Conventional periodontal surgery in conjunction with enamel matrix derivative

  • Deep intrabony defect.
  • Flap preparation.
  • Granulation tissue removal.
  • Application of Straumann® PrefGel® to the root surface and incubation for 2 min.
  • Application of Straumann® Emdogain® to the root surface in apico-coronal direction.
  • Repositioning of the flap and suturing.
  • Pocket elemination and osseous fill.
In terms of clinical attachment level gain and probing pocket depth (PPD) reduction, a surgical approach has been proven beneficial for the treatment of deep periodontal intrabony pockets (PPD ≥ 6 mm) [1, 2, 3]. Enamel matrix derivative (EMD, Straumann® Emdogain®) has been shown to be effective in sites of > 6 mm PPD associated with a radiographic vertical bone loss > 3 mm. Human histological data have demonstrated that EMD induces the de novo formation of root cementum, periodontal ligament and alveolar bone [4, 5].

Flap techniques

Straumann® Emdogain® can be used in combination with all state-of-the-art minimally invasive techniques including papilla preservation techniques (MPPF, SPPF) and the single flap approach (SFA).

Probing and radiographs

Probing is recommended earliest 6 months after the surgery. Radiographic bone changes can be observed earliest 12 months following surgery.

Wound healing

Apply remaining Straumann® Emdogain® directly under the flap before final wound closure and on the wound margins after suturing to improve soft tissue wound healing. Straumann® Emdogain® is indicated to support early soft tissue wound healing as part of oral surgical procedures in general.

Post-operative care

The patient should be instructed not to brush in the treated area until 3 weeks after the surgery and to rinse with an antiseptic mouthwash 3 to 6 weeks post-operative.

Intrabony defect treated with Straumann® Emdogain® - Dr. M. Stefanini
Intrabony defect treated with Straumann® Emdogain® - Dr. M. Stefanini

Self-contained intrabony defects are narrowed by predominantly intact osseous walls (i.e. 3-wall defects) and are indicated for a regenerative therapy with Straumann® Emdogain® alone.

After raising a full-thickness flap on the buccal and oral aspect of the teeth, granulation tissue is removed and the exposed root surface is freed from plaque and calculus. The remaining smear layer is removed by applying Straumann® PrefGel® for 2 minutes. After thorough rinsing, Straumann® Emdogain® is applied onto the root surface in apico-coronal direction to fully cover the exposed root. To achieve primary wound closure and wound stability, the flap is repositioned tension-free and sutured.

[1] Badersten et al. J Clin Periodontol. 1981 Feb;8(1):57-72
[2] Badersten et al. J Clin Periodontol. 1985 Jul;12(6):432-40
[3] Heitz-Mayfield et al. J Clin Periodontol. 2002;29 Suppl 3:92-102; discussion 160-2
[4] Sculean et al. J Periodontal Res. 1999 Aug;34(6):310-22
[5] Heijl J Clin Periodontol. 1997 Sep;24(9 Pt 2):693-6