Enamel Matrix Protein Derivative Research Articles

Long-term results of regenerative treatment of intrabony defects: a cohort study with 5-year follow-up

BackgroundThe aim of this retrospective cohort study was to evaluate the long-term clinical and radiographic outcomes and survival of teeth in periodontal regenerative treatment of intrabony defects using combined enamel matrix protein derivative (EMD) and deproteinized porcine bone mineral (DPBM) compared to EMD alone.MethodsA total of 333 intrabony defects in 176 patients (mean age: 54.7 ± 8.9 years) were followed-up for 58.6 ± 11.2 (range, 25–78) months after periodontal regenerative treatment. Changes in clinical (pocket probing depth and clinical attachment level) and radiographic (defect depth and defect width) parameters were analyzed using serial periapical radiographs. Kaplan–Meier and multivariate Cox proportional-hazards regression analyses for tooth loss were also performed.ResultsCompared to periodontal surgery with EMD alone with a mean follow-up of 5 years, combined EMD and DPBM showed significantly better gain in clinical attachment level (EMD and DPBM: 2.8 ± 2.3 mm vs. EMD alone: 2.2 ± 2.2 mm) and reduction in probing pocket depth (EMD and DPBM: 2.8 ± 1.8 mm vs. EMD alone: 2.3 ± 1.8 mm), defect depth (EMD and DPBM: 2.5 ± 2.4 mm vs. EMD alone: 2.0 ± 2.4 mm) and defect width (EMD and DPBM: 0.6 ± 1.0 mm vs. EMD alone: 0.2 ± 1.3 mm). The overall survival rates of the teeth were 91.48% and 95.20% in the patient- and tooth-based analyses, respectively, showing no statistically significant difference.ConclusionsWithin the limitations of the current study, combined EMD and DPBM offered additional clinical and radiographic benefits over a mean of 5 years compared to EMD alone. However, tooth loss did not differ significantly between the two groups.Clinical relevanceCompared to EMD alone, combined EMD and DPBM for intrabony defects has additional clinical advantages; however, patient- and tooth-related risk factors must be considered when performing periodontal regenerative surgery.

Evaluation of the Effects of Enamel Matrix Protein Derivatives on Clinical Attachment Gain in Periodontal Defects and on Proliferation and Differentiation of Periodontal Ligament Fibroblasts <i>In Vitro</i>: A Double-blind Study

Evaluation of the Effects of Enamel Matrix Protein Derivatives on Clinical Attachment Gain in Periodontal Defects and on Proliferation and Differentiation of Periodontal Ligament Fibroblasts <i>In Vitro</i>: A Double-blind Study

The Application of an Enamel Matrix Protein Derivative (Emdogain) in Furcations: A Review of Literature

Periodontal disease results in the loss of the attachment apparatus. The search for techniques and products to encourage the regeneration of this tissue has received more attention over the past three decades. The results from basic research have shown that although there are not many studies on the use of EMD in the treatment of furcations, it is an essential option in the difficult management of furcations, and more research in periodontal regeneration is required. This paper aims to evaluate the effect of enamel matrix derivative (EMD) in the treatment of furcations.

Activation of mir-30a-wnt/β-catenin signaling pathway upregulates cathepsin K expression to promote cementogenic differentiation of periodontal ligament stem cells

To explore the role of cathepsin K (CTSK) regulated by mir-30a-wnt/β-catenin signaling pathway in cementogenic differentiation of periodontal ligament stem cells (PDLSCs). Human PDLSCs isolated by limiting dilution culture were induced by enamel matrix protein derivative (EMD) for differentiation into cementoblast-like cells. MicroRNA chip technique was employed to screen the differentially expressed microRNAs in the cells during induced differentiation. The effect of inhibiting miR-30a on CTSK expression in the induced cells was examined using RT-PCR and Western blotting. Ceramic scaffolds coated with PDLSCs treated with EMD and transfected with the miR-30a inhibitor or a lentiviral vector for CTSK overexpression were prepared and implanted subcutaneously in nude mice, and 8 weeks later the cellular expressions of cementoblast markers CAP and CEMP-1 were detected with immunohistochemistry to verify whether CTSK participate in cementogenic differentiation of PDLSCs. The role of wnt signaling pathway in miR-30a-mediated regulation of CTSK expression was explored by examining CTSK protein expressions after blocking wnt signaling in PDLSCs. In PDLSCs with EMD-induced differentiation into cementoblast-like cells, multiple microRNAs exhibited differential expressions; and among them, miR-30a was specifically and significantly up-regulated (P < 0.05). Up-regulation of miR-30a obviously increased the expression of CTSK (P < 0.05) and promoted PDLSCs to form cementum-like tissues with high expressions of CAP and CEMP-1. The regulatory effect of miR-30a on CTSK expression was obviously attenuated after inhibiting wnt/β-catenin signaling pathway. EMD induces cementogenic differentiation of PDLSCs possibly by up-regulating the expression of miR-30a, which further activates the wnt/β-catenin signaling pathway to enhance the expression of CTSK.

Enamel matrix derivative effects on palatal mucosa wound healing: Randomized clinical trial.

This study was conducted to evaluate the clinical, immunologic, and patient-centered outcomes of enamel matrix protein derivative (EMD) on excisional wounds in palatal mucosa. Forty-four patients in need of ridge preservation were randomly allocated into two groups: control group (n=22): open palatal wound after free gingival graft (FGG) harvest and EMD group (n=22): open palatal wound after FGG harvest that received 0.3ml of EMD. Clinical and patient-centered parameters were analyzed for 3months post-treatment. Wound fluid levels of inflammatory markers were assessed 3 and 7days postoperatively. No significant inter-group difference was observed in remaining wound area and re-epithelialization. EMD and control groups achieved wound closure and re-epithelialization 30days postoperatively (p<.001), without inter-group differences. Similarly, number of analgesics and Oral Health Impact Profile scores did not present significant inter-group differences (p>.05). EMD appeared to selectively modulate wound fluid levels of monocyte chemoattractant protein-1, macrophage inflammatory protein-1α, matrix metallopeptidase 9, and tissue inhibitor of metalloproteinases-2. Within the limits of the present study, it can be concluded that EMD application to excisional palatal wounds using the investigated protocol does not provide clinical healing benefits, despite an apparent modulation of selected inflammatory markers.

Long-term stability of adjunctive use of enamel matrix protein derivative on porcine-derived xenograft for the treatment of one-wall intrabony defects: A 4-year extended follow-up of a randomized controlled trial.

BackgroundThe long‐term outcomes of demineralized porcine bone matrix (DPBM) in combination with enamel matrix protein derivative (EMD) for the treatment of one‐wall intrabony defects have not yet been evaluated. Therefore, this study aimed to assess the clinical, radiographic, and patient‐reported outcomes of regenerative therapy using DPBM with EMD (test group) in comparison with DPBM alone (control group) for the treatment of one‐wall intrabony defects in the molar regions.MethodsThirty‐four patients (control group, n = 18, and test group, n = 16) were available at the 4‐year follow‐up assessment. Clinical (probing pocket depth and clinical attachment level [CAL]), radiographic (defect depth and width), and patient‐reported (Oral Health Impact Profile [OHIP]‐14) parameters were evaluated at baseline, 2 years, and 4 years after regenerative treatment.ResultsBoth treatment modalities, with and without adjunctive use of EMD, resulted in significant improvement of clinical (mean gain in CAL of 1.58 ± 1.34 mm), radiographic (mean defect width fill of 2.41 ± 0.90 mm), and oral health‐related quality of life outcomes at 2 years after regenerative treatment of one‐wall intrabony defects (P < 0.001), which has been sustained over a 4‐year follow‐up period. Particularly, OHIP‐14 scores revealed a statistically significant reduction in physical pain, psychological discomfort, and physical disability (P < 0.05).ConclusionsThe clinical, radiographic, and patient‐reported outcomes were significantly improved when DPBM was used in the regenerative treatment, but no additional benefits were observed with the adjunctive use of EMD.

Regenerative Potential of Enamel Matrix Protein Derivative and Acellular Dermal Matrix for Gingival Recession: A Systematic Review and Meta-Analysis.

Objective: The purpose of this study was to assess the clinical effectiveness of using a combination of enamel matrix protein derivative and acellular dermal matrix in comparison to acellular dermal matrix alone for treating gingival recessions. Methods: The Cochrane Library (Wiley), PubMed by Medline (NLM), Medline (EBSCO), and Embase (Ovid) databases were searched for entries up to April 2020. Only clinical trials were included. Primary outcomes were root coverage (%), changes in keratinized tissue width and recession (mm). Meta-analysis was conducted for root coverage, changes in keratinized tissue width, recession, clinical attachment level and probing depth. Results: Four studies were selected for the analysis. In primary outcomes, root coverage, change in keratinized tissue width and recession analysis showed a mean difference of 4.99% (p = 0.11), 0.20 mm (p = 0.14) and 0.13 mm (p = 0.23) respectively between the two groups. Secondary outcomes analysis also exhibited a statistically insignificant difference between the test and control group with mean difference of 0.11 mm (p = 0.32) in clinical attachment level gain and -0.03 mm (p = 0.29) in probing depth reduction analysis. Conclusions: Within the limits of this study, enamel matrix protein derivative combined with acellular dermal matrix used for treating gingival recession defects resulted in no beneficial effect clinically than acellular dermal matrix only.

Comparative evaluation of fluoride varnishes, self-assembling peptide-based remineralization agent, and enamel matrix protein derivative on artificial enamel remineralization in vitro

BackgroundOne of the most unfavorable side effects of fixed orthodontic treatment is white spot lesions (WSLs). Although the most important approach is prevention of WSLs, it is also essential to evaluate the efficacy of the remineralization agents. However, there is no concurrence in the literature with respect to the remineralization process of these agents. The objective of the present study was to evaluate the effects of different fluoride varnishes, enamel matrix protein, and self-assembling peptide derivatives with varying chemical compositions on remineralization of artificially created WSLs in vitro using quantitative light-induced fluorescence (QLF).MethodsArtificial WSLs were created on bovine enamel samples using acidic buffer solution (pH 5, 10 days). Specimens were randomly allocated to six groups (n = 10/group): (1) Emdogain (Straumann, Basel, Switzerland), (2) Curodont Repair (Credentis AG, Switzerland), (3) Duraphat (Colgate-Palmolive, New York, NY), (4) Clinpro XT (3 M ESPE, Pymble, New South Wales, Australia), (5) Enamel Pro Varnish (Premier Dental Products, PA, USA), and (6) control (untreated). The agents were applied to the WSLs according to the manufacturers’ instructions. Fluorescence loss (ΔF), lesion area (area), and impact (ΔQ) values of enamel surfaces were quantified by QLF-D BiluminatorTM (Inspektor-Pro, Amsterdam, The Netherlands) at baseline and after 7, 14, and 21 days of application of the respective materials.ResultsΔF value presented a significantly decreasing trend throughout the 21 days for all groups except the Duraphat and Enamel Pro varnishes. The changes between 14th and 21st days of the Clinpro XT varnish application were significantly higher than Emdogain, Curodont, and Enamel Pro. The Curodont group showed higher lesion area changes between the first and second week in comparison to the Emdogain, Clinpro XT, and Enamel Pro groups, whereas Clinpro XT assured the highest reduction from the second to the third week of the observation period.ConclusionsThe fluorescence loss was significantly reduced with enamel matrix protein, self-assembling peptide, and light-curable fluoride varnishes in the analysis for 21 days. Curodont and Clinpro XT were effective in diminishing the fluorescence loss and lesion area compared to the Duraphat, Enamel Pro fluoride varnishes, and Emdogain in different time points.

Analysis of geometrical tomographic parameters of furcation lesions in periodontitis patients

ObjectivesThis study was aimed to investigate the relationship between geometric parameters of furcation lesions - maximum area of lesion opening (MALO), angle formed between the roots (ABR), lesion volume (LV) and presence and height of infra-osseous defects (IOD) - and the success of therapy with enamel matrix derivative proteins (EMD) in patients with grade C periodontitis, using cone-beam computed tomography (CBCT). MethodsThe study consisted of two groups of patients with grade C periodontitis: control (surgery) (n = 17) and test (surgery + EMD) (n = 17). Images parameters on CBCT were recorded using OnDemand3D and ITK-SNAP software. ResultsPearson's correlation coefficient demonstrated that only IOD was statistically significant in the probing depth PD (P = 0.01), with a moderate positive correlation (R = 0.59). MALO was found to be statistically significant (P = 0.03) in the test group (surgery + EMD), with moderate negative correlation (R = -0.5). ConclusionThe presence of infra-osseous defects and height were relevant in relation to the success of the type of treatment addressed in this study.

Miller Class III root coverage with coronary tissue repositioning associate with conjunctive graft

Miller Class III root coverage with coronary tissue repositioning associate with conjunctive graft

Adjunctive use of enamel matrix derivatives to porcine-derived xenograft for the treatment of one-wall intrabony defects: Two-year longitudinal results of a randomized controlled clinical trial.

BackgroundThe purpose of this study was to evaluate the potential advantages of adjunctive use of enamel matrix protein derivative (EMD) in combination with demineralized porcine bone matrix (DPBM) for the treatment of one‐wall intrabony defects in the molar regions, in comparison with the use of DPBM alone, through a randomized controlled clinical trial.MethodsForty‐two participants were randomly assigned to two groups: one where DPBM with the adjunctive use of EMD (test group, n = 20) was applied and the other without EMD (control group, n = 22). Changes in the clinical and radiographic parameters from baseline at 6, 12, and 24 months were measured (probing pocket depth, clinical attachment loss, defect depth, and defect width). Postoperative discomfort (severity/duration of pain and swelling) and early soft tissue wound healing (dehiscence/fenestration, persistent swelling, spontaneous bleeding, and ulceration) were also assessed.ResultsBoth treatment modalities, with and without EMD, resulted in significant improvement of clinical and radiographic outcomes without any severe adverse events. However, no statistically significant differences in any of the measured parameters were found when the two groups were compared. Early wound healing outcomes and the severity of swelling did not differ between the groups, but the severity of pain (P = 0.046), duration (P = 0.033), and swelling (P = 0.022) were significantly lower in the test group.ConclusionsDPBM has been verified for biocompatibility and can be used as a scaffold to enhance the clinical and radiographic outcomes of periodontal regeneration of one‐wall intrabony defects. In particular, the adjunctive use of EMD significantly reduced the postoperative discomfort.

PC172: Treatment of localized gingival recessions using subepithelial connective tissue graft (SCTG), xenogenous collagen matrix (CM), acellular dermal matrix (ADM), and enamel matrix derivative proteins (EMD)

PC172: Treatment of localized gingival recessions using subepithelial connective tissue graft (SCTG), xenogenous collagen matrix (CM), acellular dermal matrix (ADM), and enamel matrix derivative proteins (EMD)

PR569: Effect of enamel matrix derivative and dentin matrix protein on osteoblastic proliferation and adhesion over SLA titanium surface

PR569: Effect of enamel matrix derivative and dentin matrix protein on osteoblastic proliferation and adhesion over SLA titanium surface

Histological Effects of Enamel Matrix Derivative Proteins (Emdogain®) on the Healing of Rats Wounds

Histological Effects of Enamel Matrix Derivative Proteins (Emdogain®) on the Healing of Rats Wounds

Scaffold requirements for periodontal regeneration with enamel matrix derivative proteins

Periodontitis affects the attachment of natural teeth, and infection or inflammation associated with periodontitis may affect peri-implant tissues. Enamel matrix derivative (EMD) proteins provide stimulation for self-regeneration of the damaged tissue when applied to wide intrabony defects as part of a mixture with bone graft material. As a first step of the process enhancing cell proliferation and ligament formation, we demonstrated that EMD protein precipitation depends strongly on the physical and chemical characteristics of the bone grafts used in the mixture. To guarantee optimum protein-stimulated self-regulation, the pH of the initial EMD formulation must therefore be adjusted between 3.9 and 4.2 in order to compensate the change in pH induced by the bone graft. Moreover, the interaction between the two components resulted in precipitates of different shape and size differently covering the grafts. This outcome might potentially have clinical implications on cell attachment and periodontal ligament extension, which deserve further in vitro and in vivo tests.

Coronally advanced flap surgery with enamel matrix derivative in the treatment of gingival recession: a systematic review

Objective: Based on a review of the literature, we evaluated the clinical effect of the combination of enamel matrix derivative proteins (EMDP) and coronally advanced flap (CAF) surgery in the treatment of gingival recession (GR).Methods: Information was retrieved from the electronic databases PubMed, Lilacs, Scielo, Medline and the Cochrane Library. Controlled, randomized clinical studies of intervention in humans published in English or Spanish between 2000 and 2013 were eligible.Results: The initial sample consisted of 171 publications. Of these, eight were selected which compared CAF+EMDP (study) with CAF alone (control) in the treatment of GR. Invariably, RH decreased in both the study group and the control group. Likewise, GR width and probing depth decreased and the clinical attachment level increased in both groups, but results were significantly better in the study group. Conclusion: Despite the absence of an overall significant difference between treatment with CAF + EMDP and CAF alone, the addition of EMDP appears to increase the likelihood of achieving complete root coverage and clinically and aesthetically satisfactory results.

Coronally advanced flap surgery with enamel matrix derivative in the treatment of gingival recession: a systematic review

Objective: Based on a review of the literature, we evaluated the clinical effect of the combination of enamel matrix derivative proteins (EMDP) and coronally advanced flap (CAF) surgery in the treatment of gingival recession (GR).Methods: Information was retrieved from the electronic databases PubMed, Lilacs, Scielo, Medline and the Cochrane Library. Controlled, randomized clinical studies of intervention in humans published in English or Spanish between 2000 and 2013 were eligible.Results: The initial sample consisted of 171 publications. Of these, eight were selected which compared CAF+EMDP (study) with CAF alone (control) in the treatment of GR. Invariably, RH decreased in both the study group and the control group. Likewise, GR width and probing depth decreased and the clinical attachment level increased in both groups, but results were significantly better in the study group. Conclusion: Despite the absence of an overall significant difference between treatment with CAF + EMDP and CAF alone, the addition of EMDP appears to increase the likelihood of achieving complete root coverage and clinically and aesthetically satisfactory results.

Enamel Matrix Derivative Proteins in Combination with a Flapless Approach for Periodontal Regeneration of Intrabony Defects: A 2-Year Prospective Case Series.

The present case series evaluated the potential benefits of a flapless approach in the regenerative treatment of residual deep intrabony defects. In each of 11 patients, one periodontal defect with an intrabony component of ≥ 3 mm was treated regeneratively using enamel matrix derivative combined with a closed surgical technique. Clinical and radiographic parameters were recorded at baseline and at 12 and 24 months postoperatively. All defects experienced favorable clinical and radiographic outcomes at the 24-month follow-up. When considering only sites located in the anterior region, all experienced complete pocket closure.

Collagen Membranes Adsorb the Transforming Growth Factor-β Receptor I Kinase-Dependent Activity of Enamel Matrix Derivative.

Enamel matrix derivative (EMD) and collagen membranes (CMs) are simultaneously applied in regenerative periodontal surgery. The aim of this study is to evaluate the ability of two CMs and a collagen matrix to adsorb the activity intrinsic to EMD that provokes transforming growth factor (TGF)-β signaling in oral fibroblasts. Three commercially available collagen products were exposed to EMD or recombinant TGF-β1, followed by vigorous washing. Oral fibroblasts were either seeded directly onto collagen products or were incubated with the respective supernatant. Expression of TGF-β target genes interleukin (IL)-11 and proteoglycan 4 (PRG4) was evaluated by real time polymerase chain reaction. Proteomic analysis was used to study the fraction of EMD proteins binding to collagen. EMD or TGF-β1 provoked a significant increase of IL-11 and PRG4 expression of oral fibroblasts when seeded onto collagen products and when incubated with the respective supernatant. Gene expression was blocked by the TGF-β receptor I kinase inhibitor SB431542. Amelogenin bound most abundantly to gelatin-coated culture dishes. However, incubation of palatal fibroblasts with recombinant amelogenin did not alter expression of IL-11 and PRG4. These in vitro findings suggest that collagen products adsorb a TGF-β receptor I kinase-dependent activity of EMD and make it available for potential target cells.

A novel flapless approach versus minimally invasive surgery in periodontal regeneration with enamel matrix derivative proteins: a 24-month randomized controlled clinical trial.

This investigation was designed to compare the effectiveness of enamel matrix derivative (EMD) proteins in combination with flapless or flap procedure in periodontal regeneration of deep intrabony defects. Thirty chronic periodontitis patients who had at least one residual periodontal defect with an intrabony component of ≥3mm were consecutively enrolled. Defects were randomly assigned to test or control treatments which both consisted of the use of EMD to reach periodontal regeneration. Test sites (n=15) were treated according to a novel flapless approach, whereas control sites (n=15) by means of minimally invasive surgery (MIST). Clinical and radiographic parameters were recorded at baseline, 12 and 24months post-operatively. Both therapeutic modalities yielded similar probing depth (PD) reduction and clinical attachment level (CAL) gain at 24months. In flapless-treated sites, a mean PD reduction of 3.6±1.0mm and a CAL gain of 3.2±1.1mm were observed. In the MIST group, they were 3.7±0.6 and 3.6±0.9mm. The operative chair time was twice as long in the MIST compared to the flapless group, whereas comparable patient-oriented outcomes were observed. The flapless procedure may be successfully applied in the regenerative treatment of deep intrabony defects reaching clinical outcomes comparable with those of minimally invasive surgical approaches and may present important advantages in terms of reduction of operative chair time. The use of EMD as an adjunct to non-surgical periodontal treatment may be considered a suitable option to treat defects mainly in the anterior sextants.