Your professional life is divided between Milan and Piacenza. What do these two beautiful cities mean to you?
Piacenza is where my home is, the place where I grew up, and the hub of my life. In Piacenza not only do I have my private practice since 1991, but the city is also where I established the Education Center iPerio. Because of my frequent traveling for scientific meetings, very rarely am I there on the weekends, and only for the iPerio courses.
Milan is less than a 1-hour drive and is the city that is home to the University where I work part-time, and where I like to spend some of my little free time. I love the cosmopolitan air of Milan, the restaurants and theaters, and my football team A.C. Milan.
What did the little boy Giulio want to be when he grew up?
The little Giulino wanted to be a soccer player, but I remember myself and my classmate in elementary school both saying that we would like to have been dentists. And growing up, I never changed my mind. I liked scientific studies and always loved to work with my hands. One of my specialties as a boy scout was skillful hands.
What were your first challenges as a student?
As a student I was OK, but distracted by many interests: boy scouts, sports, guitar, and friends, so the school was just taking a bit of time from my passions. I dealt with the school as I deal with my life, seriously but lightly.
“Starting my academic career came as a natural consequence of my passion. When dentistry and periodontology became not only a job, but also my hobby.” G. Rasperini
What convinced you to pursue an academic career?
Starting my academic career came as a natural consequence of my passion. When dentistry and periodontology became not only a job, but also my hobby.
You specialized in orthodontics, but became an expert periodontist. How do the two specialties complement each other?
At that time, ortho was the only specialization possible for a dentist in Italy. But I really like all dentistry. A good knowledge of perio and ortho helps a lot when it comes to treating advanced cases, so in the end it proved to be a very good idea.
Looking back, what was an interesting project that you think about with a proud smile?
Emdogain® is definitely one of those interesting projects.
Since I started to use it, I understood, together with my friends Maurizio Silvestri and Giano Ricci, that we needed a new surgical approach, so we published the surgical technique for using Emdogain® in 1999 on PRD. In this paper we underlined the advantages of opening smaller flaps compared to the use of membranes, and introduced new concepts like inserting the sutures before then placing the biomaterial, using the Laurell-Gottlow suture. To my knowledge, this is the first publication to mention this suturing technique. The description of this technique also includes many other tips, and this paper advanced the evolution of the minimal invasiveness concept. In June 2000, I introduced this new approach at the International Symposium of Periodontics and Restorative Dentistry in Boston and at Europerio 3 in Geneva. Achieving good results in the treatment of bony defects, we considered Enamel Matrix Derivative (Emdogain®) for a root coverage procedure with the aim of stopping the apical migration of the junctional epithelium and supporting regeneration. In 2000, on PRD we published the human histological evidence of periodontal regeneration using Emdogain® and a connective tissue graft. After this important evidence we wanted to explore the predictability and efficacy, and we published RCTs on both regeneration and mucogingival surgery, as well as long-term data. We also received the Earl Robinson Periodontal Regeneration award from the AAP in 2012 on this topic.
“By the time we used Emdogain® for the first time, in 1996, we experienced some failures when using a membrane to achieve regeneration, with consequent papilla loss and complications. Therefore, we were looking forward to something different, and we got it with Straumann® Emdogain®.” G. Rasperini
You were one of the first users of Emdogain®. How was the start of your journey with our product with 25 years of experience?
It was the end of 1995, start of 1996, and Swedish and Dutch Scientists came to the Italian Society of Periodontology (SIdP) and introduced this new biological concept. I and my friend Maurizio Silvestri were immediately intrigued by the biological concept. We received three free samples of the product before its launch on the market.
At that time, we experienced some failures when using a membrane to achieve regeneration, with consequent papilla loss and complications. Therefore, we were looking forward to something different, and we got it with Straumann® Emdogain®: a young patient came with a deep infrabony defect between the two central incisors and a high smile line. I didn’t want to risk membrane exposure and complications, so that was my first successful case with Emdogain®. It was April 1996, 26 years ago!
For which clinical indications is Straumann® Emdogain® your product of choice?
Since 1996, I have been using Emdogain® in every periodontal regeneration treatment, usually combined with Deproteinized Bovine Bone Mineral as a scaffold, and in challenging soft tissue management scenarios. Recently, I have also started to use it as the final step of “one-stage full mouth disinfection” non-surgical procedure.
“For over 25 years, I have been using Straumann® Emdogain® in every periodontal surgical treatment, usually in combination with a deproteinized bovine bone mineral graft that acts as a scaffold. Recently, I have started to use Emdogain® FL as part of the non-surgical procedures, as the final step of one-stage full mouth disinfection.” G. Rasperini
Where do you see the future of our amelogenin-based gel?
When I lecture around the world, one of the questions that I am often asked is about the predictability of the treatment. Do you understand? Many dentists think that regeneration is difficult and unpredictable. I want to clarify that there is strong evidence supporting the use of Enamel Matrix Derivative. And there’s also evidence supporting the specific techniques to use it at its best. With these in mind, the treatment is very predictable. That’s why I hope that, in future, dentists will become more confident in applying periodontal regeneration and saving more natural dentition, rather than extracting teeth that could be saved.
What do you think is the secret of the success of Emdogain®?
The secret is the combination of physical and biological characteristics. The consistency helps to stabilize the clot in the wound, and the amelogenins support the proliferation and differentiation of the fibroblasts into cementoblasts. Consequently, this leads to the formation of cementum with extrinsic fibers and the regeneration of the periodontium. Clinical and macroscopic benefits also include the beautiful and faster healing of the wound and the improved opening of the soft tissues.
Could you impart a few words to inspire and motivate young researchers and clinicians in the field of periodontology?
Periodontal knowledge is the basis for being able to elaborate on the diagnosis, treatment planning, and prognosis for our patients. Most of the time, severely periodontally affected teeth may be saved with the proper treatment. It is impossible to be a good dentist without good periodontal skills. To do research in this field is fantastic, because it involves basic science, biology, clinical skills, medical and surgical dentistry, pharmacology, etc. For me, it is very important also that science has no borders and links researchers all around the world. This is an amazing personal and professional experience!
Where can our readers find details of your educational programs?
I lead the Center of Education iPerio in Piacenza, Italy, near Milan. I invite you to learn more about it at www.iperio.org. Via the Center, we offer an annual course in the Italian language and three levels of education in English: Level 1 - Foundation, Level 2 - Masterclass, and Level 3 - Advanced. In addition, we offer the possibility of spending some days in the clinic and assisting the clinical activities and surgery.
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25-year follow-up case report: A surgical technique for treating a periodontal intrabony defect with Straumann® Emdogain®
In April 1996, a 30-year-old female patient presented with a high smile line and a Pocket Depth (PD) of 7 mm, and a radiographic infrabony defect mesial to tooth #21.
At that time Emdogain® had just been offered to a restricted number of opinion leaders, and the special issue of the Journal Clinical of Periodontology was published later, in September 1997.
Moreover, the knowledge at that time about periodontal tissue regeneration included two surgical techniques: papilla preservation in combination with the use of a particulate graft (Takei, 1985), or a membrane (Cortellini et al, 1995). Membrane exposure was frequent and, when it occurred, caused loss of the papilla, compromising the clinical outcome, particularly in the esthetic area.
Having the chance to use a new biomaterial in gel form, I also had to plan a proper surgical technique to keep the space for the clot and to make the wound stable.
- Figs. 1, 2: The clinical and radiological appearance of tooth #21. Probing indicated a pocket depth of 7 mm
- Figs. 1, 2: The clinical and radiological appearance of tooth #21. Probing indicated a pocket depth of 7 mm
- Fig. 3: The flap was elevated, preserving the papilla with an incision in the palatal aspect
- Fig. 4: The defect was cleaned, and the root surface was scaled and planned
- Figs. 5, 6: A Laurell-Gottlow suture was prepared and left loose. Then the gel of Emdogain® was applied onto the clean and dry root surface using a syringe with a large diameter needle
- Figs. 5, 6: A Laurell-Gottlow suture was prepared and left loose. Then the gel of Emdogain® was applied onto the clean and dry root surface using a syringe with a large diameter needle
- Figs. 7, 8: The suture was then tightened and closed
- Figs. 7, 8: The suture was then tightened and closed
- Figs. 9, 10: At 1 year, the pocket is closed with soft tissues perfectly maintained. Together with the patient, it was decided to close the diastema orthodontically (Dr. Achille Farina)
- Figs. 9, 10: At 1 year, the pocket is closed with soft tissues perfectly maintained. Together with the patient, it was decided to close the diastema orthodontically (Dr. Achille Farina)
- Figs. 11, 12, 13: At 18 months, the diastema is closed and the PD stable, revealing a pleasant esthetic appearance.
- Figs. 11, 12, 13: At 18 months, the diastema is closed and the PD stable, revealing a pleasant esthetic appearance.
- Figs. 11, 12, 13: At 18 months, the diastema is closed and the PD stable, revealing a pleasant esthetic appearance.
- Fig. 14: A comparison of the smile at baseline and 7 years later
- Fig. 15: The radiographic controls at 18 months, and 7 and 11 years, show the bone fill and stability over time.
- Figs. 16, 17: The PD at baseline (7 mm) and the controls at 18 months, and 7 and 11 years (3 mm). Note that a veneer has been performed on tooth #22 (Dr. Federico Ferraris)
- Figs. 16, 17: The PD at baseline (7 mm) and the controls at 18 months, and 7 and 11 years (3 mm). Note that a veneer has been performed on tooth #22 (Dr. Federico Ferraris)
- Figs. 18, 19, 20: 18-year follow-up shows a stable aesthetic and radiographic outcome, and PD of 3 mm. Just slight damage at the incisal edge of the two central incisors, subsequently fixed with direct adhesive restoration.
- Figs. 18, 19, 20: 18-year follow-up shows a stable aesthetic and radiographic outcome, and PD of 3 mm. Just slight damage at the incisal edge of the two central incisors, subsequently fixed with direct adhesive restoration.
- Figs. 18, 19, 20: 18-year follow-up shows a stable aesthetic and radiographic outcome, and PD of 3 mm. Just slight damage at the incisal edge of the two central incisors, subsequently fixed with direct adhesive restoration.
- Figs. 21, 22: 20-year outcome shows stable results
- Figs. 21, 22: 20-year outcome shows stable results
- Figs. 23, 24, 25: 25-year follow-up. The patient’s smile shows less of the gums than at baseline due to the age difference (30 years old versus 55 years old now) but it is still a very pleasant smile. The soft tissues are stable as well, as the PD remained consistently at 3 mm
- Figs. 23, 24, 25: 25-year follow-up. The patient’s smile shows less of the gums than at baseline due to the age difference (30 years old versus 55 years old now) but it is still a very pleasant smile. The soft tissues are stable as well, as the PD remained consistently at 3 mm
- Figs. 23, 24, 25: 25-year follow-up. The patient’s smile shows less of the gums than at baseline due to the age difference (30 years old versus 55 years old now) but it is still a very pleasant smile. The soft tissues are stable as well, as the PD remained consistently at 3 mm
- Fig. 26: The patient’s smile and a group celebration photo with the patient, Prof Rasperini, and the assistants Sonia and Morgana, who had assisted during the surgery 25 years before!
Special notes:
- The first photos were slides on films that were subsequently scanned. Together with the evolution of the follow-up, we also observed improvements in photographic technology over the years.
- The paper “Surgical Technique for Treatment of Infrabony Defects with Enamel Matrix Derivative (Straumann® Emdogain®): 3 Case Reports” written by Giulio Rasperini, Giano Ricci, and Maurizio Silvestri was published in Int J Period & Rest Dent in 1999, and introduced for the first time a surgical technique that used a biological material, a gel. The publication was inspired by this case and a few others.
Straumann® Emdogain® is a unique gel containing enamel matrix derivative of porcine origin. The main component is amelogenin, which has demonstrated the ability to stimulate certain cell types involved in the healing process of soft and hard tissues towards a regenerative pattern, thus leading to true periodontal regeneration1 and accelerated oral wound healing2. Straumann® Emdogain® has a respected legacy as an irreplaceable tool for periodontology backed by extensive and long-term clinical documentation, including studies with 10 years of follow-up3,4. Over the past 25 years, it has been used in over 2.5 million patients5 and it is documented in over 1,100 scientific publications, including over 600 clinical papers6 on various indications. For more information: click here.
