The Use of Enamel Matrix Derivative in the Treatment of Periodontal Defects: a Literature Review and Meta-analysis

Abstract

Background-Periodontal disease results in the loss of the attachment apparatus. In the last three decades, an increasing effort has been placed on seeking procedures and materials to promote the regeneration of this tissue. The aim of this paper is to evaluate the effect of enamel matrix derivative (EMD) during regenerative procedures. In addition, a meta-analysis is presented regarding the clinical results during regeneration with EMD, to gain evidence as to what can be accomplished following treatment of intrabony defects with EMD in terms of probing depth reduction, clinical attachment level gain, defect fill (using re-entry studies), and radiographic parameters. Methods-The review includes in vitro and in vivo studies as well as human case reports, clinical comparative trials, and histologic findings. In addition, a meta-analysis is presented regarding the regenerative clinical results. For this purpose, we used 28 studies-including 955 intrabony defects treated with EMD that presented baseline and final data on probing depth, clinical attachment level (CAL) gain, or bone gain-to calculate weighted mean changes in the different parameters. The selected studies were pooled from the MEDLINE database at the end of May, 2003. Results-The meta-analysis of intrabony defects treated with EMD resulted in a mean initial probing depth of 7.94 ± 0.05 mm that was reduced to 3.63 ± 0.04 mm (p = 0.000). The mean clinical attachment level changed from 9.4 ± 0.06 mm to 5.82 ± 0.07 mm (p = 0.000). These results were significantly better than the results obtained for either open-flap debridement (OFD) or guided tissue regeneration (GTR). In contrast, histologically, GTR is more predictable than EMD in terms of bone and cementum formation. No advantage was found for combining EMD and GTR. Xenograft, or EMD and xenograft, yielded inferior results compared with EMD alone, but a limited number of studies evaluated this issue. Promising results were noted for the combination of allograft materials and EMD. Conclusions-EMD seems to be safe, was able to regenerate lost periodontal tissues in previously diseased sites based on clinical parameters, and was better than OFD or GTR. Its combination with allograft materials may be of additional benefit but still needs to be further investigated.Key words. Enamel matrix derivative, Emdogain ® , meta-analysis, periodontal regeneration. States Food and Drug Administration (FDA).In 1997, an alternative approach for periodontal regeneration was introduced that was based on embryonic tooth formation (Hammarström, 1997;Heijl et al., 1997). This approach uses an extract of embryonic enamel matrix, termed 'enamel matrix derivative' (EMD), thought to induce mesenchymal cells to mimic the processes that take place during the development of the nascent root and periodontal tissues. The present analysis reviews the data on the effect of EMD as a regenerative promoter. It encompasses in vitro and in vivo studies as well as human case reports, clinical comparative trials, and histologic findin...

Growth factor delivery for oral and periodontal tissue engineering

“…After coating the tooth root close to the periodontal defect, the propylene glycol alginate viscosity is reduced under physiological conditions and facilitates EMD release and precipitation [131]. Recent systematic reviews were published on the efficacy of this product in the treatment of periodontal bony defects supporting its use [132][133][134].…”

Effects of Enamel Matrix Derivative on Bioactive Glass in Rat Calvarium Defects

“…The bioactive glass particles were seen in the defect (Specimens stained with Hematoxylin and Eosin, original magnification ×10). 33 Saggital histological section through the calvaria showing defect from 38 the critical size bone grafted with bioactive glass plus enamel matrix derivative after 4 weeks. ( Specimens stained with Hematoxylin and Eosin, original magnification ×5 ).…”

Amelogenin Peptide Extract Increases Differentiation and Angiogenic and Local Factor Production and Inhibits Apoptosis in Human Osteoblasts

“…As noted previously, EMD is processed from the unmineralized or partially mineralized enamel matrix of porcine tooth germs, resulting in a bioscaffold for wound healing and tissue regeneration in periodontal, orthopaedic, and dermatologic applications [2,3,45]. The major protein in EMD, amelogenin, is present at the epithelial/mesenchymal transition zone in the tooth germ [6], making it a candidate for modulating osteoblastic differentiation and osteogenesis.…”

“…Enamel matrix derivative (EMD) is a decellularized extracellular matrix (ECM) isolated from porcine tooth germs and has been used clinically in a carrier as Emdogain (Institut Straumann AG, Basel, Switzerland) to promote periodontal tissue regeneration, including periodontal ligament, alveolar bone, and cementum [1][2][3]. It has been suggested that EMD induces periodontal tissue regeneration by mimicking events in normal periodontal tissue development [4].…”