Enamel matrix derivative, inflammation and soft tissue wound healing

Abstract

Over 15 years have now passed since enamel matrix derivative (EMD) emerged as an agent capable of periodontal regeneration. Following thorough investigation, evidenced-based clinical application is now established for a multitude of clinical settings to promote regeneration of periodontal hard tissues. Despite the large number of studies and review articles written on this topic, no single review has compiled the influence of EMD on tissue inflammation, an area of research that merits substantial attention in periodontology. The aim of the present review was to gather all studies that deal with the effects of EMD on tissue inflammation with particular interest in the cellular mechanisms involved in inflammation and soft tissue wound healing/resolution. The effects of EMD on monocytes, macrophages, lymphocytes, neutrophils, fibroblasts and endothelial cells were investigated for changes in cell behavior as well as release of inflammatory markers, including interleukins, prostaglandins, tumor necrosis factor-α, matrix metalloproteinases and members of the OPG-RANKL pathway. In summary, studies listed in this review have reported that EMD is able to significantly decrease interleukin-1b and RANKL expression, increase prostaglandin E2 and OPG expression, increase proliferation and migration of T lymphocytes, induce monocyte differentiation, increase bacterial and tissue debris clearance, as well as increase fibroplasias and angiogenesis by inducing endothelial cell proliferation, migration and capillary-like sprout formation. The outcomes from the present review article indicate that EMD is able to affect substantially the inflammatory and healing responses and lay the groundwork for future investigation in the field.

Strontium enhances proliferation and osteogenic behavior of periodontal ligament cells in vitro

“…The literature suggests that roughly 30% of PDLCs retain the potential to differentiate into cells with osteoblastic properties . To stimulate and enhance this differentiation process, several substances have been tested, ranging from bone‐like materials (eg, hydroxyapatite), to vitamins, polypeptides, and proteins (eg, enamel matrix derivatives and bone morphogenetic proteins ‐ BMPs) . A recently added candidate to be included in this test‐list is Sr .…”

Effectiveness of enamel matrix derivative on the clinical and microbiological outcomes following surgical regenerative treatment of peri‐implantitis. A randomized controlled trial

“…Interestingly, EMD has been shown to increase the OPG/RANKL ratio in osteoblast cultures and subsequently inhibit osteoclast formation in vitro , which may reduce local bone resorption and favour bone formation (Miron et al. ). This study revealed that gaining bone from baseline to the 12‐month follow‐up was associated with EMD treatment and a Gram+/aerobic bacterial flora, which indicate a possible role of EMD on both bone regeneration and microflora in vivo .…”

Osteogain improves osteoblast adhesion, proliferation and differentiation on a bovine‐derived natural bone mineral

“…; Miron et al. ,b,c). Amelogenins, the major components of EMD, are a family of hydrophobic proteins that account for over 90% of the total protein content (Lyngstadaas et al.…”

“…For these reasons, the combination of EMD with various bone grafting materials has been utilized to improve both hard and soft tissue regeneration (Miron et al. ,b,c; Matarasso et al. ).…”