Australasian Dentist Magazine Nov Dec 2021

Category 58 AustrAlAsiAn Dentist and adds critically: “risk factors must also be recognized and, if possible, eliminated: i would generally exclude heavy smokers from the treatment with emdogain/ emdogain Fl, while i do not deny the treatment with emdogain Fl to occasional smokers with good oral hygiene and compliance. Over time, i’ve learned to listen more to my gut feeling.” The minimally invasive procedure in accordance with the manufacturer’s treatment protocol [19] , the gums are gently retracted after appropriate anesthesia to provide access to the affected root surface. Kim’s practical tip: “i use small strips of gauze soaked in saline solution to retract the gingiva. these are placed in the pocket with a Heidemann instrument or thread-laying instrument, as with prosthetic impression techniques, and left for two minutes. the gauze strips soak up, and after removal you can almost look down on the bottom of the pocket.” After rinsing with sterile saline, the root surface is conditioned with pH-neutral, 24% eDtA (straumann ® PrefGel ® ) to remove the smear layer and a repeated rinsing follows. then, emdogain Fl can be applied to the periodontal pocket. Kim: “local anesthesia with a high adrenaline percentage (1: 100,000) is carried out 15 minutes before the procedure and again immediately before in two steps in order to additionally contribute to less bleeding.” to reach the bottom of the periodontal pocket, emdogain ® Fl is offered with a special attachment. “Overall, it should be avoided to unnecessarily risk bleeding by being too aggressive with pointed instruments. in my experience, it is very time-consuming and almost impossible to create a blood-free area in the operating room.” since proteins are highly sensitive molecules that react easily with other substances, Kim advises against “using a powder-water jet or the introduction of, for example, chlorhexidine or iron sulfate preparations.” Finally, the gingival margin is carefully adapted against the tooth until the gums surround the tooth. Kim takes a gauze pad soaked in saline, which he presses buccally and orally against the gingiva for a minute. to find out when the tendency to bleed is lowest during the different phases of systematic PAr therapy, Kim used emdogain ® Fl at different times: “the best result was three weeks after the first deep scaling.” Conclusion for practicians “emdogain Fl has been the logical evolution of periodontology over the past 100 years”, Kim is convinced. “it has been shown that the results, particularly with regards to the gain in attachment and the probing depth reduction, were getting better the more minimally invasive and atraumatic the operation was performed”, Kim recalls. For colleagues who do little or no periodontal surgery, “the procedure with emdogain Flapless is definitely an interesting alternative to surgery. Patients who would otherwise have been referred can stay in their own rooms, much for the benefit of the patients, who are reluctant to be referred to an unknown practitioner”. For periodontal oriented practices “the flapless procedure could prove to be an advantage if finally, it would be clarified whether it should be delegated to specially trained specialists such as dental hygienists as part of a deep scaling. i personally am convinced that the potential of the enamel matrix protein is not yet exhausted.” the delegation is possible in principle, explains the company. For the dentist, further studies, especially human histological examin- ations, have to follow, “which show that the flapless procedure and thus the leap to ‘non-surgical’ regeneration succeeds sustainably. the clinical results in our practice are very promising. in addition, the well-being of the patient is in the foreground: there are fewer costs, fewer complications and less risk. “ u Email gapmagazines@gmail.com for a full list of references Fig. 1: Initial clinical findings. (Illustration: Dental practice Kim & Herzog, Osnabrück) Fig. 2: Localized, three-walled defect on tooth 21 distopalatinal with a sulcus depth of 6 to 7 mm. (Illustration: Dental practice Kim & Herzog, Osnabrück) Fig. 3: To retract the gingiva, Dr. Kim uses small gauze strips soaked in saline, puts them in the pocket and leaves them for two minutes. The bag bottom is clearly visible after removal. This assures enough time to apply Straumann® Prefgel®(EDTA) and Emdogain®FL to the root surface. (Illustration: Dental practice Kim & Herzog, Osnabrück) Fig. 4: After rinsing with sterile saline, conditioning the root surface with Straumann® PrefGel (EDTA) and rinsing again, Emdogain®FL can be applied to the dried periodontal pocket. (Illustration: Dental practice Kim & Herzog, Osnabrück) Fig. 5: The special applicator makes it easy to apply Emdogain®FL. (Illustration: Straumann Group) Fig. 6: Gingiva adaptation by pressing gently for one minute with a saline-soaked gauze supra buccally and orally. (Illustration: Dental practice Kim & Herzog, Osnabrück) liniCal