Periodontal Regeneration With Enamel Matrix Derivative in Reconstructive Periodontal Therapy: A Systematic Review

Periodontal regeneration is a complex goal, which is commonly pursued with a combination of surgical techniques, biomaterials, and bioactive compounds. One such compound is enamel matrix derivative (EMD), a medical substance that is extracted from porcine tooth germs and which contains several protein fractions with BMP- and TGF-β-like action. Activation of TGF-β signaling is required for EMD activity on cells and tissues, and a growing body of evidence indicates that EMD largely relies on this pathway. As low frequency electromagnetic fields (EMFs) have long been investigated as a tool to promote bone formation and osteoblast activity, and because recent studies have reported that the effects of EMFs on cells require primary cilia, by modulating the presence of membrane-bound receptors (e.g., for BMP) or signal mediators, it can be hypothesized that the application of EMFs may increase cell sensitivity to EMD: as TGFBR receptors have also been identified on primary cilia, EMFs could make cells more responsive to EMD by inducing the display of a higher number of receptors on the cellular membrane.

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Lesões em áreas de furca: fatores etiológicos, diagnóstico e tratamento

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v9i6.5110 ◽

2020 ◽

Vol 9 (6) ◽

pp. 635-640

Author(s):

Ariana Larissa de Moura Rodrigues ◽

Ana Carolina de Sá Gomes Cruz Souza ◽

Jéssica Gomes Alcoforado de Melo ◽

Diego Moura Soares

Keyword(s):

Systematic Review ◽

Clinical Trial ◽

Meta Analysis ◽

Class Ii ◽

Periodontal Treatment ◽

Enamel Matrix Derivative ◽

Enamel Matrix ◽

Furcation Defects ◽

Furcation Involvement ◽

Matrix Derivative

As lesões de furca ocorrem quando a doença periodontal atinge a área de bifurcação dos dentes multirradiculares causando a destruição óssea e perda de inserção no espaço inter-radicular. Existem diversos fatores etiológicos que influenciam no aparecimento dessas lesões e até os dias de hoje o tratamento desse tipo de injúria ainda é um desafio na clínica odontológica. O objetivo deste artigo foi listar, através de uma revisão da literatura, os fatores que influenciam na etiologia da lesão de furca, bem como o seu diagnóstico, prognóstico e tratamento. Fatores como características morfológicas do dente e raiz e deficiência no controle do biofilme, que podem contribuir para o seu aparecimento. Além de diversos tipos de procedimentos e técnicas têm sido propostas para o tratamento das lesões de furca, seja mais ou menos conservadores. Descritores: Defeitos da Furca; Diagnóstico; Doenças Periodontais. Referências Deliberador TM, Nagata MJH, Furlaneto FAC, Messora MR, Bosco AF, Garcia VG et al. Abordagem conservadora no tratamento dos defeitos de furca. RSBO. 2008;5(8):49-55. Silva GP, Sousa Neto AC, Pereira AFV, Alves CMC, Pereira ALA, Serra LLL. Classificação e tratamento das lesões de furca. Rev Ciênc Saúde. 2014;16(2):112-28. Nibali L, Zavattini A, Nagata K, Di Iorio A, Lin GH, Needleman I, et al. Tooth loss in molars with and without furcation involvement - a systematic review and meta-analysis. J Clin Periodontol. 2016;43(2):156-66. Artacho MCI, Arambulo GM. Defectos de furcación. Etiología, diagnóstico y tratamiento. Rev Estomatol Herediana. 2010;20(3):172-78. Pereira SG, Pinho MM, Almeida RF. Regeneração periodontal em lesões de furca–revisão da literatura. Rev port estomatol med dent cir maxilofac. 2012;53(2):123-32. Queiroz LA, Casarian RCV, Daddoub SM, Tatakis DN, Enilson AS, Kumar PS. Furcation Therapy with Enamel Matrix Derivative: Effects on the Subgingival Microbiome. J Periodontol. 2017;88(7):617-25. Vieira TR, Costa FO, Zenóbio EG, Soares RV. Anatomia radicular e suas implicações na terapêutica periodontal. Rev Periodontia 2009;19(1):7-13. Bower RC. Furcation morphology relative to periodontal treatment. Furcation root surface anatomy. J Periodontol. 1979;50(7):366-74. Newman M, Takei H, Klokkevold P, Carranza F. Periodontia clínica. ed. São Paulo: Elservier; 2016. Lindhe J, Karring T, Lang NP. Tratado de periodontia clínica e implantodontia oral. ed; Rio de Janeiro: Guanabara Koogan;2010. Hamp SE, Nyman S, Lindhe J. Periodontal treatment of multirroted teeth. Result after 5 years. J Clin Periodontol. 1975;2(3):126-35. Ramjford SP, Ash MM. Periodontology and Periodontics. Philadelphia: W.B. Saunders Co; 1979. Tarnow D, Fletcher P. Classification of the vertical component of furcation involvement. J Periodontol. 1984;55(5):283-84. Walter C, Weiger R, Zitman NU. Periodontal surgery in furcation-involved maxillary molars revisited: an introduction of guidelines for comprehensive treatment. Clin Oral Investig. 2011;15(1):9-20. Sallum AW, Cicareli AJ, Querido MRM, Bastos-Neto FVR. Periodontia e implantodontia - Soluções estéticas e recursos clínicos. Rio de Janeiro: Napoleão; 2010. Graziani F, Gennai S, Karapetsa D, Rosini S, Filice N, Gabriele M, et al. Clinical performance of access flap in the treatment of class II furcation defects. A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. 2015;42(2):169-81. Svärdström G, Wennström JL. Periodontal treatment decisions for molars: an analysis of influencing factors and long-term outcome. J Periodontol. 2000;71(4):579-85. Huynh-Ba G, Kuonen P, Hofer D, Schmid J, Lang NP, Salvi GE. The effect of periodontal therapy on the survival rate and incidence of complications of multirooted teeth with furcation involvement after an observation period of at least 5 years: a systematic review. J Clin Periodontol. 2009;36(2):164-76. Shirakata Y, Miron RJ, Nakamura T, Sena K, Shinohara Y, Horai N et al. Effects of EMD liquid (Osteogain) on periodontal healing in class III furcation defects in monkeys. J Clin Periodontol. 2017;44(3):298-307. Meyle J, Gonzales JR, Bödeker RH, Hoffmann T, Richter S, Heinz B et al. A randomized clinical trial comparing enamel matrix derivative and membrane treatment of buccal class II furcation involvement in mandibular molars. Part II: secondary outcomes. J Periodontol. 2004; 75(9):1188-95. Jenabian N, Haghanifar S, Ehsani H, Zahedi E, Haghpanah M. Guided tissue regeneration and platelet rich growth factor for the treatment of Grade II furcation defects: A randomized double-blinded clinical trial - A pilot study. Dent Res J (Isfahan). 2017;14(6):363-69. Kinaia M, Steiger J, Neely AL, Shah M, Bhola M. Treatment of class II molar furcation involvement: meta-analyses of re-entry results. J Periodontol. 2011;82(1):413-28. Correa A, Ferreira PS, Barboza R, Ribeiro EDP, Bittencourt S. Fatores que influenciam no sucesso da técnica do retalho posicionado coronalmente. Rev Bahiana Odonto; 2013;4(2):117-28. Jepsen S, Gennai S, Hirschfeld J, Kalemaj Z, Buti J, Graziani F. Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta-analysis of randomized clinical trials. J Clin 2020;47(Suppl 22):352-74. Reddy MS, Aichelmann-Reidy ME, Avila-Ortiz G, Klokkevold PR, Murphy KG, Rosen PS, et al. Periodontal regeneration - furcation defects: a consensus report from the AAP Regeneration J Periodontol. 2015;86(2 Suppl):S131-3. Casarin RCV, Ribeiro EDP, Nociti-Jr FH, Sallum AW, Ambrosano GMB, Sallum EA, et al. Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective 24-month randomized clinical trial. J Clin Periodontol; 2010;37(12):1100-109. Hoffmann T, Richter S, Meyle J, Gonzales JR, Heinz B, Arjomand M et al. A randomized clinical multicentre trial comparing enamel matrix derivative and membrane treatment of buccal class II furcation involvement in mandibular molars. Part III: patient factors and treatment outcome. J Clin Periodontol. 2006;33(8):575-83.

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Two-stage approach for class II mandibular furcation defect with insufficient keratinized mucosa: a case report with 3 years’ follow-up

Journal of International Medical Research ◽

10.1177/03000605211044595 ◽

2021 ◽

Vol 49 (9) ◽

pp. 030006052110445

Author(s):

Hiroyuki Saida ◽

Shunsuke Fukuba ◽

Takahiko Shiba ◽

Keiji Komatsu ◽

Takanori Iwata ◽

...

Keyword(s):

Case Report ◽

Periodontal Regeneration ◽

Gingival Recession ◽

Enamel Matrix Derivative ◽

Enamel Matrix ◽

Two Stage ◽

Probing Depth ◽

Keratinized Mucosa ◽

Depth Reduction ◽

Matrix Derivative

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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