grafts and membrane barriers in the treatment of defects of varying morphologies. The clinical decision tree is designed to increase the predictability of a positive clinical response. Cases are shown to demonstrate the indication for each treatment.
Froum
S
S
Department of Surgical Services, New York University College of Dentistry, USA.
Lemler
J
J
Horowitz
R
R
Davidson
B
B
D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000601:surgery*; D018786:Bone Substitutes / Q000627:therapeutic use*; D016025:Bone Transplantation; D002465:Cell Movement; D002985:Clinical Protocols; D003663:Decision Trees; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D005260:Female; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D016745:Root Planing; D013234:Stem Cells / Q000502:physiology; D013524:Surgical Flaps; D014092:Tooth Root / Q000473:pathology; D016896:Treatment Outcome
D018786:Bone Substitutes; D003746:Dental Enamel Proteins; D008567:Membranes, Artificial; C109069:enamel matrix proteins