With a Bachelor’s degree in Psychology from Baylor University in Waco, TX and a DDS and Certificate of Periodontics from Emory University School of Dentistry in Atlanta, GA, Dr. McGuire is the author of over fifty scientific articles and textbook chapters on periodontology. He is a member of several editorial boards, including the Journal of Periodontology and the International Journal of Periodontics and Restorative Dentistry and a highly respected lecturer for both national and international audiences. Dr. McGuire is the recipient of the Robinson Regeneration Award, the Clinical Research Award and the Master Clinician Award by the American Academy of Periodontology as well as a Diplomate of the American Board of Periodontology and President of numerous dental organizations, including the American Academy of Periodontology and the American Academy of Periodontology Foundation.
Dr. Michael McGuire puts a very high value on scientific evidence. Though a researcher, he is a clinician first and places trust in long-term data to ensure he is using materials that will help him achieve successful results for his patients.
We took the opportunity to learn more about results of a study recently published in the Journal of Periodontology by Doctors McGuire, Scheyer and Nunn to evaluate human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue, a comparison of clinical parameters at 10 years. Here’s what Dr. McGuire shared with us.
This 10 year study was the continuation of our original 12 month study comparing Straumann® Emdogain™ to an autogenous connective tissue graft in recession defects. The original protocol was not intended as a long-term study. The follow-up provided us with real life situations. It was not highly controlled to bring patients back more frequently so maintenance was a choice for this group. Though we instructed patients on home care and encouraged them to have regular maintenance visits, we had no way of ensuring that they would follow through with our suggestions, thus giving us even more confidence that the results represent what you would find in practice and not just in a highly controlled study. It is one thing to solve a problem initially but if it’s not successful in the long-run, we are not treating our patients the best we can. Long-term data is very powerful for both the patient and clinician.
As periodontists, we were trained that the thicker tissue resulting from the connective tissue grafts (CTG) translates into less recession over time. We found in the 10 year follow-up that the CTG remains thicker which some patients considered less esthetic.That thickness did not seem to contribute to increased stability because we found there was no more recession at 10 years with the more natural-looking sites treated with Straumann Emdogain in combination with a coronally advanced flap (CAF). Our goal in soft tissue grafting today is to have the grafted tissue look like nature intended it to look and to blend into the tissue of the area treated. The results of this study send a strong message that CAF and Straumann Emdogain provides a stable, esthetic and long-term solution for our patients.
When it comes to periodontal disease, maintenance plays a very important role. We take into consideration such factors as home care including how to brush properly with the use of a soft toothbrush and we evaluate the patient’s occlusion. Many patients with recession have parafunctional habits and a nightguard is important with this group. I let them know that if they don’t wear their nightguard, then they lose their warranty. Recession treatment is very predictable and we typically release the patient back to the general practitioner at 6 weeks.
We work closely with our referring doctors through monthly education/study clubs, letters regarding patient treatment and follow-up as well as expectations and home care. With Straumann Emdogain, the results are predictable and the referring doctor knows his/her patient won’t have to return to the specialist again and again. We live in a busy society and patients do not want to come in frequently. It is important that we work together to combine excellent results and high patient satisfaction with long-term success.
As a clinician, I am intellectually curious and I am always looking for more effective modalities to achieve regeneration. Straumann Emdogain was the first material commercially available that represented a different way of attempting regeneration of oral tissue.
I first started using Emdogain when it first became available around 1997 and it is used in my practice almost every day. We use it for both intrabony defects and recession sites. From the clinical perspective, it is relatively easy to use and I can generally treat multiple sites in one patient with one vial. The tremendous body of evidence supporting Emdogain is impressive and it continues to grow, so I feel comfortable using it in my practice for a variety of reasons.
No matter what regenerative material is being used, it cannot overcome or compensate for sloppy surgery. There is no silver bullet – it doesn’t work that way. It is crucial to pay attention to surgical guidelines and keep the area as inflammation free as possible. The principles of flap design must be followed and the site must be isolated and dry prior to applying Straumann Emdogain. Primary closure is important and you need to protect the site postoperatively.
With Emdogain, the science supports that regeneration of lost tissues is possible, giving us confidence in the material. When I sit to talk with a patient, I can talk about something other than resective approaches – patients are interested in regeneration, not resection. On the whole, regenerative procedures are changing the way we practice and Emdogain was the first player in the world of biologics and continues to set the bar high.