Papilla Preservation Technique with Enamel Matrix Derivative (EMD) in the Treatment of Periodontitis – a Case Report

Local periodontal therapy primarily consists of supraand subgingival debridement, and instruction and motivation for the improvement of oral hygiene. Effective regular mechanical plaque control has been proven to be one of the most important measures to avoid and control recurrence of infection (Axelsson and Lindhe, 1978; Axelsson and Lindhe, 1981a; Axelsson and Lindhe, 1981b). In addition residual pockets may be eliminated or reduced by different surgical procedures (Becker et al, 2001). In addition to physical barriers enamel matrix derivative (Emdogain Gel‚ Straumann, Switzerland) has been proven to regenerate lost periodontal structures (Esposito et al, 2003; Heden et al, 1999; Heden, 2000; Pontoriero et al, 1999; Sculean et al, 1999). The amount of regenerated tissue may vary according to a number of different local and systemic factors, and among those the surgical procedure and the type of flap management are of crucial importance (Kornman and Robertson, 2000). Also the type of defect and the topography of the intrabony lesion influence the treatment outcome. Cortellini et al (2001) and Cortellini and Tonetti (2001) as well as Wachtel et al (2003) described some technical aspects which may help to improve the amount of regenerated tissue. Primary flap closure in the interdental area in combination with a meticulous surgical technique with minimal mechanical forces may improve treatment outcome. According to Cortellini et al (2001) cross mattress sutures or offset sutures in the interdental area help to reduce mechanical stress on the sutures for the closure of the defect and may facilitate microsurgical flap closure (Cortellini and Tonetti, 2001). The present case shows regenerative therapy using porcine enamel matrix derivative in combination with microsurgery for periodontal regeneration in a lower incisor.