Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects.

نویسندگان

  • M Esposito
  • P Coulthard
  • H V Worthington
چکیده

BACKGROUND Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. There is evidence to show that amelogenins are involved not only in enamel formation, but also in the formation of the periodontal attachment during tooth formation. OBJECTIVES To test the efficacy of EMD in comparison with open flap debridement, GTR and various BG procedures for the treatment of intrabony defects. SEARCH STRATEGY We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomised controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: January 2003. SELECTION CRITERIA RCTs on patients affected by periodontitis having intrabony defects treated with EMD compared with open flap debridement, GTR and various BG procedures with at least one year follow up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), marginal bone levels on intraoral radiographs and postoperative infections. DATA COLLECTION AND ANALYSIS Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two reviewers. Results were expressed as random effect models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval (CI). Heterogeneity was investigated including both clinical and methodological factors. MAIN RESULTS No difference in tooth loss was observed. A meta-analysis including eight trials showed that Emdogain treated sites displayed statistically significant PAL improvements (mean difference 1.3 mm, 95%CI: 0.8 to 1.8) and PPD reduction (1 mm, 95%CI: 0.5 to 1.4) when compared to flap surgery. Comparing Emdogain with 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. REVIEWER'S CONCLUSIONS Emdogain is able to significantly improve PAL levels (1.3mm) and PPD reduction (1mm) when compared to flap surgery, however these results may not have a great clinical impact, since it has not been shown that more periodontally compromised teeth could be saved. There was no evidence of clinically important differences between GTR and Emdogain.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Two patterns of histologic healing in an intrabony defect following treatment with enamel matrix derivative: a human case report.

Human histologic evidence of periodontal regeneration following treatment of intrabony defects with enamel matrix derivative has yielded inconsistent results in recent case reports. A 46-year-old woman presenting one deep intrabony defect at the distal root of a mandibular first molar scheduled for extraction was selected for enamel matrix derivative therapy. During surgery, a notch was placed ...

متن کامل

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

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 tr...

متن کامل

Papilla Preservation Technique with Enamel Matrix Derivative (EMD) in the Treatment of Periodontitis – a Case Report

Local periodontal therapy primarily consists of supraand subgingival debridement, and instruction and motivation for the improvement of oral hygiene. Effective regular mechanical plaque control has been proven to be one of the most important measures to avoid and control recurrence of infection (Axelsson and Lindhe, 1978; Axelsson and Lindhe, 1981a; Axelsson and Lindhe, 1981b). In addition resi...

متن کامل

بررسی هیستولوژیک اثربخشی Enamel matrix derivative در Surgical defect دندان گوسفند

The aim of the present study was the histological evaluation of Enamel Matrix Derivative (EMD) effectiveness for regeneration of periodontal defects. EMD activates cementum synthesis, PDL and bone during the maturation stage of follicole. In this research, EMD was used in surgical defects of premolar teeth in four adult sheep. Muccoperiosteal flap was reflected in buccal site of teeth. The bucc...

متن کامل

The application of an enamel matrix protein derivative (Emdogain) in regenerative periodontal therapy: a review.

Regenerative periodontal therapy aims at reconstitution of the lost periodontal structures such as new formation of root cementum, periodontal ligament and alveolar bone. Findings from basic research indicate that enamel matrix protein derivative (EMD) has a key role in periodontal wound healing. Histological results from animal and human studies have shown that treatment with EMD promotes peri...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • The Cochrane database of systematic reviews

دوره 4  شماره 

صفحات  -

تاریخ انتشار 2003