PERIODONTAL REGENERATION
Straumann® Emdogain
1. HISTORY
The role of enamel matrix proteins in the development of cementum and periodontal tissues
1986
Lars Hammarström
Professor of Oral Pathology
Faculty of Dentistry, Karolinska Institute, Stockholm
- 1988 Biora founded by Prof. Lars Hammarström, Karolinska Institute, Stockholm, Sweden
- Production in Malmö since 1989
- 1995 CE certification
- 1996 FDA certification, the formation of subsidiaries in Germany and in the USA
- 1998 Emdogain approved for sale in Japan
- 2003 acquisition by Institute Straumann®
- 2004 completion of integration by Straumann® Biologics
- Delivered approximately 1,5 million units since production started
- Used in over 800 000 patients worldwide
2. WHAT IS STRAUMANN® EMDOGAIN?
Enamel, dentin and cementum consist of different cells. Special cells build a matrix out of proteins (Enamel Matrix Proteins). The most important protein identified as Amelogenin.Amelogenin (Straumann® Emdogain) is a biomimetic biology-based product, which promotes the re-growth of hard and soft tissues lost due to periodontal disease.
Straumann® Emdogain documentation
- Over 60 published clinical studies demonstrate the efficacy of Straumann® Emdogain and its good treatment results
- More than 1500 defects have been followed up in different clinical studies with Straumann® Emdogain
- There is an average of 60-70% bone fill in defects treated with Straumann® Emdogain, measured one year postoperatively
What is Straumann® Emdogain?
- Resorbable, implantable material
- Enamel matrix protein (Amelogenin)
- Gel for easy handling
- pH neutral, 24% EDTA root conditioner
- Removal of “smear layer” before the application of Straumann® Emdogain
- Sold separately or co-packaged with Straumann® Emdogain
Epidemiology of periodontal diseases
Approximately 5% to 20% of any population suffers from severe generalized periodontitis even though moderate periodontal disease affects a majority of adults.
3. MODE OF ACTION
The concept used in a periodontal defect






Courtesy: F. Abbas, Amsterdam (Straumann® Education)
- The enamel matrix protein (EMD) forms a protein matrix on the root surface.
- Mesenchymal cells migrate into the lesion, attach to the surface and start to proliferate.
- Bone formation (osteogenesis) starts at the root surface treated with Straumann® Emdogain and subsequently new alveolar bone fills the defect.
- A new attachment with cementum and the periodontal ligament is formed along the treated root surface.
- New Dynamic functional attachment is achieved with time.
Straumann Emdogain® recreates previously lost attachment!
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Desired effects of Straumann® Emdogain
- Epithelial growth: embankment
- Gingival connective tissue growth: embankment
- Bony growth
- Periodontal growth
- Cemental growth
- Wound healing & prevention of Bacteria
The basic concept of Straumann® Emdogain
Deposit of enamel matrix proteins onto a developing root surface is an essential step preceding the formation of cementum.
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Pig tooth in development (Straumann® Education)
Formation of a periodontal ligament and alveolar bone is dependent on the formation of cementum.
Disease and different treatment results
Periodontitis Repair vs. Regeneration
Regeneration of Periodontal hard & soft tissue Defects
Treatment with Straumann® Emdogain
- Conditioning of root surface with Straumann® PrefGel.Application of Straumann® Emdogain (timescale: seconds).
- Amelogenins precipitate out and matrix layer on the root surface is formed (timescale: seconds).
- Formation of blood coagulum of fibrin and erythrocytes. Replaced by granulation tissue. Serves as a skeletal structure for wound healing and regeneration (timescale: hours).
- Adduction and proliferation by mesenchymal cells (timescale: days).
- Cells secrete natural and specific cytokines and autocrine substances which promote the required proliferation (timescale: weeks).
- Attraction and differentiation to cementoblasts. Begin of formation of cement matrix in which desmodontal fibres will be fixed (timescale: weeks, months).
- Anchorage of desmodontal fibres in the root surface (timescale: months).
- Filling of the defect with newly formed desmodontal tissue (timescale: months).
- In connection with the processes, new alveolar bone grows on the root surface and into defect gap (timescale: months).
- Regeneration of the desmodontium, building of new functional attachment.
4. CLINICAL INDICATIONS
I. Treatment of periodontal intrabony defects
Single-wall defect Two-wall defect Three-wall defect
The 1st visit 8 years after treatment
Courtesy G. Heden, Karlstad (Straumann Education)
II. Treatment of periodontal Furcation defects
Degree I. Degree II. Degree III.
Characteristic of Severe furcation involvement:
- horizontal bone loss
- highly avascular target area
- mesenchymal cell source far away
- proper debridement difficult / impossible
Class II mandibular furcation defect
with minimal interproximal bone loss
Baseline 12-month follow up
Treatment with Straumann® Emdogain
III. Treatment of periodontal Recession defects
Subepithelial connective tissue graft Straumann® Emdogain in conjunction with CAF
& Coronally Advanced Flap (CAF)
Courtesy McGuire & Nunn, J Periodontol 2003;74:1110-1125 (Straumann® Education)
IV. SURGICAL PROCEDURE
Treatment of wider intrabony periodontal defects: Scaling, root-planning, and conditioning50% of 0,7 ml Syringe on root surface; 50% mixed with Straumann® Bone Ceramic Suturing; Straumann® EMD Plus application
Pre-surgical procedure
- Careful patient selection:
- Oral hygiene, smoking etc.
- Cleaning, scaling, reducing the degree of inflammation
- Follow up after 2-3 months, measurement of PD, tooth stability
- Periodontal disease has to be eliminated
Pre-surgical procedure
- Remove any remaining plaque and/or calculus as well as blood from root surfaces exposed during
- periodontal surgery
- Apply Straumann® PrefGel onto exposed root surfaces for 2 minutes
- Rinse thoroughly with sterile saline solution
- Avoid recontamination of the conditioned root surfaces after the final rinse and prior to treatment with Straumann® Emdogain
Postsurgical follow-up & maintenance
Day of operation:
- Start rinsing with chlorhexidine solution (0,2 - 0,12%)
- Refrain from/minimize smoking
- Do not brush the area of the operation
- Avoid hard and crispy food
- (Antibiotics, if deemed appropriate based on the clinician’s judgement)
- Wound stability & infection control
Week 1 postoperative:
- Removal of sutures which no longer add to the stability of the healing wound
- “Professional tooth cleaning” as needed
- Continue to rinse with chlorhexidine solution (or apply chlorhexidine gel locally in the operated area).
2 - 6 weeks postoperative:
- Removal of any remaining sutures
- “Professional tooth cleaning” as needed
- Continue to rinse with chlorhexidine solution (or apply chlorhexidine gel locally in the operated area)
- Week 4 start careful tooth-brushing in the operated area on buccal/lingual surfaces, but not interproximally
6 weeks postoperative:
- Stop rinsing with chlorhexidine
- “Professional tooth cleaning” as needed
- Start interproximal tooth cleaning in the operated area
- Fluoride application as needed
- Decide on a subsequent (individual) recall schedule
6 - 12 weeks postoperative:
- Adequate tooth cleaning in the operated area
- Decide on a subsequent (individual) recall schedule
- X-rays at 12 months
- No probing before 6 months!
- Follow-up radiographs at 12 and 24 months
- Individual recall program
V. PLUS Straumann® Emdogain
Bone & periodontal attachment regenerationToolbox” for oral tissue regeneration
What is Straumann® Emdogain PLUS?
Straumann® Emdogain consists of amelogenin for periodontal regeneration
Straumann® BoneCeramic is used for filling and/or augmenting intraoral/maxillofacial osseous defects
Straumann® Emdogain + Straumann® BoneCeramic is indicated for:
- Augmenting intraoral/maxillofacial osseous defects
- Bony defects of the alveolar ridge
- Tooth extraction sites
- Pneumatized sinus
- Intrabony periodontal osseous defects and furcation defects
- Morphology determines: vascularisation & osteoconduction
- Composition determines: degradation & biocompatibility
- De; gradation determines: replacement (substitution) of bone filler material by bone
- Straumann® BoneCeramic gets close to the optimal characteristics of a bone substitute: Optimized 3D structure morphology; Osteoblast-friendly topography (osteoconductive)
- Fully synthetic composition: no risk of transfection, reproducibility; Controlled” degradability
HA protects excessive resorption, TCP initiates mineralization
Tooth replacement
Extraction site Dehiscence & fenestration Straumann® BoneCeramic granules
Localised ridge atrophy Pneumatised sinus Red staining showing newly formed bone at
augmented site with Straumann® BoneCeramic
granules. (Courtesy: Mellonig et al. 1995. University of Bern
(Straumann® Education)
http://www.straumann.com/en/dental-professionals/services/download-center/videos.html