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Miguel MMV, Mathias-Santamaria IF, Rossato A, Ferraz LFF, Rangel TP, Casarin RCV, Tatakis DN, Santamaria MP. Enamel matrix derivative effects on palatal mucosa wound healing: Randomized clinical trial. J Periodontal Res 2021; 56:1213-1222. [PMID: 34541683 DOI: 10.1111/jre.12934] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND 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. MATERIALS 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 0.3 ml of EMD. Clinical and patient-centered parameters were analyzed for 3 months post-treatment. Wound fluid levels of inflammatory markers were assessed 3 and 7 days postoperatively. RESULTS No significant inter-group difference was observed in remaining wound area and re-epithelialization. EMD and control groups achieved wound closure and re-epithelialization 30 days 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. CONCLUSION 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.
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Affiliation(s)
- Manuela Maria Viana Miguel
- São Paulo State University (UNESP), Division of Periodontics, Institute of Science and Technology, São José dos Campos, Brazil
| | - Ingrid Fernandes Mathias-Santamaria
- São Paulo State University (UNESP), Division of Periodontics, Institute of Science and Technology, São José dos Campos, Brazil.,Division of Operative Dentistry, Department of General Dentistry, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Amanda Rossato
- São Paulo State University (UNESP), Division of Periodontics, Institute of Science and Technology, São José dos Campos, Brazil
| | - Laís Fernanda Ferreira Ferraz
- São Paulo State University (UNESP), Division of Periodontics, Institute of Science and Technology, São José dos Campos, Brazil
| | - Thiago Perez Rangel
- Department of Prosthodontics and Periodontics, Division of Periodontics, Piracicaba Dental School, Piracicaba, Brazil
| | - Renato Corrêa Viana Casarin
- Department of Prosthodontics and Periodontics, Division of Periodontics, Piracicaba Dental School, Piracicaba, Brazil
| | - Dimitris N Tatakis
- College of Dentistry, Division of Periodontology, The Ohio State University (OSU), Columbus, Ohio, USA
| | - Mauro Pedrine Santamaria
- São Paulo State University (UNESP), Division of Periodontics, Institute of Science and Technology, São José dos Campos, Brazil.,College of Dentistry - Lexington, University of Kentucky, Lexington, Kentucky, USA
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Gingival recession treatment with enamel matrix derivative associated with coronally advanced flap and subepithelial connective tissue graft: a split-mouth randomized controlled clinical trial with molecular evaluation. Clin Oral Investig 2021; 26:1453-1463. [PMID: 34536136 DOI: 10.1007/s00784-021-04119-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The goal of this study was to evaluate the impact of enamel matrix derivative (EMD) on periodontal healing after root coverage (RC) surgery, involving CAF in combination with SCTG, and to assess the molecular profile, verifying the inflammation level in early stage (1 and 2 weeks). MATERIALS AND METHODS Thirty-two recessions (RT1) were submitted to periodontal surgery with (test) or without (control) EMD. The clinical parameters analyzed on the day of surgery and 6 months after the surgical procedure were as follows: recession height and width, keratinized tissue height, percentual root coverage, and the gingival thickness of keratinized tissue. Moreover, the main inflammatory biomarkers and growth factors (IL-1β, IL-6, IL-8, FGF, MIP-1α and β, PDGF, TNF-α, and VEGF) were evaluated at baseline, 7, and 14 days after procedures. RESULTS The average root coverage was significantly higher in the test group as compared to the control group (86% vs. 66%, p = 0.008). The test side had significantly lesser final RH compared to the control side (p = 0.01). Also, there was a significant reduction of RW in both groups, with more significant results in the test group. KTH and GT were not significantly different at any time and group. After 14 days, the immunological analysis showed an increase of VEGF (p = 0.03) on the test group compared to the control side. CONCLUSION The use of EMD in RC surgeries resulted in a significantly higher RC, as well as a significant increase in VEGF expression, suggesting that EMD may contribute to the angiogenic and healing process. CLINICAL RELEVANCE EMD provided better results in root coverage treatment when associated with CAF and SCTG, beyond a greater releasing of angiogenic growth factor (VEGF), which enhanced the result.
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Weinreb M, Nemcovsky CE. In vitro models for evaluation of periodontal wound healing/regeneration. Periodontol 2000 2017; 68:41-54. [PMID: 25867978 DOI: 10.1111/prd.12079] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2014] [Indexed: 12/14/2022]
Abstract
Periodontal wound healing and regeneration are highly complex processes, involving cells, matrices, molecules and genes that must be properly choreographed and orchestrated. As we attempt to understand and influence these clinical entities, we need experimental models to mimic the various aspects of human wound healing and regeneration. In vivo animal models that simulate clinical situations of humans can be costly and cumbersome. In vitro models have been devised to dissect wound healing/regeneration processes into discrete, analyzable steps. For soft tissue (e.g. gingival) healing, in vitro models range from simple culture of cells grown in monolayers and exposed to biological modulators or physical effectors and materials, to models in which cells are 'injured' by scraping and subsequently the 'wound' is filled with new or migrating cells, to three-dimensional models of epithelial-mesenchymal recombination or tissue explants. The cells employed are gingival keratinocytes, fibroblasts or endothelial cells, and their proliferation, migration, attachment, differentiation, survival, gene expression, matrix production or capillary formation are measured. Studies of periodontal regeneration also include periodontal ligament fibroblasts or progenitors, osteoblasts or osteoprogenitors, and cementoblasts. Regeneration models measure cellular proliferation, attachment and migration, as well as gene expression, transfer and differentiation into a mineralizing phenotype and biomineralization. Only by integrating data from models on all levels (i.e. a single cell to the whole organism) can various critical aspects of periodontal wound healing/regeneration be fully evaluated.
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Effects of enamel matrix derivative on non-surgical management of peri-implant mucositis: a double-blind randomized clinical trial. Clin Oral Investig 2016; 21:2379-2388. [DOI: 10.1007/s00784-016-2033-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 12/08/2016] [Indexed: 12/20/2022]
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Miron RJ, Dard M, Weinreb M. Enamel matrix derivative, inflammation and soft tissue wound healing. J Periodontal Res 2014; 50:555-69. [PMID: 25418917 DOI: 10.1111/jre.12245] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 12/17/2022]
Abstract
Over 15 years have now passed since enamel matrix derivative (EMD) emerged as an agent capable of periodontal regeneration. Following thorough investigation, evidenced-based clinical application is now established for a multitude of clinical settings to promote regeneration of periodontal hard tissues. Despite the large number of studies and review articles written on this topic, no single review has compiled the influence of EMD on tissue inflammation, an area of research that merits substantial attention in periodontology. The aim of the present review was to gather all studies that deal with the effects of EMD on tissue inflammation with particular interest in the cellular mechanisms involved in inflammation and soft tissue wound healing/resolution. The effects of EMD on monocytes, macrophages, lymphocytes, neutrophils, fibroblasts and endothelial cells were investigated for changes in cell behavior as well as release of inflammatory markers, including interleukins, prostaglandins, tumor necrosis factor-α, matrix metalloproteinases and members of the OPG-RANKL pathway. In summary, studies listed in this review have reported that EMD is able to significantly decrease interleukin-1b and RANKL expression, increase prostaglandin E2 and OPG expression, increase proliferation and migration of T lymphocytes, induce monocyte differentiation, increase bacterial and tissue debris clearance, as well as increase fibroplasias and angiogenesis by inducing endothelial cell proliferation, migration and capillary-like sprout formation. The outcomes from the present review article indicate that EMD is able to affect substantially the inflammatory and healing responses and lay the groundwork for future investigation in the field.
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Affiliation(s)
- R J Miron
- Department of Periodontology, Department of Oral Surgery, University of Bern, Bern, Switzerland.,Faculty of Dental Medicine, University of Laval, Quebec City, QC, Canada
| | - M Dard
- Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, USA
| | - M Weinreb
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Khedmat S, Dehghan S, Hadjati J, Masoumi F, Nekoofar MH, Dummer PMH. In vitro cytotoxicity of four calcium silicate-based endodontic cements on human monocytes, a colorimetric MTT assay. Restor Dent Endod 2014; 39:149-54. [PMID: 25110637 PMCID: PMC4125577 DOI: 10.5395/rde.2014.39.3.149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/19/2013] [Indexed: 11/11/2022] Open
Abstract
Objectives This study was performed to evaluate the cytotoxicity of four calcium silicate-based endodontic cements at different storage times after mixing. Materials and Methods Capillary tubes were filled with Biodentine (Septodont), Calcium Enriched Mixture (CEM cement, BioniqueDent), Tech Biosealer Endo (Tech Biosealer) and ProRoot MTA (Dentsply Tulsa Dental). Empty tubes and tubes containing Dycal were used as negative and positive control groups respectively. Filled capillary tubes were kept in 0.2 mL microtubes and incubated at 37℃. Each material was divided into 3 groups for testing at intervals of 24 hr, 7 day and 28 day after mixing. Human monocytes were isolated from peripheral blood mononuclear cells and cocultered with 24 hr, 7 day and 28 day samples of different materials for 24 and 48 hr. Cell viability was evaluated using an MTT assay. Results In all groups, the viability of monocytes significantly improved with increasing storage time regardless of the incubation time (p < 0.001). After 24 hr of incubation, there was no significant difference between the materials regarding monocyte viability. However, at 48 hr of incubation, ProRoot MTA and Biodentine were less cytotoxic than CEM cement and Biosealer (p < 0.01). Conclusions Biodentine and ProRoot MTA had similar biocompatibility. Mixing ProRoot MTA with PBS in place of distilled water had no effect on its biocompatibility. Biosealer and CEM cement after 48 hr of incubation were significantly more cytotoxic to on monocyte cells compared to ProRoot MTA and Biodentine.
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Affiliation(s)
- Sedigheh Khedmat
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran. ; Department of Endodontics, Dental School, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayyeh Dehghan
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran. ; Department of Endodontics, Dental School, Qum University of Medical Sciences, Qum, Iran
| | - Jamshid Hadjati
- Department of Immunology, Tehran University of Medical Sciences School of Medicine, Tehran, Iran
| | - Farimah Masoumi
- Department of Immunology, Tehran University of Medical Sciences School of Medicine, Tehran, Iran
| | - Mohammad Hossein Nekoofar
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran. ; Department of Endodontics, Dental School, Tehran University of Medical Sciences, Tehran, Iran. ; Endodontology Research Group, College of BioMedical and Life Sciences School of Dentistry, Cardiff University, Cardiff, UK
| | - Paul Michael Howell Dummer
- Endodontology Research Group, College of BioMedical and Life Sciences School of Dentistry, Cardiff University, Cardiff, UK
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Obregon-Whittle MV, Stunes AK, Almqvist S, Brookes SJ, Lees JD, Lee JD, Syversen U, Lyngstadaas SP, Reseland JE. Enamel matrix derivative stimulates expression and secretion of resistin in mesenchymal cells. Eur J Oral Sci 2012; 119 Suppl 1:366-72. [PMID: 22243269 DOI: 10.1111/j.1600-0722.2011.00902.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In this study we wanted to identify the effect of enamel matrix derivative (EMD) on adipocytokines, so-called adipokines. Primary human cells of mesenchymal origin (osteoblasts, periodontal ligament cells, mesenchymal stem cells, and pulp cells) and hematopoietic origin (monocytes) were incubated with EMD. The levels of adipokines in cell culture medium were quantified using the Lincoplex human adipocyte panel (Luminex) and by real-time PCR of mRNA isolated from cell lysates. Rats were injected with 2 mg of EMD or saline intramuscularly every third day for 14 d. Blood samples were taken before and after injections, and the level of resistin in rat plasma was measured by ELISA. We found a dramatic increase in the secretion of resistin from mesenchymal stem cells, and verified this result in all the cells of mesenchymal origin tested. However, we observed no significant changes in the amount of resistin secreted from monocytes exposed to EMD compared with the control. Injections of EMD significantly enhanced the circulating levels of resistin in rats, and EMD also significantly enhanced the activity of the resistin promoter in transfected mesenchymal stem cells, indicating a direct effect on resistin expression. Our results indicate that resistin may play a role in mediating the biological effect of EMD in mesenchymal tissues.
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Karima MM, Van Dyke TE. Enamel matrix derivative promotes superoxide production and chemotaxis but reduces matrix metalloproteinase-8 expression by polymorphonuclear leukocytes. J Periodontol 2012; 83:780-6. [PMID: 22050547 PMCID: PMC4502925 DOI: 10.1902/jop.2011.110397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Polymorphonuclear leukocyte (PMN) is the predominant innate immune cell type activated in acute inflammation. The aim of this study is to determine the impact of enamel matrix derivative (EMD) on superoxide (O(2)(-)) generation, chemotaxis, and matrix metalloproteinase-8 (MMP-8) secretion by PMN in vitro to better understand the role of EMD in surgical wound healing. METHODS PMNs were isolated from healthy volunteers (n = 14). O(2)(-) generation was measured using a cytochrome c reduction assay. Chemotaxis was measured in a modified Boyden chamber. MMP-8 secretion was analyzed by Western blotting. A relative density method was used to determine the percentage of MMP-8 released from the PMNs in relation to the total cellular MMP-8 content. RESULTS O(2)(-) generation was significantly elevated when PMNs were stimulated with EMD (200 μg/mL) (P <0.01). Secondary stimulation of PMNs with 1 μM N-formyl-methionyl-leucyl-phenylalanine (fMLP) triggered earlier and more sustained O(2)(-) generation with EMD. EMD significantly increased PMN chemotactic activity (P <0.05). Combined stimulation with EMD plus fMLP resulted in significantly higher chemotaxis compared to fMLP alone (P <0.05). Conversely, EMD did not induce MMP-8 secretion from PMNs. MMP-8 secretion by PMNs in response to fMLP or serum-opsonized zymosan stimulation was significantly inhibited by EMD (P <0.05). CONCLUSIONS EMD has specific, differential actions on PMNs that suggest potential for enhancement of wound healing, bacterial and tissue debris clearance (O(2)(-) generation and chemotaxis), and suppression of tissue damage and degradation (MMP-8 ). Together, the data suggest that EMD enhances wound healing and reduces inflammation.
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Affiliation(s)
- Mamdouh M. Karima
- Department of Oral Basic and Clinical Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Apical Periodontium Response to Enamel Matrix Derivative as an Intracanal Medication in Rat Immature Teeth with Pulp Necrosis: Radiographic and Histologic Findings. J Endod 2012; 38:449-53. [DOI: 10.1016/j.joen.2011.12.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 12/22/2011] [Accepted: 12/27/2011] [Indexed: 01/09/2023]
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Lee SY, Min KS, Choi GW, Park JH, Park SH, Lee SI, Kim EC. Effects of simvastain and enamel matrix derivative on Portland cement with bismuth oxide-induced growth and odontoblastic differentiation in human dental pulp cells. J Endod 2012; 38:405-10. [PMID: 22341085 DOI: 10.1016/j.joen.2011.12.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 12/12/2011] [Accepted: 12/19/2011] [Indexed: 01/09/2023]
Abstract
INTRODUCTION We previously reported that bismuth oxide containing Portland cement (BPC) showed similar biocompatibility to Portland cement (PC) in periodontal ligament cells. However, the bioactivity of simvastatin and Emdogain (Biora AB, Malmö, Sweden) on BPC was not reported. The aim of this study was to evaluate the effects of simvastatin and Emdogain on BPC compared with mineral trioxide aggregate (MTA) in human dental pulp cells (HDPCs). METHODS Cell growth was determined by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium-bromide (MTT) assay. Differentiation was evaluated by alkaline phosphatase (ALP) activity, alizarin red staining, and reverse-transcriptase polymerase chain reaction. RESULTS The cell growth of HDPCs exposed to Emdogain and simvastatin plus BPC was superior to those administered BPC alone and similar to those that received MTA for 14 days. The simvastatin and Emdogain groups increased the odontogenic potential of the BPC group with respect to ALP activity, mineralization nodules, messenger RNA expression of ALP, osteopontin, osteocalcin, Runx2, and osterix. CONCLUSIONS These results suggest that simvastatin and Emdogain improved cell growth and the differentiation of the BPC group in HDPCs and may be useful ingredients in BPC as pulp-capping material.
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Affiliation(s)
- So-Youn Lee
- Department of Maxillofacial Tissue Regeneration, School of Dentistry and Institute of Oral Biology, Kyung Hee University, Seoul, Republic of Korea
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Chen C, Wei X, Ling J, Xie N. Expression of matrilin-2 and -4 in human dental pulps during dentin-pulp complex wound healing. J Endod 2011; 37:642-9. [PMID: 21496664 DOI: 10.1016/j.joen.2011.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 02/01/2011] [Accepted: 02/03/2011] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Matrilin-2 and matrilin-4 are members of the matrilin family displaying broad tissue distribution. We recently reported that matrilin-2 showed significant down-regulation during the odontogenic differentiation of dental pulp cells (DPCs). It is reported that matrilin-4 was the only extracellular matrix biogenesis and organization-related gene detected in odontoblasts but not DPCs. However, the exact role of matrlin-2 and -4 in dental pulps remains unclear. The aim of our study was to analyze the expression of matrilin-2 and -4 in human dental pulps and their relation to dentin-pulp complex wound healing. METHODS Immunohistology was performed on the paraffin-embedded tissue sections of human dental pulps from sound and deep carious teeth. Matrilin-2 and -4 messenger RNAs were detected by quantitative real-time reverse-transcription polymerase chain reaction, and the proteins were shown by immunofluorescence and Western blot during odontogenic differentiation of the DPCs. RESULTS In the sound dental pulp, matrilin-2 immunoreactivity was observed throughout the pulp, whereas matrilin-4 was observed only in the odontoblast layer. In deep carious dental pulp, matrilin-2 protein was weakly stained, whereas matrilin-4 was detected in the pulp under the carious lesion. During odontogenic differentiation of DPCs, the expression of matrilin-2 messenger RNA was down-regulated within 14 days followed by a statistical increase on day 21, and the matrilin-2 protein level was down-regulated within the 3 weeks, whereas the messenger RNA and protein expressions of matrilin-4 increased in a time-dependent manner. CONCLUSIONS Matrilin-2 and matrilin-4 have been shown in human dental pulps and might be involved in the dentin-pulp complex wound-healing process.
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Affiliation(s)
- Chanchan Chen
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
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