Bone Regenerative Potential of Enamel Matrix Protein in the Circumferential Defect Around a Dental Implant

The Applications of Enamel Matrix Derivative in Implant Dentistry: A Narrative Review

Enamel matrix derivative (EMD) has been successfully used for periodontal regeneration in intrabony defects. Recently, its use for peri-implant bone regeneration has also been hypothesized. The aim of this paper is to review preclinical and clinical studies investigating the use of EMD in correspondence with titanium implants, alone or as an adjunct to other biomaterials. Clinical trials and case series with more than five cases were included. Seven in vitro studies evaluated the effect of EMD, placed on titanium surfaces: An increase in proliferation and viability of osteoblasts was observed in all but two studies. An increase in TGF-β1 and osteocalcin production, alkaline phosphatase activity, and angiogenesis was also reported. Nine animal studies investigated the use of EMD at implant placement or for bone regeneration of peri-implant bone defects, and some of them reported a significant increase in bone formation or bone-to-implant contact. In four of eleven clinical trials on humans, EMD was successfully used at implant placement. The other seven evaluated the use of EMD in protocols for the treatment of peri-implantitis. In conclusion, the results of EMD seem promising, but further randomized clinical trials are needed to evaluate its efficacy.

Effect of enamel matrix derivative on alveolar ridge preservation in the posterior maxilla: A randomized controlled clinical trial

BACKGROUND

EMD has been considered to exert positive effects on wound healing, postoperative discomfort, and bone regeneration.

PURPOSE

The aim of this randomized controlled clinical trial was to investigate and compare (a) horizontal and vertical bone dimensional changes, (b) early postoperative discomfort and soft tissue wound healing outcomes, and (c) treatment modalities for implant placement, following posterior maxillary alveolar ridge preservation (ARP) with and without adjunctive use of EMD.

METHODS

Twenty-eight participants were randomly assigned to three groups: extraction sockets filled with bovine bone mineral and membrane with EMD (test group 1, n = 10) and without EMD (test group 2, n = 10) and spontaneous healing (control group, n = 8). Alveolar bone dimensional changes were measured using cone-beam computed tomography 5 months after ARP, and postoperative pain and wound healing outcomes were also evaluated.

RESULTS

There were no significant differences in horizontal or vertical bone dimensional changes between test groups 1 (horizontal width changes at 1 mm apically below the alveolar ridge crest [HW]: -1.44 ± 0.54 mm) and 2 (HW: -1.42 ± 0.26 mm), but the changes at HW (-2.36 ± 1.03 mm) in the control group were significantly greater than those in test groups 1 and 2 (P < .05). Early postoperative discomfort and soft tissue wound healing outcomes were not significantly different between the two test groups. Furthermore, unlike the control group, both the test groups 1 and 2 were implanted without sinus floor elevation using the lateral approach.

CONCLUSION

Within the limitations of this study, EMD failed to provide additional benefits in ARP in the posterior maxilla.