title: Regeneration of the periodontium using enamel matrix derivative in combination with an injectable bone cement.
abstract: OBJECTIVE
  Enamel matrix derivative (EMD) has proven to enhance periodontal regeneration; however, its effect is mainly restricted to the soft periodontal tissues. Therefore, to stimulate not only the soft tissues, but also the hard tissues, in this study EMD is combined with an injectable calcium phosphate cement (CaP; bone graft material). The aim was to evaluate histologically the healing of a macroporous CaP in combination with EMD.
  
  
  METHODS
  Intrabony, three-wall periodontal defects (2 × 2 × 1.7 mm) were created mesial of the first upper molar in 15 rats (30 defects). Defects were randomly treated according to one of the three following strategies: EMD, calcium phosphate cement and EMD, or left empty. The animals were killed after 12 weeks, and retrieved samples were processed for histology and histomorphometry.
  
  
  RESULTS
  Empty defects showed a reparative type of healing without periodontal ligament or bone regeneration. As measured with on a histological grading scale for periodontal regeneration, the experimental groups (EMD and CaP/EMD) scored equally, both threefold higher compared with empty defects. However, most bone formation was measured in the CaP/EMD group; addition of CAP to EMD significantly enhanced bone formation with 50 % compared with EMD alone.
  
  
  CONCLUSIONS
  Within the limits of this animal study, the adjunctive use of EMD in combination with an injectable cement, although it did not affect epithelial downgrowth, appeared to be a promising treatment modality for regeneration of bone and ligament tissues in the periodontium.
  
  
  CONCLUSIONS
  The adjunctive use of EMD in combination with an injectable cement appears to be a promising treatment modality for regeneration of the bone and ligament tissues in the periodontium.
authors.affiliation: Department of Biomaterials (309), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Daniël A W
authors.initials: DA
authors.lastname: Oortgiesen
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Meijer
authors.forename: Antonius L J J
authors.initials: AL
authors.lastname: Bronckers
authors.forename: X Frank
authors.initials: XF
authors.lastname: Walboomers
authors.forename: John A
authors.initials: JA
authors.lastname: Jansen
mesh_terms: D016301:Alveolar Bone Loss / Q000473:pathology / Q000601:surgery*; D000818:Animals; D001843:Bone Cements / Q000627:therapeutic use*; D001861:Bone Regeneration / Q000502:physiology; D018786:Bone Substitutes / Q000627:therapeutic use; D002130:Calcium Phosphates / Q000627:therapeutic use*; D025021:Cementogenesis / Q000502:physiology; D003238:Connective Tissue / Q000473:pathology; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004337:Drug Carriers; D017823:Furcation Defects / Q000473:pathology / Q000601:surgery; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D019344:Lactic Acid; D008439:Maxillary Diseases / Q000473:pathology / Q000601:surgery; D008863:Microspheres; D008963:Molar / Q000473:pathology / Q000601:surgery; D010012:Osteogenesis / Q000502:physiology; D010513:Periodontal Ligament / Q000473:pathology; D011100:Polyglycolic Acid; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D012038:Regeneration / Q000502:physiology; D012391:Root Resorption / Q000473:pathology; D014945:Wound Healing / Q000502:physiology
chemical_list: D001843:Bone Cements; D018786:Bone Substitutes; D002130:Calcium Phosphates; D003746:Dental Enamel Proteins; D004337:Drug Carriers; C109069:enamel matrix proteins; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid; C020243:calcium phosphate