Sculean Anton, Windisch Péter, Döri Ferenc, Keglevich Tibor, Molnár Balint, Gera István
Department of Periodontology, Radboud University Medical Center, Nijmegen, The Netherlands.
Fogorv Sz. 2007 Oct;100(5):220-32, 211-9.
The goal of regenerative periodontal therapy is the reconstitution of the lost periodontal structures (i.e. the new formation of root cementum, periodontal ligament and alveolar bone). Results from basic research have pointed to the important role of the enamel matrix protein derivative (EMD) in the periodontal wound healing. Histological results from animal and human studies have shown that treatment with EMD promotes periodontal regeneration. Moreover, clinical studies have indicated that treatment with EMD positively influences periodontal wound healing in humans. The goal of the current overview is to present, based on the existing evidence, the clinical indications for regenerative therapy with EMD. Surgical periodontal treatment of deep intrabony defects with EMD promotes periodontal regeneration. The application of EMD in the context of non-surgical periodontal therapy has failed to result in periodontal regeneration. Surgical periodontal therapy of deep intrabony defects with EMD may lead to significantly higher improvements of the clinical parameters than open flap debridement alone. The results obtained following treatment with EMD are comparable to those following treatment with GTR and can be maintained over a longer period. Treatment of intrabony defects with a combination of EMD + GTR does not seem to additionally improve the results compared to treatment with EMD alone or GTR alone. The combination of EMD and some types of bone grafts/bone substitutes may result in certain improvements in the soft and hard tissue parameters compared to treatment with EMD alone. Treatment of recession-type defects with coronally repositioned flaps and EMD may promote formation of cementum, periodontal ligament and bone, and may significantly increase the width of the keratinized tissue. Application of EMD seems to provide better long-term results than coronally repositioned flaps alone. Application of EMD may enhance periodontal regeneration in mandibular Class II furcations. The clinical results are comparable to those obtained following GTR.
再生性牙周治疗的目标是重建缺失的牙周结构（即牙根牙骨质、牙周膜和牙槽骨的新形成）。基础研究结果表明釉基质蛋白衍生物（EMD）在牙周伤口愈合中起重要作用。动物和人体研究的组织学结果显示，EMD治疗可促进牙周再生。此外，临床研究表明，EMD治疗对人类牙周伤口愈合有积极影响。本综述的目的是根据现有证据，介绍EMD再生治疗的临床适应症。用EMD对深部骨内缺损进行牙周手术治疗可促进牙周再生。在非手术牙周治疗中应用EMD未能实现牙周再生。用EMD对深部骨内缺损进行牙周手术治疗可能比单纯开放瓣清创术在临床参数上有显著更高的改善。EMD治疗后的结果与引导组织再生术（GTR）治疗后的结果相当，且可维持更长时间。与单独使用EMD或GTR治疗相比，联合使用EMD + GTR治疗骨内缺损似乎并不能进一步改善结果。与单独使用EMD治疗相比，EMD与某些类型的骨移植材料/骨替代物联合使用可能会在软组织和硬组织参数上带来一定改善。用冠向复位瓣和EMD治疗退缩型缺损可能促进牙骨质、牙周膜和骨的形成，并可能显著增加角化组织的宽度。应用EMD似乎比单纯冠向复位瓣能提供更好的长期效果。在Ⅱ度根分叉病变的下颌牙中应用EMD可能会增强牙周再生。临床结果与GTR治疗后的结果相当。
