Surgical technique for treatment of infrabony defects with enamel matrix derivative (Emdogain): 3 case reports

A surgical protocol is described for the placement of Emdogain enamel matrix derivative during new attachment procedures. Three cases with infrabony defects were treated and a significant probing attachment level (PAL) gain, probing depth reduction, and bone fill were evident on clinical probing and during reentry procedures. The first patient presented a combined one-walled and circumferential defect at a maxillary central incisor. After 1 year the PAL gain was 7 mm. The second case showed a 3-walled defect distal to a maxillary canine. After 1 year the PAL gain was 8 mm, and a reentry procedure showed an almost total fill of the defect. The third patient presented a combined one- and 3-walled defect in the most apical part of the mesial aspect of a maxillary central incisor. One year after the surgical procedure, an orthodontic treatment was performed in this patient. After 6 more months the soft tissue showed a very good esthetic appearance, the papilla height was fully maintained, and there was a PAL gain of 5 mm; 18 months after surgery, reentry showed a significant regeneration of hard tissue that was impossible to probe. Because of these encouraging clinical results, further studies should be initiated to investigate the efficacy of the enamel matrix derivative in new attachment procedures.