The impact of fatwas on patients’ acceptance of enamel matrix derivatives for periodontal regeneration in Saudi Arabia

Abstract

BackgroundSince the introduction of enamel matrix derivatives (EMD) (Emdogain®), it has not been allowed to be used in Saudi Arabia due to the religious restriction on porcine products. This study was conducted to determine the impact of the fatwas permitting the use of EMD and to assess the general perception of using bone-grafting materials in Jeddah, Saudi Arabia.Materials and methodsThis cross-sectional survey study included 213 patients seeking dental treatment at the Faculty of Dentistry Clinics of King Abdulaziz University, Jeddah, Saudi Arabia. They were recruited between September and November 2017. Subjects completed a questionnaire to assess their opinions before and after reading the fatwa about using EMD.ResultsMajority of the study subjects (70%) did not accept the use of bone-grafting materials and EMD in periodontal regeneration before reading the fatwas. The highest rate of acceptance was observed for the use of tissues from one’s own body (84%) while the biomaterials of porcine origin had the lowest acceptance rate (14.1%). Strong religious belief and low education level were the two key factors responsible for the initial refusal of EMD use before reading the fatwas. Around 45.1% of the participants changed their opinions in favor of EMD use after reading the fatwas and their interpretations. McNemar’s test found a statistically significant difference in opinions collected before and after reading the fatwas (P<0.001).ConclusionA significant impact of the fatwas was found on patients’ acceptance of EMD use for periodontal regeneration. We believe reliable interpretations of the fatwas may positively shift patients’ attitudes toward using new biomaterials.

Dentistry in a multicultural society: the impact of animal-based products on person-centred care

“…Several studies involving participants who are Muslim found bone graft materials based on xenografts, especially from porcine sources, had high refusal rates due to religious reasons, while acceptance for autogenous bone grafting was high. 26,27,28 There is paucity of published literature regarding the constituents of animalbased products used in dentistry. The dental industry has witnessed a rapid growth in the last two decades, especially in the field of implantology and a wide range of new materials and products are being introduced in dentistry.…”

Osteoimmunomodulatory Effects of Enamel Matrix Derivate and Strontium Coating Layers: A Short- and Long-Term In Vivo Study

“…They reported that EMD could enhance bone regeneration through Akt/VEGF signaling in diabetic rats . Despite its bone regeneration potential, EMD has some difficulties such as animal sources, immunogenicity, regulatory assessments, ethical issues, large molecular weight (100–200 amino acids), and instability in vivo . , In this study, we compared the osteoimmunomodulatory potential of EMD with strontium ions under the same in vivo conditions to investigate whether it is worth to coat a layer of EMD with the mentioned difficulties for inducing bone regeneration or we can consider using other alternatives such as ions as a simpler and cheaper surface modification strategy.…”