Idealni  

cilj   svih   rekonstruk3vnih   mukogingivalnih   hirurških   zahvata   je  

kompletna  rekonstrukcija  svih  izgubljenih  parodontalnih  tkiva    
u  regionu  tre3rane  gingivalne  recesije.  

ü  Dugačak  pripojni  epitel

ü  Uska  zona  vezivno  tkivnog  pripoja
ü  Insuficijentna  koštana  
regeneracija

ü  Insuficijentna  regeneracija  

cementa

Carnio  J.  Camargo  P.  Kenney  B.  Histological  evalua8onof  4  cases  of  root  coverage  following  a  connec8ve  8ssue  gra<  combined  with  enamel  matrix  derivate  
prepara8on.  J  Periodontol  2002;73:1534-­‐1543.  
BIOMIMETIKA:
Primena proteina rasta gleđi “Amelogenina” koga luče ćelije Hertvigove
membrane u toku nascentnog razvoja zuba dovodi do:

ü  Proliferacije progenitornih ćelija rastom konc cAMP

ü  Oslobađanje PDGF faktora rasta
ü  Sprečavanje migracije epitela
ü  Formiranje novog cementa i
ü  Indirektno dejstvo na formiranje novog koštanog tkiva
 Evaluation of Human Recession Defects Treated with Coronally Advanced Flaps
and Either Enamel Matrix Derivative or Connective Tissue. Part 1: Comparison of
Clinical Parameters
Michael K. McGuire* and Martha Nunn
J Periodontol 2003;74:1110-1125

Conclusion: Based on the results of

this investigation, the addition of
EMD to the coronally advanced
flap resulted in root coverage
similar to the subepithelial
connective tissue graft but without
the morbidity and potential clinical
difficulties associated with the
donor site surgery
 Evaluation of Human Recession Defects Treated with Coronally Advanced Flaps
and Either Enamel Matrix Derivative or Connective Tissue. Part 2: Histological Evaluation
Michael K. McGuire and David L. Cochran
J Periodontol 2003;74:1126-1135

Conclusions: The subepithelial connective tissue

graft in this study was found to have adhered to
the root surface primarily by a connective tissue
attachment with some evidence of root resorption.
The coronally advanced flap with EMD was found
histologically to have all the tissues necessary for
regeneration: new cementum, organizing PDL
fibers, and islands of condensing bone. These
histologic sections strongly suggest that enamel
matrix derivative works in a biomimetic fashion by
mimicking the natural process of tooth
development.
 Comparative Study of Two Root Coverage Procedures:
A 24-Month Follow-Up Multicenter Study

J Periodontol   February 2006 Moses, Artzi, Sculean, et al.

Conclusions: Both treatments

proved clinically successful.
CTG treatment showed a higher
percentage of root coverage and
HKT increase.
EMD is a valuable, long-term
effective treatment alternative to
achieve root coverage
together with an increase in HKT.
Alkan EA, Parlar A. Enamel matrix derivative (emdogain) or subepithelial connective tissue
graft for the treatment of adjacent multiple gingival recessions: a pilot study.

.
Int J Periodontics Restorative Dent. 2013 Sep-Oct 33(5):619-25.

Root coverage
CAF + EMD 89%
CAF + CTG 93 %
 Treatment of class III multiple gingival
recessions: a randomized-clinical trial.
Aroca S, Keglevich T, Nikolidakis D, Gera I,
Nagy K, Azzi R, Etienne D.
J Clin Periodontol. 2010 Jan;37(1):88-97.

□  One-year results indicate that the

modified tunnel/CTG technique is
predictable for the treatment of multiple
class III recession-type defects. The
addition of EMD does not enhance the
mean clinical outcomes.
 Efficacy of periodontal plastic surgery procedures in the treatment
of localized facial gingival recessions. A systematic review.
Cairo F, Nieri M, Pagliaro U.
J Clin Periodontol. 2014 Apr;41 Suppl 15:S44-62

Results: Fifty-one RCTs (53 articles) with a total of 1574 treated patients (1744 recessions) were included in this SR.
Finally, 30 groups of comparisons were identified and a total of 80 meta-analyses were performed. Coronally
Advanced Flap (CAF) was associated with higher probability of CRC and higher amount of RecRed than
Semilunar Coronal Positioned Flap (SCPF). The combination CAF plus Connective Tissue Graft (CAF+CTG) or CAF
plus Enamel Matrix Derivative (CAF+EMD) was more effective than CAF alone in terms of CRC and RecRed. The
combination CAF plus Collagen Matrix (CAF+CM) achieved higher RecRed than CAF alone. In addition, CAF
+CTG achieved CRC more frequently than CAF+EMD, SCPF, Free Gingival Graft (FGG) and Laterally
Positioned Flap (LPS). CAF+CTG was also associated with higher RecRed than Barrier Membranes (CAF+GTR),
CAF+EMD and CAF+CM. GTR was not able to improve the clinical efficacy of CAF. Studies adding Acellular
Dermal Matrix (ADM) under CAF showed a large heterogeneity and not significant benefits compared with CAF
alone. Multiple combinations, using more than a single graft/biomaterial under the flap, usually provide similar or
less benefits than simpler, control procedures in term of root coverage outcomes.

CAF procedures alone or with CTG, EMD are supported by large

Conclusions:
evidence in modern periodontal plastic surgery. CAF+CTG achieved the
Emdogain  1
Emdogain  2
Emdogain  3
Emdogain  3
Emdogain  3
Emdogain  3
Emdogain  3
Emdogain  3
 4
Emdogain
 5
Emdogain
 6
Emdogain