Enamel Matrix Derivatives for Periodontal Regeneration: Recent Developments and Future Perspectives

Abstract

In the era of the growing population, the demand for dental care is increasing at a fast pace for both older and younger people. One of the dental diseases that has attracted significant research is periodontitis. Periodontal therapy aims to regenerate tissues that are injured by periodontal disease. During recent decades, various pioneering strategies and products have been introduced for restoring or regeneration of periodontal deficiencies. One of these involves the regeneration of tissues under guidance using enamel matrix derivatives (EMDs) or combinations of these. EMDs are mainly comprised of amelogenins, which is one of the most common biological agents used in periodontics. Multiple studies have been reported regarding the role of EMD in periodontal tissue regeneration; however, the extensive mechanism remains elusive. The EMDs could promote periodontal regeneration mainly through inducing periodontal attachment during tooth formation. EMD mimics biological processes that occur during periodontal tissue growth. During root development, enamel matrix proteins are formed on the root surface by Hertwig’s epithelial root sheath cells, initiating the process of cementogenesis. This article reviews the challenges and recent advances in preclinical and clinical applications of EMDs in periodontal regeneration. Moreover, we discuss the current evidence on the mechanisms of action of EMDs in the regeneration of periodontal tissues.

Clinical and Radiographic Evaluation of Autologous Platelet-Rich Fibrin With or Without Demineralized Bone Matrix in the Treatment of Grade II Furcation Defects

“…According to a 2017 study, PRF promotes excellent soft tissue repair compared to rhBMP-2. Furthermore, it is impossible to disregard the additional advantages of PRF's accessibility and cost [ 9 , 96 ].…”

Local drug delivery and periodontal regeneration: Are we in a dire strait? An original review

“…Limitations of EMD's  EMD'S lacks exact mechanism of action for periodontal regeneration.  When used with grafts, EMD-bone causes precipitate formation of different sizes and morphologies which envelop the grafts differently [62] .  Application of EMD alone could be used in well contained defects only [63] .…”

Enamel Matrix Derivative (Emdogain) for Wound Healing and Bone Regeneration: A Short-Review

“…Particularly, it can be used as a part of flap surgeries in general comprising dental implantation, peri-implant procedures and for soft tissue grafting and gingivectomy [7][8][9] . The application of EMD is quite easy, even if the defect is difficult to access and does not require any adaptation during the surgical procedure [10] ; brief information about Emdogain ® is listed in Table 1. The mechanism of EMD has not been fully understood.…”