Intraosseous bone defects treatment using extracellular enamel matrix protein derivative : a treatment algorithm based on the principles of regeneration

Aim of the study

In this review of the literature, the authors highlight the factors required for regeneration in intraosseous defects using Emdogain^® and suggest an algorithm for its use either alone or as an adjunct according to the morphology of the lesion to be treated.

Conclusion

Four factors that are essential for regeneration are as follows :

- the root surface must be prepared in such a way as to eliminate bacterial cells and toxic products ;

- a space must be created to allow the progenitor cells from the ligament to repopulate the root surface ;

- the fibrin clot, the membrane and the graft must be stable under the flap ;

- the shape of the flap must ensure that the material is covered in order to avoid any bacterial contamination. The algorithm for the treatment of periodontal lesions with Emdogain^® advocates :

- in the case of deep well-defined defects, Emdogain^® alone + coronally replaced flap (CRF), if possible ;

- in the case of a moderately deep pocket that is not well defined, Emdogain^® + autogenous bone graft + CRF, if possible ;

- in the case of a superficial supracrestal lesion, Emdogain^® + autogenous bone graft + CRF.

Commentary

This article, which discusses all aspects of this topical subject, proposes a treatment strategy according to the anatomy of the various lesions to be treated. Each treatment option is nicely illustrated with clinical photographs taken at surgery and at re-entry 1 year later. However, one could question the justification in terms of cost, treatment that calls for a membrane + Emdogain^® + grafting material in order to regenerate a superficial supracrestal lesion.