Dr. Todd Scheyer is in private practice specialized in periodontics and implant reconstructive dentistry in Houston, Texas and is the Partner / Director of Perio Health Clinical Research Center. He graduated magna cum laude from Dental School, Medical College of Virginia at Virginia Commonwealth University and earned his Certificate in Periodontics and Conscious Sedation from UTHSCSA as well as a Master of Science Degree from the University of Texas Health and Science Center School of Biomedical Science in San Antonio. Dr. Scheyer was the recipient of the John F. Prichard Award for graduate research, the American Academy of Periodontology Annual Award for Clinical Research in Periodontology and the American Academy of Periodontology R. Earl Robinson Periodontal Regeneration Award. He is a Diplomate of the American Board of Periodontology.
Dr. E. Todd Scheyer puts a very high value on scientific evidence and clinical outcomes. Although a researcher, he is a clinician first and places trust in long-term data to ensure he is using materials and protocols that will help him achieve successful and lasting 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. Scheyer shared with us.
For implants, there are many studies for 1-, 3- and 5-year results and beyond but with regenerative therapies, 6 month to 1 year data analysis was more typical. This paper profoundly changes the focus of a typical 6 month or 1 year study within periodontology. To have a well-controlled prospective study that was conducted in a private practice with a realistic demographic showing 10 year results is more powerful and meaningful. Clinical research is already a demand of our profession, but we need to understand that long term data is critical – this evidence needs to be brought to us routinely.
In the late 1990’s, I was among the first group of U.S. residents to begin working with Straumann Emdogain and actually did my thesis on Emdogain, Dr. Jim Mellonig being my mentor. My focus was to look at Emdogain in an attempt to understand if a biologic mediator could have clinical influence upon what we were seeing in periodontal defects with bone replacement grafts alone. There was no doubt that there was clinically improved wound healing at one week and upon 6 month re-entry when compared to a positive control. We published two papers during that time and we felt these were valuable initial efforts evaluating biologic mediators in a clinical setting treating periodontal defects.
The key to successful results include meticulous preparation with aggressive root preparation and motivating patient behavior change to optimize their ability to perform oral hygiene. If a patient’s systemic issues are not under control, I collaborate with their physician and delay surgery until they are stable. After treatment, I see patients at 1 week, 4 weeks and 6-8 weeks post-operative. Some referrers choose to alternate between Supportive Periodontal Treatment (SPT) visits, some do not. It is always important to have a flow chart of where to go next.
When I began my career in periodontology, the field was slow to adopt root coverage with alternative techniques to Connective Tissue Grafts (CTG). Periodontists wanted to see more evidence and look at different applications of various materials. With CTG, clinical observation and studies showed improved outcomes. As we began to see more histology and long term data on Emdogain*, we noticed something different. Compared to other products, we’re not just injecting one growth factor or membrane; we are introducing a biologic mediator with multiple benefits and mechanisms of action. This has greatly contributed to tissue engineering concepts.
We have witnessed Emdogain from its infancy in periodontics and I consider it a gold standard option in our practice – the recent long term evidence supports this. We will continue to look at Emdogain because most likely, it will help us to achieve our desired results.
*In combination with coronally advanced flap (CAF)