Enamel matrix proteins in the treatment of intra‐bony defects

Abstract

The surgical procedure used in the present study, aiming for maximum preservation of the regenerative potential of periodontal tissues, showed per se excellent results. The use of EMD as an adjunct to periodontal surgery in the treatment of angular defects possibly enhances periodontal regeneration rate.

Do the Clinical Effects of Enamel Matrix Derivatives in Infrabony Defects Decrease Overtime? A Systematic Review and Meta-Analysis

“…Bone levels after the use of EMDP may be compared with the initial bone levels as an interesting outcome. Eleven studies (10,15,16,(23)(24)(25)27,29,36,39,41) observed bone filling in radiographs, and in only one study it was performed in re-entry surgeries (14). Nevertheless, it is important to point out that bone measurements do not reflect connective attachment levels.…”

“…It could be hypothesized that this heterogeneity may be explained by the fact that some studies used antibiotics (14)(15)(16)24,25,27,29,34) and others did not (10,17,23,26,28,30,35), by the variable surface treatments, inclusion of smokers (10,(14)(15)(16)(17)(23)(24)(25)28,29,34,35), initial depth of defects and number of remaining bone walls, use of placebo gel in some studies (10,15,16,27,34) and not in others (14,17,23-26,28,29,35), differences in methodological quality, in addition to other variables that could influence the results, such as the surgical technique, quality of instrumentation and biofilm control performed by the patients (45).…”

“…Of the 19 studies included, nine had a split-mouth design -six with a follow-up period of 12 months (14,16,23,27,28,34) and three with duration of over 24 months (15,35,36) -and ten had a parallel design -five with a follow-up period of 12 months (10,17,(37)(38)(39) and five with a follow-up period of over 24 months (24,25,29,40,41). Regarding the evaluated outcomes, PD and CAL were evaluated in all the studies, gingival recession (GR) was additionally evaluated in eight studies (15,16,24,25,29,36,39,41) and bone filling in twelve studies (10,(14)(15)(16)(23)(24)(25)27,29,36,39,41).…”

“…Regarding the evaluated outcomes, PD and CAL were evaluated in all the studies, gingival recession (GR) was additionally evaluated in eight studies (15,16,24,25,29,36,39,41) and bone filling in twelve studies (10,(14)(15)(16)(23)(24)(25)27,29,36,39,41). As to the methodological quality, five studies presented low risk of bias (7,16,17,25,41), twelve had moderate risk (10,14,23,24,27,28,(34)(35)(36)(37)39,40) and two had high risk (29,38) of bias.…”

“…One of the indications for the use of EMDPs is for the management of infrabony periodontal defects (IPD). The use of EMDP in such defects has been histologically evaluated in animals (19,20) and in humans (8,15,21,22) with promising results regarding periodontal regeneration, and their clinical results have been shown to be significantly better than those of their comparative controls (14,15,(23)(24)(25)(26)(27)(28)(29).…”