Periodontal Regeneration with a Combination of Enamel Matrix Proteins and Autogenous Bone Grafting

• Published in: Journal of periodontology (1970) 2003-09, Vol.74 (9), p.1269-1281
• Main Authors: Cochran, David L., Jones, Archie, Heijl, Lars, Mellonig, James T., Schoolfield, John, King, Gaston N.
• Format: Article
• Language: English
• Subjects: Alveolar Bone Loss - surgery; Alveolar Process - physiopathology; Animal studies; Animals; Bone Regeneration - physiology; Bone Transplantation; Chelating Agents - therapeutic use; Dental Cementum - physiopathology; Dental Enamel Proteins - therapeutic use; Dental Scaling; Dentistry; Edetic Acid - therapeutic use; enamel matrix derivative; Female; followup studies; grafts, bone; Guided Tissue Regeneration, Periodontal; Papio; Periodontal Ligament - physiopathology; periodontal regeneration; Random Allocation; Regeneration - physiology; Root Planing
• ISSN: 0022-3492; 1943-3670
• DOI: 10.1902/jop.2003.74.9.1269

Background: Attempts to stimulate periodontal regeneration in the past have focused on either filling the defect with some type of material or providing a space for host cells to repopulate the site and elicit new tissue. In some cases, these approaches have been combined with the assumption that the filler material will help maintain the space necessary for the host cells to invade the area. Growth stimulating substances such as growth factors and other proteins have also been used to encourage periodontal tissue regeneration and histological evaluation supports the use of these substances. Thus, the role for and the necessity of a certain amount of space maintenance for periodontal regeneration is not exactly understood. In addition, it is not known if there is some critical size required for space maintenance or for exactly how long the space must be maintained in order for the host cells to stimulate new cementum, periodontal ligament, and bone. The goal of this study was to evaluate periodontal regeneration in intrabony defects of various sizes treated with a combination of enamel matrix proteins and autogenous bone graft. Methods: Periodontal defects ranging in size from 1 to 6 mm were randomized and created bilaterally beside three teeth in the mandibles of baboons. Plaque was allowed to accumulate around wire ligatures placed into the defects. After 2 months, the wire ligatures were removed, the teeth and roots scaled and root planed, and a notch was placed with a chisel at the base of the defect. On one side of the mandible, neutral ethylene diamine tetracetic acid and enamel matrix derivative (EMD) were first used to treat the defect. Autogenous bone taken from the same surgical site was treated with enamel matrix derivative in a dampen dish and then added to the EMD‐treated defects. The other side of the mandible served as control with neutral ethylene diamine tetracetic acid and scaling and root planing. Flaps were sutured and the animals were allowed to heal without oral hygiene procedures. After 5 months, the animals were sacrificed and the teeth were processed for histological evaluation. Results: The results revealed new cementum, periodontal ligament with Sharpey's fibers, and new bone tissue similar to native periodontal tissues. Remnants of the autogenous bone chips were still present at this 5‐month post‐healing period. Thus periodontal regeneration occurred in all sizes of the periodontal defects. In general, EMD plus autogenous graft