The use of enamel matrix derivative in the treatment of periodontal osseous defects: A clinical decision tree based on biologic principles of regeneration

An investigation of the periodontal literature reveals four critical factor s necessary for a regenerative response in the treatment of intrabony defec ts. These include root preparation to remove toxins and altered cementum, s pace creation by the graft or membrane barrier for migration of progenitor cells, stabilization and flap coverage of the graft, and use of a membrane barrier or enamel matrix derivative (EMD). This article reviews the literat ure supporting this concept and presents a clinical decision tree to determ ine when to use EMD alone or with autogenous grafts and membrane barriers i n the treatment of defects of varying morphologies. The clinical decision t ree is designed to increase the predictability of a positive clinical respo nse. Cases are shown to demonstrate the indication for each treatment.