Evidence-Based Dentistry Enamel Matrix Derivative for Periodontal Tissue Regeneration in Treatment of Intrabony Defects : A Cochrane Systematic Review

We reviewed the literature on the efficacy of enamel matrix derivative (EMD) in comparison with open flap debridement, guided tissue regeneration (GTR), and bone grafting for the treatment of intrabony defects. We searched four major electronic databases for randomized controlled trials (RCTs) with at least one year of follow-up. Several journals were handsearched with no language restrictions. Outcome measures were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), marginal bone levels on intraoral radiographs, and postoperative infections. Screening of eligible RCTs, assessment of the methodological quality, and data extraction were conducted in duplicate. No difference in tooth loss was observed. A meta-analysis (eight trials) showed that EMD-treated sites displayed statistically significant PAL improvements (mean difference 1.3 mm) and PPD reduction (1 mm) when compared to flap surgery. When EMD was compared to GTR (six trials), GTR showed a statistically significant reduction of PPD (0.6 mm) and increase of REC (0.5 mm). No difference in postoperative infections was observed. No trials compared EMD with bone grafts alone. EMD is able to significantly improve PAL levels and PPD reduction when compared to flap surgery; however, there is no evidence that more teeth could be saved. There was no evidence of important differences between EMD and GTR. Dr. Esposito is Associate Professor, Department of Biomaterials, the Sahlgrenska Academy at Göteborg University; Dr. Coulthard is Professor and Head of the Oral and Maxillofacial Surgery Unit, University Dental Hospital of Manchester; Dr. Thomsen is Professor and Chair, Department of Biomaterials, the Sahlgrenska Academy at Göteborg University; and Dr. Worthington is Professor and Head of the Research Methods Unit, University Dental Hospital of Manchester. Direct correspondence and requests for reprints to Dr. Marco Esposito, Institute for Surgical Sciences, Department of Biomaterials, The Sahlgrenska Academy at Göteborg University, P.O. Box 412, SE 405 30 Göteborg, Sweden; 0046-(0)31-7732980 phone; 0046-(0)31-7732941 fax; marco.esposito@biomaterials.gu. se. This invited review is based on a Cochrane systematic review entitled “Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects,” published in The Cochrane Library (see www.CochraneLibrary.net for information). Cochrane systematic reviews are regularly updated to include new research and in response to comments and criticisms from readers. If you wish to comment on this review, please send your comments to Marco Esposito. The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane review can be interpreted differently, depending on people’s perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of review authors and are not necessarily shared by the Cochrane Collaboration. This review has been supported by the Faculty of Odontology, the Sahlgrenska Academy at Göteborg University, Sweden; the University Dental Hospital of Manchester, UK; the Swedish Medical Research Council (9495); and the Hjelmar Svensson Foundation, Sweden. Conflicts of interest: none.