Enamel Matrix Derivative (EMDOGAIN) for the treatment of gum recession and dental implant infection/ridge management

All the surgical procedures will be perform by Dr. F Mercado, an experience Periodontist with 20 years of surgical experience doing these procedures. For Periodontal Recession: Treatment Test Group - Periodontal plastic surgery using connective tissue graft harvested from the palate combined with enamel matrix derivative application. The connective tissue or gum graft will be harvested from the palate by numbing the roof of the mouth. The superficial gum on the palate (1-1.5 mm) will be harvested. This usually takes around 20-30 minutes. The palate will be close by sutures that dissolves. This wound will normally be fully healed 1-2 weeks after the surgery. The patient will require 1-2 days of full rest at home with soft diet for a week. Each patient will have one carpule of emdogain (.35 ml standard car pule) which be applied on the root of the affected teeth before the gum graft is sutured onto the teeth. Control Group - Connective Tissue Graft alone. This is the standard/conventional mode of treatment of gum recession. For Peri-implantitis Test: Bone xenograft with enamel matrix derivative after peri-implantitis surgical cleaning. Each patient will receive one block (250 mg Bio-Oss xenogarft) which is made by the company Geistlich, Switzerland. This bone graft with emdogain will be applied in the socket or applied around the implant after the implants are clean and removed of infection. This bone graft is deproteinised cow bone made in Switzerland and has been used in Australia for more than 10 years. The addition of emdogain on this group will check if the bone will be more stable after treatment. Control: Bone xenograft alone after peri-implantitis surgical cleaning. This bone graft (without emdoagin) will be applied in the socket or applied around the implant after deep cleaning. This is the standard/conventional method of treatment at the moment. The purpose of this study is to improve the clinical outcomes of peri-implantitis and bone level and periodontal recession treatment. To do this, Griffith University is conducting research into the reported beneficial effects of enamel matrix proteins which are reported to play a key role in the development of tooth-supporting tissues. Emdogain™, produced by the Swiss company ‘Straumann’, is a commercially available protein-based gel derived from the baby teeth of mini-pigs. The main active ingredient, amelogenin, is the same as that found humans and does not cause any allergic reaction. The addition of Emdogain™ to current treatment protocols may therefore help improve the predictability and outcome of periodontal treatment procedures by inducing more natural bone formation in peri-implantitis affected areas and help promote the regeneration of new tissues including gum, bone and periodontal ligament required for the management of periodontal recession. The clinical success of the addition of Emdogain™ to current treatment protocols will be determined by comparing the clinical measurements taken before and after periodontal surgeries. Furthermore, samples collected during these visits will be assessed in the laboratory to help us determine what biological parameters may be responsible for any improvement in clinical outcomes.