Enamel Matrix Derivative Proteins in Combination with a Flapless Approach for Periodontal Regeneration of Intrabony Defects: A 2-Year Prospective Case Series

Aimetti, Mario; Ferrarotti, Francesco; Mariani, Giulia Maria; Fratini, Adriano; Giraudi, Marta; Romano, Federica

doi:10.11607/prd.2842

Cited by 9 publications

(6 citation statements)

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“…EMD is derived from purified enamel matrix proteins that have shown favorable preclinical and clinical results [ 39 , 40 ]. Over the past 20 years, EMDs have been shown to facilitate osteoblast and PDLSCs adhesion, proliferation and differentiation.…”

Section: Bioactive Molecules Associated With Periodontal Regeneratmentioning

confidence: 99%

Contributions of Bioactive Molecules in Stem Cell-Based Periodontal Regeneration

Liu

Jin

et al. 2018

IJMS

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Periodontal disease is a widespread disease, which without proper treatment, may lead to tooth loss in adults. Because stem cells from the inflammatory microenvironment created by periodontal disease exhibit impaired regeneration potential even under favorable conditions, it is difficult to obtain satisfactory therapeutic outcomes using traditional treatments, which only focus on the control of inflammation. Therefore, a new stem cell-based therapy known as cell aggregates/cell sheets technology has emerged. This approach provides sufficient numbers of stem cells with high viability for treating the defective site and offers new hope in the field of periodontal regeneration. However, it is not sufficient for regenerating periodontal tissues by delivering cell aggregates/cell sheets to the impaired microenvironment in order to suppress the function of resident cells. In the present review, we summarize some promising bioactive molecules that act as cellular signals, which recreate a favorable microenvironment for tissue regeneration, recruit endogenous cells into the defective site and enhance the viability of exogenous cells.

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Section: Bioactive Molecules Associated With Periodontal Regeneratmentioning

confidence: 99%

Contributions of Bioactive Molecules in Stem Cell-Based Periodontal Regeneration

Liu

Jin

et al. 2018

IJMS

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“…(Andrei et al, 2018; Siaili, Chatzopoulou & Gillam, 2018). GTR and growth factor utilization are currently applied clinically but only result in partial regeneration which may be due to the unique periodontal anatomical structure and different alveolar bone defect morphology (Ripamonti & Petit, 2009; Bottino et al, 2012; Aimetti et al, 2016; Soltani Dehnavi et al, 2018). Therefore, suitable seed cells and efficient cytotherapeutic approaches are imperative for the regeneration of periodontium.…”

Section: Introductionmentioning

confidence: 99%

Osteogenic capacity and cytotherapeutic potential of periodontal ligament cells for periodontal regeneration in vitro and in vivo

Li¹,

Zhang²,

Zhang³

et al. 2019

PeerJ

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Background The periodontal ligament cells (PDLCs) contain heterogeneous cell populations and possess stem-cell-like properties. PDLCs have attracted considerable attention as an option for periodontal regeneration. However, the osteogenic differentiation of PDLCs remains obscure owing to variable osteo-inductive methods and whether PDLCs could be directly used for periodontal regeneration without stem cell enrichment is uncertain. The aim of the present study was to clarify the osteogenic differentiation capacity of PDLCs and test PDLCs as an alternative to stem cells for periodontal regeneration. Methods We tested the performance of human PDLCs in osteo-inductive culture and transplantation in vivo while taking human bone marrow derived mesenchymal stem cells (hMSCs) as positive control. Proliferation of PDLCs and hMSCs in osteo-inductive condition were examined by MTT assay and colony formation assay. The osteogenic differentiations of PDLCs and hMSCs were assessed by Alkaline phosphatase (ALP) activity measurement, von Kossa staining, Alizarin red S staining and quantitative RT-PCR of osteogenic marker gene including RUNX2, ALP, OCN, Col I, BSP, OPN. We transplanted osteo-inductive PDLCs and hMSCs with hydroxyapatite/tricalcium phosphate (HA/TCP) scaffolds to immunodeficient mice to explore their biological behaviors in vivo by histological staining and immunohistochemical evaluation. Results After 14 days of osteo-induction, PDLCs exhibited significantly higher proliferation rate but lower colony-forming ability comparing with hMSCs. PDLCs demonstrated lower ALP activity and generated fewer mineralized nodules than hMSCs. PDLCs showed overall up-regulated expression of RUNX2, ALP, OCN, Col I, BSP, OPN after osteo-induction. Col I level of PDLCs in osteo-inductive group was significantly higher while RUNX2, ALP, OCN were lower than that of hMSCs. Massive fiber bundles were produced linking or circling the scaffold while the bone-like structures were limited in the PDLCs-loaded HA/TCP samples. The fiber bundles displayed strong positive Col I, but weak OCN and OPN staining. The in vivo results were consistent with the in vitro data, which confirmed strong collagen forming ability and considerable osteogenic potential of PDLCs. Conclusion It is encouraging to find that PDLCs exhibit higher proliferation, stronger collagen fiber formation capacity, but lower osteogenic differentiation ability in comparison with hMSCs. This characteristic is essential for the successful periodontal reconstruction which is based on the synchronization of fiber formation and bone deposition. Moreover, PDLCs have advantages such as good accessibility, abundant source, vigorous proliferation and evident osteogenic differentiation capacity when triggered properly. They can independently form PDL-like structure in vivo without specific stem cell enrichment procedure. The application of PDLCs may offer a novel cytotherapeutic option for future clinical periodontal reconstruction.

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“…The PRISMA flow diagram of the study selection process is presented in Figure 1. An initial electronic and manual search yielded a total of 1199 articles, out of which 22 potentially relevant publications were selected after an evaluation of their titles and abstracts 14,22–42 . After full‐text analysis, nine articles fulfilled the inclusion criteria and were subsequently included in the systematic review 22–25,28,30–33 …”

Section: Resultsmentioning

confidence: 99%

“…When EMD was applied in intrabony defects either flapless or using a minimally invasive flap procedure, both treatment modalities resulted in similar CAL gain and PPD reduction, while the flapless approach required less chair time 27 Similarly, a case‐series publication by Aimetti et al 26 showed significant clinical and radiographic benefits following the flapless application of EMD. EMD has also been tested in peri‐implant tissues.…”

Section: Discussionmentioning

confidence: 99%

Flapless application of enamel matrix derivative in non‐surgical periodontal treatment: A systematic review

Chatzopoulos

Anastasopoulos

Zarenti

et al. 2022

Int J Dental Hygiene

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Background and Objective To assess the effects of the flapless application of enamel matrix derivative (EMD) in combination with non‐surgical periodontal treatment (NSPT) when compared to non‐surgical periodontal treatment alone in adult patients. Material and methods An electronic literature search was conducted in MEDLINE, Scopus and Cochrane Library up to March 2021 complemented by a manual search. Human longitudinal studies of >5 participants and at least 3 months follow‐up were eligible for inclusion in the review. Clinical outcomes were extracted and pooled. Meta‐analysis of the included studies was not possible due to methodological differences. Results A total of 1199 publications were identified and reviewed for eligibility. Nine of them fulfilled the inclusion criteria. Eight studies were randomized clinical trials. The clinical findings of the majority of the included studies demonstrated that the adjunctive use of EMD with NSPT could lead to significantly improved treatment outcomes including higher PPD reduction, more CAL gain, more robust BOP reduction, higher number of sites with PPD < 5 mm and more frequent pocket closure which reduces the need for further periodontal surgical treatment. Limited biological, microbiological and histological findings were reported. Minimal adverse events were observed. Conclusion The flapless application of EMD during NSPT leads to an improved clinical outcome in regards to CAL gain and PPD reduction when compared to conventional treatment alone. The potential effect on the biological and microbiological outcome is unclear.

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Enamel Matrix Derivative Proteins in Combination with a Flapless Approach for Periodontal Regeneration of Intrabony Defects: A 2-Year Prospective Case Series

Cited by 9 publications

References 0 publications

Contributions of Bioactive Molecules in Stem Cell-Based Periodontal Regeneration

Contributions of Bioactive Molecules in Stem Cell-Based Periodontal Regeneration

Osteogenic capacity and cytotherapeutic potential of periodontal ligament cells for periodontal regeneration in vitro and in vivo

Flapless application of enamel matrix derivative in non‐surgical periodontal treatment: A systematic review

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