Efficacy of Enamel Derivatives to Improve Keratinized Tissue as Adjunct to Coverage of Gingival Recessions: A Systematic Review and Meta-Analysis

Abstract

Background: The systematic review was designed to answer the following focused question: Are enamel matrix derivatives able to improve the quantity of keratinized tissue (KT) around natural dentition in patients with recessions defects after their treatment with periodontal plastic procedures? Methods: Only Randomized Clinical Trials (RCT) in English language evaluating root coverage procedures in combination with enamel matrix derivatives (commercially known as Emdogain®—EMD), with at least 10 subjects and a minimum duration of six months, were included. The search was applied to PUBMED and SCOPUS and it consists of a combination of MeSH terms and free text words (from January 2000 to June 2019). Risk of bias in individual studies and across studies was also evaluated. Results: After the full text analysis and the exclusion of further 18 articles, 12 articles were finally included. In total 639 recessions were treated (334 tests and 305 control). The recessions defects were classified according to the classification of Miller (Class I, II, III, IV). Only one trial included Miller Class III recessions (7 in total). Enamel matrix derivatives were applied in conjunction with Coronally Advanced Flap (CAF), Coronally Advanced Flap + Sub Epithelial Connective Tissue Graft (CAF + CTG), Semilunar Flap (SF). For the group CAF vs CAF + EMD the mean difference between the keratinized tissue gain in the two procedures was 0.40 mm (95% Confindence Interval Lower/Upper: 0.014–0.81) (p < 0.058); for the comparison CAF + CTG + EMD vs. CAF + CTG the mean difference between the two groups resulted in −0.06 mm (95% Confindence Interval Lower Upper −0.45 to 0.33) (p = 0.7603). Discussion: Randomized clinical trials included medium-low quality evidence. The application of Enamel Matrix Derivatives to surgical procedures aimed to cover gingival recessions does not add robust clinical benefit to conventional plastic procedure alone.

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

“…Our study demonstrated that the use of EMD in combination with SCTG added no clinical benefits in terms of KTW gain. These results are in agreement with data presented by other authors and in recent meta-analyses that investigated whether the use of EMD could improve KTW [ 13 , 38 , 43 ]. The abovementioned seemed to be technique dependent.…”

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

“…The present study reported normal and comparable healing process in standardized FGG donor sites, with similar RWA and E results, regardless of EMD application. The lack of an apparent EMD effect on the healing of these excisional palatal mucosa wounds is comparable to the lack of significant clinical benefit when EMD is applied as an adjunct to CTG‐including root coverage procedures 38,39 or when used in other soft tissue healing models 25,40 and in vitro wound closure 41 . The reasons behind the variable effect of EMD in different wound models may relate to the inherent differences between wounds regarding defect design (e.g., incisional vs excisional wounds), time frame of normal healing (e.g., weeks for graft donor sites vs months for intrabony defect regeneration), and locally available cellular elements (e.g., periodontal ligament cells vs palatal mucosa cells), which might differ in their ability to respond to EMD.…”

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

“…Using EMD reduced PD; however, the difference was insignificant [ 63 ]. Modica et al (2000), Discepoli et al (2019) and Górski et al (2020) showed that there is no difference between EMD treated gingival recessions and non-EMD treated gingival recessions with respect to the clinical outcomes [ 64 , 65 , 66 ]. In another study, this biologically active regenerative material increased the percentage of RC and KTW than the control group [ 67 ].…”