Enamel matrix derivative (Emdogain (R)) 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: 6.03). 02/2005; (4)(4):CD003875. DOI: 10.1002/14651858.CD003875.pub2
Source: PubMed


Emdogain might have some advantages over other methods of regenerating the tissue supporting teeth lost by gum disease, such as less postoperative complications, but has not been shown to save more compromised teeth or that patients noticed any aesthetic improvement 1 year after its application. Bacteria in plaque can cause gum disease (periodontitis) that breaks down tissue supporting teeth. Surgical cleaning tries to stop the disease to save loose teeth. Bone grafting, guided tissue regeneration and enamel matrix derivatives (such as Emdogain) aim to regenerate support tissues. Emdogain contains proteins (derived from developing pig teeth) believed to regenerate tooth attachment. The review found that adjunctive application of Emdogain regenerates a little more tissue than surgical cleaning alone, although it is unclear to which extent such improvement is noticeable since patients did not find any difference in the aesthetic results. Emdogain showed similar clinical results to guided tissue regeneration, but is simpler to use and determines less complications. It has not been compared with bone grafting. No serious adverse reactions to Emdogain were reported in trials.

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    • "The use of EMD has been first demonstrated in animal [10] and later in human studies [11]. Several systematic articles have systematically compared this approach to classical flap procedures and open debridement and have evaluated the additional benefit in the clinical outcomes [8, 12-14]. These reviews underline that EMD may exhibit a measurable positive clinical effect in combination with surgical treatment of periodontally diseased teeth when treating infrabony defects and furcations, provided that patients’ compliance is adequate and correct indications are pursued, including: careful assessment of defect depth, number of residual bony walls, pocket depth, and the degree of hypermobility. "
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    ABSTRACT: A patient presented with chronic periapical periodontitis on tooth 45. The root canal was re-treated and a wide apical perforation was closed with MTA® as an apical plug. At reevaluation six month later, the tooth presented with increased mobility, bleeding on probing and probing pocket depths of 9 mm. Despite good periapical healing radio graphically, the tooth showed signs of localized marginal bone loss that was diagnosed as being due to a cemental fracture. The tooth was splinted, a muco-periostal flap was raised and the fragment of cementum was removed. The defect was treated in a regenerative approach, using enamel matrix derivatives (EMD). Six month after therapy, the probing pocket depths decreased to values of ≤ 3 mm and a defect fill was radiographically visible. The 10-year follow up showed a stable situation. It can be concluded that the occurrence of a local delamination of the root surface may contribute to the development of plaque-induced periodontal destruction. Its removal and the regenerative conditioning of the root surface with EDTA and EMD may result in a, at least partial, resolution of the problem and regeneration of bone at the affected the site.
    The Open Dentistry Journal 09/2012; 6(1):148-52. DOI:10.2174/1874210601206010148
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    • "EMD is a commercially available product isolated from the crowns of six month old pigs. It has been proven to be clinically useful in improving periodontal healing of avulsed and replanted teeth, as it was reported to be effective in treatment of periodontal intra-bony effects (6, 7). Emdogain is a commercial EMD and contains several matrix proteins from the amelogenin family. "
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    ABSTRACT: Enamel matrix derivative Emdogain (EMD) is widely used in periodontal treatment in spite of the fact that its effect on the developing embryo has not been elucidated. The aim of this study was to investigate the teratogenic effect of EMD on the rat embryo neural crest cells. The neural crest is a unique population of cells that migrates from the dorsal neural tube along defined pathways and produces various cell types including the melanocytes, neuronal and glial cells of the sensory, autonomic and enteric nervous system as well as the chromaffin cells of the adrenal gland. These cells have been used extensively for in-vitro studies of neurogenesis. Cultured cells by micromass culture method derived from midbrain of six embryos (13 day postcoitum; 34-36 smites) and exposed to various concentrations of EMD for 5 days at 37°C and differentiated foci were counted. Retinoic Acid (20 μg/mL) was used as standard positive control. These cells were stained using Mayer's hematoxylin which is specific for staining differentiated cell nucleus. Neutral red staining determines cell viability rather than related cell differentiation but is used for normalization of Mayer's hematoxylin results. At the concentration as low as 8 μg/mL of EMD, no toxic effect on fetal cells was observed and it is suggested that EMD has no teratogenic effect at studied concentrations.
    Iranian journal of pharmaceutical research (IJPR) 02/2011; 10(4):869-75. · 1.07 Impact Factor
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    ABSTRACT: Data sources Sources were MEDLINE and the Cochrane Oral Health Group Trials Register. Reference lists from relevant articles, and selected journals dated up to April 2001, were also searched by hand.Study selection Randomised controlled trials (RCT) were selected if they were of at least 6 months' duration and they compared the grafting of biomaterials or biological agents — alone or in combination — plus OFD (including open flap curettage, access flap surgery, modified Widman flap) to OFD alone or in combination with a placebo. Any type of grafting biomaterials or biological agents, apart from guided tissue regeneration, alone or in combination with other biomaterials/biological agents were considered.Data extraction and synthesis Information regarding the quality and characteristics of studies were extracted independently by two reviewers. Short-term, long-term and a range of patient-centred outcomes were assessed. The main short-term outcomes were the changes in clinical attachment levels (CAL) and probing pocket depth (PPD). Long-term measures included disease recurrence — measured as the proportion of defects presenting loss of CAL and/or bone, as assessed clinically or radiographically from 12 months after intervention — and the change of CAL from 6–12 months up to the last observation interval. A weighted treatment effect was calculated and the results were expressed as weighted mean differences for continuous outcome variables using both fixed and random models. The analysis for the continuous outcome variables was conducted using Stata (version 6; Stata Corporation, College Station, Texas, USA) to combine parallel-group and intra-individual (split-mouth) studies.Results The difference in CAL change between test and control groups varied from -1.45 mm to 1.40 mm with respect to different biomaterials or biological agents. Meta-analysis showed that CAL significantly improved after treatment with coralline calcium carbonate (weighted mean difference, 0.90 mm; 95% confidence interval (CI), 0.53–1.27), bioactive glass (weighted mean difference, 1.04 mm; 95% CI, 0.31–1.76), hydroxyapatite (weighted mean difference, 1.40 mm; 95% CI, 0.64–2.16) and enamel matrix proteins (weighted mean difference, 1.33 mm, 95% CI, 0.78–1.88). Heterogeneity in the results between studies was highly statistically significant, however, for most biomaterials or biologicals; this could not be fully explained.Conclusions Overall, the use of specific biomaterials or biological agents was more effective than OFD in improving attachment levels in intraosseous defects. Difference in CAL gain varied greatly with respect to different biomaterials/biological agents. Because of the significant heterogeneity in results between studies in most treatment groups, general conclusions about the clinical benefit of graft biomaterials/biologicals need to be interpreted with caution.
    Evidence-Based Dentistry 08/2003; 4(3):64-65. DOI:10.1038/sj.ebd.6400195
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