Efficacy Of Enamel Matrix Derivative Research Articles

Enamel Matrix Derivative, 58S5 Bioactive Glass, and Fluoride Varnish for Enamel Remineralization: A Multi-analysis Approach.

This study aimed to evaluate the enamel remineralization efficacy of enamel matrix derivative (EMD), experimental bioactive glass (BAG), and fluoride varnish in vitro. Artificial initial caries lesions were developed on fifty human enamel specimens using demineralization solution (pH 4.5, 37°C, 96 hours). Specimens were randomly assigned to five groups (n=10): I-5% NaF varnish (Enamelast), II-experimental 58S5 BAG+37% phosphoric acid (PA), III-EMD (Emdogain) + Ethylenediaminetetraacetic Acid (EDTA), IV-EMD+37% PA, V-Control (untreated). All remineralization agents were applied with pH cycling for seven days. The specimens were scanned by spectral domain optical coherence tomography (SD-OCT) at baseline, at demineralization, and after pH cycling. Lesion depths were measured using image analysis software (ImageJ). Lesions were evaluated using surface microhardness (SMH) and two fluorescence methods (FluoreCam and DIAGNOdent Pen [DDPen]). The data were statistically analyzed by Kruskal Wallis, Friedman, and Wilcoxon tests (α=0.05). According to SD-OCT results, fluoride varnish was found to be the most effective agent in reducing lesion depth (p=0.005). All agents increased the SMH values after pH cycling. No significant difference was found among fluoride varnish, BAG, and EMD+PA groups. These SMH values were significantly higher than EMD+EDTA and control groups (p<0.001). All groups showed lower DDPen scores compared with the control group (p<0.001), however, no significant difference was found among the remineralization agents. In FluoreCam assessment, size and intensity values of all treated groups showed improvement. However, there was no significant difference between the treatment groups in terms of FluoreCam size measurements (p=0.186). 58S5 BAG and EMD+PA have remineralization capacity as effective as fluoride varnish. EMD+PA showed better SMH and lesion intensity results than EMD+EDTA.

Efficacy of Enamel Matrix Derivative in Periodontal Regeneration Defects: A Systematic Review and Meta-Analysis.

To evaluate the efficacy of enamel matrix derivative (EMD) on periodontal regeneration defects. Four databases were searched until October 2021. Experimental animal studies evaluating the efficacy of EMD were used. The primary outcomes were bone formation (BF) and cementum formation (CF). The secondary outcomes were junctional epithelium (JE), gingival recession (GR), and clinical attachment level (CAL). Measures of effect were mean difference (MD) with 95% confidence intervals (CIs). Random-effects model were used for all meta-analyses. The Systematic Review Centre for Laboratory animal Experimentation tool was used to assess the risk of bias. Seven experimental animal studies (n = 40) used with a maximum follow-up period of 3 months. Compared to control, EMD did not significantly reduce BF (MD 0.02 mm; 95% CI - 1.91-1.96; I2 = 89%). However, it increased CF (MD 1.38 mm; 95% CI 0.01-2.74; I2 = 55%). For secondary outcomes it was found that compared to control, EMD only significantly reduced JE (MD - 0.54 mm; 95% CI - 1.06 to - 0.02; I2 = 55%). However, the other secondary outcomes were not significant as in the case of GR (MD - 3. 88 mm; 95% CI - 68.29-60.53; I2 = 82%), and in CAL (MD 0.02 mm; 95% CI - 0.29-0.39; I2 = 38%). Finally, according to the risk of bias assessment, all included studies had a high risk of bias. EMD had no effect on BF values while it did not reduce CF. Otherwise, in the secondary outcomes, EMD only significantly reduced JE values and had no effect on GR and CAL.

Long-term clinical outcomes of periodontal regeneration with enamel matrix derivative: A retrospective cohort study with a mean follow-up of 10 years.

BackgroundDespite the large body of evidence on the efficacy of enamel matrix derivative (EMD) in the treatment of periodontal intrabony defects, few studies reported long‐term data (≥10‐year).MethodsPeriodontal patients treated with regenerative surgery with EMD between 1999 and 2012 were invited to participate in a clinical examination. The following clinical parameters were recorded and compared at baseline (T0), 6 months after surgery (T1) and after at least 8 years of follow‐up (T2): probing depth (PD), gingival recession (GR), clinical attachment level (CAL), plaque and bleeding scores. The primary outcome variable was CAL change.ResultsForty‐one patients with 75 treated teeth were available for analysis. Out of these, 68 (tooth survival rate: 90.7%) reached the latest follow‐up with a mean observation period of 10.3 years (range: 8.0 to 21.3). The most frequent reason for tooth loss was recurrence of periodontal disease. Tooth survival curves showed a statistically significant difference between smokers and non‐smokers (P = 0.028). Mean CAL changed from 8.43 ± 1.86 (T0) to 6.47 ± 1.70 (T1) (P < 0.001) and to 5.91 ± 1.83 (T2) (P < 0.001). At T1, a CAL gain of ≥3 mm was measured in 35% of the defects whereas at T2 it was detected in 51% of cases.ConclusionsWithin their limitations, the present results have shown that in intrabony defects, the clinical improvements obtained following regenerative surgery with EMD can be maintained on a mean period of 10 years. Smoking status and maxillary molars were correlated with an increased risk for tooth and CAL loss, respectively.

Clinical efficacy of enamel matrix derivative in treatment of periodontal intra-bony defects

Objective: This study aimed at evaluating the efficacy of enamel matrix derivative (EMD) in the treatment of posterior lower intrabony defects resulted from periodontitis. Method: This split-mouth, randomized clinical trial was conducted on 15 patients with 30 posterior lower teeth with bilateral symmetrical IBD lesions which were randomly assigned into two groups: open flap debridement with EMD (OFD+EMD) and without EMD (OFD). Clinical periodontal parameters were recorded at baseline, 3 and 6 post-operative months, including the plaque index (PlI); gingival index (GI); periodontal pocket depth (PPD); clinical attachment loss (CAL) and gingival recession (GR). Results: In each group, PlI, GI, PPD, CAL decreased significantly (p &lt;0.05) after 3 and 6 postoperative months compared to baseline. Between the two treatment groups, PPD, CAL, and GR in the OFD + EMD group were significantly lower (p &lt;0.001) compared to the OFD group after 3 and 6 post-operative months. Conclusion: The adjunctive use of EMD enhances the efficiency of OFD in treatment of periodontal intra-bony defects because reducing periodontal pocket depth, clinical attachment loss, and gingival recession.

Efficacy of Enamel Matrix Derivative in Vital Pulp Therapy: A Review of Literature.

Introduction:Vital pulp therapy (VPT) aims to preserve the health and maintain life of the tooth pulp which has been compromised by caries, trauma or restorative procedures. Recently, enamel matrix derivative (EMD) has been introduced as a material for vital pulp therapy. The aim of this review is to critically analyze and summarize the available literature on EMD for VPT. Methods and Materials:Online databases (PubMED/MEDLINE, Google Scholar, ISI Web of Science, and Wiley-Online) were searched by using the following keywords in various combinations: Enamel Matrix Derivative, Emdogain, ‘Vital Pulp Therapy, ‘Apexogenisis’, Apexification, Pulp Capping, Endodontics, Dentine and Pulpotomy for studies indexed from January 1949 to April 2016. We used an English-limited search in Google.co.uk for the missing grey literature. All studies fulfilling the selection criteria were carefully reviewed for the focused question: “Does using EMD in VPT, compared with other materials, result in better clinical, radiographic and histological outcomes?”. Results:The primary search resulted in 18 articles of which, 14 articles (including 6 animal studies and 6 clinical trials and 2 case reports) met the inclusion criteria for this review and hence were included. The number of teeth tested in the animal studies ranged from 8 to 144 including pigs, rats and dogs teeth. A number of studies used EMD in the experimental group in comparison with calcium hydroxide, propylene glycol alginate (PGA) and MTA as a control. The observation period ranged from 1 to 2 months and 4 out of 6 animal trials reported more favorable outcomes with EMD while two studies reported comparable outcomes. Conclusion:Although EMD has potential for various applications in endodontics, studies conducted to date have failed to demonstrate any significant advantage of EMD over conventional VPT materials. Additionally, the 5-year and 10-year survival rate of EMD-treated teeth is not yet known. Hence, studies with a longer follow-up periods are required to deduce the long-term viability of teeth treated with EMD.

Efficacy of forced eruption/enamel matrix derivative with freeze-dried bone allograft or with demineralized freeze-dried bone allograft in infrabony defects: A randomized trial.

To determine the efficacy of enamel matrix derivative (EMD) and forced eruption alone or in combination with freeze-dried bone allograft (FDBA) or demineralized FDBA (DFDBA) when managing infrabony defects. Seventy-four patients with an inadequate biologic width due to subgingival caries were randomly assigned to one of three intervention groups: Ortho/EMD/FDBA (OEF) (n = 25), Ortho/EMD/DFDBA (OED) (n = 24), and Ortho/EMD alone without graft material as a control (OE) (n = 25). Each patient donated an infrabony defect. The primary outcomes were absolute change in probing depth (PD) reduction and clinical attachment level (CAL) gain from baseline to 1- and 3-year follow-up. Infrabony defects were surgically treated with EMD/FDBA, EMD/DFDBA, or EMD alone 4 weeks before orthodontic extrusive force was applied to reestablish a biologic width of 2 mm. Seventy-four patients (OEF, n = 25; OED, n = 24; OE, n = 25) were analyzed. All groups demonstrated significant improvement in PD reduction and CAL gain from baseline. The changes at 1 year for PD were: OEF (mm, 95% CI), 4.3, 3.7 to 4.7; OED, 4.2, 3.6 to 4.9; and OE, 3.4, 3.1 to 3.7; for CAL, changes were: OEF, 4.3, 3.9 to 4.7; OED, 3.9, 3.5 to 4.4; and OE, 3.3, 3.1 to 3.5. Longer follow-ups showed similar findings. This study showed that both forced eruption/EMD/FDBA and forced eruption/EMD/DFDBA combination therapies result in greater soft tissue improvements at 1- and 3-year follow-up in addition to greater hard tissue improvements at 6-month re-entry compared with forced eruption/EMD alone.

Efficacy of Enamel Matrix Derivative With Freeze‐Dried Bone Allograft or Demineralized Freeze‐Dried Bone Allograft in Intrabony Defects: A Randomized Trial

Promising clinical outcomes have been reported with the combination of enamel matrix derivative (EMD) and allograft materials. Direct comparison between EMD with a freeze-dried bone allograft (FDBA) and a demineralized FDBA (DFDBA) was evaluated in one case series study. To date, no randomized controlled trial has been reported. Therefore, a well-controlled randomized clinical trial was conducted to determine the relative efficacy of EMD/FDBA versus EMD/DFDBA when managing intrabony defects. A randomized parallel trial was conducted in a private practice from April 2004 to October 2011. Sixty-nine patients were randomly assigned to one of three groups: EMD/FDBA (EF) intervention group (n = 23), EMD/DFDBA (ED) intervention group (n = 23), and EMD alone without graft material (E) as a negative control group (n = 23). All of the grafting material had minocycline added. Each patient had an intrabony defect. The primary outcomes were the absolute change in probing depth (PD) reduction and clinical attachment level (CAL) gain from baseline to 1- and 3-year follow-up. Intrabony defects were surgically treated with EMD/FDBA, EMD/DFDBA, or EMD alone. Sixty-seven patients (EF, n = 21: ED, n = 23; E, n = 23) were analyzed. All groups demonstrated significant improvement in PD reduction and CAL gain from baseline. The changes for PD were as follows (mm, 95% confidence interval [CI]): at 1 year: EF (4.4 mm, 4.0 to 4.7), ED (3.7 mm, 3.4 to 4.0), and E (control) (3.3 mm, 3.0 to 3.6); at 3 years: EF (4.4 mm, 4.1 to 4.8), ED (3.7 mm, 3.4 to 4.0), and E (3.1 mm, 2.8 to 3.4). The changes for CAL were as follows (mm, 95% CI): at 1 year: EF (4.1 mm, 3.8 to 4.5), ED (3.5 mm, 3.0 to 4.0), and E (3.0 mm, 2.5 to 3.6); at 3 years: EF (4.2 mm, 3.7 to 4.7), ED (3.6 mm, 3.1 to 4.1), and E (3.0 mm, 2.5 to 3.5). The intervention groups (EF and ED) showed better treatment outcomes than the control group at 1 and 3 years. Statistically, the two bone-graft groups were not significantly different from each other at 1 and 3 years. Both EMD/FDBA and EMD/DFDBA interventions resulted in greater soft tissue improvement at 1 and 3 years of follow-up compared to EMD alone. Both graft materials worked well in managing deep intrabony defects when combined with EMD.

Efficacy of EMD versus calcium hydroxide in direct pulp capping of primary molars: a randomized controlled clinical trial

The aim was to compare the clinical and radiographic efficacy of enamel matrix derivative and self-hardening calcium hydroxide as direct pulp capping materials on decayed primary molars, with observation periods of 1, 6, and 12 months. A clinical, randomized, controlled trial was performed, following the "split-mouth" design. A total of 90 primary molars were treated. Assignation of materials and operative initial side were selected in a randomized manner. Five outcome variables were considered: internal dentin resorption, pain, gingival sinus tract, root external resorption, and pathologic mobility. The appearance of any of these signs or symptoms was considered to be a failure of treatment. Significant statistical or clinical differences were not found between the study groups. Two treatments were judged as failures, 1 per study group; both occurred during the first postoperative month. The technique used for direct pulp capping on primary molars in this study is recommended on the basis of the obtained clinical and radiographic results.

Enamel Matrix Derivative Versus Bioactive Ceramic Filler in the Treatment of Intrabony Defects: 12‐Month Results

This study examined the clinical efficacy of enamel matrix derivative (EMD) and bioactive ceramic filler (BCF) in the treatment of intrabony periodontal defects and evaluated factors influencing the treatment outcome. Thirteen chronic periodontitis patients, 41 to 74 years of age, who had two proximal intrabony defects in different jaw quadrants with > or =3 mm vertical radiographic bone loss were selected for this study. After initial therapy, the sites in each patient were randomly assigned to EMD or BCF treatment. Clinical attachment level (CAL), probing depth (PD), tooth mobility (TM), gingival recession (GR), bleeding on probing, and dental plaque were recorded at baseline and at 6 and 12 months. At surgery, the intrabony component was characterized by recording the number of bony walls, distance in millimeters from the buccal crest (BC) to the most apical point of the defect, distance from the cemento-enamel junction (CEJ) to the BC, and the mesio-distal width of the defect at the level of the bony crest. BCF treatment resulted in a significant gain in proximal CAL (P = 0.005) and a reduction in proximal PD at 6 months (P <0.001), but there was no further improvement from 6 to 12 months. Paired comparisons by time for the EMD group revealed a significant reduction in proximal PD at 12 months (P = 0.001), whereas the gain in proximal CAL approached significance (P = 0.056). Mean GR increased significantly from baseline to 6 months in both groups (P = 0.001). Regression analysis revealed that within the EMD group, smoking and TM negatively influenced the gain of attachment, whereas within the BCF group, gingival recession increased with age, increasing CEJ to BC distance, and increasing mesial-distal width of the defect. The gain in proximal attachment after treating intrabony defects by flap surgery with BCF was significant (P = 0.004) and twice that following treatment with EMD (P = 0.056). Patient and site variables affected the clinical outcome differently.

Efficacy of enamel matrix derivatives (Emdogain®) in treatment of replanted teeth – a systematic review based on animal studies

The objective of the current systematic review was to evaluate the efficacy of enamel matrix derivative (EMD) (Emdogain) on healing of replanted or autotransplanted permanent teeth. A review of the published literature [search term: (Emdogain OR enamel matrix derivative OR enamel matrix protein] AND [avulsion OR replantation OR autotransplantation)] was conducted by two independent investigators according to defined selection criteria. For data extraction of the identified animal studies, the following histomorphometric findings were considered: (i) healed PDL, (ii) surface resorption, (iii) inflammatory resorption and (iv) replacement resorption. The heterogeneity of data collection and the small amount of identified publications did not allow for statistical analysis. Four controlled trials (CT) conducted in animals, but no randomized controlled trials (RCT) or clinical controlled trials (CCT) could be received from the systematic search. From the selected studies, two CT gave evidence of EMD treatment to be effective in inducing healing of replanted teeth, while one CT found no differences between EMD treated teeth and controls. Finally, one CT compared EMD and sodium fluoride application, but revealed no differences between the treatments. The data of controlled trials available are limited and conflicting. No firm conclusion regarding the efficacy of EMD application on healing of replanted or autotransplanted permanent teeth can be drawn because of lack of RCT and CCT.

Enamel Matrix Derivative for Periodontal Tissue Regeneration in Treatment of Intrabony Defects: A Cochrane Systematic Review

We reviewed the literature on the efficacy of enamel matrix derivative (EMD) in comparison with open flap debridement, guided tissue regeneration (GTR), and bone grafting for the treatment of intrabony defects. We searched four major electronic databases for randomized controlled trials (RCTs) with at least one year of follow-up. Several journals were handsearched with no language restrictions. Outcome measures were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), marginal bone levels on intraoral radiographs, and postoperative infections. Screening of eligible RCTs, assessment of the methodological quality, and data extraction were conducted in duplicate. No difference in tooth loss was observed. A meta-analysis (eight trials) showed that EMD-treated sites displayed statistically significant PAL improvements (mean difference 1.3 mm) and PPD reduction (1 mm) when compared to flap surgery. When EMD was compared to GTR (six trials), GTR showed a statistically significant reduction of PPD (0.6 mm) and increase of REC (0.5 mm). No difference in postoperative infections was observed. No trials compared EMD with bone grafts alone. EMD is able to significantly improve PAL levels and PPD reduction when compared to flap surgery; however, there is no evidence that more teeth could be saved. There was no evidence of important differences between EMD and GTR.

Possible involvement of extracellular signal-regulated kinases 1/2 in mitogenic response of periodontal ligament cells to enamel matrix derivative.

The efficacy of enamel matrix derivative (EMD) as an adjunct to periodontal regenerative therapy has been demonstrated in recent clinical studies, however, little is known about its molecular mechanism (s). We examined the mitogenic response of cultured periodontal ligament (PDL) cells to EMD and characterized associated changes in proliferation-related intracellular signaling molecules, including mitogen-activated protein kinases (MAPK) and Akt kinases/protein kinase B (Akt/PKB) kinases. The DNA synthesis of PDL cells increased following treatment with EMD at concentrations higher than 1 microg ml(-1). This mitogenic response to EMD was associated with the selective activation of extracellular signal-regulated kinase (ERK) 1/2. No other MAPKs, or Akt/PKB kinases, responded to EMD stimulation. The EMD induction of DNA synthesis and activation of ERK 1/2 were diminished by pretreatment with suramin, an inhibitor of receptor tyrosine kinases (RTK). The signaling pathway induced by EMD from RTK to ERK 1/2 was similar to that activated by epidermal growth factor (EGF), although the specific binding of 125I-EGF to PDL cells was not affected by pretreatment or concomitant treatment with EMD. These findings suggest that EMD elicits its mitogenic signal through an EMD-specific RTK towards ERK 1/2.