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Title Adding Bone Graft or Membrane to Enamel Matrix Derivative Does Not Result In A Clinically Significant Improvement In Treatment Outcome for Infrabony Defects
Clinical Question In patients with infra-bony defects, does grafting with enamel matrix derivatives (EMD) with other regenerative materials yield greater reduction in probing depth than grafting with EMD alone?
Clinical Bottom Line There is strong evidence to support the use of EMD to treat infra-bony defects. There is little evidence to support the use of additional regenerative materials in conjunction with EMD.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19958442Tu/2010Human subjects of 28 randomized controlled trialsMeta-analysis
Key resultsGrafting with EMD alone showed an average clinical attachment level (CAL) gain of 3.57 mm and probing pocket depth (PPD) reduction of 4.48 mm at 12 months. Grafting with EMD with membranes resulted in 0.07mm [95% high probability density (HPD) interval: -1.26, 1.04] greater reduction in PPD and 0.15 mm (95% HPD interval: -1.37, 0.30) greater CAL gain. The addition of bone grafts to EMD resulted in 0.24 mm (95% HPD interval: -0.38, 0.65) greater PPD reduction and 0.46 mm (95% HPD interval: -0.17, 0.83) greater gain in CAL.
#2) 18647201Sculean/200838 subjectsRandomized Controlled Trial
Key resultsMean CAL gain for patients who received treatment with EMD was 3.4 +/- 1.0 mm. For patients who received treatment with EMD + GTR, the mean CAL gain was 3.3 +/- 1.1 mm. Compared with open-flap debridement (2.0 +/- 1.2 mm), both groups had statistically significant improvements in CAL (p<0.001). However, there was no significant difference in CAL gain between EMD and EMG+GTR groups.
Evidence Search "enamel matrix proteins"[Supplementary Concept] AND "Guided Tissue Regeneration, Periodontal"[Mesh] AND (Meta-Analysis[ptyp] AND systematic[sb])
Comments on
The Evidence
The meta-analysis started with 337 studies and excluded 309 of them. The remaining 28 articles included in the meta-analysis were randomized controlled trials which evaluated treatment outcomes of probing pocket depth, clinical attachment level and infra-bony defect depth recorded no less than 6 months following periodontal regeneration procedures.
Applicability These findings suggest that grafting with EMD alone may be equivalent to grafting with EMD + bone graft or EMD + membrane.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Emdogain, Enamel Matrix Proteins, Enamel Matrix Derivatives, Bone Grafting, Guided Tissue Regeneration, Infra-bony defects
ID# 2097
Date of submission: 09/22/2011spacer
E-mail hoge@livemail.uthscsa.edu
Author Michael Hoge
Co-author(s) e-mail
Faculty mentor/Co-author Archie Jones, DDS, MBA
Faculty mentor/Co-author e-mail JonesA@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Gustavo Garza, Jared Ricks (San Antonio, Texas) on 11/28/2017
PubMed and TRIP databases were searched on November of 2017, and two more recent publications were found that corroborated the findings of CAT #2097. Both studies were RCTs that compared the effectiveness of treating infrabony defects with EMD and bone grafts as compared to EMD alone. The 2017 study (PMID: 27958765) found that there was a significant difference between the pretreatment attachment loss and probing depth levels and the posttreatment measurements but found no significant differences between the EMD only and the EMD/bone graft groups. The 2011 study (PMID: 21564156) also treated two groups, one with EMD only and another with EMD/bone graft, and found no significant difference in the mean defect fill and clinical attachment loss levels between the groups.

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