牙釉基質蛋白－現存的臨床證據與未來的展望

Enamel Matrix Derivatives-Existing Clinical Evidences and Future Inspection

何政昇(Albert Cheng-Sheng Ho)

《臺灣牙周病醫學會雜誌》 19卷1期 (2014/03) Pp. 27-53

https://doi.org/10.6121/TAP.2013.19.1.04

摘要

傳統的牙周引導再生手術藉由清除骨內缺損處的結石及發炎的肉芽組織後，覆蓋不同材料的再生膜來達到日後的牙周組織再生重建。有時在大型缺陷中配合使用人工骨粉來獲得更多的骨頭與牙周組織的再生。牙釉基質蛋白（enamel matrix derivatives, EMD）取自發育中幼豬胚胎的牙釉質母細胞所分泌一種類似牙釉蛋白（amelogenin）的生長因子，經由萃取分離後，溶解於液態的攜帶因子蛋白（propylene glycol alginate, PGA）中製成針劑，臨床操作時將EMD打到骨內缺損處，EMD會在不同的溫度及酸鹼度下可以再度沉澱出來，吸附於牙根表面，進而促進造牙骨質母細胞與造骨母細胞的分化，在不使用再生膜及人工骨粉的情況下，也能達到牙周組織再生的效果。使用牙釉基質蛋白，在操作上更為簡便，且不必擔心再生膜的暴露，以及減少術後的明顯腫痛。眾多研究文獻的治療評估，顯示出良好的牙周組織再生的效果。此外，牙釉基質蛋白搭配人工骨粉與再生膜的治療使用，臨床上是否能有更好的額外治療效益？本文將就目前相關研究的臨床證據來釐清此種治療的成果與評估，並對牙釉基質蛋白的研究背景與文獻回顧做一探討。

關鍵字

牙釉基質蛋白 ； 牙釉質母細胞 ； 造牙骨質母細胞

並列摘要

The traditional technique of guided tissue regeneration is based on the elimination of calculus and granuloma inside the intrabony defect, which is followed by coverage by a barrier membrane, which can be made of various different materials, of the defect site with the aim of allowing regeneration of the periodontal tissue. Sometimes, when there is a large intrabony defect, a bone graft is used as an adjunct to allow faster regeneration of new bone and new periodontal tissue. Enamel matrix derivatives (EMD) are purified from the proteins secreted by ameloblasts within porcine tooth buds and this product is very similar to amelogenin. After purification, the enamel matrix derivatives are dissolved with carrier protein (propylene glycol alginate, PGA) to form a solution and this is used delivered via a type of syringe. Enamel matrix derivatives once delivered separate due to changes in temperature and pH and are then absorbed onto the root surface; the aim being to enhance the differentiation of cementoblasts and osteoblasts, which will aid regeneration without the use of either a bone graft or a barrier membrane. The use of enamel matrix derivatives simplifies the surgical procedure and reduces the risk of early membrane exposure, which is often accompanied by wound contamination as well as post-operative swelling and pain. Various evaluation studies and a number of research studies have shown that enamel matrix derivatives are able to bring about good regeneration of periodontal tissue. In addition, there remains the question as to whether there would be additional treatment benefits if enamel matrix derivatives are used in combination with a bone graft and/or a membrane. This article evaluates and clarifies the clinical outcomes of such combined treatments, as well as exploring the research background of enamel matrix derivatives. Finally, a literature review of the use of enamel matrix derivatives, based on existing clinical and research evidence, will be presented.

並列關鍵字

enamel matrix derivatives ； osteoblast ； cementoblast