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Biological Treatment forPeriodontal Regeneration

Use of growth and differentiation factors

Reference: Lindhe (5 th ed), pp 938-940

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Human BMP-2 (INFUSE ®)• Action: stimulation of bone formation via

recombinant human bone morphogeneticprotein-2

• With INFUSE, rhBMP-2 powder is mixedwith sterile water and applied to collagensponges

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Photos: Dr. Shaun Rotenberg

Regeneration of a peri-implantbone defect with INFUSE ®

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Left: surgical access to osseous defect, with missing F and L walls

Right: decortication of bone to enhance nutrient supply

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Left: INFUSE ® sponge positioned around implant

Right: placement of bone graft

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Left: Bone graft covered with INFUSE ® sponge

Right: Closure of surgical site

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Enamel Matrix Derivative(Emdogain®)

• Action: forms layer of extracellular matrix on theroot surface that promotes selective cellcolonization (enhances mesenchymal celladhesion and inhibits epithelial cell adhesion)

• Meta-analysis of 10 randomized clinical trialsshowed EMD significantly improved attachmentlevels (1.2 mm) and pocket reduction (0.8 mm)compared to placebo or control when assessed1 year after application (Esposito et al, 2005)

• Histological studies show formation of new bone,PDL and cementum in primate model

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Photos: Dr. Shaun Rotenberg

Periodontal regeneration withEmdogain ®

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Placement of bone graft materialcoated with Emdogain ®

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Facial and lingual views after suturing. Emdogain ® wasapplied to marginal tissue and sutures

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Post-operative appearance 2 weeks aftertreatment with Emdogain ®, showing accelerated

healing of wound site

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Human Platelet-Derived GrowthFactor in Tri-calcium Phosphate

(GEM 21S ®)• Action: PDGF stimulates migration and

proliferation of osteoblasts, fibroblasts and

cementoblasts, leading to formation of newbone, PDL and cementum• Randomized clinical trial suggested that GEM

21S ® produced a significantly greater extent ofradiographic bone fill, but did not significantlyenhance attachment gain relative to control (tri-calcium phosphate alone)

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Photos: Dr. Shaun Rotenberg

Upper panels: Facial and lingual views of surgical site

Lower panels: Facial and lingual sulcular incisions

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Facial and Lingual views of osseous defect,showing severe furcational bone loss

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GEM 21S ® delivery system

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Left: Placement of synthetic bone matrix (tricalciumphosphate) containing GEM 21S ®

Right: A collagen membrane was used to confine the graftand isolate the lingual osseous defect

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Facial and lingual view of sutured surgical site.