Enamel matrix derivative and bone grafts for periodontal regeneration of intrabony defects. A systematic review and meta-analysis

Abstract

Objective: To assess the clinical efficacy of regenerative periodontal surgery of intrabony defects using a combination of enamel matrix derivative (EMD) and bone graft compared with that of EMD alone. Materials and methods:The Cochrane Oral Health Group specialist trials, MEDLINE and EMBASE databases were searched for entries up to February 2014. The primary outcome was gain of clinical attachment (CAL). Weighted means and Forest plots were calculated for CAL gain, probing depth (PD) and gingival recession (REC).Results: Twelve studies reporting on 434 patients and 548 intrabony defects were selected for the analysis. Mean CAL gain amounted to 3.76 ± 1.07 mm (median 3.63 95% CI: 3.51-3.75) following treatment with a combination of EMD and bone graft and to 3.32±1.04 mm (median 3.40; 95% CI 3.28; 3.52) following treatment with EMD alone. Clinical relevance: The present findings support the use of EMD and bone grafts for the treatment of intrabony periodontal defects.3

Periodontal reconstructive surgery of deep intraosseous defects using an apical approach. Non‐incised papillae surgical approach (NIPSA): A retrospective cohort study

“…In this type of intraosseous non‐contained defects, EMD may not be sufficient to prevent flap collapse and maintain space for periodontal regeneration . In this type of defects, studies show better results when applying EMD together with a xenograft that acts as a vehicle to improve the physical properties of EMD …”

Addition of enamel matrix derivatives to bone substitutes for the treatment of intrabony defects: A systematic review, meta‐analysis and trial sequential analysis

“…In relation to such multiple rationale, the former aspect (i.e. full expression of EMD regenerative potential) has been addressed by a recent systematic review of the literature including randomized controlled trials (RCTs) comparing the combination therapy of EMD + BS to EMD alone, which demonstrated beneficial effects in CAL improvement and PD reduction with the use of the combination therapy, although a high rate of heterogeneity limits the quality of the evidence (Matarasso et al., ), and such results are not in line with previous meta‐analyses on the same topic, which failed to demonstrate statistically significant positive effects (Li, Xiao, & Hu, ; Tu, Woolston, & Faggion, ).…”

Osteogain improves osteoblast adhesion, proliferation and differentiation on a bovine‐derived natural bone mineral

“…,b,c; Matarasso et al. ). A recent systematic review concluded that the combination of EMD with a bone grafting material for the regeneration of intrabony defects led to significant clinical improvements in terms of clinical attachment level and probing depth reduction compared with those obtained with EMD alone (Matarasso et al.…”

“…Although clinical variability exists between randomized clinical trials, one of the main hypothesized factors was attributed to the choice of graft material utilized during periodontal regenerative therapy (Matarasso et al. ).…”