Abstract
Background: The systematic review was designed to answer the following focused question: Are enamel matrix derivatives able to improve the quantity of keratinized tissue (KT) around natural dentition in patients with recessions defects after their treatment with periodontal plastic procedures? Methods: Only Randomized Clinical Trials (RCT) in English language evaluating root coverage procedures in combination with enamel matrix derivatives (commercially known as EmdogainĀ®āEMD), with at least 10 subjects and a minimum duration of six months, were included. The search was applied to PUBMED and SCOPUS and it consists of a combination of MeSH terms and free text words (from January 2000 to June 2019). Risk of bias in individual studies and across studies was also evaluated. Results: After the full text analysis and the exclusion of further 18 articles, 12 articles were finally included. In total 639 recessions were treated (334 tests and 305 control). The recessions defects were classified according to the classification of Miller (Class I, II, III, IV). Only one trial included Miller Class III recessions (7 in total). Enamel matrix derivatives were applied in conjunction with Coronally Advanced Flap (CAF), Coronally Advanced Flap + Sub Epithelial Connective Tissue Graft (CAF + CTG), Semilunar Flap (SF). For the group CAF vs CAF + EMD the mean difference between the keratinized tissue gain in the two procedures was 0.40 mm (95% Confindence Interval Lower/Upper: 0.014ā0.81) (p < 0.058); for the comparison CAF + CTG + EMD vs. CAF + CTG the mean difference between the two groups resulted in ā0.06 mm (95% Confindence Interval Lower Upper ā0.45 to 0.33) (p = 0.7603). Discussion: Randomized clinical trials included medium-low quality evidence. The application of Enamel Matrix Derivatives to surgical procedures aimed to cover gingival recessions does not add robust clinical benefit to conventional plastic procedure alone.
Highlights
Isolated and multiple gingival recessions are a common finding among adult populations
Enamel matrix derivatives are commercially available in a gel formulation containing porcine-derived enamel matrix proteins, propylene glycol alginate, and water [8], and it is commercially known as EmdogainĀ®
We conducted a search on electronic databases from January 2000 until June 2019; the search was applied to PUBMED and SCOPUS
Summary
Isolated and multiple gingival recessions are a common finding among adult populations. Enamel matrix derivatives are commercially available in a gel formulation containing porcine-derived enamel matrix proteins, propylene glycol alginate, and water [8], and it is commercially known as EmdogainĀ® In this perspective, Enamel matrix derivatives have been widely and successfully described as enhancers of the quality of healing in conjunction with periodontal plastic procedures [15]. There is no systematic pair-wise data available in the literature that relates the application of enamel matrix derivatives and the improvement of the keratinized tissue with periodontal plastic procedures. The aim of the current investigation is to review systematically the evidence that assess the adjunctive benefit of enamel matrix derivatives applied with periodontal plastic procedure in terms of keratinized tissue gain around gingival recession type defect
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