EXPERIENCE OF USING ENAMEL MATRIX PROTEIN IN COMBINATION WITH A CORONARY ADVANCED FLAP AND A CONNECTIVE TISSUE GRAFT TO ELIMINATE GUM RECESSION

The article presents the experience of complex managing a patient with gum recession in the area of the maxillary premolars. Periodontal treatment of gum recession consisted of initial therapy, including supra- and subgingival scaling, root planing, pharmacotherapeutic support (broad-spectrum antiseptics, drugs that stimulate regeneration), surgical combined method based on the use of enamel matrix protein to stimulate regenerative processes. The clinical material Emdogaine is a combination of an enamel matrix derivative and propylene glycol alginate, which performs the function of a carrier. Biora company has been producing it for more than 20 years (Emdogain, BIORA): now the rights to this material belong to Straumann). This preparation was developed to stimulate regeneration of periodontal tissues. Amelogenin is a specific enamel protein capable of stimulating regeneration of lost periodontal tissues by influencing cell differentiation. Dental cement is an osteoid connective tissue that covers the roots of teeth and serves to attach periodontal fibers. Application of an enamel matrix derivative to the sanitized root surface leads to regeneration of non-cellular cement and to the formation of periodontal tissues, which was observed in our study. Transplantation of free connective tissue grafts to eliminate gum recessions makes it possible to effectively eliminate gum recession in most clinical cases (complete root coverage, an increase in the level of clinical attachment from the keratinized attached gum area). In our clinical case, free grafts were obtained in the donor area of the maxillary tuberosity. Transplantation of free connective tissue grafts provides an aesthetic result and is currently considered a standard technique for eliminating gum recession. According to the clinical study, a combined use of connective tissue grafts and the enamel matrix derivative, an additional use of enamel matrix derivative enabled to obtain a satisfactory result and to improve the appearance of the dentition. Such combined surgeries are indicated in an aesthetically significant area. The described materials, methods and stages of patient's follow up can serve as the basis for the protocol of managing patients with gum recession.