open access

Vol 66, No 2 (2007)
ORIGINAL ARTICLES
Published online: 2007-03-09
Submitted: 2012-02-06
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Enamel matrix derivative Emdogain® as an adjuvant for a laterally-positioned flap in the treatment of gingival recession: an electron microscopic appraisal

A. Lafzi, R.M. Farahani, R.S. Tubbs, L. Roushangar, M.M. Shoja
Folia Morphol 2007;66(2):100-103.

open access

Vol 66, No 2 (2007)
ORIGINAL ARTICLES
Published online: 2007-03-09
Submitted: 2012-02-06

Abstract

Enamel matrix derivative (EMD), such as Emdogain®, has been suggested for the improvement of wound healing in periodontal surgical therapy. The present qualitative study seeks to illustrate the ultrastructural changes associated with a human gingival wound at 10 days after the application of EMD as an adjunct to a laterally-positioned flap in a patient with gingival recession. An otherwise healthy patient, who had been suffering from bilateral gingival recession defects on teeth #23 and #26, was studied. One defect was treated with a laterally-positioned flap, while the other was treated with a combination of EMD and a laterally-positioned flap. Ten days after the operation gingival biopsy specimens were obtained from the dentogingival region and examined using a transmission electron microscope. A considerable difference was found in both the cellular and extracellular phases of EMD and non-EMD sites. The fibroblasts of EMD site were more rounded with plump cytoplasms and euchromatic nuclei. A well-developed rough endoplasmic reticulum and numerous mitochondria could be detected. In contrast, the fibroblasts of non-EMD site were of flattened spindle-like morphology. While the signs of apoptosis could rarely be detected at EMD site, apoptotic bodies and ultra-structural evidence of apoptosis (crescent-like heterochromatic nuclei and dilated nuclear envelopes) were consistent features at non-EMD site. The extracellular matrix at EMD site mainly consisted of well-organised collagen fibres, while non-EMD site contained sparse and incompletely-formed collagen fibres. Coccoid bacteria were noted within the extracellular matrix and neutrophils at non-EMD site. It seems that EMD may enhance certain features of gingival wound healing, which may be attributable to its anti-apoptotic, anti-bacterial or anti-inflammatory properties.

Abstract

Enamel matrix derivative (EMD), such as Emdogain®, has been suggested for the improvement of wound healing in periodontal surgical therapy. The present qualitative study seeks to illustrate the ultrastructural changes associated with a human gingival wound at 10 days after the application of EMD as an adjunct to a laterally-positioned flap in a patient with gingival recession. An otherwise healthy patient, who had been suffering from bilateral gingival recession defects on teeth #23 and #26, was studied. One defect was treated with a laterally-positioned flap, while the other was treated with a combination of EMD and a laterally-positioned flap. Ten days after the operation gingival biopsy specimens were obtained from the dentogingival region and examined using a transmission electron microscope. A considerable difference was found in both the cellular and extracellular phases of EMD and non-EMD sites. The fibroblasts of EMD site were more rounded with plump cytoplasms and euchromatic nuclei. A well-developed rough endoplasmic reticulum and numerous mitochondria could be detected. In contrast, the fibroblasts of non-EMD site were of flattened spindle-like morphology. While the signs of apoptosis could rarely be detected at EMD site, apoptotic bodies and ultra-structural evidence of apoptosis (crescent-like heterochromatic nuclei and dilated nuclear envelopes) were consistent features at non-EMD site. The extracellular matrix at EMD site mainly consisted of well-organised collagen fibres, while non-EMD site contained sparse and incompletely-formed collagen fibres. Coccoid bacteria were noted within the extracellular matrix and neutrophils at non-EMD site. It seems that EMD may enhance certain features of gingival wound healing, which may be attributable to its anti-apoptotic, anti-bacterial or anti-inflammatory properties.
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Keywords

Emdogain®; gingiva; laterally-positioned flap; ultrastructure; wound

About this article
Title

Enamel matrix derivative Emdogain® as an adjuvant for a laterally-positioned flap in the treatment of gingival recession: an electron microscopic appraisal

Journal

Folia Morphologica

Issue

Vol 66, No 2 (2007)

Pages

100-103

Published online

2007-03-09

Bibliographic record

Folia Morphol 2007;66(2):100-103.

Keywords

Emdogain®
gingiva
laterally-positioned flap
ultrastructure
wound

Authors

A. Lafzi
R.M. Farahani
R.S. Tubbs
L. Roushangar
M.M. Shoja

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