Give a patient the option to avoid surgical treatment and they’ll take it – naturally. The non-surgical treatment of periodontal disease has always been preferable but when regeneration of periodontal tissues, such as cementum, periodontal ligament, alveolar bone and gingiva, is required, surgery has often been the only answer.
Applying Straumann Emdogain® to the cleaned root surface of a periodontally diseased tooth has been proved to support the predictable regeneration of the lost hard and soft tissues of the periodontium, and in this way helps to preserve the tooth[i]. Emdogain contains enamel matrix derivative – the active natural protein matrix responsible for tooth formation. When applied to cleaned root surfaces, the unique protein composition in Emdogain is able to induce the regeneration of all periodontal tissues.
There is a vast body of clinical evidence that supports Emdogain’s use as an adjunct to periodontal surgery[ii], enabling significantly increased clinical attachment levels and reducing periodontal pocket depths when compared with periodontal surgery alone.
In 2018, Emdogain FL was launched – a new application of this powerful material for use in non-surgical periodontal treatment – with extremely positive results.
All the benefits without the flap!
FL stands for ‘flapless’, referring to the fact that there is no requirement to surgically lift a flap before application of Emdogain FL in periodontal pockets up to 9mm deep. Much less invasive, but still efficient and effective, Emdogain FL can reduce the need for follow-up treatment, including surgery, after the initial phase of periodontal treatment.
Italian periodontist and professor at the University of Pisa, Professor Filippo Graziani, put Emdogain FL to the test in a recent randomised trial, with positive results, as he explained in a recent interview at the International Dental Show (IDS), Cologne 2019. The benefits to the patient are both local and systemic and its application as part of the initial treatment phase means improved patient comfort and faster recovery.
Emdogain FL is straightforward to use thanks to the new applicator. In the video, Filippo gives some useful tips on the successful use of Emdogain FL and how it fits into the initial treatment workflow. This advice will be invaluable to any hygienist or general dental practitioner who wishes to add this treatment to their periodontal toolkit.
A clinical study with promising results
You can also watch Filippo in conversation with Francesca De Santi at the Straumann Arena of Confidence at IDS 2019, where they talk in depth about his findings from the clinical trial. This includes details of those in the test group, who had initial therapy that included the non-surgical application of Emdogain FL, and had a 30% increased chance of not requiring periodontal surgery afterwards.
In comparison with the surgical application of Emdogain, the flapless protocol even shows similar clinical results after 24 months[iii].
Add Emdogain FL to your initial periodontal treatment workflow
In modern periodontal treatment there are typically three phases. After diagnosis of periodontal disease, initial phase periodontal therapy starts with non-surgical subgingival instrumentation to remove causative bacteria, plaque and biofilm.
Post-treatment evaluation determines whether there is a need for repeated treatment or follow-up treatment which may involve surgery (phase 2) or supportive treatments (phase 3).
Emdogain FL can easily be integrated into the initial phase in cases of pockets with depths of 5-9 mm in the following sequence:
- Root instrumentation (debridement and scaling)
- PrefGel®(2 mins)
- Emdogain FL
The inclusion of Emdogain FL makes this initial phase more effective by reducing the pocket probing depth, gaining additional clinical attachment (in pockets 6 mm deep or more) and reducing the need for follow-up treatments including surgery.
Emdogain has been a powerful tool in the periodontist’s kit for over 20 years. There is no reason why Emdogain FL won’t become similarly indispensable for every hygienist and general dental practitioner involved in the treatment of periodontal disease.
Links to Youtube interview – https://www.youtube.com/watch?v=w6jzdK89Pyg
Links to Youtube video – https://www.youtube.com/watch?v=K6_eGABylIY
 Bosshardt DD. Biological mediators and periodontal regeneration: a review of enamel matrix proteins at the cellular and molecular levels. J Clin Periodontol. 2008 Sep;35(8 Suppl):87-105. doi: 10.1111/j.1600-051X.2008.01264.x.
 Miron RJ et al. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. 2016 Aug;43(8):668-83. doi: 10.1111/jcpe.12546.
 Aimetti M, Ferrarotti F, Mariani GM, Romano F. A novel flapless approach versus minimally invasive surgery in periodontal regeneration with enamel matrix derivative proteins: a 24-month randomized controlled clinical trial. Clin Oral Investig. 2017 Jan;21(1):327-337.