Case Report Volume 10 Issue 5 - April 2019 DOI: 10.19080/ADOH.2019.10.555797 Adv Dent & Oral Health Copyright © All rights are reserved by DG Gillam The Use of Enamel Matrix Derivative in Combination with a Synthetic Bone Graft in the Treatment of Periodontitis: A Case Report M Siaili, D Chatzopoulou and DG Gillam* Barts and the London School of Medicine and Dentistry QMUL, United Kingdom Submission: April 05, 2019; Published: April 17, 2019 *Corresponding author: Dr David Gillam, Oral Bioengineering, Institute of Dentistry, Barts and the London School of Medicine and Dentistry QMUL, Turner Street, London E1 2AD, London, United Kingdom Adv Dent & Oral Health 10(5): ADOH.MS.ID.555797 (2019) Introduction It has been recognised that periodontal disease in susceptible individuals may lead to the gradual loss of the tooth supportive apparatus. Therefore, the objective of periodontal treatment is not only the arrestment of the progression of periodontitis but additionally to aid in the reconstruction of lost structures such as bone, cementum and periodontal ligament using regenerative procedures and techniques such as Guided tissue regeneration (GTR) with and without the use of bone grafting materials [1,2]. Over the last three decades there has been a major development of novel materials for the treatment of periodontal disease, par- ticularly regarding the treatment of infra bony defects. For exam- ple, stem cells, conductive scaffolds, platelet-rich plasma, Bone Morphogenetic Proteins (BMPs), cell binding peptides, fibroblast growth factors and Enamel matrix proteins (EMD) as well as bone replacement products such as autograft, xenograft, allograft and alloplastic grafts [2]. Several investigators have, however report- ed on the efficacy of EMD compared to the other biomaterials in combination with regenerative procedures [3-6]. According to Fernandes et al. [6] there are considerable benefits in combining both EMD and a bone ceramic as there is potential to create a syn- ergetic effect of both these materials. Aim The aim of this case report therefore was to describe a surgi- cal procedure for the application of a mixed regenerative materi al, combining enamel matrix derivative (Straumann™ Emdogain, Straumann, Basel, Switzerland) and alloplastic bone substitute (hydroxyapatite and β- tricalcium phosphate) (Straumann™ Bone Ceramic, Straumann, Basel, Switzerland), in intra bony defects and furcation involved areas located at upper posterior teeth. Materials and Methods A 26-year old, non-smoking Asian male with a diagnosis of Generalized Aggressive Periodontitis, presented to the postgradu- ate periodontal clinic in the Dental Hospital. The patient provided written informed consent for the proposed treatment and after the completion of two courses of non-surgical periodontal treat- ment with adjunctive systemic antibiotics (Doxycycline 100mg, s.i.d. for 21 days), surgical treatment of the infra bony defects and furcation defects of the affected sites was provided. The pa- tient’s compliance with self-performed plaque control was opti- mal throughout both non-surgical and surgical procedures as well with the post-surgical maintenance phase. Surgical procedure On the maxillary left first premolar the maximum probing pocket depth (PPD) was 7mm on the mesial site with bleeding on probing. An angular bony defect was noted on the same site on a periapical radiograph (PA). On the maxillary left first molar the maximum PPD was 8mm on the mesial and distal site, with a Mill- 005 Abstract This case report describes the surgical management of a patient with a diagnosis of Generalized Aggressive Periodontitis using a mixed regenerative material which combined an enamel matrix derivative with an alloplastic bone substitute in both infra bony defects and furcation areas. The importance of an extensive oral hygiene regime following the surgical procedure as well as the patient’s ability to maintain an optimal plaque control is also key to the successful management of the patient’s condition. Keywords: Surgical technique; Infra bony and furcation defects; Enamel matrix derivative; Bone ceramic; Case report; Patient compliance; Synthetic bone graft; Periodontal disease Abbreviations: GTR: Guided Tissue Regeneration; BMP: Bone Morphogenetic Proteins; EMD: Enamel Matrix Proteins; PPD: Probing Pocket Depth