Treatment of Intrabony Periodontal Defects With Enamel Matrix Derivative: A Literature Review

Abstract

The enamel matrix derivative (EMD) has been recently introduced in the periodontal field to overcome short-comings associated with currently available regenerative techniques. Information accumulated over the past years with application of EMD guided regeneration (EGR) in intrabony periodontal defects allowed a thorough evidence-based retrospective analysis. Clinical data from EMD controlled studies were pooled for meta-analysis and weighted according to the number of treated defects. Clinical attachment gain amounted to 3.2 +/- 0.9 mm (33% of the original attachment level) and probing reduction averaged 4.0 +/- 0.9 mm (50% of the baseline probing depth) for a total of 317 lesions with a mean baseline depth of 5.4 +/- 0.8 mm. Improvements in clinical parameters achieved with EMD were statistically significant in reference to preoperative measurements. However, despite the overall efficacy of EGR therapy, a significant variation in clinical outcomes was observed. Similar therapeutic results were reported in studies where EGR was compared directly to guided tissue regeneration. However, the controlled clinical trials did not have adequate statistical power to firmly support superiority or equivalency between the 2 regenerative therapies. The statistical superiority of EGR over treatment with open flap debridement has been established. Preliminary histologic investigations with surgically created defects and experimental periodontal lesions demonstrated the ability of EGR to induce formation of acellular cementum and promote significant anaplasis of the supporting periodontal tissues. The potential of EMD to encourage periodontal regeneration was also confirmed in human intrabony defects. However, recent human histologic studies have questioned both the consistency of the histologic outcomes and the ability of EGR to predictably stimulate formation of acellular cementum. Identifying clinical modifying parameters and understanding cellular interactions are apparently essential for the development of methodologies to enhance predictability and extent of EGR clinical and histologic results.

Clinical Outcome of Surgical Periodontal Therapy: A Short-term Retrospective Study

“…Although clinical results are often dependent upon the dimension and morphology of the defect 6) , mean CAL gain (2.8 mm) observed for sites with regenerative therapy appeared to be comparable to that reported in our previous study 18) and others 13,20) . An increase in the proportion of defects demonstrating a CAL gain≥4 mm was also observed for regenerative therapy when compared to open flap debridement.…”

“…Since its introduction, EMD has demonstrated the ability to encourage periodontal regeneration in both animal studies and clinical trials 7,9,13,23) . Although clinical results are often dependent upon the dimension and morphology of the defect 6) , mean CAL gain (2.8 mm) observed for sites with regenerative therapy appeared to be comparable to that reported in our previous study 18) and others 13,20) .…”

Treatment of Periodontal Defects with Enamel Matrix Derivative: Clinical Evaluation at Early Healing Stages

“…This product is composed primarily of acidic extracted amelogenins in an aqueous viscous solution of propylene glycol alginate 6) . The activities of EMD on epithelial cells suggest a potential desirable inhibitory effect on epithelial downgrowth during the early regenerative stages 10) . Since its introduction, extensive research regarding EMD has been carried out.…”

Do the Clinical Effects of Enamel Matrix Derivatives in Infrabony Defects Decrease Overtime? A Systematic Review and Meta-Analysis

“…At present, advancements in molecular biology studies emphasized the importance of extracellular matrices in periodontal regeneration. Enamel matrix derivative proteins (EMDP), especially amelogenin, appear to play an important role in cementogenesis (12,13). Thus, in an endeavor to provide mimicking of what occurs during root development, an enamel matrix derivative of porcine origin has been used in an attempt to regenerate previously lost periodontal structures (13)(14)(15)(16)(17).…”