The Association of Guided Bone Regeneration and Enamel Matrix Derivative for Suprabony Reconstruction in the Esthetic Area: A Case Report

Periodontal regenerative treatment is useful for intrabony defects and furcation involvement, but is difficult when there is insufficient keratinized mucosa to cover and maintain the regenerative material, particularly in the mandibular molar region. We report the case of a 27-year-old woman who underwent a two-stage surgical approach for a class II furcation defect with gingival recession and insufficient keratinized mucosal width (KMW) and vestibular depth at the mandibular left first molar. We first improved the KMW and keratinized mucosal thickness using an epithelial embossed connective tissue graft with enamel matrix derivative, and then focused on periodontal regeneration at the furcation defect using an enamel matrix derivative and a bovine-derived xenograft. Probing depth reduction, clinical attachment gain, horizontal probing depth reduction, KMW gain, and gingival recession reduction were observed 3 years postoperatively. This case report suggests that this novel staged approach may be effective for treating furcation defects with insufficient keratinized mucosa, thus providing useful insights into periodontal regeneration therapy.

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The Applications of Enamel Matrix Derivative in Implant Dentistry: A Narrative Review

Materials ◽

10.3390/ma14113045 ◽

2021 ◽

Vol 14 (11) ◽

pp. 3045

Author(s):

Alice Alberti ◽

Luca Francetti ◽

Silvio Taschieri ◽

Stefano Corbella

Keyword(s):

Clinical Trials ◽

Bone Regeneration ◽

Randomized Clinical Trials ◽

Periodontal Regeneration ◽

Case Series ◽

Titanium Implants ◽

Enamel Matrix Derivative ◽

Enamel Matrix ◽

Implant Placement ◽

Matrix Derivative

Enamel matrix derivative (EMD) has been successfully used for periodontal regeneration in intrabony defects. Recently, its use for peri-implant bone regeneration has also been hypothesized. The aim of this paper is to review preclinical and clinical studies investigating the use of EMD in correspondence with titanium implants, alone or as an adjunct to other biomaterials. Clinical trials and case series with more than five cases were included. Seven in vitro studies evaluated the effect of EMD, placed on titanium surfaces: An increase in proliferation and viability of osteoblasts was observed in all but two studies. An increase in TGF-β1 and osteocalcin production, alkaline phosphatase activity, and angiogenesis was also reported. Nine animal studies investigated the use of EMD at implant placement or for bone regeneration of peri-implant bone defects, and some of them reported a significant increase in bone formation or bone-to-implant contact. In four of eleven clinical trials on humans, EMD was successfully used at implant placement. The other seven evaluated the use of EMD in protocols for the treatment of peri-implantitis. In conclusion, the results of EMD seem promising, but further randomized clinical trials are needed to evaluate its efficacy.

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