Australasian Dentist Magazine Nov Dec 2021

Category 56 AustrAlAsiAn Dentist “the treatment with emdogain is as familiar to me as the feeling of coming home,” says Min-Young Kim, describing his many years of experience with emdogain ® , which has been tried and tested in periodontology and implantology for 25 years. “My confidence in the therapy has grown steadily and i think it is absolutely safe. since i started practicing, i have never had bad results due to the preparation.” Dr. Kim, who has had his own practice in Osnabrück, Germany since 2004 together with Dr. Barbara Herzog, summarizes few points that are convincing for periodontists and implantologists “the most simple and safe handling, good tissue compatibility, good clinical results and broad areas of application, both for open and closed regenerative procedures.” Over the past 25 years, procedures have become less invasive: the new therapy approach with emdogain ® Fl (flapless), which straumann presented at iDs 2019, aims at the gentle use of emdogain without flap surgery; a patient-friendly procedure, because “the enthusiasm of the patients about surgical-regenerative therapy procedures was retrospectively to be classified as rather restrained compared to other interventions”, Kim knows. He treated his first case with emdogain ® Fl in October 2019. “the young woman came to our practice with bony defects in regions 16 and 21. After the systematic periodontal therapy, we treated tooth 21 with the new procedure. this was a localized, three-wall defect on tooth 21 distopalatinal with a sulcus depth of 6 to 7mm. now i was able to convince myself that the closed treatment with emdogain ® Fl subjectively led to better results in the early aftercare phase with regard to color and texture of the gingiva, residual swelling and pain sensation than after deep scaling treatment alone. that motivated me to treat more cases using the flapless procedure and around 20 cases have occurred in the past four months.” A plus for wound healing and regeneration For a quarter of a century, straumann ® emdogain has been a well-researched and easy-to-use gel based on propylene glycol alginate (PGA). it contains enamel matrix proteins and is a complex of native proteins such as amelogenin (approx. 90 percent) and other proteins that play a key role in the development of tooth-supporting tissues. Applied to the cleaned root surface of the periodontally diseased tooth, eMD promotes the regeneration of all the periodontium structures. the product is documented by more than 1000 peer review publications, from which over 600 human studies, including 10-year data and human histological examinations [11,14,15,17] . in the first phase of wound healing, emdogain shows antibacterial properties and favors a significantly faster fibroblast attachment to the root surface. this promoted proliferation will cause cells to reconstruct and consolidate the tissue and a new periodontal attachment is created [1-6,8-10,12,13,18,20] . the regeneration process takes place in the following months and continues as “biological maturation” of the bone defect for up to three years [16] . Indications for EMD and EMD FL For Kim, “the area of indication for emdogain ® and emdogain ® Fl flows into one another”. in addition to the usual factors such as patient and defect selection, the indication also depends in particular on the surgical skills and experience of the practitioner”, Dr. Kim is convinced. “Many consider the surgical treatment to be sensitive to indications and technique. if the practitioner feels unsafe with the surgical procedure, i would tend to recommend the emdogain flapless procedure.” the closed procedure with emdogain ® Fl is recommended for single-root teeth with localized two to three-walled, intraosseous bone defects and pocket probing depths of 5 to 9mm and no recession or furcation involvement. “the range of indications for the surgical therapy with emdogain ® could result from this: multi-rooted teeth with a probing depth of over 6mm that do not respond to closed therapy and single- rooted teeth with probing depths above 9mm.” the classic indication areas for emdogain (open procedure) are: u 1 to 3-wall intraosseous defects u furcation defects exceeding 2mm (but not through-and-through defects) u gingival recession defects u oral wound healing procedures “Depending on the defect morphology, i use emdogain ® to stabilize the blood clot in combination with a filler and / or a membrane” explains Kim. “With single- or double-wall defects, it is often not possible to stabilize the defect space three-dimensionally.” in this way, the soft tissue is kept away from the defect. in this context, Dr. Kim refers to a “novel approach of a working group fromHanover and the granulation tissue-preserving technique (GtPt).” the granulation tissue is elevated with microsurgical techniques and after instrumentation and treatment of the root surface with PrefGel ® and emdogain ® , the tissue is repositioned back into the defect. Kim: “this avoids introducing, for example, foreign and expensive filling materials.” [7] For both, closed and open procedure, the decisive factor for therapeutic success is “the right preparation and adequate follow-up as part of systematic periodontitis therapy”, emphasizes Kim On the way to non-surgical regeneration – 25 years of Straumann®Emdogain® By Min-Young Kim What convinced experienced dentist Min-Young Kim about enamel matrix proteins in periodontal surgery and the minimally invasive procedure without flap preparation. liniCal