Controlled tissue regeneration
Oral surgery specialists
Tissue regeneration in advanced periodontal disease
If there is severe bone loss, conventional periodontitis therapy is often no longer promising. However, in certain cases it is possible to rebuild or regenerate some of the lost bone using various methods. Emdogain is a protein gel sold by Straumann® that supports the regeneration of the periodontium.
The gel can be applied to the diseased tooth as part of periodontitis therapy and combined with other bone-building measures.
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What damage occurs with advanced periodontal disease?
With advanced periodontal disease, the gums recede. This leads to pockets forming between the tooth and gums, where bacteria can accumulate and multiply. The gums may be inflamed, red, swollen, and often bleed easily, especially when brushing your teeth.
The alveolar bone, which holds the teeth in the jaw, can be damaged in periodontal disease. Bacteria and the inflammation they cause cause bone to break down. This bone loss is irreversible and, in the worst case, can lead to tooth loss as the teeth' grip on the jaw weakens.
The root cementum covers the root surface of the tooth and is important for anchoring the teeth in the jaw. In periodontal disease, the root cementum can become exposed due to inflammation-related breakdown of the surrounding tissue, which can lead to sensitivity and pain.
The periodontal membrane connects the tooth to the alveolar bone. In advanced periodontal disease, this tissue is also damaged by inflammation and bone loss. This leads to loosening of the teeth and, in the worst case, tooth loss.
The inflammation and bacteria can cause significant damage to all components of the periodontium: the gums recede due to the inflammation, the roots are attacked and the jawbone shrinks.
The three goals of every periodontal therapy are therefore:
- Restoration of lost bone substance.
- Regeneration of the tooth root.
- Soft tissue management.
- Control of tissue growth that hinders reconstruction (scars and epithelial cells).
Several approaches are suitable for treating periodontal defects. A classic measure, for example, would be bone building with donor bone or foreign bone.
For this purpose, bone parts from other regions of the jaw or donor bone are transplanted to the defects. This usually works very well.
In principle, enamel proteins work completely differently. They stimulate the growth of new cells directly on site. This can be much gentler than inserting donor bone and provides solid and aesthetic results. It has proven to be very effective for minor damage. If there is major damage to the jawbone, the only option left is mechanical reconstruction work.
The gel can not only stimulate bone growth, but also has a universal effect on the formation of new cells throughout the periodontium. The tooth root and soft tissue can also practically regenerate themselves.
What exactly is Emdogain gel and how does it work?
This is a so-called enamel matrix protein that can stimulate the regeneration of the periodontium. The gel is manufactured by Straumann®, a specialist manufacturer of dental accessories Implantology.
Enamel matrix proteins are obtained from animal tooth germs. These germs contain the primal growth information for the bone and tissue.
This process normally only occurs in the development of a baby and child. Later, when the jaw is fully formed, the impulses to build up and regenerate are missing.
Enamel matrix proteins deliver exactly this information to the jaws and periodontium of adult humans.
In a purely biological process, the protein stimulates the stem cells of the periodontal membrane, root cementum and jawbone to produce new growth.
The triggering amino acid is called amelogenin. The development of humans and animals is identical, which is why preparations of animal origin can be used very well.
In addition to stimulating growth for the jawbone, the gel has a particularly beneficial effect on the reconstruction of the root cement.
The Emdogain gel lies on the root surface like a solid matrix, i.e. a tissue, and enables undisturbed new cell formation. In other measures for controlled tissue reconstruction, soluble or insoluble membranes are inserted to cover the tooth root. This is eliminated with a melt protein treatment.
Controlled tissue regeneration with Emdogain gel
In order for the tooth to regain support and the tissue to normalize, these two steps are necessary:
- Existing inflammation must be contained.
- Healthy tissue must be built.
The inflammation is eliminated through periodontitis therapies.
Enamel matrix proteins can then be introduced: the gel acts on the bone, helps with soft tissue management and regenerates the root cementum.
Root cementum is a thin layer that lies on the root of the tooth. The so-called Sharpey fibers are anchored in it. The tooth root is connected to the tooth socket and the jawbone (alveolar bone) via these fibers.
The root cementum is a mineralized hard substance with a certain proportion of organic structures made of collagen and cementocytes. In terms of structure, root cementum is similar to fibrous bone.
The role of cement is of great importance in securely anchoring a tooth in the jawbone. Very good results are achieved in root cement regeneration with enamel matrix proteins.
How does treatment with Emdogain gel work?
In order to apply the gel to the tooth root, the periodontal bed must be opened. This is a surgical procedure that takes place under local Anesthesia takes place.
Typically, treatment is combined with other tissue building measures or periodontal disease treatments. The Dentist decides together with the patient which treatments are most likely to be successful at the given time. In order to keep the number of interventions as low as possible, sensible steps are combined.
Treatment with Emdogain gel can make other measures unnecessary, replace or supplement them.
Is treatment with enamel matrix proteins covered by health insurance?
Controlled tissue regeneration with Emdogain is a private service and is not covered by statutory health insurance companies.
With private insurance, it depends on the scope of the contractual relationship as to whether the costs are covered in full or in part.
The advantages and disadvantages of this treatment
The advantages clearly lie in the simplicity and universal effect of the melting proteins. The healing of the entire periodontium can be stimulated in one procedure. The active principle is biological and enables the lost tissue to grow back naturally.
The extent to which and whether further measures are necessary must be assessed on a case-by-case basis.
Disadvantages of the treatment may include high costs. It can never be XNUMX% predicted to what extent treatment with enamel matrix proteins can actually contribute to the complete reconstruction of the damage.
Are there any risks associated with the treatment?
The use of Emdogain gel is certainly easier and risk-free than many other periodontal therapies. The intervention is minimal. “Only” a gel is inserted into the tooth bed.
However, the ten bed must also be opened surgically. The usual risks of infection and possible delays in healing after surgical procedures remain.
Although some very good results have been achieved with Emdogain gel, there remains a residual risk that the treatment will not bring the desired results.
But then there are still other options to treat the defects in the periodontum with other measures such as bone augmentation using your own or foreign bone. However, this results in additional costs that are generally not covered by statutory health insurance companies.
