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    Emdogain Research: Emdogain in Regenerative Periodontal Therapy. A Review of The Literature

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    Mohammed Nabeel

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    Emdogain Research: Emdogain in Regenerative Periodontal Therapy. A Review of The Literature

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    Mohammed Nabeel
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    Emdogain Research: Emdogain in Regenerative Periodontal Therapy. A Review of The Literature

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    Mohammed Nabeel

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    Emdogain Research

    : Fogorv Sz. 2007 Oct;100(5):220-32, 211-9.

    Emdogain in regenerative periodontal therapy. A review of the literature.


    Sculean A, Windisch P, Döri F, Keglevich T, Molnár B, Gera I.

    Department of Periodontology, Radboud University Medical Center, Nijmegen, The Netherlands.

    The goal of regenerative periodontal therapy is the reconstitution of the lost periodontal structures (i.e. the new
    formation of root cementum, periodontal ligament and alveolar bone). Results from basic research have pointed to
    the important role of the enamel matrix protein derivative (EMD) in the periodontal wound healing. Histological
    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 the current overview is to present, based on the existing evidence, the clinical indications for
    regenerative therapy with EMD. Surgical periodontal treatment of deep intrabony defects with EMD promotes
    periodontal regeneration. Surgical periodontal therapy of deep intrabony defects with EMD may lead to significantly
    higher improvements of the clinical parameters than open flap debridement alone. The results obtained following
    treatment with EMD are comparable to those following treatment with GTR and can be maintained over a longer
    period. Treatment of intrabony defects with a combination of EMD + GTR does not seem to additionally improve
    the results compared to treatment with EMD alone or GTR alone. The combination of EMD and some types of bone
    grafts/bone substitutes may result in certain improvements in the soft and hard tissue parameters compared to
    treatment with EMD alone. Treatment of recession-type defects with coronally repositioned flaps and EMD may
    promote formation of cementum, periodontal ligament and bone, and may significantly increase the width of the
    keratinized tissue. Application of EMD seems to provide better long-term results than coronally repositioned flaps
    alone. Application of EMD may enhance periodontal regeneration in mandibular Class II furcations. The clinical
    results are comparable to those obtained following GTR.

    Perioscopy aided MIS using Enamal Matrix Proteins compared to conventional surgery
    Harrell, SK,T.G. Wilson- Journal of Periodontology
    2005, Vol. 76, No. 3, Pages 380-384
    (doi:10.1902/jop.2005.76.3.380)

    Clinical Trials:

    Perioscopy + Emdogain: CAL 3.57mm


    Surgery + Emdogain: CAL 1.8mm

    Perioscopy + Emdogain: PD reduction 3.56mm


    Surgery + Emdogain: PD reduction 2.7mm

    Perioscopy + Emdogain: Recession .01mm


    Surgery + Emdogain: Recession .9mm
    J Clin Periodontol. 2007 Dec;34(12):1082-8. Epub 2007 Oct 22

    Minimally invasive surgical technique and enamel matrix derivative in intra-bony defects. I: Clinical
    outcomes and morbidity.

    Cortellini P, Tonetti MS.

    Accademia Toscana di Ricerca Odontostomatologica, Via Carlo Botta 16, Florence, Italy.
    studiocortellini@cortellini.191.it

    AIMS: This case cohort study was designed to evaluate the clinical performance and the intra-operative and post-
    operative morbidity of the minimally invasive surgical technique (MIST) associated with the application of an
    enamel matrix derivative (EMD) in the treatment of isolated deep intra-bony defects. MATERIAL AND
    METHODS: Forty deep isolated intra-bony defects in 40 patients were surgically accessed with the MIST. This
    technique was designed to limit the mesio-distal flap extension and the corono-apical flap reflection in order to
    reduce the surgical trauma and increase flap stability. The incision of the defect-associated papilla was performed
    according to the principles of the papilla preservation techniques. EMD was applied on the debrided and dried root
    surfaces. Stable primary closure of the flaps was obtained with modified internal mattress sutures. Surgery was
    performed with the aid of an operating microscope and microsurgical instruments. Clinical outcomes were collected
    at baseline and at 1 year. Intra-operative and post-operative morbidity was evaluated with questionnaires.
    RESULTS: The 1-year clinical attachment gain was 4.9+/-1.7 mm (p<0.0001 compared with baseline). This
    corresponded to a 77.6+/-21.9% resolution of the defect. Residual probing pocket depths were 3+/-0.6 mm. A
    minimal increase of 0.4+/-0.7 mm in gingival recession between baseline and 1 year was recorded. No patients
    experienced intra-operative pain, while only 14 reported a very moderate perception of the hardship of the surgical
    procedure [7+/-12 visual-analogue scale (VAS) units, on average]. Primary closure was obtained in all treated sites.
    At the 1-week follow-up visit, 38 sites (95%) were still closed. Only 12 subjects reported moderate post-operative
    pain (VAS 19+/-10) that lasted for 26+/-17 h. CONCLUSIONS: These data indicate that the minimally invasive
    surgical technique, in combination with EMD, can be successfully applied in the treatment of isolated deep intra-
    bony defects, resulting in excellent clinical outcomes with very limited intra- and post-operative morbidity.

    Schweiz Monatsschr Zahnmed. J Clinical Perio 2007;117(6):598-606.

    The use of Emdogain in periodontal and osseous


    regeneration
    Sculean A, Rathe F, Junker R, Becker J, Schwarz F, Arweiler N.

    Department of Periodontology, Radboud University Medical Center, Nijmegen, The Netherlands.


    a.sculean@dent.umcn.nl

    The goal of regenerative periodontal therapy is the reconstitution of the lost periodontal structures (i. e. the new
    formation of root cementum, periodontal ligament and alveolar bone). Results from basic research have pointed to
    the important role of an enamel matrix protein derivative (EMD) in periodontal wound healing. Histological results
    from experiments in animals and from human case reports 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.
    Five-year follow-up of regenerative periodontal therapy with enamel matrix derivative at sites with angular
    bone defects.

    Full Abstract

    BACKGROUND: This prospective case series report aimed at analyzing the long-term (5 years) stability of
    clinical attachment level (CAL) gains following regenerative therapy with the use of enamel matrix proteins in
    intrabony defects. METHODS: A total of 114 consecutively treated periodontal patients (mean age: 55.8
    years) were initially included. Each subject exhibited at least one deep proximal intrabony defect with the
    inclusion criteria of 1) probing depth (PD)>or=5 mm, 2) clinical attachment loss>or=6 mm, and 3)
    radiographic evidence of a >or=3-mm intrabony component. A total of 146 defects met the criteria for
    inclusion. At least 6 months after the completion of an initial phase of mechanical infection control, a baseline
    examination was performed to characterize the experimental site. Reconstructive therapy with the use of
    enamel matrix proteins was subsequently performed. Experimental sites were reexamined 1 and 5 years after
    reconstructive surgery. Primary efficacy variables were considered to be changes in PD, CAL, soft tissue
    recession (REC), and radiographic defect depth (RDD). Stepwise regression analysis was employed for
    evaluation of predicting factors of CAL change between the 1- and 5-year reexaminations. RESULTS: A total of
    82 patients (102 defects) were included in the analysis. One year following the regenerative surgery, a mean
    CAL gain of 4.3 mm (P<0.001), a mean PD reduction of 4.9 mm (P<0.001), and a mean increase in REC of
    0.6 mm (P<0.001) were recorded. At the 5-year follow-up, a further mean PD reduction of 0.3 mm (P>0.05),
    CAL gain of 1.1 mm (P<0.01), and reduction in recession of 0.8 mm (P<0.01) had taken place. Radiographs
    revealed that the bone defect had been reduced in depth with an average of 2.9 mm at 1 year (P<0.001). No
    statistically significant alteration in defect depth was observed between 1 and 5 years of follow-up. The
    stepwise regression analysis identified the degree of REC and residual PD at 1 year as significant predictors of
    CAL change between 1 and 5 years. CONCLUSION: Results demonstrated long-term (5 years) stability of CAL
    gains following regenerative therapy with the use of enamel matrix proteins in intrabony defects.

    Abstract
    Journal of Periodontology
    2009, Vol. 80, No. 9, Pages 1534-1540 , DOI 10.1902/jop.2009.090160
    (doi:10.1902/jop.2009.090160)

    Clinical and Histologic Evaluation of Non-Surgical Periodontal Therapy With Enamel


    Matrix Derivative: A Report of Four Cases

    James T. Mellonig,* Pilar Valderrama,* Holly J. Gregory,* and David L. Cochran*


    *Department of Periodontics, Dental School, University of Texas Health Science Center at San
    Antonio, San Antonio, TX.
    Correspondence: Dr. James T. Mellonig, Department of Periodontics, The University of Texas Health
    Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229. E-mail:
    mellonig@uthscsa.edu.
    Background: Enamel matrix derivative (EMD) is a composite of proteins that was demonstrated
    histologically to work as an adjunct to periodontal regenerative surgical therapy. The purpose of
    this study was to evaluate the clinical and histologic effects of EMD as an adjunct to scaling and
    root planing.
    Methods: Four patients with severe chronic periodontitis and scheduled to receive complete
    dentures were accrued. Probing depth and clinical attachment levels were obtained. Unlimited time
    was allowed for hand and ultrasonic instrumentation. A notch was placed in the root ≥1 to 2 mm
    from the apical extent of root planing. EMD was inserted into the pocket, and a periodontal
    dressing was placed. Patients were seen every 2 weeks for plaque control. At 6 months post-
    treatment, soft tissue measurements were repeated, and the teeth were removed en bloc and
    prepared for histomorphologic analysis.
    Results: Probing depth reduction and clinical attachment level gain were obtained in three-fourths
    of the specimens. Three of the four specimens analyzed histologically demonstrated new
    cementum, bone, periodontal ligament, and connective tissue attachment coronal to the notch. In
    one specimen, the gingival margin had receded below the notch.
    Conclusions: The results were unexpected and may represent an aberration. However, the
    substantial reduction in deep probing depths and clinical attachment level gain in three of four
    specimens, in addition to the histologic findings of new cementum, new bone, a new periodontal
    ligament, and a new connective tissue attachment, suggest that EMD may be useful as an adjunct
    to scaling and root planing in single-rooted teeth.

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