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Leonardo Trombelli: Periodontal regeneration with the Single Flap Approach (Straumann® Emdogain)


Periodontitis is the most common chronic inflammatory disease seen in humans. 5 – 15% of the worldwide population suffers from severe periodontitis that may lead to tooth loss [1]. Subjects with periodontitis have a 25% increased risk for coronary heart disease when compared to periodontitis-free individuals [2].  Over the years, many treatment strategies have been devised to treat this condition by regenerating the hard and soft tissues lost due to periodontal disease or trauma. Various surgical techniques and biomaterials have been explored. With the Single Flap Approach (SFA), Prof. Leonardo Trombelli has developed a simplified but effective procedure.

Prof. Leonardo Trombelli
“Simplified Surgical Procedures for Periodontal Regeneration” – Live surgery and hands-on course
September 7-8 2017 at the Ferrara Regeneration Campus in Ferrara, Italy


Technique matters: Flap design and suture techniques are of paramount importance for maximizing the reconstructive potential of a biomaterial [3]. Watch Prof. Leonardo Trombelli’s surgical movies on the Straumann website.

Key: the adequate surgical procedure
While an adequate biomaterial contributes to the success of a regenerative treatment, an adequate surgical procedure is key. In recent years, it has been understood that the stability of the root surface-adhering blood clot is of paramount importance to ensure adequate early healing which allows for the cascade of biologic events leading to periodontal regeneration to take place. A dehiscence of the wound margin which may occur as a result of a compromised vascular supply due to surgical manipulation and/or tensile forces could jeopardize regeneration. [4] 

A simplified and effective procedure
A flap design and suturing technique which allow for stabilization of the blood clot and its protection from mechanical and microbiologic challenges is then the solution. The Single Flap Approach (SFA) is one of the techniques which fulfills such requirements. It represents a simplified procedure that allows to surgically access intrabony periodontal defects by raising a single full thickness flap (either buccal or lingual, depending on the defect extension). [5] The Single Flap Approach (SFA) leads to considerable clinical improvement [6]. It is similarly effective to the double flap (i.e., buccal and palatal) approach [7]. SFA leads to limited postsurgical recession making it a suitable option to surgically treat defects in areas with high esthetic demands [8].

Case report by Prof. Leonardo Trombelli illustrating the Single Flap Approach

At the diagnosis stage, periodontal probing indicates a deep periodontal pocket (Fig. 1). A regenera¬tive treatment based on the single flap approach technique in combination with Straumann® Emdogain® is performed (Figs. 2 and 3). Two weeks after the treatment, the soft tissue at the surgical site is in good condition (Fig.4). Probing at one year post-op indicates healthy periodontal conditions (Figs. 5 and 6, right). Courtesy of Prof. Leonardo Trombelli.

Straumann® Emdogain® (used alone or in combination with bone graft) is arguably the material of choice to treat periodontal defects. Adding Emdogain® to an open flap debridement surgical procedure has demonstrated to yield significantly better clinical results than the procedure alone . Adding Emdogain® to the procedure has also been shown to significantly reduce post-surgical pain and swelling, as well as improve wound healing .
    • 20 years on the market
    • 2 million patients treated*
    • Over 1000 scientific publications***
    • Over 600 clinical publications
    • Extremely well tolerated**

*based on number of syringes sold globally
**based on a global post-surgical complication rate of less than 0.002%
*** based on pubmed search for Emdogain or “enamel matrix derivative”

Leonardo Trombelli

Full Professor and Chair, Periodontology and Implantology, School of Dentistry, University of Ferrara. Director of Research Center for the Study of Periodontal and Periimplant Diseases, University of Ferrara. Director, Dental Clinic, University Hospital, Ferrara. Dean, Dental School, University of Ferrara. Private pratice focused on Periodontology and Implantology.

1 AAP: Position Paper: Epidemiology of Periodontal diseases. J Periodontol 76, 2005;1406 – 1419 2 DeStefano et al., Dental disease and risk of coronary heart disease and mortality. BMJ. 1993 Mar 13;306(6879):688-91. 3 Sculean et al. Ten-year results following treatment of intra-bony defects with enamel matrix proteins and guided tissue regeneration. J Clin Periodontol. 2008 Sep;35(9):817-24 4 Ozcelik et al. Immediate post-operative effects of different periodontal treatment modalities on oral health-related quality of life: a randomized clinical trial. J Clin Periodontol. 2007 Sep;34(9):788-96. 5 Polimeni G, et al. Biology and principles of periodontal wound healing/regeneration. Periodontol 2000, 2006; 41:30–47 6 Farina et al. Single-flap approach in combination with enamel matrix derivative in the treatment of periodontal intraosseous defects. Int J Periodontics Restorative Dent. 2014 Jul-Aug;34(4):497-506. 7 Trombelli et al. Single-flap approach for surgical debridement of deep intraosseous defects: a randomized controlled trial. J Periodontol. 2012 Jan;83(1):27-35. 8 Trombelli et al. Single-flap approach with buccal access in periodontal reconstructive procedures.J Periodontol. 2009 Feb;80(2):353-60.

By | 2017-08-17T08:29:31+00:00 March 18th, 2017|Clinical Cases, Dental Biomaterials, Education|1 Comment

One Comment

  1. Sergio Iván Tobón Correa April 12, 2017 at 1:52 pm - Reply

    Great concept and technique. I hope to meet you on next month. Thank you very much dear colleague.


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