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 treatment with EMD promotes periodontal regeneration. Moreover, clinical studies have indicated that treatment with EMD positively influences periodontal wound healing in humans. The goal of the current overview is to present, based on the existing evidence, the clinical indications for regenerative therapy with EMD. Surgical periodontal treatment of deep intrabony defects with EMD promotes periodontal regeneration. The application of EMD in the context of non-surgical periodontal therapy has failed to result in periodontal regeneration. Surgical periodontal therapy of deep intrabony defects with EMD may lead to significantly higher improvements of the clinical parameters than open flap debridement alone. The results obtained following treatment with EMD are comparable to those following treatment with GTR and can be maintained over a longer period. Treatment of intrabony defects with a combination of EMD + GTR does not seem to additionally improve the results compared to treatment with EMD alone or GTR alone. The combination of EMD and some types of bone grafts/bone substitutes may result in certain improvements in the soft and hard tissue parameters compared to treatment with EMD alone. Treatment of recession-type defects with coronally repositioned flaps and EMD may promote formation of cementum, periodontal ligament and bone, and may significantly increase the width of the keratinized tissue. Application of EMD seems to provide better long-term results than coronally repositioned flaps alone. Application of EMD may enhance periodontal regeneration in mandibular Class II furcations. The clinical results are comparable to those obtained following GTR.