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Healing of periodontal defects treated with enamel matrix proteins and root surface conditioning-an experimental study in dogs

机译：牙釉质基质蛋白治疗牙周缺损及根部表面调理的修复-犬的实验研究

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Application of enamel matrix proteins has been introduced as an alternative method for periodontal regenerative therapy. It is claimed that this approach provides periodontal regeneration by a biological approach, i.e. creating a matrix on the root surfaces that promotes cementum, periodontal ligament (PDL) and alveolar bone regeneration, thus mimicking the events occurring during tooth development. Although there have been numerous in vitro and in vivo studies demonstrating periodontal regeneration, acellular cementum formation and clinical outcomes via enamel matrix proteins usage, their effects oil the healing pattern of soft and hard periodontal tissues are not well-established and compared with root conditioning alone. In the present study, the effects of Emdogain(R) (Biora, Malmo, Sweden), an enamel matrix derivative mainly composed of enamel matrix proteins (test), on periodontal wound healing were evaluated and compared with root surface conditioning (performed with 36% orthophosphoric acid) alone (control) histopathologically and histomorphometrically by means of the soft and hard tissue profile of periodontium. An experimental periodontitis model performed at premolar teeth of four dogs were used in the study and the healing pattern of periodontal tissues was evaluated at days 7, 14, 21, 28 (one dog at each day), respectively. At day 7, soft tissue attachment evaluated by means of connective tissue and/or epithelial attachment to the root surfaces revealed higher connective tissue attachment rate in the test group and the amount of new connective tissue proliferation in the test group was significantly greater than the control group (p < 0.01). New bone formation by osteoconduction initiated at day 14 in the test and control group. At day 21, the orientation of supra-alveolar and PDL fibers established, and new cementum formation observed in both groups. At day 28, although regenerated cementum was cellular in all of the roots in the control samples, an acellular type of cementum (1.32 +/- 0.83 mm in length and 3.16 +/- 0.23 mum in width) was also noted in six roots of test samples with an inconsistent distribution on the root surfaces. The amount of new cementum was significantly higher in the test group than the control group samples (p < 0.01). The width of the cellular Cementum in the control group was more than the cellular cementum in the test group, but the difference was not statistically significant (p > 0.05). A firm attachment of acellular cementum to the root dentin with functional organization of its collagen fibers was noted, and, the accumulation and organization of cellular cementum in the control group was more irregular than the cellular cementum formed in the test group. The amount of new bone was 2.41 +/- 0.75 mm in the test and 1.09 +/- 0.46 mm in the control group at day 28. The rate of bone maturation (the number of osteons) was found higher in the test group (10.75 +/- 0.85) than the control group (5.50 +/- 0.86). Under the limitations of the study, our results reveal that when compared with root surface conditioning, enamel matrix proteins have more capacity for stimulating periodontal regeneration via their positive effects on root surfaces, i.e. inhibition of gingival epithelium down growth and stimulation of connective tissue proliferation and attachment to the root surfaces during wound healing. An acellular type of cementum regeneration and new alveolar bone formation by an accelerated osteoconductive mechanism are also achieved with application of enamel matrix proteins. (C) 2003 Elsevier Ltd. All rights reserved. [References: 48]
机译：牙釉质基质蛋白的应用已被引入作为牙周再生治疗的替代方法。据称该方法通过生物学方法提供牙周再生，即在牙根表面形成促进牙骨质，牙周韧带（PDL）和牙槽骨再生的基质，从而模拟牙齿发育过程中发生的事件。尽管有大量的体外和体内研究表明牙釉质基质蛋白的使用可证明牙周再生，脱细胞牙骨质的形成和临床结果，但它们对软，硬牙周组织愈合模式的影响尚不明确，仅与根部调理相比较。在本研究中，评估了主要由牙釉质基质蛋白组成的牙釉质基质衍生物Emdogain（Biora，Malmo，Sweden）对牙周伤口愈合的影响，并将其与牙根表面调理相比较（用36通过牙周组织的软组织和硬组织分布，在组织病理学和组织形态学上单独控制（％正磷酸）。在研究中使用在四只狗的磨牙前牙齿上进行的实验性牙周炎模型，并分别在第7、14、21、28天（每天一只狗）评估牙周组织的愈合模式。在第7天，通过结缔组织和/或上皮附着在根表面的软组织附着评估了测试组较高的结缔组织附着率，并且测试组中新的结缔组织增殖量明显大于对照组组（p ＜0.01）。测试和对照组在第14天开始通过骨传导形成新的骨骼。在第21天，上牙槽纤维和PDL纤维的取向确定，并且在两组中观察到新的牙骨质形成。在第28天，尽管对照样品的所有根中都有再生的牙骨质细胞，但在6个牙根中也发现了无细胞型牙骨质（长1.32 +/- 0.83毫米，宽3.16 +/- 0.23毫米）。根表面分布不一致的测试样品。试验组新牙骨质的数量显着高于对照组样品（p <0.01）。对照组中的细胞牙骨质的宽度大于测试组中的细胞牙骨质的宽度，但差异无统计学意义（p> 0.05）。注意到无细胞牙骨质牢固地附着在其牙本质胶原纤维的根部牙本质上，并且对照组中细胞牙骨质的积累和组织比测试组中形成的细胞牙骨质更加不规则。第28天，测试组的新骨量为2.41 +/- 0.75 mm，对照组为1.09 +/- 0.46 mm。测试组的骨成熟率（骨量）更高（10.75）。 （+/- 0.85）比对照组（5.50 +/- 0.86）。在这项研究的局限性下，我们的研究结果表明，与牙根表面调节相比，牙釉质基质蛋白通过对牙根表面的积极作用，具有更大的刺激牙周再生的能力，即抑制牙龈上皮的向下生长和刺激结缔组织的增生和在伤口愈合过程中附着在牙根表面。牙釉质基质蛋白的应用还可以实现无细胞牙骨质再生和通过加速的骨传导机制形成新的牙槽骨。 （C）2003 Elsevier Ltd.保留所有权利。 [参考：48]

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