The Use of a Membrane and/or a Bone Graft may not Improve the Effects of Enamel Matrix Derivatives in Infrabony Defects

Abstract

This study undertook a network meta-analyses of studies comparing the effect of enamel matrix derivatives when used alone or in combination with bone grafts and/or membranes in the treatment of infrabony periodontal defects. A literature search was conducted on several medical databases (Medline, EMBASE, LILACS, and CENTRAL) and also on regular Web search engines (Google). Twenty-eight randomized controlled trials (RCTs) were included in the review. For study inclusion, the patients (or the periodontal defects) had to be randomly assigned to the test or control group and there had to have been follow-up for a minimum of 6 months. Treatment of infrabony defects with emdogain alone and with emdogain plus membrane and/or bone graft. The primary outcomes were reduction in pocket probing depth (PD), gain of clinical attachment level (CAL), and infrabony defect depth recorded at least 6 months after the procedure was completed. Twenty-eight publications were included in this systematic review with meta-analysis. In the initial search, 337 articles were found: 35 articles were found on medical databases (PubMed, EMBASE, LILACS, Central); 1 article was found through the gray search (Google); and 1 article was found through the electronic search in 3 periodontal journals. Of the 337 articles, 306 were excluded at the assessment of titles and abstracts phase because they were either case reports or they were not considered RCTs. The remaining 31 articles were examined in their full length (not just abstracts and titles). Three of these articles were excluded because they were not RCTs or because the adjunctive treatment was not considered regenerative. Because many variations of the treatment were used in the selected studies, the authors used network meta-analysis for the statistical synthesis of direct and indirect comparisons. Enamel matrix derivatives (EMDs) plus bone grafts and EMDs plus membranes attained 0.24 mm and 0.07 mm more PPD reduction than EMDs alone, respectively. For CAL gain, EMDs plus bone grafts and EMDs plus membranes attained 0.46 mm and 0.15 mm, respectively. The analysis shows that adding membranes and/or bone grafts to the EMDs does not provide significant benefits in the treatment of periodontal defects.