釉基质蛋白促进牙周组织再生作用的再认识

Re-understanding the role of enamel matrix proteins in periodontal regeneration

釉基质蛋白(enamel matrix proteins,EMP)在牙骨质形成前沉积在发育中的牙根表面,并可能在牙骨质形成中发挥作用,釉原蛋白(amelogenins,Am)是EMP中的主要组分和活性成分。研究显示EMP在牙周组织再生治疗等领域具有重要的应用价值。EMP可通过影响生长因子和炎症因子的表达,作用于各类牙周组织再生相关细胞,发挥促进血管形成、抗炎抑菌和加速组织愈合等功能,从而达到牙周组织再生的临床效果(新生牙骨质、牙槽骨并有牙周膜功能性穿通)。单独使用EMP或EMP联合植骨材料或屏障膜,可用于骨内缺损、上颌颊侧和下颌Ⅱ度根分叉病变的再生性手术治疗;EMP还可以辅助治疗退缩类型为1或2类的牙龈退缩,使暴露的根面重新获得真正的牙周组织再生。随着学界对EMP的牙周再生原理和当前临床应用的全面了解和认识,可进一步展望EMP未来的发展。采用生物工程技术开发重组的人Am以替代动物来源的EMP,研究EMP与其他胶原生物材料的联合应用,以及探讨在重度牙周软硬组织缺损和种植体周病变中EMP的具体应用方式,都是未来EMP相关研究的重要发展方向。

Enamel matrix proteins(EMP)are deposited on the surface of developing roots before dentin formation and may play a role in osteogenesis.Amelogenins(Am)are the main and active component in EMPs.Studies had showed great clinical values of EMPs in periodontal regenerative treatment and other fields.By affecting the expression of growth factors and inflammatory factors,EMPs could act on various periodontal regeneration-related cells to promote angiogenesis,anti-inflammation,bacteriostasis and tissue healing,achieving the clinical effect of periodontal tissue regeneration(newly generated cements and alveolar bones as well as functionally penetrated periodontal ligament).EMPs alone or combined with bone graft material and barrier can be used for regenerative surgical treatment in intrabony defects and degreeⅡfurcation-involved at maxillary buccal or mandibular teeth.EMPs can also be adjunctively used to treat recession type 1 or 2 gingival recessions,forming periodontal regeneration on the exposed root surface.Through a comprehensive understanding of the principle and current clinical application of EMPs on periodontal regeneration,we can look forward to their future development.The development of recombinant human amelogenin to replace animal-derived EMPs through bioengineering technologies,the study of the clinical application of EMPs combined with other collagen biomaterials,and the specific application of EMPs in severe soft and hard periodontal tissue defects and peri-implant lesions are all important development directions of future EMPs-related researches.