Objectives : The aim of the present study was to evaluate the effectiveness of EMDOGAIN^® treatment through a multiple-clinic survey.
Methods : The probing pocket depth (PPD), clinical attachment level (CAL,) and radiographic bone level (RBL) of 256 single-rooted teeth with partial vertical osseous defects in 185 clinics were evaluated at baseline and 8 months after surgical application of EMDOGAIN^®. The number of walls, depth, and width of intrabony defects were measured.
Results : At 8 months post-surgery, a PPD reduction of 3.58mm and a clinical attachment (CA) mean value of 2.87mm were obtained. The bone gain along the axis of the teeth determined in terms of RBL was on average 2.15mm. The deeper the PPD and bone defect depth, the greater the PPD reduction, the gain of CA, and the level of bone regeneration. The number of walls and defect width did not affect the post-surgery reduction of PPD, gain in CA or bone gain.
Conclusion : The results of the present study showed no great difference with those obtained in studies performed in European and North American specialist clinics. The constant improvement regardless of number of walls or width of intrabony defects suggest that EMDOGAIN^® should be indicated more widely than bone graft or GTR therapy.

View full abstract

We studied the effect of Platelet-Rich Plasma alone (PRP) weekly compared to flap operation (FOP) using an enamel matrix derivative (EMD), after experimental periodontal breakdown was induced around the 2nd premolar (P2) and 3rd premolar (P3) of the lower and right left jaw in dogs. Sbjects were 6 beagles. Bilaterally mucoperiosteal flaps were raised. Single-wall osseous defects were created on the mesial aspect of P2 and distal aspect of P3 and at insertion forced down toward periodontal pockets. Beagles under went periodontal surgery 3 weeks after defects were created; this time was made the baseline. Beagles were divied into 3 groups—a FOP group for FOP alone, a PRP group applying PRP, and an EMD group applying EMD (Emdogain^® Gel). FOP was companed to PRP on P2 and EMD to PRP on P3. Periodontal parameters, i.e., probing pocket depth (PPD), probing attachment level (PAL), tooth mobility (TM), gingival crevicular fluid volume (GCF), and X-ray assessment were measured at baseline 6, 8, 10, and 12 weeks after periodontal surgery. From 6 weeks, daily plaque was controlled by tooth cleaning 3 times a week. After the experiment, histological sections were processed and analyzed.
Results were as follows : In P2, TM and GCF improved more in the PRP group than in the FOP group (p<0.05). In P3, no significant difference was seen in periodontal parameters between the EMD and PRP groups, although EMD showed a marked gain in forming new cementum compared to PRP (p<0.05).
Our results suggest that PRP alone heals wounds earlier than FOP for single-wall osseous defects, while PRP had no difference compared to EMD at the clinical level, and PRP alone did not necessarily effectively improve PPD and PAL in periodontal tissue with single-wall osseous defects.

View full abstract

We clinically studied the effects on plaque removal of differences in the reverse angle and frequency of a rotated electric toothbrush. We used a newly designed electric toothbrush under four conditions—2,000cpm frequency and 20°, 40°, and 75° reversal angles and 3,500cpm frequency and 40° reversal angle. Differences between 2,000cpm/20° and 2,000cpm/40°, 2,000cpm/75°, and 3,500cpm/40° were significant for total, proximal and mesial tooth surfaces. and between 2,000cpm/20° and 2,000cpm/40° and 3,500cpm/40° on distal surfaces. The clinical trial also showed, the effect of plaque removal to be almost the same as a brushing simulator. We concluded that the rotary electric toothbrush is more effective in plaque removal at wigher reverse angles and frequencies.

View full abstract

The basic approach to periodontitis is to eliminate causative agents by means of scaling and root planing. In advanced periodontitis, however, the treatment goal should be set to establish a long-lasting, functional, easy-care dentition free of occlusal trauma. Opportunities to restore severely deteriorated dentition have dramatically increased, and multidisciplinary work is a must. This is a case report of a skeletal class II patient with advanced periodontitis. Because of the retruded small mandible and proclination of upper incisors, the 40-year-old woman had a bird-face profile with a deep bite and a huge overjet. Lip seal had been lost and her temporo-mandibular joints clicked audibly. The radiographs showed considerable alveolar bone loss despite ralatively shallow periodontal pockets —5mm at the deepest. Since her malocclusion had to be solved by surgical orthodontics, we set up a team to provide interdisciplinary therapy. During the first 8 months, periodontal therapy —oral hygiene instruction followed by meticulous root planing— was carried out together with endodontic treatment and temporary restoration. The patient was highly motivated and the tissue responded satisfactorily. The next 2 years were spent in orthodontic treatment. With the help of multi-bracketed appliances, the cant of occlusal plane was corrected by Le Fort I osteotomy and the mandibular deficiency was improved by distraction osteogenesis (DOG). During the active movement phase, the teeth became loose and slight gingivitis developed. Once retention started, the patient was retrained in oral hygiene and the teeth were again thoroughly planed. Provisional restorations were also installed in this corrective phase. After the periodontal tissue recovered from damage and the new occlusal position functioned well, carefully designed permanent restorations were brought in. The outcome was successful esthetically as well as in function. As most of the abutment teeth are poorly supported with alveolar bone, it is essential to keep check-ups to maintain good plaque control and avoid occlusal trauma.

View full abstract