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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Available from: Helen V Worthington
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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.
    Full-text · Article · Sep 2012 · The Open Dentistry Journal
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    • "In numerous studies it has been demonstrated that enamel matrix derivatives (EMD) modulate the behavior of cells in stimulating proliferation, inducing production of transforming growth factor ß as well as interleukin-6 and differentiation of immature cells in vitro (Foster et al. 2006, Foster et al. 2008, Giannobile & Somerman 2003, Hakki et al. 2001, Lyngstadaas et al. 2001, Okubo et al. 2003, Sato et al. 2008, Schwartz et al. 2000, Swanson et al. 2006, Tokiyasu et al. 2000, Van der Pauw et al. 2000) EMD favor the formation of a new attachment apparatus In vivo, characterized by the presence of acellular and cellular cementum with inserting collagen fibres and new alveolar bone (Hammarstrom 1997, Hammarstrom et al. 1997, Heijl et al. 1997, Jepsen et al. 2004, Meyle et al. 2004, Sculean et al. 2000, Sculean et al. 2001) In several controlled clinical trials treatment of intrabony defects with EMD resulted in significantly more attachment gain and bone fill than open flap debridement (Esposito et al. 2005, Froum et al. 2001a, Froum et al. 2001b, Sanz et al. 2004, Tonetti et al. 2004a, Tonetti et al. 2004b, Tonetti et al. 2002). EMD was also successfully used in class II furcation defects.. Compared with guided tissue regeneration EMD treatment resulted in reduced postoperative swelling and pain (Jepsen et al. 2004, Meyle et al. 2004, Hoffmann et al. 2006). "
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    ABSTRACT: Comparison of the clinical and radiographic outcomes of a combination of enamel matrix derivatives (EMD) and a synthetic bone graft (EMD/SBG) with EMD alone in wide (≥2 mm) and deep (≥4 mm) one- and two- wall intra-bony defects 12 months after treatment. Seventy-three patients with chronic periodontitis and one wide (≥2 mm) and deep (≥4 mm) intra-bony defect were recruited in five centres in Germany. During surgery, defects were randomly assigned to EMD/SBG (test) or EMD (control). Assessments at baseline, after 6 and 12 months included bone sounding, attachment levels, probing pocket depths, bleeding on probing, and recessions. Changes in defect fill were recorded radiographically. Both treatment modalities led to significant clinical improvements. In the EMD/SBG group a mean defect fill of 2.7 ± 1.9 mm was calculated, in the EMD group the defect fill was 2.8 ± 1.6 mm. A mean gain in clinical attachment of 1.7 ± 2.1 mm in the test group and 1.9 ± 1.7 mm in the control group after 1 year was observed. Radiographic analysis confirmed for both groups that deeper defects were associated with greater defect fill. The results show comparable clinical and radiographic outcomes following both treatment modalities 12 months after treatment.
    Full-text · Article · Jul 2011 · Journal Of Clinical Periodontology
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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.
    Full-text · Article · Feb 2011 · Iranian journal of pharmaceutical research (IJPR)
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