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Yang Z, Yu Q, Ren L, Wang H, Zhu L. Efficacy of OFD with EMD for treatment of periodontal defects: A systematic review and meta-analysis. Oral Dis 2024; 30:4113-4125. [PMID: 38852154 DOI: 10.1111/odi.15029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES In order to enhance clinical improvement of periodontal defects, the addition of enamel matrix derivatives (EMD) to open flap debridement (OFD) has been investigated. The aim of this systematic review is to figure out whether such a combination, in comparison to the treatment with OFD alone has some effects on the following outcomes: clinical attachment level gain, probing depth reduction, and gingival recessions increase. METHODS Electronic databases (PubMed, Embase, Web of Science, and Cochrane) were searched for randomized controlled trials in humans addressing the use of a combination of OFD and EMD versus a control group with OFD alone for the treatment of periodontal defects, with a minimum of 6 months of follow-up; meta-analysis and trial sequential analysis were then performed. RESULTS From a total of 204 records screened by title and abstract, 13 studies were read full-text and eight out of them included in the meta-analysis. Some significant differences have been demonstrated both for clinical attachment level gain and probing depth reduction between test and control groups. CONCLUSIONS In the treatment of periodontal defects, the addition of EMD to OFD seems to be beneficial in terms of clinical attachment level gain, probing depth reduction, promoting periodontal regeneration. However, such results should be considered with caution because of the small number of studies included in the meta-analysis and their heterogeneity.
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Affiliation(s)
- Ziyue Yang
- Department of Stomatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qin Yu
- Department of Stomatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lulu Ren
- Department of Stomatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongyan Wang
- State Key Laboratory of Tea Plant Biology and Utilization, School of Tea and Food Science and Technology, Anhui Agricultural University, Hefei, Anhui, China
| | - Lifang Zhu
- Department of Stomatology, The First Affiliated Hospital of Soochow University, Suzhou, China
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2
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Sawada K, Shimomura J, Takedachi M, Murata M, Morimoto C, Kawasaki K, Kawakami K, Iwayama T, Murakami S. Activation of periodontal ligament cell cytodifferentiation by juxtacrine signaling from cementoblasts. J Periodontol 2024; 95:256-267. [PMID: 37492992 DOI: 10.1002/jper.23-0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/12/2023] [Accepted: 07/22/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND New cementum forms from existing cementum during periodontal tissue regeneration, indicating that cementoblasts may interact with progenitor cells in the periodontal ligament to enhance cementogenesis. However, the molecular mechanisms of this process are currently unknown. This study aims to clarify the role of cell-cell interactions between cementoblasts and periodontal ligament cells in differentiation into cementoblasts. METHODS To analyze the role of human cementoblast-like cells (HCEMs) on human periodontal ligament cells (HPDLs), we mixed cell suspensions of enhanced green fluorescent protein-tagged HPDLs and HCEMs, and then seeded and cultured them in single wells (direct co-cultures). We sorted co-cultured HPDLs and analyzed their characteristics, including the expression of cementum-related genes. In addition, we cultured HPDLs and HCEMs in a non-contact environment using a culture system composed of an upper insert and a lower well separated by a semi-permeable membrane (indirect co-cultures), and similar analysis was performed. Gene expression of integrin-binding sialoprotein (IBSP) in cementoblasts was confirmed in mouse periodontal tissues. We also investigated the effect of Wingless-type (Wnt) signaling on the differentiation of HPDLs into cementoblasts. RESULTS Direct co-culture of HPDLs with HCEMs significantly upregulated the expression of cementoblast-related genes in HPDLs, whereas indirect co-culture exerted no effect. Wnt3A stimulation significantly upregulated IBSP expression in HPDLs, whereas inhibition of canonical Wnt signaling suppressed the effects of co-culture. CONCLUSION Our results suggest that direct cell interactions with cementoblasts promote periodontal ligament cell differentiation into cementoblasts. Juxtacrine signaling via the canonical Wnt pathway plays a role in this interaction.
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Affiliation(s)
- Keigo Sawada
- Department of Periodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Junpei Shimomura
- Department of Periodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Masahide Takedachi
- Department of Periodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Mari Murata
- Department of Periodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Chiaki Morimoto
- Department of Periodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Kohsuke Kawasaki
- Department of Periodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Kazuma Kawakami
- Department of Periodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Tomoaki Iwayama
- Department of Periodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Shinya Murakami
- Department of Periodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
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3
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Abu-Ta'a M, Marzouka D. Enamel Matrix Derivative (EMD) as an Adjunct to Non-surgical Periodontal Therapy: A Systematic Review. Cureus 2023; 15:e43530. [PMID: 37719602 PMCID: PMC10500965 DOI: 10.7759/cureus.43530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
If left untreated, periodontitis is a chronic, irreversible disease that can contribute to tooth loss. The primary objective of periodontal treatment is to arrest the progression of the disease and restore the supporting structures of the tooth. Scaling and root planing (SRP) is a common non-surgical periodontal therapy (NSPT) used to reduce inflammation, pocket depth, and clinical attachment loss. However, NSPT has limitations, notably in difficult-to-access deep pockets and molar furcations. Deep pockets (greater than 4 mm) frequently retain calculus following NSPT. To attain direct access, surgical periodontal therapy (SPT) is recommended, particularly for pockets deeper than 5 mm. Enamel matrix derivative (EMD) has emerged in recent years as a tool for periodontal regeneration when used in conjunction with NSP for infrabony defects. EMD may also have advantageous effects when combined with NSPT. The purpose of this review is to provide a thorough understanding of the effects of EMD as an adjunct to NSPT. The databases Scopus, PubMed/MEDLINE, Google Scholar, Cochrane, and Embase were systematically searched to identify relevant studies on the benefits of EMD and its use as an adjunct to NSPT. Incorporating EMD into NSPT reduces chair time, and 60% of studies demonstrated considerable benefits compared to SRP alone, according to the findings. On the basis of research, it can be concluded that EMD can be used as an adjunct to NSPT, thereby reducing the amount of time spent in the operating chair. In some cases, it can, therefore, be regarded as an alternative to surgical treatment.
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Affiliation(s)
| | - Dina Marzouka
- Dental Sciences, Arab American University, Ramallah, PSE
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4
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Tavelli L, Chen CYJ, Barootchi S, Kim DM. Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis. J Periodontol 2022; 93:1803-1826. [PMID: 36279121 DOI: 10.1002/jper.22-0120] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects. METHODS A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration. RESULTS A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor. CONCLUSIONS Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Chia-Yu Jennifer Chen
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - David M Kim
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Kormas I, Pedercini A, Alassy H, Wolff LF. The Use of Biocompatible Membranes in Oral Surgery: The Past, Present & Future Directions. A Narrative Review. MEMBRANES 2022; 12:841. [PMID: 36135860 PMCID: PMC9503881 DOI: 10.3390/membranes12090841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
The use of biocompatible membranes in periodontal and oral surgery is an important part of regeneration. Over the years, several different membranes have been developed, ranging from non-resorbable membranes that have to be removed in a separate procedure, to collagen membranes that completely resorb on their own, thus avoiding the need for a second surgery. Autogenous membranes are becoming increasingly popular in more recent years. These membranes can be used with a great variety of techniques in the four main hard tissue regenerative procedures: guided tissue regeneration, alveolar ridge preservation, guided bone regeneration and sinus floor augmentation. A review of the literature was conducted in order to identify the most commonly used membranes in clinical practice, as well as the most promising ones for regeneration procedures in the future. The information provided in this review may serve as a guide to clinicians, in order to select the most applicable membrane for the clinical case treated as the correct choice of materials may be critical in the procedure's success.
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Affiliation(s)
- Ioannis Kormas
- Department of Periodontics, School of Dentistry, Texas A&M University, Dallas, TX 75246, USA
| | | | | | - Larry F. Wolff
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
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Khan MA, Sivaraj LD, Nahar P, Kollata VRS, Prakash M, Vaderhobli RM. Efficacy of the Use of Adjunctives in Periodontal Surgeries: An Evidenced-based Summary. J Long Term Eff Med Implants 2022; 32:63-82. [DOI: 10.1615/jlongtermeffmedimplants.2022043326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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7
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Osteoprotective Effect of Enamel Matrix Derivatives on the Regeneration of Mandibular Defects in Experimentally Glucocorticoid-Induced Osteoporosis. Int J Dent 2021; 2021:8659010. [PMID: 34804167 PMCID: PMC8598373 DOI: 10.1155/2021/8659010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/12/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Osteoporosis is a progressive systematic skeletal illness characterized by low bone mineral density and susceptibility to fracture caused by bone resorption. Aim of the Study. This study intended to evaluate the possible role of emdogain in combination with calcitonin on the healing of surgically induced mandibular defects performed on osteoporotic rats. Materials and Methods Forty healthy female white albino rats were included in this study and divided into four groups. In group I (negative control), 10 rats received a vehicle injection after which a unilateral mandibular defect was created in each rat of all groups. Three groups were subjected to induction of osteoporosis by subcutaneous injection of 0.1 mg/kg/day dexamethasone for 60 days. In group II, rats were kept without treatment. In group III, rats were treated with daily intramuscular injection of 2.5 IU/kg of synthetic salmon calcitonin. In group IV, rats were handled as group III, and the created cavity was filled with emdogain. Rats were euthanized at 2nd and 4th week postsurgically. Hematoxylin and eosin, Masson's trichrome, NF-κB (nuclear factor of activated B cells), and immunohistochemical stains were used, followed by statistical analysis. Results Group I showed normal stages of bone defects healing. Group II revealed the formation of granulation tissue with dilated blood vessels, while groups III and IV showed enhanced bone healing and proper collagen fibers. The percentage area of newly formed collagen fibers was significantly higher in group IV at 2nd week (13.96 ± 0.020%) and 4th week (16.95 ± 0.024%) than in group II (8.75 ± 0.015% and 10.29 ± 0.015%, respectively) and group III (12.93 ± 0.015% and 14.61 ± 0.021%, respectively), but was lower than that in group I (15.75 ± 0.015% and 17.49 ± 0.015%, respectively). Conclusion The local application of emdogain combined with systemically injected calcitonin improves bone healing in surgically induced bone defects in osteoporotic rats.
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8
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Treatment of intrabony periodontal defects in controlled diabetic patients with an enamel matrix derivative: a split-mouth randomized clinical trial. Clin Oral Investig 2021; 26:2479-2489. [PMID: 34643808 DOI: 10.1007/s00784-021-04215-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/26/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This split-mouth randomized controlled trial aimed to evaluate the effect of enamel matrix derivative (EMD) associated with a simplified papilla preservation flap (SPPF) compared to SPPF alone in the surgical treatment of intrabony defects (ID) in type 2 diabetic mellitus (T2DM) patients. MATERIAL AND METHODS Thirteen patients with controlled T2DM presenting with ID in at least two quadrants were included. In each patient, the test site (TS) was treated with SPPF plus EMD, whereas the control site (CS) was treated only with SPPF. Prior to surgery and at 6 months after intervention, the following parameters were evaluated: clinical attachment level (CAL), probing pocket depth (PPD), and gingival recession (GR). RESULTS The TS and CS demonstrated a mean CAL gain of 3.31 ± 0.96 mm and 1.61 ± 1.12 mm, and a PPD reduction from 8.15 ± 0.98 to 3.00 ± 0.57 mm and 7.53 ± 0.96 to 4.69 ± 0.63 mm after 6 months, respectively. In both sites, the mean CAL gain and PPD reduction improved significantly after 6 months compared to baseline; however, the improvement was higher in the TS (p < 0.001). CONCLUSIONS Both surgical procedures presented with clinical improvements in controlled T2DM patients. However, the additional use of EMD showed enhanced clinical results after 6 months with regard to CAL gain and PPD reduction. CLINICAL RELEVANCE This study showed a better PPD reduction and CAL gain when an EMD was applied in addition to SPPF. Therefore, EMD may be used to enhance clinical outcomes in periodontal ID of controlled T2DM patients.
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9
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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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10
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Lam LRW, Schilling K, Romas S, Misra R, Zhou Z, Caton JG, Zhang X. Electrospun core-shell nanofibers with encapsulated enamel matrix derivative for guided periodontal tissue regeneration. Dent Mater J 2021; 40:1208-1216. [PMID: 34121026 DOI: 10.4012/dmj.2020-412] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The osteogenic effect of a composite electrospun core-shell nanofiber membrane encapsulated with Emdogain® (EMD) was evaluated. The membrane was developed through coaxial electrospinning using polycaprolactone as the shell and polyethylene glycol as the core. The effects of the membrane on the osteogenic differentiation of periodontal ligament stem cells (PDLSCs) were examined using Alizarin Red S staining and qRT-PCR. Characterization of the nanofiber membrane demonstrated core-shell morphology with a mean diameter of ~1 µm. Examination of the release of fluorescein isothiocyanate-conjugated bovine serum albumin (FITC-BSA) from core-shell nanofibers over a 22-day period showed improved release profile of encapsulated proteins as compared to solid nanofibers. When cultured on EMD-containing core-shell nanofibers, PDLSCs showed significantly improved osteogenic differentiation with increased Alizarin Red S staining and enhanced osteogenic gene expression, namely OCN, RUNX2, ALP, and OPN. Core-shell nanofiber membranes may improve outcomes in periodontal regenerative therapy through simultaneous mechanical barrier and controlled drug delivery function.
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Affiliation(s)
- Linda R Wang Lam
- Center for Musculoskeletal Research, University of Rochester, School of Medicine and Dentistry.,Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, School of Medicine and Dentistry
| | - Kevin Schilling
- Center for Musculoskeletal Research, University of Rochester, School of Medicine and Dentistry.,Department of Biomedical Engineering, University of Rochester
| | - Stephen Romas
- Department of Pediatrics, University of Rochester, School of Medicine and Dentistry
| | - Ravi Misra
- Department of Pediatrics, University of Rochester, School of Medicine and Dentistry
| | - Zhuang Zhou
- Center for Musculoskeletal Research, University of Rochester, School of Medicine and Dentistry
| | - Jack G Caton
- Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, School of Medicine and Dentistry
| | - Xinping Zhang
- Center for Musculoskeletal Research, University of Rochester, School of Medicine and Dentistry
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11
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Vincent-Bugnas S, Charbit Y, Charbit M, Dard M, Pippenger B. Maxillary Sinus Floor Elevation Surgery With BioOss Mixed With Enamel Matrix Derivative: A Human Randomized Controlled Clinical and Histologic Study. J ORAL IMPLANTOL 2020; 46:507-513. [PMID: 32299097 DOI: 10.1563/aaid-joi-d-19-00119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Xenograft bone substitutes are commonly used to increase bone volume and height in the deficient posterior maxilla. The addition of enamel matrix derivate (Emdogain) could increase the efficiency of the bone healing process. The aim of this prospective randomized, controlled split-mouth design study was to compare the percentage of newly formed bone in sinus floor augmentation with deproteinized bovine bone mineral with or without the addition of enamel matrix derivative after 6 months of healing. Sixteen bilateral sinus floor augmentation procedures were performed. Deproteinized bovine bone mineral combined with enamel matrix derivative (test) and deproteinized bovine bone mineral alone (control) groups were randomly allocated within each patient. Six months after augmentation and concurrent to implant placement, bone biopsies were taken for histomorphometric analysis. Additionally, implant survival and peri-implant bone levels were radiographically assessed at baseline and 24 months after functional loading. Histomorphometric analysis revealed a significantly higher amount of newly formed bone in the test group compared with the control group (22.6% and 15.5%, respectively; P = .033). No significant differences in the amount of remaining graft or connective tissue was found. Enamel matrix derivative added to deproteinized bovine bone mineral particles significantly increased new bone formation in sinus lift procedures in edentulous or partially edentulous patients with deficient bilateral posterior alveolar ridges requiring augmentation for implant placement.
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Affiliation(s)
- Séverine Vincent-Bugnas
- Département de parodontologie, Pôle odontologie, Centre Hospitalier Universitaire de Nice.,Laboratoire MICORALIS, Université Côte d'Azur
| | - Yves Charbit
- Département de parodontologie, Pôle odontologie, Centre Hospitalier Universitaire de Nice
| | - Mathieu Charbit
- Département de parodontologie, Pôle odontologie, Centre Hospitalier Universitaire de Nice.,Laboratoire MICORALIS, Université Côte d'Azur
| | - Michel Dard
- Section of Oral, Diagnosis and Rehabilitation Sciences, Columbia University, College of Dental Medicine, New York, New York.,Straumann Group, Basel, Switzerland
| | - Benjamin Pippenger
- Preclinical & Translational Research, Institut Straumann AG, Basel, Switzerland
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12
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Jasa EE, Gradoville JM, Christiansen MM, Samson KK, Reinhardt RA, Payne JB, Killeen AC. Effects of enamel matrix derivative on clinical and inflammatory outcomes in periodontal maintenance patients: Randomized controlled clinical trial. J Periodontol 2020; 91:1400-1408. [PMID: 32182380 DOI: 10.1002/jper.19-0623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/13/2020] [Accepted: 02/27/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Efficient methods to treat persistent pockets during periodontal maintenance therapy (PMT) require further investigation. The hypothesis of this randomized controlled clinical trial was that local application of enamel matrix derivative (EMD) added to papilla reflection/root preparation (PR/RP) could enhance clinical and inflammatory outcomes, primarily clinical attachment level (CAL). METHODS Fifty PMT patients with generalized stage III-IV, grade B periodontitis presenting with a 6- to 9-mm interproximal PD were randomly allocated to (PR/RP+EMD; n = 24) and control (PR/RP+saline; n = 26) therapies by sex and smoking status. Roots were treated with reflection of interproximal papillae, root planing assisted with endoscope evaluation, and acid etching, followed by EMD or saline application. Probing depth (PD), CAL, plaque index (PI), and interproximal bone height were evaluated at baseline and 12-months post-therapy. Gingival crevicular fluid, bleeding on probing (BOP), and interleukin-1β were tested (ELISA) at baseline, 2 weeks, and 6 and 12 months. Groups were compared over time and between groups with Wilcoxon Rank Sum and t-tests. RESULTS Both PR/RP+ EMD and PR/RP+S resulted in significant improvements in clinical outcomes (PD and CAL, BOP) from baseline to 12 months. No significant differences were found in clinical or inflammatory outcomes between the experimental and control groups. CONCLUSIONS The addition of EMD to PR/RP does not significantly improve clinical or inflammatory outcomes compared with PR/RP alone during periodontal maintenance therapy.
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Affiliation(s)
- Erica E Jasa
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Jessica M Gradoville
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Mary M Christiansen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Kaeli K Samson
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | - Richard A Reinhardt
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Jeffrey B Payne
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Amy C Killeen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
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13
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Lee JH, Kim DH, Jeong SN. 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. J Periodontol 2019; 91:880-889. [PMID: 31811645 PMCID: PMC7497188 DOI: 10.1002/jper.19-0432] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022]
Abstract
Background The 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. Methods Forty‐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. Results Both 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. Conclusions DPBM 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.
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Affiliation(s)
- Jae-Hong Lee
- Department of Periodontology, Daejeon Dental Hospital, Institute of Wonkwang Dental Research, Wonkwang University College of Dentistry, Daejeon, Korea
| | - Do-Hyung Kim
- Department of Periodontology, Daejeon Dental Hospital, Institute of Wonkwang Dental Research, Wonkwang University College of Dentistry, Daejeon, Korea
| | - Seong-Nyum Jeong
- Department of Periodontology, Daejeon Dental Hospital, Institute of Wonkwang Dental Research, Wonkwang University College of Dentistry, Daejeon, Korea
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Seshima F, Kigure T, Saito A. Periodontal Regenerative Therapy Using Enamel Matrix Derivative for Treatment of Generalized Severe Chronic Periodontitis: A 2-year Case Report. THE BULLETIN OF TOKYO DENTAL COLLEGE 2019; 60:97-104. [PMID: 30880297 DOI: 10.2209/tdcpublication.2018-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Here, we describe the treatment course and 2-year follow-up in a case of multiple deep intrabony defects treated with periodontal regenerative therapy. The patient was a 50-year-old woman presenting with the chief complaint of mobile teeth in the maxillary molar region. Examination at her initial visit revealed sites with a probing depth of ≥7 mm in the molar region. Radiographic examination revealed generalized bone resorption. Angular bony defects were evident in the molar region. Initial periodontal therapy was commenced based on a clinical diagnosis of generalized chronic periodontitis. At re-evaluation, an improvement was observed in periodontal conditions. Periodontal regenerative therapy with enamel matrix derivative was performed on teeth #13, 15, 24, 27, 33, 35, 37, 46, and 47. Following re-evaluation, a removable partial denture was used to replace teeth #26 and 45, and the patient placed under supportive periodontal therapy. Periodontal conditions have remained stable. Careful supportive periodontal therapy needs to be continued, however, to monitor and treat sites requiring further attention, including those with furcation involvement.
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Affiliation(s)
- Fumi Seshima
- Department of Periodontology, Tokyo Dental College
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15
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Efficacy of Adjunctive Bioactive Materials in the Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8670832. [PMID: 29977919 PMCID: PMC5994283 DOI: 10.1155/2018/8670832] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 02/07/2023]
Abstract
Objectives Lots of bioactive materials have been additionally applied for the treatment of periodontal intrabony defect. However, there is dearth of studies to systematically evaluate the supplementary role of them in periodontal regeneration. The goal of this meta-analysis is to evaluate the adjunctive effects of bioactive materials such as platelet-rich plasma (PRP), platelet-rich fibrin (PRF), enamel matrix derivative (EMD), and amnion membrane (AM) on the outcomes of bone grafting treatment for periodontal intrabony defects. Methods Articles published before December 2017 were searched electronically in three databases (PubMed, Embase, and Cochrane Central), with no date or language limits. Randomized controlled trials (RCTs) on the assessment of effectiveness of the four biomaterials in conjunction with demineralized freeze-dried bone allografts (DFDBA) in the treatment of periodontal intrabony defects were enrolled in this meta-analysis. Data were analyzed with STATA 12. Results Nine studies were included. PRF and PRP significantly improved pocket depth (PD) reduction and clinical attachment loss (CAL) gain. Only PRF exhibited a positive result in recession reduction (RecRed). Only PRP showed a statistically significant increase in bone fill. AM merely gained more CAL. EMD did not improve any clinical outcome. Conclusion Our data suggest that PRF/PRP could be taken as a preferred adjunct to facilitate periodontal regeneration of intrabony defects.
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16
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Seshima F, Aoki H, Takeuchi T, Suzuki E, Irokawa D, Makino-Oi A, Sugito H, Tomita S, Saito A. Periodontal regenerative therapy with enamel matrix derivative in the treatment of intrabony defects: a prospective 2-year study. BMC Res Notes 2017; 10:256. [PMID: 28683765 PMCID: PMC5501118 DOI: 10.1186/s13104-017-2572-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/28/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To date, enamel matrix derivative (EMD) has been considered to be one of the few biomaterials for clinical use capable of demonstrating true periodontal regeneration. The aim of this two-center prospective clinical study was to evaluate 2-year outcome of periodontal regenerative therapy using EMD in the treatment of intrabony defects, performed as an 'advanced medical treatment' under the national healthcare system in Japan. RESULTS Patients with chronic periodontitis who have completed initial periodontal therapy at either of the two dental school clinics were enrolled. Each contributed at least one intrabony defect of ≥3 mm in depth. During surgery, EMD was applied to the defect following debridement. Twenty-two participants (mean age 55.2 years old, 9 men and 13 women) completed 2-year reevaluation, and a total of 42 defects were subjected to data analysis. Mean gains in clinical attachment level (CAL) at 1 and 2 years were 2.9 mm (38% of baseline CAL) and 3.1 mm (41%), respectively, both showing a significant improvement from baseline. There was also a significant reduction in probing depth (PD): mean reductions at 1 and 2 years were 3.2 and 3.3 mm, respectively. There was a progressive improvement in the mean percentages of bone fill from 26% at 1 year to 36% at 2 years. No significant difference in CAL gain at 2 years was found between 3-wall bone defects and other defect types combined. In multiple regression analysis, the baseline PD was significantly associated with CAL gain at 2 years. In this population of patients, the treatment of intrabony defects with EMD yielded clinically favorable outcomes, as assessed by periodontal and radiographical parameters, over a period of 2 years.
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Affiliation(s)
- Fumi Seshima
- Department of Periodontology, Tokyo Dental College, Tokyo, Japan
| | - Hideto Aoki
- Department of Periodontology, Tokyo Dental College, Tokyo, Japan
| | | | - Eiichi Suzuki
- Department of Periodontology, Tokyo Dental College, Tokyo, Japan
| | - Daisuke Irokawa
- Department of Periodontology, Tokyo Dental College, Tokyo, Japan
| | - Asako Makino-Oi
- Department of Periodontology, Tokyo Dental College, Tokyo, Japan
| | - Hiroki Sugito
- Department of Operative Dentistry, Cariology and Pulp Biology, Tokyo Dental College, Tokyo, Japan.,Department of Dental Hygiene, Tokyo Dental Junior College, Tokyo, Japan
| | - Sachiyo Tomita
- Department of Periodontology, Tokyo Dental College, Tokyo, Japan
| | - Atsushi Saito
- Department of Periodontology, Tokyo Dental College, Tokyo, Japan. .,Oral Health Science Center, Tokyo Dental College, Tokyo, Japan.
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17
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Wu YC, Lin LK, Song CJ, Su YX, Tu YK. Comparisons of periodontal regenerative therapies: A meta-analysis on the long-term efficacy. J Clin Periodontol 2017; 44:511-519. [PMID: 28278363 DOI: 10.1111/jcpe.12715] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/30/2022]
Abstract
AIM We conducted a meta-analysis for the long-term differences in treatment outcomes between periodontal regeneration therapies and flap operation. METHODS A systematic literature search was conducted using the EMBASE, PubMed and Cochrane databases up to June 2016. Treatment outcomes were changes in probing pocket depth and clinical attachment level. We extracted data reported at different time points after periodontal surgery and incorporated all data into the same model. The restricted cubic spline regression was used to estimate the non-linear trend in treatment outcomes. As some studies reported outcomes at multiple time points, we considered several correlation structures for data reported by the same study. RESULTS A total of 52 randomized controlled trials were included in our longitudinal meta-analysis. The follow-up length ranged from 0.5 year to 10 years. The trends in the treatment outcomes were similar under different correlation structures. Enamel matrix derivatives (EMD) and guided tissue regeneration (GTR) achieved greater probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain than flap operation (FO) in the long-term follow up, but no differences were found between EMD and GTR. CONCLUSION Compared with FO, periodontal regeneration surgeries achieved greater PPD reduction and gain in CAL after 1 year, and its effects may last for 5-10 years.
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Affiliation(s)
- Yun-Chun Wu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Liang-Ko Lin
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Cheng-Jie Song
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Xuan Su
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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18
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Agustín-Panadero R, Ferreiroa A, Pascual-Moscardó A, Fons-Font A, Solá-Ruíz MF. In vivo evaluation of three-dimensional of volumetric changes using a CAD/CAM chair-side system: Technical procedure. J Clin Exp Dent 2017; 9:e489-e493. [PMID: 28298996 PMCID: PMC5347303 DOI: 10.4317/jced.53531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/06/2016] [Indexed: 11/05/2022] Open
Abstract
An intraoral digital scanner in combination with specialized three-dimensional surface analysis software monitors volumetric changes to soft tissues or dental restorations. This technology can evaluate the success of a specific technique or medium- or long-term clinical outcomes in both clinical and research situations. This article describes how this technology was used to provide immediate chair-side data analysis without the help of specialized laboratory support. Key words:Intraoral scanner, CAD-CAM, best fit-method, surface tessellation language.
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Affiliation(s)
- Rubén Agustín-Panadero
- DMD, PhD, Associate Professor. Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Alberto Ferreiroa
- DMD, PhD, Associate Professor. Department of Buccofacial Prosthetics, Faculty of Dentistry, Complutense University of Madrid, Spain
| | - Agustín Pascual-Moscardó
- MD, DMD, PhD, Professor. Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Antonio Fons-Font
- MD, DMD, PhD, Adjunct Professor. Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - María-Fernanda Solá-Ruíz
- MD, DMD, PhD, Professor. Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Spain
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Awada T, Kunimatsu R, Yoshimi Y, Hirose N, Mitsuyoshi T, Sumi K, Tanimoto K. Effects of C-terminal amelogenin peptides on the metabolism of osteoblasts. Biochem Biophys Res Commun 2017; 482:1154-1159. [DOI: 10.1016/j.bbrc.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
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20
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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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21
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Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, Donos N, Lyngstadaas SP, Deschner J, Dard M, Stavropoulos A, Zhang Y, Trombelli L, Kasaj A, Shirakata Y, Cortellini P, Tonetti M, Rasperini G, Jepsen S, Bosshardt DD. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol 2016; 43:668-83. [PMID: 26987551 DOI: 10.1111/jcpe.12546] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 12/27/2022]
Abstract
BACGROUND On June 5th, 2015 at Europerio 8, a group of leading experts were gathered to discuss what has now been 20 years of documented evidence supporting the clinical use of enamel matrix derivative (EMD). Original experiments led by Lars Hammarström demonstrated that enamel matrix proteins could serve as key regenerative proteins capable of promoting periodontal regeneration including new cementum, with functionally oriented inserting new periodontal ligament fibres, and new alveolar bone formation. This pioneering work and vision by Lars Hammarström has paved the way to an enormous amount of publications related to its biological basis and clinical use. Twenty years later, it is clear that all these studies have greatly contributed to our understanding of how biologics can act as mediators for periodontal regeneration and have provided additional clinical means to support tissue regeneration of the periodontium. AIMS This review article aims to: (1) provide the biological background necessary to understand the rational for the use of EMD for periodontal regeneration, (2) present animal and human histological evidence of periodontal regeneration following EMD application, (3) provide clinically relevant indications for the use of EMD and (4) discuss future avenues of research including key early findings leading to the development of Osteogain, a new carrier system for EMD specifically developed with better protein adsorption to bone grafting materials.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, Nova Southeastern University, Fort Lauderdale, Florida, USA.,Department of Periodontology, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - David L Cochran
- Department of Periodontics, Dental School, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stuart Froum
- Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, USA
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carlos Nemcovsky
- Department of Periodontology and Dental Implantology, Dental School, Tel-Aviv University, Tel-Aviv, Israel
| | - Nikos Donos
- Department of Periodontology, Queen Marry University of London, London, UK
| | | | - James Deschner
- Section of Experimental Dento-Maxillo-Facial Medicine, University of Bonn, Bonn, Germany
| | - Michel Dard
- New York University, College of Dentistry, New York, NY, USA
| | | | - Yufeng Zhang
- Department of Oral Implantology, Wuhan University, Wuhan, China
| | - Leonardo Trombelli
- Department of Periodotology, Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
| | - Adrian Kasaj
- Department of Operative Dentistry and Periodontology, University Medical Center, Mainz, Germany
| | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Maurizio Tonetti
- European Research Group on Periodontology (ERGOPerio), Genova, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Foundation IRCCS Ca' Granda Polyclinic, Milan, Italy
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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22
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Liu S, Hu B, Zhang Y, Li W, Song J. Minimally Invasive Surgery Combined with Regenerative Biomaterials in Treating Intra-Bony Defects: A Meta-Analysis. PLoS One 2016; 11:e0147001. [PMID: 26785405 PMCID: PMC4718618 DOI: 10.1371/journal.pone.0147001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 12/26/2015] [Indexed: 11/23/2022] Open
Abstract
Background With the popularity of minimally invasive surgery (MIS) in periodontics, numerous publications have evaluated the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects. However, it is unclear if it is necessary to use biomaterials in MIS. Thus, we conducted a meta-analysis of randomized clinical trials in patients with intra-bony defects to compare the clinical outcomes of MIS with regenerative biomaterials for MIS alone. Methods The authors retrieved English publications on relevant studies from Cochrane CENTRAL, PubMed, Medline, Embase, Clinical Evidence, and ClinicalTrails.gov (up to June 30, 2015). The main clinical outcomes were the reduction of probing pocket depths (PPDs), gain of clinical attachment level (CAL), recession of gingival margin (REC) and radiographic bone fill. Review Manager 5.2 (Cochrane Collaboration, Oxford, England) was used to calculate the heterogeneity and mean differences of the main clinical outcomes. Results In total, 464 studies in the literature were identified but only four were ultimately feasible. The results showed no significant difference regarding CAL gain (P = 0.32) and PPD reduction (P = 0.40) as well as REC increase (P = 0.81) and radiographic bone fill (P = 0.64) between the MIS plus biomaterials group and the MIS alone group. Conclusions The meta-analysis suggested no significant difference in treatment of intra-bony defects between the MIS plus biomaterials group and the MIS alone group, indicating that it is important to take costs and benefits into consideration when a decision is made about a therapeutic approach. There needs to be an in-depth exploration of the induction of intrinsic tissue healing of MIS without biomaterials to achieve optimal outcomes.
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Affiliation(s)
- Shan Liu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Bo Hu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, United States of America
| | - Wenyang Li
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
- * E-mail:
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Zanatta FB, de Souza FG, Pinto TMP, Antoniazzi RP, Rösing CK. Do the clinical effects of enamel matrix derivatives in infrabony defects decrease overtime? A systematic review and meta-analysis. Braz Dent J 2015; 24:446-55. [PMID: 24474283 DOI: 10.1590/0103-6440201302192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 09/13/2013] [Indexed: 11/22/2022] Open
Abstract
Previous systematic reviews have demonstrated better results with enamel matrix derivative proteins (EMDP) as compared with open flap debridement (OFD) for the management of infrabony periodontal defects (IPD). The aim of this study was to determine whether these differences vary according to the follow-up and quality of the studies. Cochrane Central Register of Controlled Trials, Medline/PubMed, Lilacs, Embase and Web of Science electronic databases were searched up to August 2013 for randomized clinical trials.Eligible outcomes were changes in probing depth (PD), clinical attachment level (CAL),gingival recession (GR) and bone changes (BC). Studies with follow-up of 12 months showed differences of 0.97 mm (CI95% 0.52 - 1.43) and 1.19 mm (CI95% 0.77 - 1.60) for PD and CAL, respectively, favorable for EMDP. Studies with follow-up ≥ 24 months presented advantages of 1.11 mm (CI95% 0.74 -1.48) for CAL and 0.83 mm (CI95% 0.19 -1.48) for PD,with use of EMDP. Considering the quality of studies, those with low risk of bias showed lower difference between groups, presenting 0.8 mm (CI95% 0.24-1.36) for CAL, favorable for EMDP and without differences for PS (0.51 mm, CI95% -0.21 - 1.23). In conclusion, follow-up time (< or > 2 years) and the risk of bias influence the results of treatment with EMDP in IPD.
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24
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Miller RJ. The Use of Enamel Matrix Derivative in Two-Stage Guided Bone Regeneration Procedures. Clin Adv Periodontics 2015; 5:184-191. [DOI: 10.1902/cap.2014.130098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/27/2014] [Indexed: 11/13/2022]
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25
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Hoffmann T, Al-Machot E, Meyle J, Jervøe-Storm PM, Jepsen S. Three-year results following regenerative periodontal surgery of advanced intrabony defects with enamel matrix derivative alone or combined with a synthetic bone graft. Clin Oral Investig 2015; 20:357-64. [DOI: 10.1007/s00784-015-1522-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 06/30/2015] [Indexed: 01/08/2023]
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26
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Shah M, Patel J, Dave D, Shah S. Comparative evaluation of platelet-rich fibrin with demineralized freeze-dried bone allograft in periodontal infrabony defects: A randomized controlled clinical study. J Indian Soc Periodontol 2015; 19:56-60. [PMID: 25810594 PMCID: PMC4365159 DOI: 10.4103/0972-124x.145803] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/17/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Several bone graft materials have been used in the treatment of infrabony defects. Demineralized freeze-dried bone allograft (DFDBA) has been histologically proven to be the material of choice for regeneration. However, platelet-rich fibrin (PRF) has been said to have several properties that aid in healing and regeneration. Hence, this study focuses on the regenerative capacity of PRF when compared with DFDBA. MATERIALS AND METHODS A total of 40 sites with intrabony defects were selected and were assigned to the test group (open flap debridement [OFD] and PRF, n = 20) and the control group (OFD + DFDBA, n = 20). At the test sites, two PRF plugs were placed in the intrabony defect after debridement of the site and flap was sutured in place. The parameters measured were probing depth (PD), relative attachment level (RAL), and gingival marginal level (GML). These parameters were measured just before surgery (baseline) and at 6 months postsurgery. The changes in PD, RAL, and GML were analyzed at baseline and postsurgically after 6 months in each group with paired t-test and between the two groups with unpaired t-test. RESULTS The mean reduction in PD after 6 months in the test PRF group is 3.67 ± 1.48 mm where in control DFDBA group is 3.70 ± 1.78 mm. Gain in RAL in the test PRF group is 2.97 ± 1.42 mm where in control DFDBA group, it is 2.97 ± 1.54 mm. Gingival margin migrated apically in the test PRF group by 0.43 ± 1.31 mm where in control DFDBA group by 0.72 ± 2.3 mm. It was seen that the differences in terms of PD (P = 0.96), RAL (P = 1.00) and GML (P = 0.62) were not significant. CONCLUSION Platelet-rich fibrin has shown significant results after 6 months, which is comparable to DFDBA for periodontal regeneration in terms of clinical parameters. Hence, it can be used in the treatment of intrabony defects.
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Affiliation(s)
- Monali Shah
- Department of Periodontics, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Jay Patel
- Department of Periodontics, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Deepak Dave
- Department of Periodontics, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Sujal Shah
- Department of Periodontics, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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Ogihara S, Tarnow DP. Efficacy of Enamel Matrix Derivative With Freeze-Dried Bone Allograft or Demineralized Freeze-Dried Bone Allograft in Intrabony Defects: A Randomized Trial. J Periodontol 2014; 85:1351-60. [DOI: 10.1902/jop.2014.130520] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Kao RT, Nares S, Reynolds MA. Periodontal regeneration - intrabony defects: a systematic review from the AAP Regeneration Workshop. J Periodontol 2014; 86:S77-104. [PMID: 25216204 DOI: 10.1902/jop.2015.130685] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous systematic reviews of periodontal regeneration with bone replacement grafts and guided tissue regeneration (GTR) were defined as state of the art for clinical periodontal regeneration as of 2002. METHODS The purpose of this systematic review is to update those consensus reports by reviewing periodontal regeneration approaches developed for the correction of intrabony defects with the focus on patient-, tooth-, and site-centered factors, surgical approaches, surgical determinants, and biologics. This review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews. A computerized search of the PubMed and Cochrane databases was performed to evaluate the clinically available regenerative approaches for intrabony defects. The search included screening of original reports, review articles, and reference lists of retrieved articles and hand searches of selected journals. All searches were focused on clinically available regenerative approaches with histologic evidence of periodontal regeneration in humans published in English. For topics in which the literature is lacking, non-randomized observational and experimental animal model studies were used. Therapeutic endpoints examined included changes in clinical attachment level, changes in bone level/fill, and probing depth. For purposes of analysis, change in bone fill was used as the primary outcome measure, except in cases in which this information was not available. The SORT (Strength of Recommendation Taxonomy) grading scale was used in evaluating the body of knowledge. RESULTS 1) Fifty-eight studies provided data on patient, tooth, and surgical-site considerations in the treatment of intrabony defects. 2) Forty-five controlled studies provided outcome analysis on the use of biologics for the treatment of intrabony defects. CONCLUSIONS 1) Biologics (enamel matrix derivative and recombinant human platelet-derived growth factor-BB plus β-tricalcium phosphate) are generally comparable with demineralized freeze-dried bone allograft and GTR and superior to open flap debridement procedures in improving clinical parameters in the treatment of intrabony defects. 2) Histologic evidence of regeneration has been demonstrated with laser therapy; however, data are limited on clinical predictability and effectiveness. 3) Clinical outcomes appear most appreciably influenced by patient behaviors and surgical approach rather than by tooth and defect characteristics. 4) Long-term studies indicate that improvements in clinical parameters are maintainable up to 10 years, even in severely compromised teeth, consistent with a favorable/good long-term prognosis.
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Groeneveldt LC, Knuth C, Witte-Bouma J, O'Brien FJ, Wolvius EB, Farrell E. Enamel Matrix Derivative has No Effect on the Chondrogenic Differentiation of Mesenchymal Stem Cells. Front Bioeng Biotechnol 2014; 2:29. [PMID: 25229057 PMCID: PMC4151337 DOI: 10.3389/fbioe.2014.00029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/07/2014] [Indexed: 01/25/2023] Open
Abstract
Background: Treatment of large bone defects due to trauma, tumor resection, or congenital abnormalities is challenging. Bone tissue engineering using mesenchymal stem cells (MSCs) represents a promising treatment option. However, the quantity and quality of engineered bone tissue are not sufficient to fill large bone defects. The aim of this study was to determine if the addition of enamel matrix derivative (EMD) improves in vitro chondrogenic priming of MSCs to ultimately improve in vivo MSC mediated endochondral bone formation. Methods: MSCs were chondrogenically differentiated in 2.0 × 105 cell pellets in medium supplemented with TGFβ3 in the absence or presence of 1, 10, or 100 μg/mL EMD. Samples were analyzed for gene expression of RUNX2, Col II, Col X, and Sox9. Protein and glycoaminoglycan (GAG) production were also investigated via DMB assays, histology, and immunohistochemistry. Osteogenic and adipogenic differentiation capacity were also assessed. Results: The addition of EMD did not negatively affect chondrogenic differentiation of adult human MSCs. EMD did not appear to alter GAG production or expression of chondrogenic genes. Osteogenic and adipogenic differentiation were also unaffected though a trend toward decreased adipogenic gene expression was observed. Conclusion: EMD does not affect chondrogenic differentiation of adult human MSCs. As such the use of EMD in combination with chondrogenically primed MSCs for periodontal bone tissue repair is unlikely to have negative effects on MSC differentiation.
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Affiliation(s)
- Lisanne C Groeneveldt
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center , Rotterdam , Netherlands
| | - Callie Knuth
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center , Rotterdam , Netherlands
| | - Janneke Witte-Bouma
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center , Rotterdam , Netherlands
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center , Rotterdam , Netherlands
| | - Eric Farrell
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center , Rotterdam , Netherlands
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Mitani A, Takasu H, Horibe T, Furuta H, Nagasaka T, Aino M, Fukuda M, Fujimura T, Mogi M, Noguchi T. Five-year clinical results for treatment of intrabony defects with EMD, guided tissue regeneration and open-flap debridement: a case series. J Periodontal Res 2014; 50:123-30. [DOI: 10.1111/jre.12188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Mitani
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - H. Takasu
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - T. Horibe
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - H. Furuta
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - T. Nagasaka
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - M. Aino
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - M. Fukuda
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - T. Fujimura
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - M. Mogi
- Department of Medicinal Biochemistry; School of Pharmacy; Aichi Gakuin University; Nagoya Japan
| | - T. Noguchi
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
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Di Tullio M, Femminella B, Pilloni A, Romano L, D’Arcangelo C, De Ninis P, Paolantonio M. Treatment of Supra-Alveolar-Type Defects by a Simplified Papilla Preservation Technique for Access Flap Surgery With or Without Enamel Matrix Proteins. J Periodontol 2013; 84:1100-10. [DOI: 10.1902/jop.2012.120075] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bhutda G, Deo V. Five years clinical results following treatment of human intra-bony defects with an enamel matrix derivative: a randomized controlled trial. Acta Odontol Scand 2013; 71:764-70. [PMID: 23078573 DOI: 10.3109/00016357.2012.728245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Emdogain® represents an extracellular matrix derivative that controls and promotes periodontal regeneration. Several studies have demonstrated that the treatment of periodontal defects with Emdogain® leads to improvements in clinical parameters. However, long-time clinical trials establishing clinical usefulness of Emdogain® are scarce. Therefore, the present randomized split mouth, controlled study was undertaken to evaluate the effectiveness of Emdogain® as an adjunct to open flap debridement for the treatment of intra-bony defects over a period of 5 years. MATERIALS AND METHODS The study population consisted of 15 chronic periodontitis patients with bilateral interproximal osseous defects. The test group was treated by open flap debridement with EDTA 24% (PrefGel®) followed by enamel matrix derivative (Emdogain®). The control group was treated by open flap debridement with EDTA 24% (PrefGel®). RESULTS After 1 and 5 years, both the test and control groups showed significant mean PPD reduction. A greater reduction in mean Probing Pocket Depth (PPD) was observed in the test group (3.84 ± 1.05) as compared to the control group (1.92 ± 0.35). The mean Clinical Attachment Level (CAL) gain of 3.18 ± 0.87 mm was observed in the test group, while the control group displayed mean CAL gain of 1.60 ± 0.54 mm. The observed differences were found to be statistically significant in both the groups (p < 0.05). Percentage bone fill was significantly increased at 12 months post-surgery in test group (66.66 ± 7.8%) as compared to control group (31.71 ± 4.1%). CONCLUSION The treatment with Emdogain resulted in a significantly higher CAL gain and PPD reduction in comparison with OFD and PrefGel®.
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De Leonardis D, Paolantonio M. Enamel Matrix Derivative, Alone or Associated With a Synthetic Bone Substitute, in the Treatment of 1- to 2-Wall Periodontal Defects. J Periodontol 2013; 84:444-55. [DOI: 10.1902/jop.2012.110656] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lafzi A, Shirmohammadi A, Faramarzi M, Jabali S, Shayan A. Clinical Comparison of Autogenous Bone Graft with and without Plasma Rich in Growth Factors in the Treatment of Grade II Furcation Involvement of Mandibular Molars. J Dent Res Dent Clin Dent Prospects 2013; 7:22-9. [PMID: 23486928 PMCID: PMC3593201 DOI: 10.5681/joddd.2013.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 12/25/2012] [Indexed: 11/17/2022] Open
Abstract
Background and aims Plasma rich in growth factors (PRGF) is a concentrated suspension of growth factors, which is used to promote periodontal tissue regeneration. The aim of this randomized, controlled, clinical trial was to evaluate of the treatment of grade II mandibular molar furcation involvement using autogenous bone graft with and without PRGF.
Materials and methods In this double-blind clinical trial, thirty mandibular molars with grade II furcation involvement in 30 patients were selected. The test group received bone graft combined with PRGF, while the control group was treated with bone graft only. Clinical parameters included clinical probing depth (CPD), vertical clinical attachment level (V-CAL), horizontal clinical attachment level (H-CAL), location of gingival margin (LGM), surgically exposed horizontal probing depth of bony defect (E-HPD), vertical depth of bone crest (V-DBC), vertical depth of the base of bony defect (V-DBD), and length of the intrabony defect (LID). After six months, a re-entry surgery was performed. Data were analyzed by SPSS 14, using Kolmogorov, Mann-Whitney U, and paired t-test.
Results After 6 months, both treatment methods led to significant improvement in V-CAL and H-CAL and significant decreases in CPD, E-HPD, V-DBD and LID; there was no significant difference in LGM and V-DBC in any of the treated groups compared to the baseline values. Also, none of the parameters showed significant differences between the study groups.
Conclusion Although autogenous bone grafts, with or without PRGF, were successful in treating grade II furcation involvement, no differences between the study groups were observed.
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Affiliation(s)
- Ardeshir Lafzi
- Professor, Department of Peiodontics, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Döri F, Arweiler NB, Szántó E, Agics A, Gera I, Sculean A. Ten-year results following treatment of intrabony defects with an enamel matrix protein derivative combined with either a natural bone mineral or a β-tricalcium phosphate. J Periodontol 2012; 84:749-57. [PMID: 22873657 DOI: 10.1902/jop.2012.120238] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of the present study is to evaluate the 10-year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or β-tricalcium phosphate (β-TCP). METHODS Twenty-two patients with advanced chronic periodontitis and displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + β-TCP. Clinical evaluations were performed at baseline and at 1 and 10 years. The following parameters were evaluated: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS The defects treated with EMD + NBM demonstrated a mean CAL change from 8.9 ± 1.5 mm to 5.3 ± 0.9 mm (P <0.001) and to 5.8 ± 1.1 mm (P <0.001) at 1 and 10 years, respectively. The sites treated with EMD + β-TCP showed a mean CAL change from 9.1 ± 1.6 mm to 5.4 ± 1.1 mm (P <0.001) at 1 year and 6.1 ± 1.4 mm (P <0.001) at 10 years. At 10 years two defects in the EMD + NBM group had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. In the EMD + β-TCP group three defects had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. Compared with baseline, at 10 years, a CAL gain of ≥3 mm was measured in 64% (i.e., seven of 11) of the defects in the EMD + NBM group and in 82% (i.e., nine of 11) of the defects in the EMD + β-TCP group. No statistically significant differences were found between the 1- and 10-year values in either of the two groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and 10 years. CONCLUSION Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + β-TCP can be maintained over a period of 10 years.
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Affiliation(s)
- Ferenc Döri
- Department of Periodontology, Semmelweis University, Budapest, Hungary
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Miron RJ, Bosshardt DD, Laugisch O, Katsaros C, Buser D, Sculean A. Enamel Matrix Protein Adsorption to Root Surfaces in the Presence or Absence of Human Blood. J Periodontol 2012; 83:885-92. [DOI: 10.1902/jop.2011.110404] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tu YK, Needleman I, Chambrone L, Lu HK, Faggion CM. A bayesian network meta-analysis on comparisons of enamel matrix derivatives, guided tissue regeneration and their combination therapies. J Clin Periodontol 2012; 39:303-14. [DOI: 10.1111/j.1600-051x.2011.01844.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ian Needleman
- Unit of Periodontology and International Centre for Evidence-Based Oral Health; UCL Eastman Dental Institute; London; UK
| | - Leandro Chambrone
- Division of Periodontics; Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo; Brazil
| | - Hsein-Kun Lu
- Department of Periodontology; Taipei Medical University; Taipei; Taiwan
| | - Clovis Mariano Faggion
- Department of Prosthodontics; School of Dentistry; University of Heidelberg; Heidelberg; Germany
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Abstract
The role of regenerative periodontal therapy is the reconstitution of lost periodontal structures, ie, new formation of root cementum, periodontal ligament, and alveolar bone. The outcome of basic research has pointed to the important role of enamel matrix protein derivative (EMD) in periodontal wound healing. Histologic results from animal and human studies have shown that treatment with EMD promotes periodontal regeneration. Moreover, clinical studies have indicated that treatment with EMD positively influences periodontal wound healing in humans. The goal of this paper is to review the existing literature on EMD.
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Affiliation(s)
- Vandana J Rathva
- Department of Periodontics, KM Shah Dental College and Hospital, Sumandeep University, Gujarat, India
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Koop R, Merheb J, Quirynen M. Periodontal regeneration with enamel matrix derivative in reconstructive periodontal therapy: a systematic review. J Periodontol 2011; 83:707-20. [PMID: 22050544 DOI: 10.1902/jop.2011.110266] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Richard Koop
- Department of Periodontology, Catholic University Leuven, Leuven, Belgium
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Ribeiro FV, Casarin RC, Palma MA, Júnior FH, Sallum EA, Casati MZ. Clinical and Patient-Centered Outcomes After Minimally Invasive Non-Surgical or Surgical Approaches for the Treatment of Intrabony Defects: A Randomized Clinical Trial. J Periodontol 2011; 82:1256-66. [DOI: 10.1902/jop.2011.100680] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Four-year results following treatment of intrabony periodontal defects with an enamel matrix derivative alone or combined with a biphasic calcium phosphate. Clin Oral Investig 2011; 16:1191-7. [DOI: 10.1007/s00784-011-0611-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 08/10/2011] [Indexed: 11/27/2022]
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Sculean A, Alessandri R, Miron R, Salvi GE, Bosshardt DD. Enamel Matrix Proteins and Periodontal Wound Healing and Regeneration. Clin Adv Periodontics 2011; 1:101-117. [DOI: 10.1902/cap.2011.110047] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 06/14/2011] [Indexed: 12/13/2022]
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Schneider D, Weber FE, Hämmerle CHF, Feloutzis A, Jung RE. Bone regeneration using a synthetic matrix containing enamel matrix derivate. Clin Oral Implants Res 2011; 22:214-22. [PMID: 21223377 DOI: 10.1111/j.1600-0501.2010.01985.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of the present study was to test whether the delivery of enamel matrix derivate (EMD) via synthetic polyethylene glycol (PEG)-based hydrogels with and without RGD sequences enhances bone formation in vivo. MATERIAL AND METHODS In each of 10 rabbits, four titanium cylinders were placed on the external cortical bones of their calvaria. The following four treatment modalities were randomly allocated: One of the four cylinders was left empty (control), the other three were filled with a combination of PEG matrix with hydroxyapatite/tricalciumphosphate (HA/TCP) granules and EMD in a concentration of 100 μg/ml (test 1) or 500 μg/ml (test 2) or 500 μg/ml and RGD peptide (test 3). After 8 weeks, the animals were sacrificed and ground sections were obtained for histological analysis. For statistical analysis, the Kruskal-Wallis test was applied (P<0.05). RESULTS The histomorphometric analysis revealed a statistically larger area fraction of newly formed bone in the EMD 500/RGD group (54.8±14.5%) compared with the control group (28.7±10.3%) and the EMD 500 group (31.2±14.1%) and non-significantly higher area fraction compared with the EMD 100 group (38.2±10.4%). The percentage of mineralized bone showed no statistically significant differences among the four groups. The mean percentage of mineralized bone was 13.6±3.3% in the control group, 14.2±5.8% in the EMD 100 group, 11.69±5.9% in the EMD 500 group and 15.66±5.2% in the EMD 500/RGD group. No statistically significant difference regarding the bone-to-graft contact between the EMD 100 group (23±15.7%), the EMD 500 group (22.2±14.6%) and the EMD 500/RGD group (21.6±8.8%) was observed. CONCLUSIONS The combination of a PEG matrix containing EMD with HA/TCP granules had no effect on the formation of mineralized bone tissue in rabbit calvaria. The addition of RGD peptide to the PEG/EMD 500 combination increased the area fraction of newly formed bone compared with the other treatment groups. Further studies are indicated to study a possible synergistic effect of EMD and RGD.
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Affiliation(s)
- David Schneider
- Center for Dental and Oral Medicine and Cranio-Maxillofacial Surgery, Clinic for Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Plattenstrasse 11, Zurich, Switzerland
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Alkan EA, Parlar A. EMD or subepithelial connective tissue graft for the treatment of single gingival recessions: a pilot study. J Periodontal Res 2011; 46:637-42. [DOI: 10.1111/j.1600-0765.2011.01381.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Meyle J, Hoffmann T, Topoll H, Heinz B, Al-Machot E, Jervøe-Storm PM, Meiß C, Eickholz P, Jepsen S. A multi-centre randomized controlled clinical trial on the treatment of intra-bony defects with enamel matrix derivatives/synthetic bone graft or enamel matrix derivatives alone: results after 12 months. J Clin Periodontol 2011; 38:652-60. [DOI: 10.1111/j.1600-051x.2011.01726.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Silvestri M, Rasperini G, Milani S. 120 Infrabony Defects Treated With Regenerative Therapy: Long-Term Results. J Periodontol 2011; 82:668-75. [DOI: 10.1902/jop.2010.100297] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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47
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Ribeiro FV, Casarin RC, Júnior FH, Sallum EA, Casati MZ. The Role of Enamel Matrix Derivative Protein in Minimally Invasive Surgery in Treating Intrabony Defects in Single-Rooted Teeth: A Randomized Clinical Trial. J Periodontol 2011; 82:522-32. [DOI: 10.1902/jop.2010.100454] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Possibilities and potential roles of the functional peptides based on enamel matrix proteins in promoting the remineralization of initial enamel caries. Med Hypotheses 2011; 76:391-4. [DOI: 10.1016/j.mehy.2010.10.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 10/21/2010] [Accepted: 10/29/2010] [Indexed: 11/18/2022]
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Tu YK, Woolston A, Faggion CM. Do bone grafts or barrier membranes provide additional treatment effects for infrabony lesions treated with enamel matrix derivatives? A network meta-analysis of randomized-controlled trials. J Clin Periodontol 2010; 37:59-79. [DOI: 10.1111/j.1600-051x.2009.01499.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Esposito M, Grusovin MG, Papanikolaou N, Coulthard P, Worthington HV. Enamel matrix derivative (Emdogain(R)) for periodontal tissue regeneration in intrabony defects. Cochrane Database Syst Rev 2009; 2009:CD003875. [PMID: 19821315 PMCID: PMC6786880 DOI: 10.1002/14651858.cd003875.pub3] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. OBJECTIVES To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects. SEARCH STRATEGY We searched the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomised controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: February 2009. SELECTION CRITERIA RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years. DATA COLLECTION AND ANALYSIS Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed. MAIN RESULTS Thirteen trials were included out of 35 potentially eligible trials. No included trial presented data after 5 years of follow up, therefore all data refer to the 1-year time point. A meta-analysis including nine trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.1 mm, 95% CI 0.61 to 1.55) and PPD reduction (0.9 mm, 95% CI 0.44 to 1.31) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had < 2 mm PAL gain in the control group, with RR 0.53 (95% CI 0.34 to 0.82). Approximately nine patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 25%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating only trials at a low risk of bias in a sensitivity analysis (four trials), the effect size for PAL was 0.62 mm (95% CI 0.28 to 0.96), which was less than 1.1 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed statistically significant more postoperative complications (three trials, RR 0.12, 95% CI 0.02 to 0.85) and more REC (0.4 mm 95% CI 0.15 to 0.66). The only trial comparing EMD with a bioactive ceramic filler found statistically significant more REC (-1.60 mm, 95% CI -2.74 to -0.46) at the EMG treated sites. AUTHORS' CONCLUSIONS One year after its application, EMD significantly improved PAL levels (1.1 mm) and PPD reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less REC than EMD.
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Affiliation(s)
- Marco Esposito
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthCoupland Building 3, Oxford RoadManchesterUKM13 9PL
| | | | - Nikolaos Papanikolaou
- School of Dentistry, The University of ManchesterDepartment of Oral and Maxillofacial SurgeryHigher Cambridge StreetManchesterUKM15 6FH
| | - Paul Coulthard
- Institute of Dentistry, Queen Mary University of LondonDean's Office, Floor 5, Turner StreetLondonUKE1 2AD
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthCoupland Building 3, Oxford RoadManchesterUKM13 9PL
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