ABSTRACT
Enamel matrix proteins (EMP) are deposited on the surface of developing roots before dentin formation and may play a role in osteogenesis. Amelogenins (Am) are the main and active component in EMPs. Studies had showed great clinical values of EMPs in periodontal regenerative treatment and other fields. By affecting the expression of growth factors and inflammatory factors, EMPs could act on various periodontal regeneration-related cells to promote angiogenesis, anti-inflammation, bacteriostasis and tissue healing, achieving the clinical effect of periodontal tissue regeneration (newly generated cements and alveolar bones as well as functionally penetrated periodontal ligament). EMPs alone or combined with bone graft material and barrier can be used for regenerative surgical treatment in intrabony defects and degree Ⅱ furcation-involved at maxillary buccal or mandibular teeth. EMPs can also be adjunctively used to treat recession type 1 or 2 gingival recessions, forming periodontal regeneration on the exposed root surface. Through a comprehensive understanding of the principle and current clinical application of EMPs on periodontal regeneration, we can look forward to their future development. The development of recombinant human amelogenin to replace animal-derived EMPs through bioengineering technologies, the study of the clinical application of EMPs combined with other collagen biomaterials, and the specific application of EMPs in severe soft and hard periodontal tissue defects and peri-implant lesions are all important development directions of future EMPs-related researches.
ABSTRACT
Periodontitis can lead to periodontal tissue defect, tooth mobility and loss, which seriously affects the quality of life. Periodontal regeneration surgery is an important treatment method for repairing periodontal defects, and it is also the hotspot of current periodontal clinical and basic research. A comprehensive understanding of the factors affecting the efficacy of periodontal regenerative surgery can improve clinicians' periodontal treatment concepts, increases the predictability of treatment results, and enhances the level of clinical diagnosis and periodontal treatment. In order to instruct the clinicians, this article will explain the basic principles of periodontal regeneration and the key points of periodontal wound healing, and analyze the elements of periodontal regeneration surgery, which including the patient-related factors, local factors, surgical factors and regenerative material selection.
ABSTRACT
Objective · To observe the short-term clinical efficacy of adjunctive Er, Cr:YSGG laser application following subgingival scaling in patients with severe periodontitis. Methods · In this parallel control design clinical trial, 46 patients with severe periodontitis were selected. Baseline examination was performed 2 weeks after supragingival scaling. Then the patients were randomly divided into the test group and the control group, with 23 cases in each group. After ultrasonic subgingival scaling, sites with probing depth (PD) ≥5 mm of patients in two groups received subgingival debridement with Er, Cr:YSGG laser and hand curettes, receptively. The changes in plaque index (PLI), PD, clinical attachment level (CAL), the percentage of bleeding on probing (BOP) positive sites, and the degree of subjective pain during treatment with visual analogue scale (VAS) were compared between two groups at baseline, 6 weeks after treatment, and 3 months after treatment. Results · For sites with PD≥5 mm, PLI, PD, CAL, and the percentage of BOP positive sites significantly reduced for both groups at 6 weeks and 3 months after treatment compared with baseline (all P=0.000). For sites with 5 mm ≤ PD ≤ 6 mm, the CAL of the test group was significantly lower compared with the control group at 6 weeks after treatment (P=0.036). For sites with PD ≥ 7 mm, the PDs of the test group were significantly lower compared with the control group at 6 weeks and 3 months after treatment (P=0.002, P=0.039). The PD reduction between baseline and 6 weeks after treatment was greater in the test group compared with the control group (P=0.015). The CAL of the test group was lower compared with the control group at 6 weeks after treatment (P=0.011). The VAS of the test group was significantly lower than that of the control group (P=0.005). Conclusion · Adjunctive Er, Cr:YSGG laser application following subgingival scaling can achieve similar short-term clinical efficacy compared with traditional hand curettes. Er, Cr:YSGG laser may be beneficial particularly on the reduction of PD and regain of CAL in deep pockets on a short-term basis, which can make the patients more comfortable. Subgingival scaling with adjunctive Er, Cr:YSGG laser application can be an effective way for the non-surgical periodontal therapy.