Comparison of Enamel Matrix Derivative Alone or in Combination with Bone Replacement Graft Materials in the Treatment of Intrabony Defects: A Systematic Review

The ultimate goal of any periodontal therapy is to regenerate all lost tissues of the periodontium: bone, cementum and periodontal ligament. The purpose of this systematic review was to compare the outcome when BRG was combined with EMD vs. EMD alone for the treatment of periodontal intrabony defects. A comprehensive literature search through February 11, 2015 was performed using Medline and EMBASE for all literature related to intrabony defects treatment using EMD with and without bone graft. Either EMD or combination of EMD with BG resulted in improved clinical outcomes. In conclusion, most studies report differences for gingival recession with the addition of bone graft but this trend was not statistically significant. Bone fill, as measured at reentry, was the only variable yielding more favorable outcome with the combined approach. Mean defect fill 2.36 ± 3.9 mm and 3.78 ± 0.7mm (p< 0.05) for EMD alone and combination therapy, respectively.

Chapter Pages I. Introduction … A. A Historical Perspective ….. 1 B. Enamel Matrix Derivative (EMD): An Introduction ... 5 C. Cellular Effects... 5 D. Root Conditioning: A Prerequisite... 6 E. Experimental and Human Studies.... 7 F. Safety of Enamel Matrix Derivative... 8 G. Enamel Matrix Derivative Regeneration vs. GTR, an Observation.... 8 II. Purpose... 9 III. Material and Methods... 10 A. Search Protocol... 10 B. Selection Criteria... 11 C. Data Collection and Analysis... 13 IV. Results... 17 A. Characteristics of Interventions... 19 B. Characteristics of Outcome Measures... 22 V. Discussion... 39 VI. Conclusion... 45 VII. References...46 List of Tables Table 1. Characteristics of the Reviewed Studies….14-15 Table 2. Study Description…22 List of Figures Figure 1. Data Flowchart depicting initial search results to final studies...12 Figure 2. The Basis For Strength of Recommendation...16 Figure 3. The Basis For Grading The Quality of Evidence...16 Figure 4. Comparison of Mean PD Reduction among EMD groups and EMD + BG group in all studies….23 Figure 5. Comparison of Mean Clinical Attachment Gain (CAL) between EMD Groups and EMD + Bone Graft Groups...25 Figure 6. Comparison of Mean Recession Change among EMD groups and EMD + BG group in all studies...26 . Figure 7. Comparison of Mean Re-entry Bone Fill Change among EMD groups and EMD + BG group in all studies….27 Figure 8. Comparison of Mean Radiographic Bone Gain Change among EMD groups and EMD + BG group in all studies...29 Figure 9. Comparison of Weighted Mean Pocket Depth Change Between EMD only and EMD + Bone Groups....31 Figure 10. Comparison of Weighted Mean Clinical Attachment Levels Change Between EMD only and EMD + Bone Groups....32 Figure 11. Comparison of Weighted Mean Recession Change Between EMD only and EMD + Bone Groups....33 Figure 12. Comparison of Weighted Mean Bone Fill Change Between EMD only and EMD + Bone Groups (P < 0.05) ….34 Figure 13. Comparison of Weighted Mean Radiographic Bone Gain Change Between EMD only and EMD + Bone Groups...35 Figure 14. Mean Change in Parameters in EMD only Group and EMD + Synthetic Bone Group...36 Figure 15. Mean Change in Parameters in EMD only Group and EMD + Mammalian Bone Group….37 Figure 16. Mean Change in Parameters in EMD + Mammalian Bone Group and EMD + Synthetic Group…38

Description

University of Maryland, Baltimore. Biomedical Sciences-Dental School. M.S. 2015

Keyword

EMD
synthetic bone
Emdogain
intrabony
mammalian bone
Bone and Bones
Periodontics
Bone-grafting

Identifier to cite or link to this item

http://hdl.handle.net/10713/4577