Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis

Meza‐Mauricio, Jonathan; Furquim, Camila Pinheiro; Bustillos-Torrez, Willy; Soto-Peñaloza, David; Peñarrocha‐Oltra, David; Retamal‐Valdes, Belén; Faveri, Marcelo

doi:10.1007/s00784-021-03782-2

Cited by 14 publications

(13 citation statements)

References 55 publications

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“…SCTG demonstrated moderate certainty evidence in favor of their use for further reduction in recession height and CAL gain at 6 and 12 months[38]. In addition, the application of EMD affected the stability of gingival margin during the maintenance phase, since the EMD group also showed less recession rebound up to 36 months.…”

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confidence: 94%

Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes

et al. 2021

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Objectives To investigate factors that influence 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG) with enamel matrix derivative (EMD) (tests) or without (controls). Materials and methods Twenty patients with 150 GR were treated. Logistic regression models were used to identify baseline parameters that could predict 12-month average root coverage (ARC), complete root coverage (CRC), root esthetic coverage score (RES), gain in keratinized tissue width (KTW), and gain in gingival thickness (GT). Results The likelihood of ARC > 85% increased sevenfold (odds ratio [OR] = 7.33; 95% confidence interval [CI] = 2.43–12.12), of achieving CRC: 21-fold (OR = 21.23; 95% CI = 10.21–45.32), and of gaining RES = 10: tenfold (OR = 10.23; 95% CI = 5.78–32.23) in favor of EMD-treated sites. With each 1-mm2 increase in baseline avascular exposed root surface area (AERSA), the odds of failure (ARC ≤ 85%, not achieving CRC and postoperative GT ≤ 2 mm) increased almost fourfold (OR = 3.56; 95% CI = 1.98–10.19), fourfold (OR = 4.23; 95% CI = 1.11–9.02), and nearly sixfold (OR = 5.76; 95% CI = 2.43–12.87), respectively. The greater the baseline GT, the more likely the chance of achieving CRC (OR = 10.23; 95% CI = 8.37–16.23) and RES = 10 (OR = 5.50; 95% CI = 3.34–16.43). All models exhibited fair to excellent discrimination and satisfactory calibration. Conclusions Based on logistic regression, EMD application improved postoperative ARC, CRC and RES; baseline AERSA predicted 12-month ARC, CRC, and GT gain, whereas baseline GT was a predictor of achieving CRC and perfect RES. Clinical relevance Additional use of EMD, lower baseline AERSA, and greater baseline GT significantly increase the odds of obtaining better outcomes 12 months after MCAT + SCTG technique.

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confidence: 94%

Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes

et al. 2021

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“…Histologic observations in humans and animals have provided evidence for true periodontal regeneration with formation of new alveolar bone, acellular cementum and new attachment formation when EMD was applied [ 15 , 16 , 17 ]. Different studies have found beneficial effects of EMD application prior to root coverage procedures either with CAF or SCTG [ 18 , 19 , 20 ]. However, the role of EMD in periodontal plastic treatment with MCAT cannot be consistently evaluated and the extent to which outcomes of MCAT might be improved with EMD usage remains uncertain [ 5 , 7 , 21 , 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Root Surface Biomodification on Multiple Recession Coverage with Modified Coronally Advanced Tunnel Technique and Subepithelial Connective Tissue Graft: A Retrospective Analysis

Górski

Szerszeń

2022

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To improve treatment efficacy of gingival recessions (GR), chemical preparation of the exposed root surface was advocated. The aim of this study was to compare the additional influence of root biomodifications with 24% ethylenediaminetetraacetic acid (EDTA) alone or with enamel matrix derivative (EMD) on the 12 month outcomes of modified coronally advanced tunnel (MCAT) with subepithelial connective tissue graft in the treatment of multiple GR. Average root coverage (ARC), complete root coverage (CRC), reduction in GR, reduction in recession width (RW), gain in clinical attachment level (CAL), increase in gingival thickness (GT), increase in keratinized tissue width (KTW) and changes in root coverage esthetic score (RES) were evaluated. A total of 60 patients with 215 GR were enrolled. In 70, GR root surfaces were treated with EDTA + EMD, in other 72, with EDTA, while in the remaining 73 saline solution was applied. ARC was 94%, 89%, and 91% in the EDTA + EMD, the EDTA and the saline groups, respectively (p = 0.8871). Gains in clinical attachment level (CAL; 2.1 ± 1.1 mm) and RES values (9.6 ± 0.9) were significantly higher in the EDTA + EMD group, when compared with two other groups. The differences between other preoperative and postoperative parameters showed statistical significance only within but not between groups. MCAT outcomes may benefit from adjunctive use of EDTA + EMD regarding 12 month CAL gain and professionally assessed esthetics using RES following treatment of GR.

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“…The use of EMD was widely validated in periodontal surgery by a number of systematic reviews of the literature [ 4 , 5 , 6 , 7 ]. The effect of such biomaterial was demonstrated for the regeneration of periodontal intrabony defects, alone or as an adjunct to bone substitute material, even when using mini-invasive surgical approaches [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, a growing evidence supported the use of EMD in the surgical treatment of gingival recessions, associated or not with connective tissue graft [ 4 ]. The systematic review published in 2021 on the use of EMD to treat Miller class I or II gingival recessions proved the beneficial effect of EMD application for all the techniques tested [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, in one recent systematic review of the literature EMD performed better than platelet derivatives and better than the bone substitute alone in regenerative/reconstructive procedures [6]. Interestingly, a growing evidence supported the use of EMD in the surgical treatment of gingival recessions, associated or not with connective tissue graft [4]. The systematic review published in 2021 on the use of EMD to treat Miller class I or II gingival recessions proved the beneficial effect of EMD application for all the techniques tested [4].…”

Section: Introductionmentioning

confidence: 99%

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The Applications of Enamel Matrix Derivative in Implant Dentistry: A Narrative Review

et al. 2021

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Enamel matrix derivative (EMD) has been successfully used for periodontal regeneration in intrabony defects. Recently, its use for peri-implant bone regeneration has also been hypothesized. The aim of this paper is to review preclinical and clinical studies investigating the use of EMD in correspondence with titanium implants, alone or as an adjunct to other biomaterials. Clinical trials and case series with more than five cases were included. Seven in vitro studies evaluated the effect of EMD, placed on titanium surfaces: An increase in proliferation and viability of osteoblasts was observed in all but two studies. An increase in TGF-β1 and osteocalcin production, alkaline phosphatase activity, and angiogenesis was also reported. Nine animal studies investigated the use of EMD at implant placement or for bone regeneration of peri-implant bone defects, and some of them reported a significant increase in bone formation or bone-to-implant contact. In four of eleven clinical trials on humans, EMD was successfully used at implant placement. The other seven evaluated the use of EMD in protocols for the treatment of peri-implantitis. In conclusion, the results of EMD seem promising, but further randomized clinical trials are needed to evaluate its efficacy.

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Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis

Cited by 14 publications

References 55 publications

Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes

Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes

Effect of Root Surface Biomodification on Multiple Recession Coverage with Modified Coronally Advanced Tunnel Technique and Subepithelial Connective Tissue Graft: A Retrospective Analysis

The Applications of Enamel Matrix Derivative in Implant Dentistry: A Narrative Review

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