title: Clinical and histologic evaluation of non-surgical periodontal therapy with enamel matrix derivative: a report of four cases.
abstract: BACKGROUND
  Enamel matrix derivative (EMD) is a composite of proteins that was demonstrated histologically to work as an adjunct to periodontal regenerative surgical therapy. The purpose of this study was to evaluate the clinical and histologic effects of EMD as an adjunct to scaling and root planing.
  
  
  METHODS
  Four patients with severe chronic periodontitis and scheduled to receive complete dentures were accrued. Probing depth and clinical attachment levels were obtained. Unlimited time was allowed for hand and ultrasonic instrumentation. A notch was placed in the root >or=1 to 2 mm from the apical extent of root planing. EMD was inserted into the pocket, and a periodontal dressing was placed. Patients were seen every 2 weeks for plaque control. At 6 months post-treatment, soft tissue measurements were repeated, and the teeth were removed en bloc and prepared for histomorphologic analysis.
  
  
  RESULTS
  Probing depth reduction and clinical attachment level gain were obtained in three-fourths of the specimens. Three of the four specimens analyzed histologically demonstrated new cementum, bone, periodontal ligament, and connective tissue attachment coronal to the notch. In one specimen, the gingival margin had receded below the notch.
  
  
  CONCLUSIONS
  The results were unexpected and may represent an aberration. However, the substantial reduction in deep probing depths and clinical attachment level gain in three of four specimens, in addition to the histologic findings of new cementum, new bone, a new periodontal ligament, and a new connective tissue attachment, suggest that EMD may be useful as an adjunct to scaling and root planing in single-rooted teeth.
authors.affiliation: Department of Periodontics, Dental School, University of Texas, Health Science Center at San Antonio, San Antonio, TX 78229, USA. mellonig@uthscsa.edu
authors.forename: James T
authors.initials: JT
authors.lastname: Mellonig
authors.forename: Pilar
authors.initials: P
authors.lastname: Valderrama
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Gregory
authors.forename: David L
authors.initials: DL
authors.lastname: Cochran
mesh_terms: D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000628:therapy; D000539:Alveolar Process / Q000187:drug effects; D001861:Bone Regeneration / Q000187:drug effects; D055113:Chronic Periodontitis / Q000473:pathology / Q000628:therapy*; D003739:Dental Cementum / Q000187:drug effects; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D012534:Dental Scaling; D005260:Female; D005881:Gingiva / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000628:therapy; D010511:Periodontal Dressings; D010513:Periodontal Ligament / Q000187:drug effects; D010514:Periodontal Pocket / Q000628:therapy; D012038:Regeneration / Q000187:drug effects; D016745:Root Planing; D014464:Ultrasonic Therapy
chemical_list: D003746:Dental Enamel Proteins; C109069:enamel matrix proteins