Find out what the Jury had to say - Straumann

28 STARGET 2011 

STRAUMANN ® EMDOGAIN 

NEW ESTHETIC CASE BOOK 

Straumann ® Emdogain : Going beyond Functional Treatment 

The focus of periodontology is no longer limited to the functional success of the 

surgical treatment. Esthetic outcome has become more important and is now 

one of the most frequent reasons for recession treatment. The patient does not 

only want healthy teeth, but an overall attractive look, including a harmonious 

gingival line. The ultimate goal of root coverage is therefore complete coverage 

of the recession defect and a good appearance of adjacent soft tissue 1 . 

Straumann Emdogain has been successfully used in conjunction with the 

coronally advanced flap technique (CAF) to improve the clinical outcome, 

including root coverage, and the quality and quantity of tissue (e.g., keratinized 

tissue). 2 Studies also indicate long-term stability following recession coverage 

procedures. 2,3 

STRAUMANN EMDOGAIN: THE REGENERATIVE APPROACH 

Straumann Emdogain is a scientifically documented solution for promoting the 

predictable regeneration of lost periodontal hard and soft tissue. In this way, 

Emdogain helps to save and stabilize teeth. 

The development of Emdogain is based on a breakthrough in the basic biology 

of tooth development. Emdogain helps initiate regeneration of the periodontiumcementum, 

periodontal ligament and alveolar bone. This provides a foundation 

for all necessary tissues associated with a true functional attachment. Emdogain 

provides a unique solution for the periodontal treatment aimed at restoring the 

supporting structures of your patients’ teeth.


STARGET 2011 

29 

“Growth in Recession: An Esthetic Case Selection” 

In 2009, Straumann ® organized a worldwide contest called 

“Growth in Recession – an Esthetic Case Selection.” The 

outcome is a case book showing the esthetic results that can 

be achieved by using Straumann ® Emdogain in combination 

with known surgical procedures for the treatment of gingival 

recession. Case selection was through stringent evaluation by 

an international jury of seven renowned experts in the field of 

periodontal surgery. 

Case evaluation was performed using a scorecard developed 

and kindly provided by Prof. Giovanni Zucchelli, based on his 

prior scientific work 4 and professional expertise in the field of 

esthetic periodontology. This scorecard ensured that all experts 

applied the same evaluation parameters of: 

GROWTH IN RECESSION: AN ESTHETIC CASE 

SELECTION ON STRAUMANN ® EMDOGAIN 

Contact your local Straumann 

representative or Straumann Customer 

Service at 800/448 8168 if you 

would like a copy of the Esthetic 

Case Book. 

» contiguity 

» color match 

» contour 

» mucogingival junction alignment 

» amount of keratinized tissue 

» root coverage 

» soft tissue thickness 

» complexity 

» final result 

Pre- and post-operative images were rated according to the 

presented criteria and quantified improvements. Eleven cases 

were selected and presented together with the patient’s history, 

description of the surgical procedure and step-by-step images 

for a detailed understanding of the surgical procedures involved. 

Jury Members’ Testimonials 

On the next pages, we would like to share the evaluation 

experiences of the jury members with you.

30 STARGET 2011 STRAUMANN ® EMDOGAIN 

VÉRONIQUE BENHAMOU 

BSC, DDS, CERT. PERIO. 

ALAIN BORGHETTI 

DCD, DSO, DUO 

Associate Professor and Director of the Division of 

Periodontics at the McGill University Dental School, 

Montreal, Canada 

As a jury member it was interesting to compare the 

different approaches selected by the clinicians to treat 

various recession defects. I had always believed that 

when treating recessions, proper case selection had a 

significant impact on the outcome. My participation in 

this contest has reinforced that belief. The clinicians who 

participated in this contest were very talented and gave 

an excellent presentation of root coverage surgery. It 

was sometimes quite difficult to compare the cases and 

decide which of them had been most successful. I myself 

have obtained some very good results in the treatment of 

Class I and II recession defects with coronally advanced 

flap and Straumann ® Emdogain. Patients experience a 

minimal amount of post-operative discomfort and, as it 

does not require soft tissue to be harvested from the palate, 

multiple teeth can be treated in one sitting. The esthetic 

outcomes were excellent and very predictable. Recession 

treatment can be important when the gingival margin is 

so uneven that the patient finds it difficult to maintain oral 

hygiene. Leveling the marginal tissue facilitates plaque 

control. In some cases root coverage can also help control 

root sensitivity. Today, patients tend to be more aware of 

their oral condition and are often quite concerned about 

the esthetics of their gingiva and teeth. Periodontal plastic 

surgery can help restore damaged areas and obtain more 

natural outcomes. 

Professor of Periodontology at the Department of 

Odontology, University of Aix-Marseille, France 

Initially, it was difficult for me to identify the small 

differences between all these wonderful cases. I learned 

something from the way some of them had been treated. 

The most important aspect I will take home with me will 

be the scorecard developed by Prof. Zucchelli, which I 

found extremely interesting. When I was treating gingival 

recessions with Straumann Emdogain, I had no personal 

clinical comparative study with which I could measure the 

actual benefits of Emdogain for root coverage procedures 

compared to conventional techniques with the coronal 

positioning of flaps. But I was able to observe how quick 

the healing process was and how convincing the results 

turned out to be. In view of the constant increase in the 

demand for esthetic treatment over the past twenty years, 

gingival recession treatment has become very important.


STARGET 2011 

31 

MICHAEL K. MCGUIRE 

DDS 

GIOVANNI ZUCCHELLI 

DDS, PHD 

DDS and Certificate of Periodontics from the Emory 

University School of Dentistry, Atlanta, Georgia, USA 

Professor of Periodontology at the University of Bologna, 

Italy 

I was impressed by the expertise and excellent surgical 

skills of the partners, demonstrated in the excellent 

outcomes of the cases they submitted. My personal 

experience is that with the appropriate case, Straumann ® 

Emdogain significantly improves root coverage compared 

to using the coronally advanced flap on its own. Most root 

coverage procedures are performed to resolve patientrelated 

issues such as esthetics or sensitivity. Treatment 

with a coronally advanced flap and Emdogain provides 

an option that is less invasive and often as effective as the 

traditional connective tissue graft. 

The evaluation was an insightful experience, as it showed 

me that the main objective of gingival recession treatment 

has changed throughout the world. From mere root 

coverage it has developed to a stage where the surgically 

treated area is now esthetically indistinguishable from 

the adjacent soft tissue. The clinicians who attended the 

contest have adopted modern surgical approaches to 

achieve convincing esthetic results. The additional use of 

Straumann ® Emdogain increases keratinized tissue 5 and 

improves overall coverage and the healing outcome 6 

following coronally advanced flap surgery. I also suggest 

the additional use of Emdogain in the treatment of gingival 

recession associated with buccal dislocated root or buccallingual 

attachment and bone loss. In the latter situation a 

greater amount of new connective tissue attachment with 

respect to long junctional epithelium would be clinically 

significant. The patient’s discontentment with his or her oral 

esthetics is the main indication for the treatment of gingival 

recession. In order to limit the extent of root exposure 

treatment should therefore not be delayed. It is decidedly 

more difficult to accomplish truly satisfying esthetic results in 

the case of deep recession defects and very small amounts 

of residual keratinized tissue, although root coverage may 

be still achieved.

32 STARGET 2011 STRAUMANN ® EMDOGAIN 

ANTON SCULEAN 

DMD, MS, PHD 

Professor and Chairman of the Department of 

Periodontology, University of Bern, Switzerland 

The evaluation was more of a challenge than I had 

expected. The jury members performed the evaluation 

in a blind approach (i.e., first they evaluated the final 

outcomes after therapy, and then compared the scores 

with the baseline images). The scorecard approach was 

very detailed and enabled the jury not only to evaluate 

recession coverage itself, but also other important 

parameters, such as tissue blending, esthetic appearance, 

amount of keratinized gingiva, etc. The procedure allowed 

us to make an objective and replicable assessment. The 

object of the blind approach was to provide an objective 

evaluation of the outcomes. Several cases showed great 

improvements compared to the baseline. I have been using 

Straumann ® Emdogain since it was introduced to the 

market. The results of our research group with recession 

treatment on monkeys and the evaluation of human 

histological material provided evidence for periodontal 

regeneration on root surfaces with gingival recessions. 

Moreover, in my experience early wound healing improved 

with Emdogain compared to controls (without Emdogain), 

which is an important aspect for obtaining predictable 

results. On the basis of this biologic rationale, I have been 

using Emdogain continually either alone or in combination 

with connective tissue grafts. The main indication for the 

treatment of gingival recessions is the improvement of the 

so-called “pink esthetics” (i.e., the dissatisfaction of patients 

with their “overlong” teeth). In some cases a deep recession 

may make dental hygiene difficult, as well as lead to 

cervical hypersensitivity, gingival inflammation or caries. My 

own personal recommendations for the treatment of gingival 

recession are either to follow an appropriate surgical 

approach that allows tension-free coronal flap advancement 

with the technique described by Prof. Zucchelli, or to 

employ the coronally advanced tunneling technique. 

Personally, I combine these flap techniques with Emdogain 

(for the reasons given above) as well as, in most cases, 

with connective tissue grafts.


STARGET 2011 

33 

THOMAS G. WILSON JR. 

DDS 

Private Practice of Periodontist, Dallas, Texas, USA 

I found it difficult to choose a winner because of the 

number of interesting cases. I have been using Straumann ® 

Emdogain in conjunction with sub-epithelial connective 

tissue grafts to treat gingival recession for approximately 

12 years. I find that it enhances the probability of complete 

root coverage compared to the use of connective tissue 

graft without Emdogain. In my opinion gingival recession 

should be treated in the following cases: ongoing 

recession, tooth displacement into an area of deficient 

keratinization, when the restoration margin would be 

placed level with or slightly apical to the free gingival 

margin, or when it is a matter of esthetic concern to the 

patient. 

1 

Roccuzzo M, Bunino M, Needleman I and Sanz M: Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. 

J Clin Periodontol 2002; 29(Suppl. 3):178–194 

2 

Pilloni A, Paolantonio M, Camargo PM. Root coverage with a coronally positioned flap used in 

combination with enamel matrix derivative: 18-month clinical evaluation. J Periodontol. 2006 Dec;77(12):2031-9. 

3 

Spahr A, Haegewald S, Tsoulfidou 

F, Rompola E, Heijl L, Bernimoulin JP, Ring C, Sander S, Haller B. Coverage of Miller class I and II recession defects using enamel matrix proteins versus 

coronally advanced flap technique: a 2-year report. J Periodontol. 2005 Nov;76(11):1871-80. 

4 

G. Zucchelli, M. Mele, C. Mazzotti, M. Marzadori, 

L. Montebugnoli, and M. De Sanctis: Coronally Advanced Flap With and Without Vertical Releasing Incisions for the Treatment of Multiple Gingival 

Recessions: A Comparative Controlled Randomized Clinical Trial Journal of Periodontology, July 2009, Vol. 80, No. 7, 1083 - 1094. 

5 

Del Pizzo M, et 

al. Coronally advanced flap with or without enamel matrix derivative for root coverage: a 2-year study. J Clin Periodontol. 2005;32:1181–1187. 

6 

Cairo F, 

Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol 2008; 35 (Suppl. 8): 

136–162

Find out what the Jury had to say - Straumann

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