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Enamel matrix derivative (EMD), such as Emdogain®, has been suggested for the improvement of wound healing in periodontal surgical therapy. The present qualitative study seeks to illustrate the ultrastructural changes associated with a human gingival wound at 10 days after the application of EMD as an adjunct to a laterally-positioned flap in a patient with gingival recession. An otherwise healthy patient, who had been suffering from bilateral gingival recession defects on teeth #23 and #26, was studied. One defect was treated with a laterally-positioned flap, while the other was treated with a combination of EMD and a laterally-positioned flap. Ten days after the operation gingival biopsy specimens were obtained from the dentogingival region and examined using a transmission electron microscope. A considerable difference was found in both the cellular and extracellular phases of EMD and non-EMD sites. The fibroblasts of EMD site were more rounded with plump cytoplasms and euchromatic nuclei. A well-developed rough endoplasmic reticulum and numerous mitochondria could be detected. In contrast, the fibroblasts of non-EMD site were of flattened spindle-like morphology. While the signs of apoptosis could rarely be detected at EMD site, apoptotic bodies and ultra-structural evidence of apoptosis (crescent-like heterochromatic nuclei and dilated nuclear envelopes) were consistent features at non-EMD site. The extracellular matrix at EMD site mainly consisted of well-organised collagen fibres, while non-EMD site contained sparse and incompletely-formed collagen fibres. Coccoid bacteria were noted within the extracellular matrix and neutrophils at non-EMD site. It seems that EMD may enhance certain features of gingival wound healing, which may be attributable to its anti-apoptotic, anti-bacterial or anti-inflammatory properties.
Twenty five women (21 to 50 years old) with genetic diseases (phenylketonuria, Down’s syndrome, achondroplasia, epilepsy), patients of the II Maxillo-Facial Surgery Clinic of the Medical University of Warsaw, were examined for the pre-treatment status of the oral cavity and the occurrence of oral protozoans, Entamoeba gingivalis and/or Trichomonas tenax. On the basis of the clinical characteristics and light and transmission electron microscopic examination, relationship between periodontal condition and presence of the oral protozoans were analysed and factors which may play the main role in the maintenance of the infection in these patients were determined. The highest prevalence of infection with E. gingivalis and T. tenax was noted in the 41-50 year age group in which more than 88% of the patients were infected. In 11 among of 20 of the cases with periodontal disease, infection with T. tenax, and/or E. gingivalis occurred. In 10 among of 16 of the individuals with limited mobility the oral protozoans was present. Our studies indicate that age as well as limited mobility of the patients examined resulting in difficulties with maintaining of good hygiene of oral cavity may play an important role in occurrence of infection with the oral protozoans and inflammatory processes in gingiva and periodontium.
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