Systematic review of clinical effects of enamel matrix derivative as adjunctive therapy for gingival recession / 口腔疾病防治

Objective @#To evaluate the clinical effect of enamel matrix derivative(EMD) assisted with connective tissue graft(CTG) in the treatment of gingival recession.@*Methods @#Search The Cochrane Library, PubMed, EMbase, Web of Science, Wanfang Public Database,VIP database and CNKI to search for randomized controlled trials of EMD in the treatment of gingival recession. The search period is from the establishment of the databases to October 3, 2022. The test group was treated with EMD+CTG, while the control group was treated with CTG alone. Meta-analyses were performed using Review Manager 5.4.1 and Stat12.0.@*Results@# Meta analysis results showed that only 12 months after treatment, there was a statistically significant difference in the PD and CAL outcome indicators between the EMD assisted treatment group and the control group [MDPD=-0.10, 95% CI (-0.19, -0.01), P = 0.03], [MDCAL=-0.38, 95% CI(-0.71, -0.04), P = 0.03]. There was no significant difference between the test group and the control group in other indicators.@*Conclusion @#EMD assisted CTG in the treatment of gingival recession may be beneficial to the reduction of PD and CAL.

Effect of Protein-Based Treatment on Chemical Composition, Hardness and Bond Strength of Remineralized Enamel

Abstract This study evaluated the chemical composition and microhardness of human enamel treated with an Enamel Matrix Derivative (EMD) solution, and the bond strength between composite resin and this enamel. Thirty human enamel samples were randomly divided into three groups: Untouched Enamel (UE), Demineralized Enamel (DE) and Demineralized Enamel Treated with EMD (ET). DE and ET groups were subjected to acid challenge and ET treated with EMD (EMD was directly applied over conditioned enamel and left for 15 min). Samples from each group (n=4) had chemical composition assessed through to attenuated total reflectance Fourier transform infrared (ATR-FTIR). Knoop microhardness of enamel samples from each group (n=10) was measured. For the microshear bond strength, the samples were etched for 30 s, and the adhesive was applied and cured for 10 s. Two matrixes were placed on the samples, filled with Filtek Z350 XT composite and cured for 20 s, each. The matrix was removed, and the microshear bond strength of each group (n=10) was tested. Data were subjected to Kruskal-Wallis test (for microhardness), to analysis of variance and to Tukey's test (for microshear bond strength); (α=0.05). FTIR results have shown phosphate (hydroxyapatite indicator) in 900-1200 cm-1 bands in the UE and ET groups, which were different from the DE group. Microhardness and microshear analyses recorded higher statistical values for the UE and ET groups than for DE. EMD application to demineralized enamel seems to have remineralized the enamel; thus, the microhardness and bond strength was similar between UE and ET groups.

Resumo Este estudo avaliou a composição química e microdureza do esmalte humano tratado com solução de Derivados da Matriz do Esmalte (EMD) e a resistência de união entre compósito e este esmalte. Trinta amostras de esmalte humano foram aleatoriamente divididas em três grupos: Esmalte Intocado (UE), Esmalte Desmineralizado (DE) e Esmalte Desmineralizado Tratado com EMD (ET). Os grupos DE e ET foram submetidos a desafio ácido e ET tratado com EMD (O EMD foi aplicado diretamente sobre esmalte condicionado e deixado por 15 minutos). Amostras de cada grupo (n = 4) tiveram composição química avaliada através de espectroscopia no infravermelho por transformada de Fourier com reflectância total atenuada (FTIR-ATR). A microdureza Knoop das amostras de esmalte de cada grupo (n=10) foi mensurada. Para a resistência ao microcisalhamento, as amostras foram condicionadas por 30 s, o adesivo aplicado e foto-ativado por 10 s. Duas matrizes plásticas (1 mm de comprimento) foram posicionadas sobre as amostras, preenchidas com compósito Filtek Z350 XT e foto-atiavadas por 20 s cada. As matrizes foram removidas e a resistência ao microcisalhamento de cada grupo (n=10) foi testada. Os dados foram submetidos ao teste de Kruskal-Wallis (para análise da microdureza), à análise de variância e ao teste de Tukey (para análise da resistência ao microcisalhamento); (α=0.05). Os resultados do FT-IR mostraram fosfato (indicador de hidroxiapatita) na banda entre 900-1200 cm-1 nos grupos UE e ET, diferentemente do grupo DE. Análises de microdureza e microcisalhamento demonstraram resultados estatisticamente superiores para os grupos UE e ET quando comparados ao DE. A aplicação de EMD ao esmalte desmineralizado parece ter remineralizado o esmalte; assim, a microdureza e a resistência de união foram semelhantes entre os grupos UE e ET.

Progress in clinical treatment and etiology of gingival recession / 口腔疾病防治

@#Gingival recession is one of the common oral symptoms. Periodontal soft tissue defects caused by gingival recession and problems related to aesthetics, prosthetics and orthodontic treatment have garnered increasing attention. This article reviews the etiology, classification and treatment of gingival recession to provide a reference for the diagnosis and treatment of gingival recession. Anatomical characteristics of teeth, bacterial and viral infection, Occlusion trauma, Improperbrushing methods and other daily behaviors and iatrogenic factors may lead to gingival recession. Miller classification is the most commonly used classification standard. It is divided into 4 degrees according to the relationship between gingival recession and the association between the gingival membrane and the loss of adjacent alveolar bone or interdental papilla. Gingival surgeries, such as coronally advanced flap, laterally positioned flap, subepithelial connective tissue graft for Miller Ⅰ degrees and Ⅱ gingival recession retreat, obtain a more satisfactory success rate. Regarding the Ⅲ degree gingival recession, the postoperative curative effect is poor and can only cover part of the root. Regarding Ⅳ degrees gingival recession, surgery cannot reach the root surface coverage. For patients with Miller Ⅳgingival recession caused by severe periodontitis, the surgical treatment is poor, and repair methods, such as sputum, can also be considered. In recent years, a variety of biological materials have been jointly applied to gingival surgery, such as tooth enamel matrix derivative (EMD), allograft acellular dermal matrix (ADM), porcine collagen matrix (PCM) and platelet-rich fibrin (PRF). The use of these biomaterials can improve root coverage, increase gingival thickness and keratinized gingival width, avoid the requirement of palatal flap removal, reduce the surgical risk and increase patient compliance.

Application of biological factor in cementum regeneration / 中华口腔医学杂志

At the present day, curettage and periodontal surgery comprise the main strategy for the treatment of periodontitis, however, these methods are limited in regenerating cementum. It has been found that some biological factors such asenamel matrix derivative (EMD), transforming growth factor-β (TGF-β) and insulin-like growth factor (IGF) could promote cementum regeneration. In the cementum regenerationstudies, there has been a lack of criteria to distinguish cementum from alveolar bone and other types of cementum. Therefore, this article will briefly review the biological factors that affect the cementum regeneration and the molecular markers used to judge the regenerating cementum.

Recent advances in direct pulp capping materials / 华西口腔医学杂志

The long-term effect of direct pulp capping and pulpotomy is closely related to the type of pulp capping materials. Various kinds of direct pulp capping materials are available, such as calcium hydroxide and mineral trioxide aggregates. Diverse new pulp capping materials have been reported recently. The excellent performance of calcium silicates has attracted much attention in previous studies. Moreover, enamel matrix derivative (Emdogain), which is capable of regeneration and remineralization, and other materials with similar capabilities have shown potential for use in pulp capping.

The effects of bone graft combined with enamel matrix derivative in the treatment of periodontal osseous defects compared with that of bone graft alone: A meta-analysis / 实用口腔医学杂志

Objective: To analyze the efficacy of enamel matrix derivative (EMD) combined with bone grafts in the treatment of periodontal osseous defects comparied with that of bone grafts alone by Meta-analysis. Methods: The randomized controlled trials(RCTs) about the efficacy of enamel matrix derivative and bone grafts for the treatment of periodontal osseous defects were collected from Cochrane Library,EMBASE,PubMed,CNKI,Wanfang databases and Google scholar from inception may,2016 by electronic search,scored literatures with the methodological index for non-randomized studies(MINORS) evaluation tool. Revman 5. 3 was used for the Meta-analysis. Results: 5 RCTs articles with 145 cases were included. Meta-analysis showed that: at 6 months of follow-up, PD reduction and CAL gain was found more in test group than in control group(WMD = 0. 40,95％ CI =[0. 01,0. 79],P ＜ 0. 05) and (WMD = 0. 50,95％ CI =[0. 12,0. 88],P ＜ 0. 05) respectively. At 12 months of follow-up,there was no statistical significant difference in PD reduction and CAL gain respectively between the 2 treatments. Conclusion: The combined use of EMD and bone grafts may improve PD reduction and CAL gain in the early stage of convalescence following treatment of periodontal osseous deffects.

Development and progresses of periodontal tissue regeneration in clinical research / 实用口腔医学杂志

Along with recent advances in biological signal molecule and tissue engineering technology,periodontal regeneration has been gained more and more new opportunities,but also faces many challenges.This paper briefly reviewes the preclinical and clinical studies of periodontal tissue regeneration,highlighting the latest achievement and progress in the clinical study of biological signal molecules and stem cell therapy in the treatment of periodontal disease worldwide.

The effects of bone morphogenetic protein-2 and enamel matrix derivative on the bioactivity of mineral trioxide aggregate in MC3T3-E1cells

OBJECTIVES: The effects of bone morphogenetic protein-2 (BMP-2) and enamel matrix derivative (EMD) respectively with mineral trioxide aggregate (MTA) on hard tissue regeneration have been investigated in previous studies. This study aimed to compare the osteogenic effects of MTA/BMP-2 and MTA/EMD treatment in MC3T3-E1 cells. MATERIALS AND METHODS: MC3T3-E1 cells were treated with MTA (ProRoot, Dentsply), BMP-2 (R&D Systems), EMD (Emdogain, Straumann) separately and MTA/BMP-2 or MTA/EMD combination. Mineralization was evaluated by staining the calcium deposits with alkaline phosphatase (ALP, Sigma-Aldrich) and Alizarin red (Sigma-Aldrich). The effects on the osteoblast differentiation were evaluated by the expressions of osteogenic markers, including ALP, bone sialoprotein (BSP), osteocalcin (OCN), osteopontin (OPN) and osteonectin (OSN), as determined by reverse-transcription polymerase chain reaction analysis (RT-PCR, AccuPower PCR, Bioneer). RESULTS: Mineralization increased in the BMP-2 and MTA/BMP-2 groups and increased to a lesser extent in the MTA/EMD group but appeared to decrease in the MTA-only group based on Alizarin red staining. ALP expression largely decreased in the EMD and MTA/EMD groups based on ALP staining. In the MTA/BMP-2 group, mRNA expression of OPN on day 3 and BSP and OCN on day 7 significantly increased. In the MTA/EMD group, OSN and OCN gene expression significantly increased on day 7, whereas ALP expression decreased on days 3 and 7 (p < 0.05). CONCLUSIONS: These results suggest the MTA/BMP-2 combination promoted more rapid differentiation in MC3T3-E1 cells than did MTA/EMD during the early mineralization period.

Cellular viability and genetic expression of human gingival fibroblasts to zirconia with enamel matrix derivative (Emdogain(R))

PURPOSE: The objective of this study was to investigate the biologic effects of enamel matrix derivative (EMD) with different concentrations on cell viability and the genetic expression of human gingival fibroblasts (HGF) to zirconia surfaces. MATERIALS AND METHODS: Immortalized human gingival fibroblasts (HGF) were cultured (1) without EMD, (2) with EMD 25 microg/mL, and (3) with EMD 100 microg/mL on zirconia discs. MTT assay was performed to evaluate the cell proliferation activity and SEM was carried out to examine the cellular morphology and attachment. The mRNA expression of collagen type I, osteopontin, fibronectin, and TGF-beta1 was evaluated with the real-time polymerase chain reaction (RT-PCR). RESULTS: From MTT assay, HGF showed more proliferation in EMD 25 microg/mL group than control and EMD 100 microg/mL group (P<.05). HGFs showed more flattened cellular morphology on the experimental groups than on the control group after 4h culture and more cellular attachments were observed on EMD 25 microg/mL group and EMD 100 microg/mL group after 24h culture. After 48h of culture, cellular attachment was similar in all groups. The mRNA expression of type I collagen increased in a concentration dependent manner. The genetic expression of osteopontin, fibronectin, and TGF-beta1 was increased at EMD 100 microg/mL. However, the mRNA expression of proteins associated with cellular attachment was decreased at EMD 25 microg/mL. CONCLUSION: Through this short term culture of HGF on zirconium discs, we conclude that EMD affects the proliferation, attachment, and cell morphology of HGF cells. Also, EMD stimulates production of extracellular matrix collagen, osteopontin, and TGF-beta1 in high concentration levels. CLINICAL RELEVANCE: With the use of EMD, protective barrier between attached gingiva and transmucosal zirconia abutment may be enhanced leading to final esthetic results with implants.

Enamel matrix derivative for replanted teeth in animal models: a systematic review and meta-analysis

OBJECTIVES: To investigate the effect of enamel matrix derivative (EMD) on periodontal healing of replanted teeth in animal models. MATERIALS AND METHODS: The authors searched MEDLINE, PubMed, EMBASE, Cochrane Library, Web of Knowledge and Scopus for articles published up to Oct 2012. Animal studies in which EMD was applied in transplanted or replanted teeth with adequate controls and histological data were considered. Normal periodontal healing or root resorption determined by histology after EMD was applied in replanted teeth with adequate controls was used as outcome measures. The following search strategy was used: ('Emdogain' OR 'enamel matrix proteins' OR 'enamel matrix derivative') AND ('avulsion' OR 'transplantion' OR 'autotransplantation' OR 'replantation'). RESULTS: Six animal studies were included in the final review. There was great heterogeneity in study design among included studies. Two studies with similar study designs were identified and analyzed by a meta-analysis. The pooled estimates showed a significantly higher normal healing and surface resorption and significantly less inflammatory and replacement resorption in EMD-treated groups compared with non-EMD-treated groups. CONCLUSIONS: With the limitations of this systematic review, the use of EMD led to greater normal periodontal healing and surface root resorption and less inflammatory and replacement root resorption in the presence of periodontal ligaments. However, no definite conclusion could be drawn with regard to the effect of EMD on periodontal healing and root resorption when no periodontal ligaments exist.

Effect of enamel matrix derivative (EMD, Emdogain(R)) on the differentiation of cultured human periodontal ligament cells and mesenchymal stem cells

Clinical effect of enamel matrix derivative(EMD) in the treatment of periodontal intrabony defects / 대한치주과학회지

tachment level was changed from 8.67+/-1.72mm to 7.00+/-1.60mm (control); from 8.93+/-2.23mm to 6.00+/-1.92mm (test); and bone probing depth was decreased from 10.20+/-1.90mm to 9.07+/-1.95mm (control); from 10.14+/-2.14mm to 7.43+/-2.06mm (test). This study indicates that treatment of periodontal intrabony defects with EMD is clinically superior to treatment without EMD (OFD alone) in every parameter evaluated. Within the limits of this study, the application of EMD in intrabony defects resulted in clinically significant gain of clinical attachment level and decrease of bone probing depth. And further controlled clinical studies are required to confirm the effectiveness of the EMD in the treatment of various osseous defects.

Effects of enamel matrix derivative and titanium on the proliferation and differentiation of osteoblasts / 대한치주과학회지

Among objectives of periodontal therapy, the principal one is the morphological and functional reconstruction of lost periodontal supporting tissues. This includes de novo formation of connective tissue attachment and the regrowth of alveolar bone. The use of enamel matrix derivative(EMD) may be a suitable means of regeneration new periodontal attachment in the infrabony defects. Implant used to replace lost tooth but, implantitis occurred after installation. The purpose of this study was to investigate the effects of EMD on differentiation and growth of osteoblast in titanium disc. Twentyfive millimeter diameter and 1mm thick Ti disc which was coated 25, 50, 100, 200microgram/ml of EMD(Emdogain(R)) used as experimental group, 25, 50, 100, 200ng/ml of rhBMP-2 as positive control group, and no coat as negative control group. A human osteosarcoma cell line Saos-2 was cultured in Ti disc and cell proliferation and Alkaline phosphatase (ALP) activity were measured at 1 and 6 days. PCR was performed at 2 and 8 hours. Semi-quantitative RT-PCR for mRNA expressions of various osteoblastic differentiation markers - type I collagen, ALP, osteopontin, and bone sialoprotein - were performed at appropriate concentrations based upon the results of MTT and ALP assay. Cultured cell-disc complexes were prepared for scanning electron microscopy (SEM) at 2 hour. Data were analyzed using Mann-Whitney and repeated- measures 1-way analysis of variance(SPSS software version 10,SPSS, Chicago, IL). After culture, there was more osteoblast in EMD100microgram/ml than in EMD50, 200microgram/ml on day 6. There was significant difference in experimental and positive control group compared control group, as times go by(1 and 6 days). Alkaline phosphatase activity was different significantly in EMD100, 200microgram/ml and BMP100, 200ng/ml on day 6. The results of reverse transcriptase-polymerase chain reaction (RT-PCR) showed that expression of mRNA for ALPase, collagen type I, osteopontin, bone sialoprotein and BMP-2 was detected at 2 hour and 8 hour in EMD200microgram/ml subgroup and BMP100ng/ml subgroup. The results of this study suggest that application of enamel matrix derivative on osteoblast attached to titanium surface facilitate the expression of bone specific protein and the differentiation and growth of osteoblast.

The Effects of Enamel Matrix Derivative and Calcium Sulfate Paste on the Healing of 1-Wall Intrabony Defects in Beagle Dogs / 대한치주과학회지

Recently, it was reported that enamel matrix derivative may be beneficial in periodontal regeneration procedures in expectation of promoting new bone and cementum formation. The aim of present study was to evaluate the effect of enamel matrix derivative(Emdogain?)and Caso4 sulfate paste in 1-wall intrabony defects in beagle dogs. Surgically created 1-wall intrabony defects were randomly assigned to receive root debridement alone or Emdogain(R) or Emdogain(R) and Caso4. Clinical defect size was 4 X 4mm. The control group was treated with root debridement alone,and Experimental group I was treated with enamel matrix derivative application, and Experimental group II was treated with enamel matrix derivative and Caso4 sulfate paste application,. The healing processes were histologically and histometrically observed after 8 weeks and the results were as follows : 1. The length of junctional epithelium was 0.41+/-0.01mm in the control group, 0.42+/-0.08mm in the experimental group I and 0.50+/-0.13mm in the experimental group II. 2. The connective tissue adhesion was 0.28+/-0.02 mm in the control group, 0.13+/-0.08mm in the experimental group I and 0.19+/-0.02 mm in the experimental group II. 3. The new cementum formation was 3.80+/-0.06 mm in the control group, 4.12+/-0.43mm in the experimental group I and 4.34+/-0.71mm in the experimental group II. 4. The new bone formation was 1.43+/-0.03mm in the control group, 1.53+/-0.47 mm in the experimental group I and 2.25+/-1.35mm in the experimental group II. Although there was limitation to present study, the use of enamel matrix derivative in the treatment of periodontal 1-wall intrabony defect enhanced new cementum and bone formation. Caso4 sulfate paste will be the candidate for carriers to deliver enamel matrix derivative, and so enhance the regenerative potency of enamel matrix derivative.

The effects of enamel matrix derivative on the healing of 1-wall intrabony defects in beagle dogs / 대한치주과학회지

Guided tissue regeneration, bone graft procedures, and application of growth factors have been used to regenerate lost periodontal tissues. Recently, enamel matrix derivative has been introduced into periodontal regeneration procedures in expectation of promoting new bone and cementum formation. The purpose of this study was to evaluate the effect of enamel matrix derivative in 1-wall intrabony defects in beagle dogs. For this purpose, each dog was anesthesized using intravenous anesthesia and mandibular 1st, 3rd premolars were extracted. 2 months later, the 1-wall intrabony defects(mesio-distal width; 4mm, depth; 4mm) were created on the distal side of 2nd premolars and mesial side of 4th premolars. The control group was treated with debridement alone,and experimental group was treated with debridement and enamel matrix derivative application. The healing processes were histologically and histometrically observed after 8 weeks and the results were as follows : 1. The length of junctional epithelium was 0.94+/-0.80mm in the control group, 0.57+/-0.42mm in the experimental group, with no statistically significant difference between groups. 2. The connective tissue attachment was 1.36+/-0.98mm in the control group, 0.38+/-0.43mm in the experimental group, with statistically significant difference between groups(P<0.05). 3. The new cementum formation was 2.49+/-1.06mm in the control group, 3.59+/-0.74mm in the experimental group, with statistically significant difference between groups(P<0.05). 4. The new bone formation was 1.92+/-0.97mm in the control group, 2.32+/-0.59mm in the experimental group, with no statistically significant difference between groups. Within the limitation to this study protocol, enamel matrix derivative application in 1-wall intrabony defect enhanced new cementum formation. Although there was no statistically significant difference, enamel matrix derivative also seems to be effective in inhibition of apical migration of junctional epithelium and new bone formation.