Journal of periodontology vol:83 issue:6 pages:707-720
Background: Enamel matrix derivative (EMD) is commonly used in periodontal therapy. The aim of this systematic review is to give an updated answer to the question whether the additional use of EMD in periodontal therapy is more effective in comparison to control or other regenerative procedures. Material and methods: A literature search in MEDLINE (PubMed) for the use of EMD in periodontal treatment was performed up to May 2010. The use of EMD in treatment of intrabony defects, furcations and recessions was evaluated. Only randomized controlled trials with at least one year of follow-up were included. The primary outcome variable for intrabony defects was the change in clinical attachment level, for furcations the change in horizontal furcation depth and for recession complete root coverage. Results: Following screening 27 studies (20 for intrabony defects,1 for furcation and 6 for recession) were eligible for the review. A meta-analysis was performed for intrabony defects and recession. The treatment of intrabony defects with EMD showed a significant additional gain in clinical attachment of 1.30 mm in comparison to open flap debridement, EDTA or placebo, but no significant difference in comparison to resorbable membranes was shown. The use of EMD in combination with a coronally advanced flap compared to a coronally advanced flap alone showed significant more complete root coverage (OR=3.5), but in comparison to a connective tissue graft the result was not significantly different. The use of EMD in furcations (2.6±1.8 mm) gave significant more improvement in horizontal defect depth in comparison to resorbable membranes (1.9±1.4 mm) as shown in one study. Conclusions: In the treatment of intrabony defects the use of EMD is superior to control treatments, but as effective as resorbable membranes. The additional use of EMD with a coronally advanced flap for recession coverage will give superior results in comparison to control, but is as effective as a connective tissue graft. The use of EMD in furcations will give more reduction in horizontal furcation defect depth as resorbable membranes.