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Biological Treatment for Periodontal Regeneration

Biological Treatment for Periodontal Regeneration. Use of growth and differentiation factors Reference: Lindhe (5 th ed), pp 938-940. Human BMP-2 (INFUSE ® ). Action: stimulation of bone formation via recombinant human bone morphogenetic protein-2

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Biological Treatment for Periodontal Regeneration

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  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® Photos: Dr. Shaun Rotenberg

  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® Photos: Dr. Shaun Rotenberg

  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 Photos: Dr. Shaun Rotenberg

  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.

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