Article

Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects.

School of Dentistry, University of Manchester, Oral and Maxillofacial Surgery, Higher Cambridge Street, Manchester, UK M15 6FH.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2005; DOI: 10.1002/14651858.CD003875.pub2
Source: PubMed

ABSTRACT Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development.
To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects.
We searched the Cochrane OHG Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of RCTs identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: May 2005.
RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years.
Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed.
Ten trials were included out of 29 potentially eligible trials. No included trial presented data after 5 years of follow up, therefore all data refer to the 1-year time point. A meta-analysis including eight trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.2 mm, 95% CI 0.7 to 1.7) and PPD reduction (0.8 mm, 95% CI 0.5 to 1.0) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had < 2 mm PAL gain in the control group, with RR 0.48 (95% CI 0.29 to 0.80). Approximately six patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 35%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating the only two trials at a low risk of bias in a sensitivity analysis, the effect size for PAL was 0.6 mm, which was less than 1.2 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed a statistically significant increase of REC (0.4 mm) and significantly more postoperative complications. No trials were found comparing EMD with BG.
One year after its application, EMD significantly improved PAL levels (1.2 mm) and PPD reduction (0.8 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition a sensitivity analyses indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD.

1 Bookmark
 · 
191 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The periodontal bone regeneration has always been considered as a major challenge in maxillofacial clinic. Unfortunately, current treatments cannot achieve optimal therapeutic effect. Self-setting calcium phosphate bone cement (CPC) is regarded as promising material to solve periodontal problem due to its good biocompatibility, mineral similarity to the natural bone’s composition. Moreover, it can be arbitrarily shaped, form bio-resorbable hydroxyapatite (HA) in situ to fill complex periodontal bone cavities perfectly. So far, there are lots of related in-vitro investigations; however, in-vivo experiments which could precisely show the real effects of CPC’s internal performances are rarely reported. Therefore, in this study, CPC were implanted into bilateral mandible defect of 8 beagles to evaluate its degradation ability and osteogenesis through Micro-CT scan and histological morphology analysis at determined time. Because of the intrinsic drawbacks of raw CPC, reinforced ingredients including collagen and growth factors were selected to synthesis different modified-CPC systems. The results illustrated that the samples’ degradation ability could be largely increased by nearly 60% with the help of macro-porous structure and collagen. In addition, by using the same ingredients, the osteogenisis of those samples could be promoted by 12%. What’s more, growth factors were proved to be the most important factor to increase the CPC’s new bone formation ability (22% more new bone could be obtained after using growth factors after 6 months implantation). The data obtained from histological analysis has presented the similar changing trend. Overall, these results illustrated macro-porous structure; collagen and growth factors could both effectively promote the CPC’s degradation ability and osteogenesis in vivo, which suggested the macro-porous CPC with collagen and growth factors would be promising as bioactive materials for periodontal bone tissue regeneration.
    Ceramics International 01/2015; 41(1). · 2.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. Periodontitis is an inflammatory process in response to dental biofilm and leads to periodontal tissue destruction. The aim of this study was the comparison of outcomes using either an enamel matrix derivative (EMD) or a nanocrystalline hydroxyapatite (NHA) in regenerative periodontal therapy after 6 and 12 months. Methods. Using a parallel group, prospective randomized study design, we enrolled 19 patients in each group. The primary outcome was bone fill after 12 months. Attachment gain, probing pocket depth (PPD) reduction, and recession were secondary variables. Additionally, early wound healing and adverse events were assessed. Data analysis included test of noninferiority of NHA group (test) compared to EMD group (reference) in bone fill. Differences in means of secondary variables were compared by paired t-test, frequency data by exact χ (2) test. Results. Both groups showed significant bone fill, reduction of PPD, increase in recession, and gain of attachment after 6 and 12 months. No significant differences between groups were found at any time point. Adverse events were comparable between both groups with a tendency of more complaints in the NHA group. Conclusion. The clinical outcomes were similar in both groups. EMD could have some advantage compared to NHA regarding patients comfort and adverse events. The trial is registered with ClinicalTrials.gov NCT00757159.
    BioMed research international. 01/2014; 2014:786353.
  • Source
    Open Journal of Stomatology 01/2014; 04(01):14-21.

Full-text (2 Sources)

Download
342 Downloads
Available from
May 16, 2014