Correction of bone defects (around teeth) The procedure consists of filling up the defect or cavity in the bone with a biocompatible material providing a protected environment for regeneration.
	Note the bony defect around the premolar and the molar teeth
	The regenerative material is placed into the defect to help promote regeneration
	With proper oral hygiene and appropriate  periodontal maintance visits regeneration can be observed

Regenerative Materials Used in Minimally Invasive Periodontal Therapy

Emdogain

GEM 21S

Emdogain® Gel is comprised of a number of proteins that self-assemble to create a matrix. The dominant protein in this matrix is amelogenin, which has been shown to be responsible for tooth development, and has been well-conserved throughout evolution. This protein is considered as "self" when encountered by the human body, and therefore, no allergic or immunologic reactions have been demonstrated with the use of Emdogain® Gel. Emdogain® Gel is intended as an adjunct to periodontal surgery for topical application onto exposed root surfaces to treat periodontal intrabony defects. After a single application, Emdogain® Gel leaves only a resorbable protein matrix on the root surface. No additional surgery is necessary. Regain of clinical attachment and alveolar bone has been proven with the use of Emdogain® Gel.

GEM 21S ® (Fully Synthetic Growth-factor enhanced Matrix) is a fully synthetic regeneration system for the treatment of periodontal bone defects and associated gingival recession. GEM 21S ® is composed of the tissue growth factor, recombinant human platelet derived growth factor (rhPDGF-BB), and a synthetic bone matrix, beta tricalcium phosphate (β-TCP). It is the first totally synthetic product combining a purified recombinant growth factor with a synthetic bone matrix to be approved by the FDA for human application.  The combination of the two components ((rhPDGF-BB and β-TCP )are key to the overall effectiveness of the product.  The rhPDGF-BB provides the biological stimulus for tissue repair by stimulating the proliferation and in-growth of osteoblasts, cells responsible for the formation of bone, while the β-TCP provides the framework or scaffold for new bone growth to occur.

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Grafting Materials:

With respect to the Bone Graft material used, we have to differentiate between several choices. All materials can be categorized into five different categories:

The Autograft is considered the Gold Standard. It is defined as tissue transplanted from one site to another within the same individual. It is basically your very own bone taken from a donor site and placed somewhere else in the body, into the recipient site. The best success rates in bone grafting have been achieved with autografts, because these are essentially living tissues with their cells intact. There is no immune reaction and the microscopic architecture is perfectly matched. The only disadvantage of the autograft is that it has to be harvested from a secondary site in your body, which usually means more morbidity and a more complicated surgery, overall. For most grafting purposes confined to Oral Implantology we can use another part of the jaw (i.e., chin or back portions of jaw) as an acceptable donor site. This way, we stay surgically inside the mouth and avoid any extraoral wounds and scarring. Sometimes, however, when there is not enough bone volume available intraorally, we have to get bone from other parts of the body (usually your hip bone or your tibia (shin) bone) or even from a bottle - alloplast, allograft, or xenograft.

 The Allograft is defined as a tissue graft between individuals of the same species (i.e., humans) but of non-identical genetic composition. The source is usually cadaver bone, which is available in large amounts. This bone however has to undergo many different treatment sequences in order to render it neutral to immune reactions and to avoid cross contamination of host diseases. These treatments may include irradiation, freeze-drying, acid washing and other chemical treatments. In the U.S. virtually all donors are being prescreened for infectious diseases before their bone is even accepted into the tissue banks. After that the processing of the bone would eliminate virtually any chance of cross-infection.

The Xenograft is defined as a tissue graft between two different species (i.e. bone of bovine origin). Tissue banks usually choose these graft materials, because it is possible to extract larger amounts of bone with a specific microstructure (which is an important factor for bone growth) as compared to bone from human origin.

The Alloplast usually includes any synthetically derived graft material not (coming) from animal or human origin. In Oral Implantology this usually includes Hydroxyapatite or any formulation thereof.

Each of the bone graft materials is usually developed with a specific purpose or advantage in mind. Some claims made by tissue banks about a certain bone graft material may sometimes have to be taken with a grain of salt, until independent research can verify those claims. The main purpose of using the latter four of the above graft materials is usually to avoid a secondary surgery for harvesting autogenous bone. Your surgeon will make a decision with respect to the bone graft material, based on your individual needs and the latest research in that field.

 

Remember, not every case is suitable for grafting so ask your dentist or Dr.'s Aldredge or Nejat if this procedure can benefit you.