Enamel Matrix Derivative In Treatment Research Articles

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 <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 <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.

Xenogenous Collagen Matrix and/or Enamel Matrix Derivative for Treatment of Localized Gingival Recessions: A Randomized Clinical Trial. Part I: Clinical Outcomes.

Considering xenogeneic collagen matrix (CM) and enamel matrix derivative (EMD) characteristics, it is suggested that their combination could promote superior clinical outcomes in root coverage procedures. Thus, the aim of this parallel, double-masked, dual-center, randomized clinical trial is to evaluate clinical outcomes after treatment of localized gingival recession (GR) by a coronally advanced flap (CAF) combined with CM and/or EMD. Sixty-eight patients presenting one Miller Class I or II GRs were randomly assigned to receive either CAF (n = 17); CAF + CM (n = 17); CAF + EMD (n = 17), or CAF + CM + EMD (n = 17). Recession height, probing depth, clinical attachment level, and keratinized tissue width and thickness were measured at baseline and 90 days and 6 months after surgery. The obtained root coverage was 68.04% ± 24.11% for CAF; 87.20% ± 15.01% for CAF + CM; 88.77% ± 20.66% for CAF + EMD; and 91.59% ± 11.08% for CAF + CM + EMD after 6 months. Groups that received biomaterials showed greater values (P <0.05). Complete root coverage (CRC) for CAF + EMD was 70.59%, significantly superior to CAF alone (23.53%); CAF + CM (52.94%), and CAF + CM + EMD (51.47%) (P <0.05). Keratinized tissue thickness gain was significant only in CM-treated groups (P <0.05). The three approaches are superior to CAF alone for root coverage. EMD provides highest levels of CRC; however, the addition of CM increases gingival thickness. The combination approach does not seem justified.

Xenogenous Collagen Matrix and/or Enamel Matrix Derivative for Treatment of Localized Gingival Recessions: A Randomized Clinical Trial. Part II: Patient-Reported Outcomes.

Gingival recession (GR) might be associated with patient discomfort due to cervical dentin hypersensitivity (CDH) and esthetic dissatisfaction. The aim is to evaluate the effect of root coverage procedure with a xenogenous collagen matrix (CM) and/or enamel matrix derivative (EMD) in combination with a coronally advanced flap (CAF) on CDH, esthetics, and oral health-related quality of life (OHRQoL) of patients with GR. Sixty-eight participants with single Miller Class I/II GRs were treated with CAF (n = 17), CAF + CM (n = 17), CAF + EMD (n = 17), and CAF + CM + EMD (n = 17). CDH was assessed by evaporative stimuli using a visual analog scale (VAS) and a Schiff scale. Esthetics outcome was assessed with VAS and the Questionnaire of Oral Esthetic Satisfaction. Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to assess OHRQoL. All parameters were evaluated at baseline and after 6 months. Intragroup analysis showed statistically significant reduction in CDH and esthetic dissatisfaction with no intergroup significant differences (P >0.05). The impact of oral health on QoL after 6 months was significant for CAF + CM, CAF + EMD, and CAF + CM + EMD (P <0.05). Total OHIP-14 score and psychologic discomfort, psychologic disability, social disability, and handicap dimensions showed negative correlation with esthetics. OHIP-14 physical pain dimension had positive correlation with CDH (P <0.05). OHIP-14 showed no correlation with percentage of root coverage, keratinized tissue width, or keratinized tissue thickness (P >0.05). Root coverage procedures improve patient OHRQoL by impacting on a wide range of dimensions, perceived after reduction of CDH and esthetic dissatisfaction of patients with GRs treated with CAF + CM, CAF + EMD, and CAF + CM + EMD.

Hydroxyapatite/β‐tricalcium phosphate and enamel matrix derivative for treatment of proximal class II furcation defects: a randomized clinical trial

To clinically evaluate proximal furcations treated with hydroxyapatite/β-tricalcium phosphate (HA/β-TCP) isolated or combined with enamel matrix derivative (EMD). Thirty patients, presenting at least one proximal class II furcation defect, probing pocket depth (PPD) ≥5mm and bleeding on probing, were included. The defects were assigned to the HA/β-TCP group (n=15); open-flap debridement (OFD)+HA/β-TCP filling, or, HA/β-TCP-EMD group (n=15); OFD+HA/β-TCP+EMD filling. Plaque (PI) and gingival index (GI), PPD, relative gingival margin position (RGMP), vertical and horizontal attachment level (RVAL and RHAL), vertical and horizontal bone level (RVBL and RHBL), and furcation diagnosis were evaluated at baseline and at 6months. Both groups presented improvements after therapies (p<0.05); however, no inter-group differences could be seen in any single parameter (p>0.05). At 6months, the gains in rVCAL in the HA/β-TCP and HA/β-TCP-EMD groups were 1.47±0.99 and 2.10±0.87mm, while the RHCAL gains were 1.47±1.46 and 1.57±1.58mm (p>0.05). The RVBL and RHBL gains for the HA/β-TCP and HA/β-TCP-EMD group were 1.47±1.13 and 1.70±1.26mm, and 1.90±1.11 and 1.70±1.37mm respectively (p>0.05). The HA/β-TCP-EMD group showed seven closed furcations versus four in the HA/β-TCP group (p>0.05). Both treatments lead to improvements in all clinical variables studied in the present trial. However, the closure of proximal class II furcation defects is still unpredictable.

Periodontal Regeneration With Enamel Matrix Derivative in Reconstructive Periodontal Therapy: A Systematic Review

Enamel matrix derivative (EMD) is commonly used in periodontal therapy. The aim of this systematic review is to give an updated answer to the question of whether the additional use of EMD in periodontal therapy is more effective compared with a control or other regenerative procedures. A literature search in MEDLINE (PubMed) for the use of EMD in periodontal treatment was performed up to May 2010. The use of EMD in treatment of intrabony defects, furcations, and recessions was evaluated. Only randomized controlled trials with ≥1 year of follow-up were included. The primary outcome variable for intrabony defects was the change in clinical attachment level (CAL), for furcations the change in horizontal furcation depth, and for recession complete root coverage. After screening, 27 studies (20 for intrabony defects, one for furcation, and six for recession) were eligible for the review. A meta-analysis was performed for intrabony defects and recession. The treatment of intrabony defects with EMD showed a significant additional gain in CAL of 1.30 mm compared with open-flap debridement, EDTA, or placebo, but no significant difference compared with resorbable membranes was shown. The use of EMD in combination with a coronally advanced flap compared with a coronally advanced flap alone showed significantly more complete root coverage (odds ratio of 3.5), but compared with a connective tissue graft, the result was not significantly different. The use of EMD in furcations (2.6 ± 1.8 mm) gave significantly more improvement in horizontal defect depth compared with resorbable membranes (1.9 ± 1.4 mm) as shown in one study. In the treatment of intrabony defects, the use of EMD is superior to control treatments but as effective as resorbable membranes. The additional use of EMD with a coronally advanced flap for recession coverage will give superior results compared with a control but is as effective as a connective tissue graft. The use of EMD in furcations will give more reduction in horizontal furcation defect depth compared with resorbable membranes.