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Straumann® Emdogain®: Orchestrating wound healing and oral regeneration

  After celebrating the 20th anniversary of Emdogain® since it was launched on the market in 1995, Straumann is now setting new milestones in the area of oral tissue regeneration by extending the use of Emdogain® to improve soft tissue wound healing in oral surgical procedures and dental implantation procedures in general. Straumann® Emdogain® is one of the best documented products in oral tissue regeneration. Its excellent clinical tolerability [1,2] has been demonstrated in over two million surgical applications. Emdogain® contains enamel matrix proteins (amelogenins). When applied to the wound, these proteins form an extracellular matrix that stimulates cells and processes that are fundamental for wound healing [3]. These properties make Emdogain® a unique solution to stimulate and accelerate the healing of wounds and regeneration of tissues. What leading experts say Everybody who is creating a wound in the oral cavity, for instance in the context of conventional periodontal surgery, connective tissue harvesting, tooth extraction or even implant placement can use Emdogain® to improve early wound healing. Prof. Anton Sculean, Switzerland Emdogain® is a really unique protein mixture. It influences a number of different cells and a number of different processes. It really helps the wound healing and wound closure in the oral cavity. Prof. David Cochran – San Antonio, USA New approved indication: the stimulation of soft tissue wound healing From the earliest days of market experience it soon became evident that the proteins in Emdogain® have a broader biologic function and stimulate and modulate healing in a more general way. The ability to stimulate periodontal regeneration might only be a consequence of this broad biologic stimulation. Likewise, early clinical observations have indicated that the product has great potential to stimulate the wound healing of soft tissues. In 1999, the inventors of Emdogain® patented the use of enamel matrix derivative, the active principle in Emdogain®, as a wound healing agent. To date,  around 150 scientific publications and reviews have described the effect of enamel matrix derivatives on wound healing and soft tissue wound healing, and the unique properties to stimulate wound healing have led to the clinical establishment of a treatment to cure hard-to-heal wounds like diabetic foot ulcers with excellent clinical results. Recent scientific publications clearly demonstrate the potential of Emdogain® to induce faster reepithelialization, faster wound closure, faster resolution of inflammation and faster and extended blood vessel formation. Recent scientific publications clearly demonstrate the potential of Emdogain® to induce faster reepithelialization, faster wound closure, faster resolution of inflammation and faster and extended blood vessel formation. Emdogain® as a standard step in implant surgical procedures This strong scientific evidence and the market input from experienced users have encouraged Straumann to strive for new milestones in the field of implant dentistry and oral tissue regeneration. As the first dental implant company to do so, Straumann will incorporate a biologic in the surgical procedure of implant placement as a standard step in order to improve wound healing. The properties of Emdogain® have the potential to render procedures less prone to complications and to increase patient satisfaction by a. allowing faster healing and recovery, b. reducing the level of post-surgical discomfort (pain and swelling) and c. increasing the quality of the outcomes of esthetic procedures in implant dentistry. Distinguish your practice by meeting your patients’ requirements. Adopt Emdogain® to achieve patient satisfaction. Oral surgeries always bear the risk of undesired suffering of your patients such as pain and swelling of the soft tissues or wound healing complications – Emdogain® can increase your patients’ tolerance of surgical interventions by reducing these unwanted side effects. . The goal of every surgical procedure around teeth or dental implants is to restore the natural soft tissue architecture and esthetics for your patient – Emdogain® supports the soft tissue build-up and formation of keratinized gingiva necessary to achieve pleasing esthetic results. After any surgery, your patients suffer from discomfort and reduced quality of life – Emdogain® accelerates the healing process, which reduces the length and impact of surgery on your patients’ daily life. . . . Increase the quality of life for your patient by using Straumann® Emdogain® Your primary goal is to create a functional and esthetically pleasing restoration for your patient. Unfortunately, surgical interventions used to achieve this always bear the risk of complications such as pain, swelling and discomfort. You can increase your patients’ acceptance and tolerance of oral surgery by: Informing the patient about possible undesired effects of the procedure Applying surgical techniques that reduce invasiveness Using additional products to improve healing; reduce pain, swelling, the risk of infections and wound complications. Roll-out from April 2016: Straumann will launch the new application from April 2016, starting in Europe, with an official indication. The registration of the technology in other countries outside Europe is currently ongoing. Since the product’s potential to stimulate wound healing is clearly documented, Straumann is committed to work with key opinion leaders and clinical experts to establish the new usage in the key target indications, ranging from invasive to esthetic indications. Likewise, the combination of Emdogain® with existing products like the new Straumann® Bone Level Tapered Implant for esthetic and immediate indications, or with existing solutions like the Straumann® Pro Arch solution, will form the focus of our work to further improve these and other solutions for the benefit of our clinicians and patients. For availability information in your country contact your official Straumann representative. Brochure Download our brochure for more information on how to improve wound healing in implant surgery procedures by using Straumann® Emdogain.® Background article Prof. Staale Petter Lyngstadaas, Norway: “The scientific documentation for the use of Emdogain® for promoting soft tissue wound healing is now solid, providing a strong base to further extend its clinical evidence and use in oral surgical procedures in general.” Subscribe Subscribe to our monthly STARGET newsletter to receive the latest news about implant dentistry. REFERENCES [1] Clinical evaluation of wound healing following multiple exposures to enamel matrix protein derivative in the treatment of intrabony periodontal defects. Heard RH, Mellonig JT, Brunsvold MA, Lasho DJ, Meffert RM, Cochran DL. J Periodontol. 2000 Nov;71(11):1715-21. [2] Clinical safety of enamel matrix derivative (EMDOGAIN) in the treatment of periodontal defects. Zetterström O, Andersson C, Eriksson L, Fredriksson A, Friskopp J, Heden G, [3] Jansson B, Lundgren T, Nilveus R, Olsson A, Renvert S, Salonen L, Sjöström L, Winell A, Ostgren A, Gestrelius S. J Clin Periodontol 1997 Sep;24(9 Pt 2):697-704. 29. Emdogain Promotes Healing of a Surgical Wound in the Rat Oral Mucosa. Maymon-Gil T, Weinberg E, Nemcovsky C, Weinreb M. J. Periodontol. 2016 Jan 16:1-16. The post Straumann® Emdogain®: Orchestrating wound healing and oral regeneration appeared first on STARGET COM.

From a Swedish biotech lab to gold standard in periodontal tissue regeneration – an interview with Prof. Lars Hammarström and Dr. Stina Gestrelius (Straumann® Emdogain®)

  Since its introduction twenty years ago, more than 2 million patients around the world have been treated for periodontal disease with Emdogain®, which has not only become the gold standard in periodontal tissue regeneration, but is also one of the best researched dental treatments currently available. Twenty years have passed since Emdogain®’s market launch by Biora AB, a Swedish start-up company founded by Prof. Lars Hammarström of the Karolinska Institute Dental School in Stockholm, Sweden. “I have built many theories in my life. I am happy that this one worked!” Prof. Lars Hammarström Recently, we had the privilege to interview both Prof. Lars Hammarström as well as Dr. Stina Gestrelius, who was in charge of research and development at Biora AB and therefore played a very important part in making Prof. Hammarström’s idea become a commercial product. About Straumann® Emdogain® (EMD): Straumann® Emdogain® is an easy to apply gel containing Enamel Matrix Derivative (EMD) originating from unerupted porcine tooth buds. As a component of embryonic tissues, it is designed to promote predictable regeneration of hard and soft tissues lost due to periodontal disease or trauma. More STARGET articles about EMD Where did the idea of Emdogain come from? Prof. Lars Hammarström: As you know, in the 1980s membranes were the only treatment option for periodontal regeneration. Although membranes work, they represent a mechanical approach. I wanted to bring an alternative,  biological approach to the dental treatment. While doing research at the Karolinska Institute, I had observed that in some animals, there is a thin layer of enamel which extends between the dentin and cementum. This lead me to the hypothesis that enamel related proteins induce cementum formation. How did you test your idea? Prof. Lars Hammarström:  My team and I went to the slaughterhouse in Stockholm and got some lower jaws from pigs that were being processed for the meat industry. We scraped off the enamel in the early stages of development, when  the mineral content is low and the consistency is like Philadelphia cream cheese, making it very easy to remove. We dispersed it in physiological saline solution. We then made a groove in the surface of the root of an animal model, put a little bit of the enamel protein solution in the groove and repositioned the soft tissue. After two months the hole was filled with nicely attached cementum and also periodontal ligament! How did your idea become a product? Prof. Lars Hammarström: After this initial breakthrough, I wanted to get a patent on my discovery and hopefully launch a regenerative dental product based on it. I was fortunate enough to meet Per Wahlström, who was just starting Euroventures Nordica, a venture capital company. When I explained my concept, he was keen to collaborate with me and that is how I got some starting capital. We then established Biora AB in 1987 and started a collaboration with Ferring, a big pharmaceutical company in Malmö, Sweden, with a very good reputation for  protein chemistry. We gave the enamel matrix to a research group there, of which Dr. Stina Gestrelius was in charge. The aim of the collaboration was for us to get more information for our patent, while Ferring was interested in making a marketable active synthetic peptide out of the enamel matrix. After 9 months of research,  Dr. Gestrelius’ results showed that, while the matrix as a whole or the full mix of proteins extracted from the matrix had some activity, all subsets of peptides tested showed none – so Ferring lost interest in our collaboration. Fortunately, Dr. Gestrelius agreed to come work for us at Biora AB in 1988. Dr. Gestrelius, was this a big leap of faith to leave your job at Ferring to work at Biora? Dr. Stina Getrelius: No, because throughout the 9 months that I worked on EMD, I had seen it work. I also knew the people behind this project and trusted that we could make a product out of it. How was your collaboration? Prof. Lars Hammarström: Dr. Gestrelius brought her experience of good laboratory practice and registration. She was very important for the development of the product and when we had collected enough material to apply to the registration authorities in Europe and also in the United States, she was very instrumental. We were able to register the product both in Europe and the USA, even though it was unusual for an animal protein to be used in humans. “Emdogain is based on biomimicry – a very academically smart principle.” Prof. Dr. Nicholas Lang What evidence did you need to collect? Dr. Stina Gestrelius: Immunological studies were crucial to demonstrate that there was no risk of allergic or immunological reactions. Actually, before formally starting any studies, many of us at Biora performed skin-prick tests on ourselves with EMD to see if this would generate any reactions. Because there were none, we started a range of clinical immunological studies. Of course, a wide array of in vitro studies, kinetic and physicochemical studies, in vivo pre-clinical studies, non-clinical safety studies and clinical studies (in collaboration with clinicians such as Dr. Gunnar Heden, Dr. Leif Blomlöf and Dr. Lars Heijl) also had to be performed. What was the best moment? Dr. Stina Gestrelius: The entire experience was very interesting. But probably the highlights were when we received the European registration (CE mark) in 1995 and the FDA approval in 1996. Both of these events made national news in important newspapers in Sweden. That was very exciting. What was your main hurdle along the way? Dr. Stina Gestrelius: Financially, it was not always easy. To collect all the required evidence, we needed altogether 7 years and during this time, we needed financial support. We had to be creative to find ways to generate revenues somehow. I feel like we did almost everything possible besides robbing a bank! For instance, we became a service provider of aseptic freeze drying for pharmaceutical companies from 1992 until 1995. “I am truly amazed that twenty years later, Emdogain® is still considered an innovative product and is so well looked upon by dentists all over the world. I am very proud of Lars!” Dr. Christina Hammarström, Prof. Lars Hammarström’s wife and pediatric dentist What were the next steps? Dr. Stina Gestrelius: As soon as we had the approval, we needed more money to start subsidiaries and marketing activities to promote Emdogain in various markets. We obtained this money through two public offerings – one in Sweden and one in New York City. At its peak, Biora had 6 subsidiaries (in the USA, Germany, Italy, the UK, Switzerland, and the Netherlands) and was also available through distributors in many countries such as in Japan. We also published our main collective research findings in an issue of the Journal of Clinical Periodontology (Volume 24, Number 9) in September of 1997. We continued to develop the product and extend the indications in different markets to get the range we have today: intrabony defects, furcation defects and recession defects. How did the market react during the launch? Dr. Stina Gestrelius: Because Emdogain® was the first biological product used in dentistry, it was not easy to explain the concept to dentists and this took some time. Nevertheless, year after year, our sales kept growing. I was initially afraid – despite all the tests and studies – that there would be some negative side effects. But there were none. Instead, we started to receive phone calls from clinicians, asking us if we had noticed the good wound healing, which occurs when Emdogain® is used. We had not. We did more research on this topic and applied for a patent which was later licenced to Mölnlycke for use in extra-oral wounds. Today, Emdogain is 20 years old, still the gold standard in periodontology and helped to save the teeth of over 2 million patients. How do you feel about this? Dr. Stina Gestrelius: I am very happy, of course. Prof. Lars Hammarström: I am very happy as well. I have built many theories in my life. I am happy that this one worked! Prof. Lars Hammarström and Mark Hill (Corporate Communications Straumann) at the EAO 2015 in Stockholm, Sweden. Prof. Lars Hammarström DDS/PhD Lars Hammarström co-founded Biora AB in 1986. He was the director of the College of Oral Biology at the Karolinska Institute from 1992 to 1998, and served as professor of Oral Pathology at the Karolinska Institute from 1975. Prior thereto, Prof. Hammarström was the dean of the Dental School at the University of Lund from 1974 through 1975. Dr. Hammarström holds a D.D.S. in Dentistry and a Ph.D. in Pharmacology from the Karolinska Institute’s School of Dentistry in Stockholm, Sweden. Dr. Stina Gestrelius PhD Stina Gestrelius was responsible for research and development and a vice president at Biora AB from 1988 until 2003. Previous to that, she worked for several pharmaceutical companies such as Novo Nordisk, Astra and Ferring. She is now the CEO of Sigrid Science, a consulting firm within life science. Dr. Stina Gestrelius holds a Ph.D. in biotechnology from the University of Lund in Sweden. The post From a Swedish biotech lab to gold standard in periodontal tissue regeneration – an interview with Prof. Lars Hammarström and Dr. Stina Gestrelius (Straumann® Emdogain®) appeared first on STARGET COM.

Richard Zimmermann/Stefanie Seitz: Insertion of a Straumann® PURE Ceramic Implant through the DWOS Synergy™ workflow with immediate digital provisionalization

  The Straumann® PURE Ceramic Implant has a natural looking ivory color. This specific feature makes the implant look more like a natural tooth and it supports the clinician in cases of thin gingiva biotype or soft tissue recession. It has a monotype design based on features of the Straumann® Soft Tissue Level Standard Plus and Straumann® Bone Level Implants. (Product information by the manufacturer) PICTURE DOCUMENTATION Fig. 01 Virtual planning of PURE implant for site #12 using coDiagnostiX™. Fig. 02 Restoration design #12 PURE implant in Straumann® CARES® Visual software. Fig. 03 Surgical guide design in coDiagnostiX™. Fig. 04 Provisional design based on virtual position for the PURE implant. Note the software takes into account the abutment facets. Fig. 05 Product illustration Fig. 06 PURE position indicator in place for evaluation of osteotomy. Fig. 07 PURE and transfer piece showing the indicator dots used for orientation during placement. Fig. 08 PURE placed with tissue reapproximated to evaluate depth of shoulder. Fig. 09 Final placement of PURE implant. Fig. 10 One week follow up showing tissue response and modified provisional. Fig. 11 Transfer piece indicator dots were not properly centered on abutment facets preventing complete seating onto the PURE. INITIAL SITUATION A 30 year old female with non-contributory medical history presented to the clinic for evaluation of a maxillary edentulous site.  Review of her dental history revealed that tooth #12 (ADA) was lost due to failed endondontic therapy approximately a year ago during her pregnancy and she was now ready to have it replaced.  She presented with a high smile line, medium-scalloped gingiva with medium thickness and a desire not to have any metal in her oral cavity.  When discussing the various options regarding implant therapy, the patient was very interested in being evaluated for an all ceramic implant. On January 11, the FDA cleared the Straumann® PURE Ceramic Implant for use within the US.  Though new to the US, European case documentation has shown excellent osseointegration and soft tissue response.  The Straumann® PURE Ceramic Implant is a monotype style implant, meaning the abutment and implant body are one-piece. TREATMENT PLAN The patient was sent to get a computerized cone beam tomography (Morita, USA) of the area and digital diagnostic impressions were taken using an intra-oral scanner (3Shape Trios 3).  Once obtained, the DICOMs were imported into the implant planning software (coDiagnostiX™) while the scan files were imported into the laboratory software (Straumann® CARES® Visual) (Figs. 1,2). Since the Straumann® PURE Ceramic Implant are monobody in design and it is not recommend to modify the abutment, the DWOS Synergy™ workflow was utilized to virtually plan this case. DWOS Synergy™ provides real-time communication between the implant planning software (coDiagnostiX™) and the lab software (Straumann®CARES®Visual). This feature improves implant planning by allowing the visualization of the relationship between the proposed implant position and the proposed restoration.  Modifications made to the implant position or restoration design are immediately transferred to the other software, providing instantaneous feedback on how the modification of one affects the other. Of special interest in regard to the Straumann® PURE Ceramic Implant, is that one can design the restoration and ensure that the planned position will not require modification for restorative materials. Once the planning was complete, both the surgical guide and the provisional designs were sent off for fabrication. The guide was sent to a lab to be printed by an Objet30 OrthoDesk (Stratasys) while the provisional file was sent to Straumann Milling Center in Arlington to be fabricated out of polycon ae (PMMA) (Figs 3, 4). During the surgical planning utilizing the DWOS Synergy™ workflow, a Straumann® PURE Ceramic Implant (4.1x12mm) was selected with an abutment height of 5.5 mm. SURGICAL PROCEDURE The Straumann® PURE Ceramic Implant design is a combination of the tissue level and bone level implant – the neck of the implant mirrors the Straumann® Tissue Level implant while the implant body mimics the Straumann® Bone Level design (Fig. 5). As such, the surgical protocol for preparing the osteotomy for the PURE is the same as the corresponding Bone Level implant.  For this case a guide was used to prepare the osteotomy following the protocol set forth for Bone Level implants given by coDiagnostiX™. Though this case was performed with Straumann Guided Surgery (SGS), a small flap was made to ensure the desired position of the Straumann® PURE Ceramic Implant shoulder. SGS utilizes different combinations of sleeve positions, drill lengths and drill handles to prepare the osteotomy to the correct depth.  Sleeves can be placed at three different heights from the implant level (2, 4 or 6mm) based on the case and surgeons preference.  The combination of drill length (short, long or extra-long) and drill handle (1mm or 3mm) are determined by the implant planning software which provides the surgical protocol to use at time of surgery.  The Straumann® PURE Ceramic Implant system uses a series of “position indicators” that aid in ensuring the correct position of the implant during surgery.  Both abutment diameters and heights have corresponding position indicators that are placed into the osteotomy for evaluation (Fig. 6). Once the osteotomy has been prepared, typically a surgeon will use a “guided implant”, which has a unique driver, to ensure proper placement of the implant.  However, the Straumann® PURE Ceramic Implant currently does not have such a driver therefore the surgical guide was only used to prepare the osteotomy while implant placement was performed free-hand.  Bone quality was determined to be Type II. The Straumann® PURE Ceramic Implant comes with a separate transfer piece for placement which snaps into place much like the Tissue Level impression cap.  Three dots on the driver line up with a flat surface of the abutment portion of the implant and also indicate distance to the shoulder (1, 2 and 3mm).  The implant was placed without any incidence to the desired depth and position of the dots (Figs. 7-9). During the healing phase, a protective cap is placed over the abutment to protect it.  Since the patient was concerned with esthetics and has a high smile line, it was decided to place a provisional to provide more esthetic appearance.  The recommendation by Straumann not to immediately load a PURE implant was taken into account during the DWOS Synergy™ design session by eliminating occlusal and lateral contacts.  This provisional was then further modified at time of surgery by further reducing the anatomy and creating more of a custom healing abutment than immediate provisional. The provisional was cemented using temporary cement (TempBond, Kerr) and only two interrupted sutures were required to secure the flap.  At the one-week follow up the tissue was healing beautifully around the implant and the patient was scheduled for the final impression seven weeks out (Fig. 10). FINAL RESULT The patient was in slight discomfort following the surgery, but stated that this surgery was less painful than the previous extraction. She was pleased to have the modified provisional versus a dark space in her smile. CONCLUSION “AS IMPLANT THERAPY HAS EVOLVED, PATIENT EXPECTATIONS HAVE RISEN. THE DESIRE TO HAVE A NATURAL LOOKING, METAL-FREE RESTORATION IS INCREASING AS CAN BE SEEN BY THE DECREASE OF METAL SUBSTRUCTURES FOR CROWNS AND FRAMEWORKS AND THE INCREASE IN CERAMIC RESTORATIONS.” RICHARD ZIMMERMANN/STEFANIE SEITZ Since the Straumann® PURE Ceramic Implant endosteal portion is based on the Straumann® Bone Level design, it does not require additional surgical instruments or drilling protocols for placement while the specialized transfer piece comes with the implant.  When placing the driver onto the Straumann® PURE Ceramic Implant abutment care must be taken to align the indicator dots up with the facets, otherwise incomplete seating of the driver may occur (Fig. 11). As implant therapy has evolved, patient expectations have risen. The desire to have a natural looking, metal-free restoration is increasing as can be seen by the decrease of metal substructures for crowns and frameworks and the increase in ceramic restorations. While titanium can cause a graying of the tissues, the ivory coloring of the Straumann® PURE Ceramic Implant can provide a more esthetic outcome.  Another patient was ecstatic to have the option for a Straumann® PURE Ceramic Implant implant since her husband has a titanium implant in the anterior region and she can see the gray.  All ceramic implants have the potential to provide greater esthetic outcomes but do require more precise planning and placement. Initially one might consider the Straumann® PURE Ceramic Implant to be limited by design, to a degree it is, however the DWOS Synergy™ workflow can help to reduce the challenge of placing a monotype implant. RICHARD ZIMMERMANN DDS UT School of Dentistry, San Antonio/Texas STEFANIE SEITZ DDS UT School of Dentistry, San Antonio/Texas Clinical review The clinical facts behind the Straumann® PURE Ceramic Implant. Brochure Download the brochure for the Straumann® PURE Ceramic Implant. SUBSCRIBE Subscribe to our monthly STARGET newsletter to receive the latest news about implant dentistry. The post Richard Zimmermann/Stefanie Seitz: Insertion of a Straumann® PURE Ceramic Implant through the DWOS Synergy™ workflow with immediate digital provisionalization appeared first on STARGET COM.

Rising stars sought in YoungProAward 2016 – apply now!

  Straumann and botiss biomaterials are pleased to announce the opening of the YoungProAward in Regenerative Dentistry 2016 with the aim of fostering the development of young dental professionals in the field of regenerative dentistry and dental biomaterials research. We cordially invite applications for the 2016 Award, in the form of written abstracts presenting original work that contributes to the advancement of treatment/care or research in regenerative dentistry. Dissertations, projects or practical experience may form the basis of applications. Submissions will be judged by a peer panel in a blind review process. The jury comprises leading academics/clinicians, who are internationally renowned authorities in the field and recognized experts from the industry. The winning application will be selected on the basis of its clinical and/or scientific quality as judged from the abstract and submitted materials. The first “Straumann-botiss YoungProAward in Regenerative Dentistry” was presented on 4 December 2015 to Andreas Pabst, DMD,, at the botiss bone & tissue days event in Salzburg, Austria. Entitled “In-vitro and in-vivo characterization of biocompatibility and biomechanical properties of a new acellular collagen matrix (mucoderm®)”, Dr Pabst’s winning entry concerns research into the use of tissue-graft products for regenerating gum tissues. WHO? The Award is open to dental professionals, including practitioners, students, researchers etc., who are under the age of 35. WHEN? Deadline for entries is 30 June, 2016. HOW? Complete details and the application process can be found at WHY? The winner will receive a cash prize of €10 000 as well as travel to, and participation at, the bone & tissue days World Congress Berlin 2016, 9-10 September where the Award will be presented, and announced to the media. The winner will present their abstract at the congress and it will be subsequently published on STARGET Digital. The post Rising stars sought in YoungProAward 2016 – apply now! appeared first on STARGET COM.


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