What’s the Plus in RegeneRative theRapy?

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Straumann induStry Forum EuroPerio 5 Congress

Friday, June 30, 2006, 14:30 – 16:30

What’s the Plus

in RegeneRative theRapy?

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D. Cochran, Moderator

Biologically-driven product innovations by straumann – straumann^® emdogain pLUs and straumann^® sLactive

D. Bosshardt

Do enamel matrix proteins regenerate cementum, bone or both?

A. Sculean

histological evaluation of the regenerative potential of straumann^® emdogain in combination with a new bone graft material in periodontal defects around human teeth

S. Jepsen

a randomized controlled multi-centre clinical trial to evaluate the effect of emdogain^® with straumann^® BoneCeramic in intrabony defects

M. McGuire

Recession defects with coronally advanced flaps and straumann^® emdogain: a blend of diagnostic guidelines and step-by-step techniques

S. Hägewald

improvement of long-term stability in the treatment of recession: new clinical data

pRogRam

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3 Dr. David L. Cochran is a graduate of the University of virginia and received his D.D.s., and ph.D., in Biochemistry from the medical College of virginia (mCv). he also was trained in periodontology from the harvard school of Dental medicine. Dr. Cochran is currently professor and Chairman of the Department of periodontics at the University of texas health science Center at san antonio, Dental school. prior to his appointment at san antonio, Dr. Cochran was Director of postgraduate periodontics at mCv. Dr. Cochran is a member of many profes- sional dental organizations and is a Diplomate of the american Board of periodontology. he is a fellow of the american College of Dentistry and the international College of Dentistry.

Dr. Cochran has published numerous scientific articles and abstracts on various periodontal biochemistry and implant topics. he has received awards for his research work at both the na- tional and international levels. Dr. Cochran is an active basic science and clinical researcher who has received funding from both the nih-niDR and private industry.

D. CoChRan, moDeRatoR

David L. Cochran, DDS, PhD San Antonio, Texas (USA) cochran@uthscsa.edu

Dear colleagues,

the systematic treatment of dental defects is evolving at a strong pace, demanding solutions capable of responding to the technical chal- lenges and, above all, capable of responding to the biological aspects of natural tissue regeneration.

today, our patients have grown to expect perfect results regarding es- thetic solutions combined with long- term predictability and effectiveness.

these aspects form the basis of straumann’s research and develop- ment program.

the aim is to develop new break- through technologies for regenerative products which offer a solution for the overall treatment of tooth preservation to tooth replacement.

Recent examples include the sLactive dental implant and a continuing line of regenerative products including straumann^® emdogain pLUs.

in this Corporate Forum international experts will present to you the latest findings on the biology of straumann^® emdogain, its long-term effectiveness in recession defects and

the clinical and histological results of combining straumann^® emdogain with straumann^® BoneCeramic, now on the market as straumann^® emdogain pLUs.

We would like to take this opportu- nity to wish you an exciting congress, with many new and exciting insights into the biological, regenerative and clinical developments in the dental field.

yours truly, David L. Cochran

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D. BosshaRDt

1979–1981 study of Civil engineering, 3 semesters, swiss Federal institute of technology (sFit), Zurich, switzerland

1981–1985 study of Biology, sFit, Zurich, switzerland 1985 master’s degree in natural sciences, sFit,

Zurich, switzerland

1986–1992 assistant, Dept. of oral structural Biology, Dental institute,

University of Zurich, switzerland 1992 phD degree, sFit, Zurich, switzerland 1992–1994 Research associate, Dept. of oral structural

Biology, Dental institute, University of Zurich, switzerland

1994–1997 postdoctoral training, Laboratory for the study of Calcified tissues and Biomaterials, Faculty of Dental medicine, University of montreal, montreal, QC, Canada

1998–1999 Research associate, Dept. of periodontology, endodontology & Cariology, school of Den- tal medicine,

University of Basel, switzerland

2000–2005 Research scientist, Dept. of periodontology &

Fixed prosthodontics, school of Dental medicine, University of Berne, switzerland 2005–present Research scientist, Dept. of periodontology

& Fixed prosthodontics and Dept. of oral surgery & stomatology, school of Dental medicine, University of Berne, switzerland 2006 habilitation, venia docendi (privatdozent) for

“oral structural and Developmental Biology, medical Faculty,

University of Berne, switzerland

Do enamel matrix proteins regenerate cementum, bone or both?

the reconstitution of the periodontium is a major goal in regenerative periodontal therapy. one option to achieve this goal is the therapeutic use of biologically active molecules like growth or differentiation factors. straumann^® emdogain, which contains a derivative of enamel matrix proteins (emD), has proven its clinical efficacy in numerous studies. While about a decade ago straumann^® emdogain was introduced as a device to promote cementum regeneration, enamel matrix proteins (emps) are now recognized as having a much broader spectrum of activities. numerous studies document that besides their role in biomineralization, emps also have cell signaling functions that mediate cell attachment, proliferation and differentiation, and the synthesis of cytokines and growth factors. straumann^® emdogain or other emp formula- tions take action on various cell types: 1) emD slows down epithelial cell proliferation; 2) emD upregulates the synthesis of gingival macromolecules. Furthermore, emD’s effect on cell attachment, spreading, and proliferation is less pronounced in gingival fibroblasts than in periodontal ligament fibroblasts; 3) emD stimulates attachment and proliferation of periodontal ligament fibroblasts, and upregulates cell metabolism and the synthesis of extracellular matrix proteins, cytokines, and growth factors; 4) emD promotes cementoblast differentiation and upregulates the expression of osteopontin, a typical bone matrix protein, but downregulates osteocalcin expression; 5) emD stimulates proliferation and differentiation of osteogenic cells, and upregulates the expression of bone markers and bone regulatory molecules. interestingly, specific emps induce synthesis of cartilage-associated macro-molecules, cell proliferation and osteogenic cell differentiation, as well as ectopic cartilage and bone formation; 6) emD accelerates early wound healing, results in better wound-fill rates, stimulates proliferation of specific lymphocytes, and promotes vascularization; and 7) emD, pga (propylene glycol alginate; the emD vehicle), and straumann^® emdogain (=emD+pga) exert antibacte- rial effects. in conclusion, straumann^® emdogain – from a biological point of view – meets the requirements for a device aimed at supporting periodontal wound healing and regeneration. it may well be that further refinement of enamel matrix products may allow targeted therapeutic applications in wound healing, periodontal regeneration, and implant dentistry.

Dr. sc.nat. Dieter Bosshardt Bern, Switzerland

dieter.bosshardt@zmk.unibe.ch

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a. sCULean

1990 Doctor medical Dentistry (D.m.D.) semmelweis University Budapest, hungary.

1991–1992 postgraduate training in periodontology Department of periodontology, University of münster, germany

1993–1995 postgraduate training in periodontology, Royal Dental College, aarhus, Denmark Certificate of specialization in periodontics, Royal Dental College, aarhus, Denmark.

1994 Doctor medicinae Dentium (Dr. med. dent.), University of münster, germany.

1995 Certificate of specialization in periodontics, Royal Dental College, aarhus, Denmark.

1997 master of science (m.s.) in periodontology, Royal Dental College, aarhus, Denmark 1999 specialist of the german society of peri-

odontology.

2001 habilitation (ph.D.), University of saarland, homburg, germany (title of thesis: “healing of intrabony periodontal Defects Following treatment with guided tissue Regeneration or enamel matrix proteins. experimental and Clinical studies”).

oct. 2002–aug. 2004 associate professor of periodontology, in the Department of Conservative Dentistry and periodontology, Johannes gutenberg-Univer- sity mainz, germany and part time private practice Limited to periodontics, in prüm, germany

sept. 2004–now head of Department of periodontology, Rad- boud University medical Center nijmegen, the netherlands.

sept. 2004–now Director of the european Federation of periodontology postgraduate education Commit- tee (eFp-peC) accredited graduate program in periodontology at the Radboud University medical Center nijmegen, the netherlands.

Histological evaluation of the regenerative potential of Straumann^® Emdogain in combination with a new bone graft material in periodontal defects around human teeth

the aim of the lecture is to present the results of a human histological study evaluating the healing of advanced intrabony defects following regenerative periodontal surgery with an enamel matrix protein derivative (straumann^® emdogain, switzerland) (emD) combined with a new bone graft material (straumann^®

BoneCeramic, switzerland) (Bg). ten patients, each of them displaying very advanced combined 1 and 2 - wall intrabony defects around teeth scheduled for extraction were included in the study. the defects were consecu- tively treated with a combination of emD + Bg. in all defects a notch was placed at the most apical extent of the calculus present on the root surface or at the most apical part of the defect (if no calculus was present) in order to serve as a reference for the histological evaluation. at ten months after surgery the teeth or roots were extracted together with some of their surrounding soft and hard tissues and processed for histologic evaluation.

at ten months following therapy the results demonstrated in most defects significant probing depth reductions and clinical attachment level gains. the histologic findings indicated formation of cementum with inserting collagen fibers to a varying extent and occasionally a bone-like tissue around the graft particles was observed. Direct contact between the graft particles and the root surface (cementum or dentin) was not observed in any of the analyzed specimens.

Within their limits, the present data indicate that the regenerative potential reported for emD does not seem to be blocked if emD is combined with the new bone graft material.

Prof. Dr. Anton Sculean, Nijmegen, The Netherlands a.sculean@dent.umcn.nl

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s. Jepsen

Dental and medical school, University of hamburg 1982–1985 Dept. of prosthodontics,

University of hamburg

1987–1988 postgraduate-program periodontology, Loma Linda University, California, Usa, 1989 private practice hamburg

1990–1991 periodontology/oral implantology Loma Linda University and postdoctoral Research Fellow, Laboratory for mineral metabolism, v.a. hospital Loma Linda California, Usa 1990 Us-Certificate in periodontics

1992 master of science Degree, young investiga- tor award aaDR-mineralized tissue group 1992–2002 associate professor, Dept. of periodontology

and operative Dentistry, University of Kiel since 1998 german representative in the european Fed-

eration of periodontology (eFp)

1999 Diplomate of the american Board of periodontology

since 2002 Chairman Research-Committee of the eFp, editorial Board: Journal of Dental Research, Journal of Clinical periodontology, Clinical oral implants Research

professor and Chairman of the Dept. of periodontology, operative and preventive Dentistry, University of Bonn, germany

A randomized controlled multi-centre clinical trial to evaluate the effect of Straumann^® Emdogain^® with Straumann^® BoneCeramic in intrabony defects s. Jepsen, p.-m. Jervøe-storm,

University of Bonn, germany B. heinz, m. teich,

private practice hamburg, germany h. topoll, h. Rengers,

private practice münster, germany J. meyle, J. mahabadi,

University of giessen, germany t. hoffmann, e. al-machot, University of Dresden, germany

a new synthetic bone substitute (straumann^®

BoneCeramic) has been developed in particulate form composed of 60% hydroxylapatite and 40% beta-trical- cium phosphate.

in combination with enamel matrix derivative the new bone substitute may improve the healing of advanced periodontal defects. thus, it was the objective of this study to evaluate the effects of a combination of straumann^® emdogain with straumann^® BoneCeramics in the treatment of wide one- and two-wall intrabony defects. a total of 63 patients each contributing one defect (at least 4 mm depth of the osseous component) participated and were randomised into a test group (straumann^® emdogain with straumann^® BoneCeramics) and a control group (straumann^® emdogain). access to the defects was accomplished using papilla preservation flap surgery.

Clinical assessments by a blinded and calibrated ex- aminer were performed at baseline and at 6 months and included: probing depth, bleeding on probing and relative attachment level with a constant force electronic probe. the distance from the stent to the deepest point of the defect was measured during surgery and after 6 months by bone sounding under local anesthesia. the change in bone level was the primary outcome variable.

oral hygiene was continuously controlled and reinforced throughout the study.

Case series of the surgical procedure and postoperative healing will be shown and initial data will be presented.

Prof. Dr. Søren Jepsen, Bonn, Germany jepsen@uni-bonn.de

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m. mcgUiRe

Dr. mcguire graduated from Bayior University and received both his D.D.s. and Certificate of periodontics from emory University school of Dentistry. he maintains a full time private practice limited to periodontics in houston, texas and is a Clinical assistant professor of periodontics at both the University of texas Dental Branch at houston and the University of texas health science Center at san antonio.

Dr. mcguire is a Diplomate of the american Board of periodontology and is past president of the american academy of periodontology.

he participates in clinical research and has published many papers in prestigious Journals as well as contributed chapters to textbooks.

in 1997, the american academy of periodontology presented Dr. mcguire the Clinical Research award recognizing a series of his papers as the most clinically relevant periodontal research published that year. Dr. mcguire serves on the editorial board of the Journal of periodontology, the international Journal of oral and maxillofacial implants, and the international Journal of periodontics and Restorative Dentistry and he is a member of the american Dental association‘s Council on scientific affairs. Dr. mcguire has given many continuing education programs throughout the United states and abroad.

Recession defects with coronally advanced flaps and Straumann^® Emdogain: a blend of diagnostic guide- lines and step-by-step techniques

Recession defects around teeth have been treated with a variety of surgical techniques.

most of the literature suggests that the subepithelial connective graft has the highest percentage of mean root coverage with the least variability. studies have also demonstrated that enamel matrix derivative (straumann^® emdogain) has the ability to improve clinical param- eters. this program will compare the clinical efficacy of straumann^® emdogain placed under a coronally advanced flap to subepithelial connective tissue placed under a coronally advanced flap in patients with recession type defects. this clinically oriented course will blend diagnostic guidelines and step-by-step techniques to provide a well rounded understanding regarding this treatment option and when it is indicated.

Michael K. McGuire, DDS Houston, Texas (USA) mkmperio@swbell.net

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s. hägeWaLD

1962 Born in Berlin, graduated from Dental school of the Freie Universität Berlin

1987 general dentistry in private practice 1988 one year research grant at the institute

pasteur, paris (France)

since 1989 staff member at the Department of periodontology, University Berlin

1991 Dissertation research “experimental study to secretory antibodies after oral immunization“

since 1997 Co-worker in the graduate colleg of the german Research Foundation (DFg) “aetiopatho- genesis and therapy of periodontitis“

2002 Best prize of the german society of periodontology (Dgp)

2005 habilitation research “Wound healing and regeneration with enamel matrix proteins“

Lectures in several countries and publications to clinical and scientific subjects

since 10/2005 senior lecturer at the University Berlin and private practice

activities:

- treatment of advanced periodontitis, periodontal surgery, mucogingival surgery

- Basic research and clinics of periodontal regeneration - immunology and pathogenesis of periodontitis

Improvement of long-term stability in the treatment of recession: new clinical data

various surgical techniques have been proposed for coverage of denuded root surfaces and were shown to be effective after six to twelve months postoperatively.

however, data from randomized clinical trials on long- term stability are still rare. We have studied the long-term effects of a coronally repositioned flap procedure with or without the use of straumann^® emdogain in the treatment of paired recession defects of at least 3 mm depths.

the study was conducted as a blinded, split-mouth, placebo-controlled and randomized design. after

12 months, the analysis of patient data showed the same amount of root coverage in both groups, but signifi- cantly more gain in keratinized tissue in the straumann^® emdogain group. after 24 months, the recession defects additionally treated with straumann^® emdogain were sig- nificantly more stable than the control defects that often lost some of the gingival tissue at the surgical sites.

six years after the recession coverage procedures, the results confirmed the earlier observations, i.e. the addi- tional application of straumann^® emdogain supported the maintenance of the surgically established position of the gingival margin. the presentation will show the new clinical data of the study after 6 years and will emphasize the improvement of the long-term stability in the treatment of recession by application of straumann^® emdogain.

PD Dr. Stefan Hägewald, Berlin, Germany

stefan.haegewald@charite.de

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With Straumann^® Emdogain PLUS you have the solution for every treatable surgery where mechanical support and the regeneration of various tissues is indicated. Its promotion of predictable regeneration of wide intraosseous defects is proven by scientific evidence.

How can you promote regrowtH of tissue and create more stability?

With Straumann

^®

Emdogain PLUS – a co-pack of Straumann

^®

Emdogain and Straumann

^®

BoneCeramic – for wide defects

· Stabilizes

· Regenerates lost tissue

· Easy to use Learn more at

www.straumann.com/

EmdogainPLUS

[ if you would like to receive more information about the straumann

^®

]

Regenerative system, please contact your local straumann

representative or send an email to info@straumann.com or

rebecca.ellenrieder@straumann.com.

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15 With Straumann^® Emdogain PLUS you

have the solution for every treatable surgery where mechanical support and the regeneration of various tissues is indicated.

Its promotion of predictable regeneration of wide intraosseous defects is proven by scientific evidence.