Emdogain Gel Research Articles

The Combined Effects of Hydraulic Calcium Silicate Cement and Enamel Matrix Derivative Regarding Osteogenic and Dentinogenic Differentiation on Human Dental Pulp Stem Cells.

The ideal treatment option for immature necrotic permanent teeth is regeneration of the pulp-dentin complex. Mineral trioxide aggregate (MTA), the conventional cement used for regenerative endodontic procedures, induces hard tissue repair. Various hydraulic calcium silicate cements (HCSCs) and enamel matrix derivative (EMD) also promote osteoblast proliferation. The purpose of the present study was to determine the osteogenic and dentinogenic potential of commercially distributed MTA and HCSCs when applied in combination with Emdogain gel on human dental pulp stem cells (hDPSCs). The presence of Emdogain resulted in greater cell viability, and higher alkaline phosphatase activity was detected in the Emdogain-supplemented groups in the early days of cell culture. On qRT-PCR, the groups treated, respectively, with Biodentine and Endocem MTA Premixed in the presence of Emdogain showed an increased expression of the dentin formation marker DSPP, and the group treated with Endocem MTA Premixed in the presence of Emdogain showed an upregulated expression of the bone formation markers OSX and RUNX2. In an Alizarin Red-S staining assay, all of the experimental groups exhibited a greater formation of calcium nodules when treated in combination with Emdogain. Overall, the cytotoxicity and osteogenic/odontogenic potential of HCSCs were similar to that of ProRoot MTA. The addition of the EMD increased the osteogenic and dentinogenic differentiation markers.

Effect of an enamel matrix derivative (Emdogain) on the microhardness and chemical composition of human root dentin: an in vitro study

The advantage of using an Enamel matrix derivative EMD Emdogain as an intracanal medication could be a manner to strength the tooth structure, improving the physical and chemical properties of dentin. We tested, in vitro, the effect of Emdogain on the surface microhardness and chemical composition of root dentin. Ten human teeth were used to produce dentin specimens originated from the canal walls (n = 30) that remained in contact to Emdogain gel for 90 days. Baseline and 90-days after Emdogain treatment measurements were performed using Fourier Transform Infrared Spectroscopy (ATR/FTIR), Scanning Electron Microscopy/Energy Dispersive Spectroscopy (SEM/EDS) and Knoop indenters. The use of EMD (Emdogain) for 90 days in contact with human root canal dentin specimens did not alter the microhardness and morphology of dentin. The elemental structure of dentin was altered because there was a reduction in carbonate content.

Success Evaluation of Pulpotomy in Primary Molars with Enamel Matrix Derivative: a Pilot Study

Aim: To investigate the effect of Emdogain gel (EMD) in pulpotomized primary molars and its clinical and radiographic outcomes. Methods and Materials: In this study, 18 lower second primary molars of nine children were treated by pulpotomy. The teeth were randomly assigned to the EMD (experimental) and Formocresol (control) groups in each patient (split mouth). Following removal of the coronal pulp and haemostasis, the pulp stumps were covered with Emdogain gel in the experimental group followed by application of resin-modified glass ionomer cement over the gel. In the control group, Formocresol (FC) was placed with a cotton pellet over the pulp stumps. Lastly, the teeth in both groups were restored with stainless steel crowns. Results: Nine children referred with clinical failure before/at two months follow up. The radiographic evaluation revealed furcation involvement and extensive radicular radiolucency in molars treated with Emdogain gel. Conclusion: The present study showed the failure of enamel matrix derivative in pulpotomy of primary molars; therefore, we do not recommend using Emdogain as a pulpotomy agent for treatment of cariously exposed primary teeth

Histologic Evaluation of the Effects of Emdogain Gel on Injured Root Apex in Rats

IntroductionThis study investigated the effects of Emdogain gel (EMD) on the injured open apex within periapical lesions. MethodsPeriapical lesions were induced in rats by opening the pulp chambers of the mandibular first molars and filing the apical foramen through the distal root canal with #25 K-files to make an open apex. The teeth were exposed to the oral environment for 7 days. Then we irrigated the distal root canals and divided them into EMD-treated and propylene glycol alginate–treated groups. The rats were killed 7, 14, and 28 days after treatment and examined histochemically. ResultsIn the EMD-treated rats, more cells expressed transforming growth factor-β1 or bone morphogenetic protein-2 at 7 days after treatment, and the regeneration of cementum and bone was observed around the root apex at 14 days after treatment. Conversely, in the propylene glycol alginate–treated group, few cells expressed transforming growth factor-β1 or bone morphogenetic protein-2, and apical periodontal tissue recovery was rarely seen within the periapical lesions throughout the experiment. ConclusionsThese results suggest that EMD does not irritate injured periapical tissue and may create a favorable environment that promotes the healing of destroyed periapical tissues.

The effectiveness of enamel matrix protein (Emdogain® ) in combination with coronally advanced flap in the treatment of multiple marginal tissue recession: A clinical study

Background:Gingival recession resulting in root exposure is a common problem faced by clinicians. This clinical study compared the results obtained by treating gingival recession using enamel matrix derivative (Emdogain gel®) along with coronally positioned flap and coronally positioned flap alone.Materials and Methods:Twenty patients with a total of 46 gingival recession defects, each patient with a minimum of two recession defects, were included in the study. The test group, which consisted of 10 patients with 22 recession defects, was treated by enamel matrix derivatives (Emdogain gel) in combination with a coronally positioned flap, while the control group, which consisted of 10 patients with 24 gingival recession defects, was treated with 24% ethylenediaminetetraacetic acid (EDTA; Prefgel®) in combination with coronally positioned flap.Results:Student's paired and unpaired t-test was used for statistical analysis. If the probability value (P) was less than 0.05, it was considered significant. Data from this study demonstrated that application of (EMD) Emdogain gel resulted in a statistically significant increase in root coverage, gain in the clinical attachment level (CAL), and probing pocket depth (PPD) reduction when compared with coronally advanced flap (CAF) alone, but there was no statistically significant difference in the width of keratinized gingiva (WKG) between the two groups.

Dentine sialoprotein and Collagen I expression after experimental pulp capping in humans using Emdogain®Gel

To characterize the hard tissue formed in human teeth experimentally pulp capped either with calcium hydroxide or with Emdogain Gel (Biora AB, Malmö, Sweden) - a derivative of enamel matrix (EMD), using two markers for dentine; dentine sialoprotein (DSP) and type 1 collagen (Col I). Affinity-purified rabbit anti-Col I and anti-DSP polyclonal antibodies were used to stain histological sections from nine pairs of contra-lateral premolars that had been experimentally pulp amputated and randomly capped with EMDgel or calcium hydroxide. Twelve weeks after the teeth had been pulp capped, they were extracted, fixed, demineralized and serially sectioned prior to immunohistochemical staining. In the calcium hydroxide treated teeth DSP was seen in the new hard tissue which formed a bridge. DSP was also seen in the newly formed hard tissue in the EMDgel-treated teeth. Proliferated pulp tissue partly filled the space initially occupied by EMDgel and DSP-stained hard tissue was observed alongside exposed dentine surfaces as well as in isolated masses within the proliferated pulp tissue, although the new hard tissue did not cover the pulp exposure. DSP staining was also seen in the cells lining the hard tissue in both groups. Col I staining was seen in the newly formed hard tissue in both groups. The new hard tissue formed after pulp capping with EMDgel or calcium hydroxide contained DSP and Col I, considered to be markers for dentine. Thus, the newly formed hard tissue can be characterized as dentine rather than unspecific hard tissue.

Effects of Enamel Matrix Derivative on Bioactive Glass in Rat Calvarium Defects

Tissue engineering-based bone grafting has emerged as a viable alternative to biologic and synthetic grafts. The purpose of this study was to evaluate the effect of enamel matrix derivative (EMD; Emdogain gel, Biora AB, Malmö, Sweden) on bioactive glass in enhancing bone formation in rat calvarium defects. Twenty rats were used in the study. In all animals, 2 standardized critical-sized calvarial defects (5.0 mm diameter) were created surgically. The animals were randomly allocated into 4 groups of 5 animals each. Group AI: one calvarial defect was filled with bioactive glass plus EMD, while the contralateral defect was filled with bioactive glass alone. The healing period was 2 weeks. Groups AII and AIII: the animals were treated in the same manner as in group AI, but the healing periods were 4 and 8 weeks, respectively. Group B: one calvarial defect was filled with EMD only, while the contralateral defect was empty (CSD). The healing period was 8 weeks. New bone formation was evaluated by radiomorphometry and histomorphometry. Results of radiomorphometry showed no significant difference in the mean optical density between bioactive glass with EMD and bioactive glass alone; no defect completely regenerated with bone. The histologic analysis revealed that defects filled with bioactive glass plus EMD in all groups contained slightly more percentage of new bone than those filled with bioactive glass alone; however, the difference was not statistically significant. The highest percentage of new bone formation was present at 8 weeks in the bioactive glass plus EMD group. Bioactive glass particles, used with or without EMD, maintained the volume and contour of the area grafted in CSD. However, they did not lead to a significant difference in bone formation when compared with CSD 8 weeks postoperatively.

Wound Healing Process of Injured Pulp Tissues with Emdogain Gel

This study aimed to investigate the wound healing process of injured pulp tissues with Emdogain gel (EMD). Pulpotomy was performed for the first molars of the mandibles in rats. EMD or Vitapex (VIT)-containing calcium hydroxide was applied to the exposed pulp tissues. The treated teeth were extracted after 7, 14, and 28 days and prepared for histologic examination. In the VIT-treated group, the number of interleukin-1β (IL-1β)–expressing macrophages initially increased, followed by that of transforming growth factor–β1 (TGF-β1)–expressing macrophages. The number of cells expressing bone morphogenetic proteins (BMPs) gradually increased with reparative dentin formation. Meanwhile, in the EMD-treated group, cells expressing IL-1β or TGF-β1 were few. However, the number of BMP-expressing cells, partly macrophages, increased in the early phase, and large amounts of reparative dentin were observed. This study demonstrated that different healing processes existed for EMD and VIT. BMP-expressing macrophages might play important roles in reparative dentin formation.

The role of macrophages in the periodontal regeneration using Emdogain® gel

Emdogain gel is clinically used as a periodontal regenerative material. However, the mechanism of the regeneration has not been completely elucidated. Although many studies have focused on the regenerative effect of Emdogain on connective tissue attachment and alveolar bone, the role of macrophages and the expression of growth factors remains unclear in the regeneration stimulated by Emdogain gel in vivo. The aim of this study was to investigate the effect of Emdogain gel on the expression of cytokines and growth factors by macrophages in vivo using a newly devised rat experimental periodontitis model. Rat experimental periodontitis was induced by elevating a full-thickness gingival flap and ligating silk threads around the first molars of the mandible. At 14 d after inducing experimental periodontitis, Emdogain gel or propylene glycol alginate was applied to the furcation area. The rats were killed 7 and 14 d after treatment with propylene glycol alginate or Emdogain gel. The expression of cytokines and growth factors, and the regeneration of periodontal tissue, were examined by histochemical and immunohistochemical methods. Fourteen days after the induction of periodontitis, the resorption of alveolar bone at furcation was observed and cytokines such as interleukin-1beta, transforming growth factor-beta1, receptor activator of nuclear factor-kappaB ligand, receptor activator of nuclear factor-kappaB and osteoprotegerin were found. In the Emdogain-treatment group, the formation of new acellular cementum and, more remarkably, recovery of the bone, were observed. The new bone formation ratio in the Emdogain treatment group was significantly higher than that of the propylene glycol alginate treatment group. Although the expression of cytokines such as interleukin-1beta, transforming growth factor-beta1, receptor activator of nuclear factor-kappaB ligand and receptor activator of nuclear factor-kappaB was very low, bone morphogenetic protein-2- and bone morphogenetic protein-4-expressing macrophages were observed close to the root, and bone morphogenetic protein-4-expressing macrophages were mainly observed close to the bone surface at the furcation in the Emdogain-treatment group. These results suggest that wound-healing macrophages may express bone morphogenetic protein and play an important role in the regeneration of periodontal tissue at the furcation following the application of Emdogain gel.

Moderate effect of enamel matrix derivative (Emdogain ® Gel) on Porphyromonas gingivalis growth in vitro

The aim of this study was to analyse the antibacterial effects of Emdogain Gel or its constituents on the growth of the suspected periodontopathogen Porphyromonas gingivalis. The effects of the proteins of enamel matrix derivative (EMD), the commercial product Emdogain Gel or its vehicle propylene glycol alginate (PGA) (Straumann, Switzerland) on P. gingivalis growth were determined by two methods: broth dilution assay (BDA) and agar diffusion assay (ADA). BDA-Emdogain Gel inhibited moderately the growth of P. gingivalis, whereas EMD showed no effect. The PGA vehicle inhibited the growth completely. ADA-Emdogain Gel resulted in some inhibition in growth but was not significantly different from control. EMD revealed no zone of inhibition. PGA demonstrated statistically significant zones of inhibition. Emdogain Gel shows moderate antibacterial activities against P. gingivalis. These properties seem to be due to the PGA component of the gel preparation.

The combined use of enamel matrix proteins and a tetracycline‐coated expanded polytetrafluoroethylene barrier membrane in the treatment of intra‐osseous defects

The purpose of this split-mouth study was to evaluate the clinical response of enamel matrix proteins (EMPs, Emdogain Gel in intra-osseous defects with or without a combined application of a tetracycline-coated expanded polytetrafluoroethylene barrier membrane (e-PTFE, Gore-Tex). Twelve pairs of intra-osseous periodontal defects in 11 patients received the application of EMPs on the exposed root surface (EMP). One of the two defects received randomly, as an adjunct to EMP treatment, a tetracycline-coated e-PTFE membrane (MEMP). At baseline, 6- and 12-month probing pocket depth (PPD), clinical attachment level (CAL) and probing bone level (PBL) were measured. After 12 months, the EMP defects showed a significant mean PPD reduction of 2.86+/-0.75 mm, a mean gain in CAL of 1.28+/-2.04 mm, a mean PBL gain of 1.63+/-1.21 mm and a mean increase of recession (REC) of 1.56+/-2.30 mm. The MEMP defects showed a significant mean PPD reduction of 3.02+/-1.55 mm, a mean gain in CAL of 1.65+/-1.29 mm, a mean PBL gain of 1.58+/-1.92 mm and a mean increase of REC of 1.38+/-1.63 mm. Except for significantly more post-operative discomfort at the MEMP sites, no significant differences were found between EMP and MEMP defects. Within the limits of this study, it is concluded that in the treatment of intra-osseous defects with EMP, the adjunctive use of a tetracycline-coated e-PTFE membrane failed to show more gain of CAL and PBL.

Dental pulp capping: effect of Emdogain Gel on experimentally exposed human pulps

To investigate the effect of Emdogain Gel (Biora AB, Malmo, Sweden), consisting of a enamel matrix derivative (EMD) in a propylene glycol alginate (PGA) vehicle, on experimentally exposed human pulps and to register postoperative symptoms. Nine pairs of contralateral premolars scheduled for extraction on orthodontic indications were included. Following a superficial pulp amputation performed with a small (016) diamond bur, either EMDgel or a mix of calcium hydroxide and sterile saline was placed at random in contact with the pulp wound. The subjects made records of symptoms and were also interviewed about pain/discomfort by a blinded examiner. After 12 weeks the teeth were extracted, prepared and subjected to light microscopic examination in which the inflammation and newly formed hard tissue in the pulp were analysed. Immunohistochemistry was performed using affinity-purified rabbit anti-EMD polyclonal antibodies. Postoperative symptoms were less frequent in the EMDgel-treated than in the calcium hydroxide-treated teeth, especially during the first six weeks. In the EMDgel-treated teeth, new tissue partly filled the space initially occupied by the gel and hard tissue was formed alongside the exposed dentine surfaces and in patches in the adjacent pulp tissue. EMD was detected in the areas where new hard tissue had been formed. The wound area of the EMDgel-treated teeth exhibited inflammation in the majority of the teeth whereas less inflammation was seen in the calcium hydroxide-treated teeth where the hard tissue was formed as a bridge. In the EMDgel-treated teeth, postoperative symptoms were less frequent and the amount and pattern of hard tissue formation were markedly different than in the teeth treated with calcium hydroxide. However, the operative procedure and the formulation with EMD in a PGA vehicle do not seem to be effective for the formation of a hard tissue barrier.

The effect of Emdogain gel on periodontal healing in replanted monkeys' teeth.

We sought to histologically evaluate the effect of Emdogain gel on periodontal healing in monkeys' teeth undergoing delayed replantation. Study design Mature monkey teeth simulating avulsion were endodontically treated before extraction. Negative control teeth (group N = 10 roots) underwent immediate replantation, whereas the rest were bench-dried for 1 hour and treated in one of the following ways before replantation: the positive control teeth (group P = 12 roots) had no further treatment; group C teeth (4 roots) had the periodontal ligament removed; group D teeth (10 roots) were treated with Emdogain gel; group E teeth (6 roots) had the periodontal ligament removed before the application of Emdogain gel; and group F teeth (7 roots) had the periodontal ligament removed, the root surface conditioned, and Emdogain gel applied. Periodontal healing was evaluated after 16 weeks by undertaking histomorphometric analysis. The Kruskal-Wallis and Mann-Whitney U tests revealed that group N teeth had a statistically higher occurrence of complete healing than did all other groups, whereas group P was not significantly different in any of the healing categories from D, E, and F, the groups in which Emdogain gel was used. Group C teeth had a significantly higher occurrence of replacement root resorption than did the teeth in groups P and F-but were not significantly different from teeth in groups D and E. Emdogain gel did not appear to significantly reduce replacement resorption in monkeys' teeth that had undergone delayed replantation.