Biological Treatment for Periodontal Regeneration

1
Biological Treatment for Periodontal Regeneration

• Use of growth and differentiation factors
• Reference Lindhe (5th ed), pp 938-940

2
Human BMP-2 (INFUSE)

• Action stimulation of bone formation via
  recombinant human bone morphogenetic protein-2
• With INFUSE, rhBMP-2 powder is mixed with
  sterile water and applied to collagen sponges

3
Regeneration of a peri-implant bone defect with
INFUSE
4
Left surgical access to osseous defect, with
missing F and L wallsRight decortication of
bone to enhance nutrient supply
5
Left INFUSE sponge positioned around
implantRight placement of bone graft
6
Left Bone graft covered with INFUSE
spongeRight Closure of surgical site
7
Radiographic assessment
Pre-operative
2 month post-op
5 month post-op
8
Enamel Matrix Derivative (Emdogain)

• Action forms layer of extracellular matrix on
  the root surface that promotes selective cell
  colonization (enhances mesenchymal cell adhesion
  and inhibits epithelial cell adhesion)
• Meta-analysis of 10 randomized clinical trials
  showed EMD significantly improved attachment
  levels (1.2 mm) and pocket reduction (0.8 mm)
  compared to placebo or control when assessed 1
  year after application (Esposito et al, 2005)
• Histological studies show formation of new bone,
  PDL and cementum in primate model

9
Periodontal regeneration with Emdogain
10
Right Osseous defect after debridement and root
planingLeft Removal of smear layer from root
with PrefGel prior to treatment of root surface
with Emdogain
11
Placement of bone graft material coated with
Emdogain
12
Facial and lingual views after suturing.
Emdogain was applied to marginal tissue and
sutures
13
Post-operative appearance 2 weeks after treatment
with Emdogain, showing accelerated healing of
wound site
14
Human Platelet-Derived Growth Factor in
Tri-calcium Phosphate (GEM 21S )

• Action PDGF stimulates migration and
  proliferation of osteoblasts, fibroblasts and
  cementoblasts, leading to formation of new bone,
  PDL and cementum
• Randomized clinical trial suggested that GEM 21S
  produced a significantly greater extent of
  radiographic bone fill, but did not significantly
  enhance attachment gain relative to control
  (tri-calcium phosphate alone)

15
Upper panels Facial and lingual views of
surgical siteLower panels Facial and lingual
sulcular incisions
16
Facial and Lingual views of osseous defect,
showing severe furcational bone loss
17
GEM 21S delivery system
18
Left Placement of synthetic bone matrix
(tricalcium phosphate) containing GEM 21S
Right A collagen membrane was used to confine
the graft and isolate the lingual osseous defect
19
Facial and lingual view of sutured surgical site.