:Reconstructive periodontal surgery aims at predictably restoring tooth’s supporting structure lost due to periodontal disease or trauma. One such modality, which has been demonstrate to promote periodontal regeneration, is an enamel matrix derivative (EMD), consisting of a formulation of amelogenin proteins from developing porcine enamel. This review article provides a brief update on the effects of blood interaction, occurring during periodontal surgery, on the effectiveness of EMD adsorption on the root surfaces and its implications for periodontal reconstructive surgery.
The clinical use of an enamel matrix derivative (EMD) has been successfully proved in periodontal surgery, as promoting regeneration of periodontal tissues including new cementum, periodontal ligament (PDL) and alveolar bone [1]. Despite its widespread use, only recently has the effect of blood, occurring during periodontal surgery, been evaluated for contamination of the effectiveness of EMD adsorption onto root surfaces. The aim of this review article is to provide the clinician a summary of findings from in vitro experiments testing the effects of EMD adsorption onto root surfaces in the presence and absence of blood and its effect on PDL cell behavior [2]. Until recently, the extent to which bleeding occurring during periodontal surgery affects the adsorption of EMD onto root surfaces could not be established.
In summary, the teeth extracted for orthodontic reasons were subject to ex vivo scaling and root planing and exposed to 6 clinically relevant scenarios, as illustrated in figure 1. EMD application is usually performed following root surface conditioning with 24% EDTA. Findings from high resolution scanning electron microscopy (SEM) demonstrated that the proteins found in blood (mainly albumin) were able to compete with those found in EMD (Figure 2), reducing the effectiveness of EMD thereafter. No apparent effect of conditioning the surface with 24% EDTA was observed. Clinically, the effect of EDTA root conditioning on the healing of intrabone defects treated with an enamel matrix protein derivative has been tested, however no statistical clinical differences were observed between open flat debridement (OFD), followed by root surface conditioning with EDTA, and application of EMD versus that of OFD + EMD alone.