Title	Enamel Matrix Proteins Improve Clinical Outcomes in the Treatment of Intrabony Defects
Clinical Question	In patients with intrabony defects, does the adjunctive use of Emdogain result in greater long-term reduction in clinical attachment levels (CAL), pocket depths (PD), and other clinical improvements as compared to bone grafting alone?
Clinical Bottom Line	The addition of enamel matrix proteins when bone grafting intrabony defects with demineralized freeze-dried bone allografts resulted in better clinical outcomes at 12 months.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 20054593 Aspriello/2011 56 patients Randomized clinical trial Key results The test group was enamel matrix derivative (EMD) + demineralized freeze-dried bone allograft (DFDBA), and the control group was DFDBA alone for the treatment of periodontal intrabony defects. The test groups showed statistically significant better results than the control group in PD reduction (5.0 mm vs. 4.0 mm; P < 0.05), CAL gain (4.0 mm vs. 3.25 mm), and hard tissue fill (4.0 mm vs. 3.5 mm; P < 0.05) at 12 months post-surgery.
Evidence Search	Enamel matrix derivative AND intrabony bone graft
Comments on The Evidence	Validity: Several factors contributed to the validity of this experiment, including a double-blinded design wherein the patient and the investigator who took the clinical measurements were both blinded as to the treatment, random assignment of patients to the test or control group, and an accurate comparison of bone fill between baseline and 12 months by using a stent/template for the radiographs. The study length of 12 months is a reasonable follow-up time in that at that point the tissues should be completely healed and stable, and lastly 100% of the patients completed the study. Perspective: This randomized clinical trial was well conducted and designed. However, even though the addition of Emdogain resulted in statistically better results in PD reduction, CAL gain, and hard tissue fill, the differences might not be clinically significant; for example, a difference of 0.5 mm more hard tissue fill might not be enough to merit using Emdogain. Furthermore, I would find the results to be more convincing if more studies were done by other researchers with similar results.
Applicability	Emdogain is an enamel matrix extract designed to help regenerate the loss of bone and soft tissues due to periodontitis. It helps promote periodontal regeneration, including the formation of new bone, cementum, and attachment fibers. The use of Emdogain is indicated in the treatment of moderate or severe periodontitis, the treatment of gingival recession defects, etc. Emdogain is a cost-effective treatment available in a small volume (0.15 ml). An additional patient benefit of Emdogain is less patient discomfort post-surgery.
Specialty	(General Dentistry) (Oral Surgery) (Periodontics)
Keywords	Enamel matrix derivatives, demineralized freeze-dried bone allograft
ID#	3209
Date of submission	04/26/2017
E-mail	reald@livemail.uthscsa.edu
Author	Diana Real
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Suman Challa, BDS, MS
Faculty mentor e-mail	challas@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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available