ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Enamel Matrix Derivative (Emdogain) Reduces Attachment Loss In Patients With Intra-Bony Periodontal Defects
Clinical Question In a patient with intra-bony defects does Enamel Matrix Derivative (Emdogain) reduce attachment loss more than open flap debridement alone?
Clinical Bottom Line Current research shows that Enamel Matrix Derivative (Emdogain) reduces attachment loss in patients with intra-bony defects more than open flap debridement alone. However, treatment with EMD has not been shown to save more compromised teeth and patients have not seen noticeable esthetic improvements in one year follow ups. (See Comments on the CAT below)
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) 19821315Esposito/2011317 patients with periodontal attachment lossCochrane Review
Key resultsThe mean improvement in probing attachment level (PAL) for Emdogain and open flap debridement (OFD) over the control of OFD alone was 1.1mm with a 95% confidence interval of 0.61-1.55. The reduction in PAL for OFD alone was 0.8-2.2mm. The mean improvement in periodontal probing depths (PPD) for Emdogain and OFD over OFD alone was 0.7mm with a 95% confidence interval of 0.44-1.31. The improvement in PPD for OFD alone was 1.4-4.5mm.
Evidence Search ("enamel matrix proteins"[Supplementary Concept] OR "enamel matrix proteins"[All Fields] OR "emdogain"[All Fields]) AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND intrabony[All Fields] AND ("abnormalities"[Subheading] OR "abnormalities"[All Fields] OR "defects"[All Fields]) AND Meta-Analysis[ptyp]
Comments on
The Evidence
A Cochrane Review that contains a meta-analysis of 13 randomized controlled trials supports this evidence. 371 patients were included in these studies. A comprehensive, detailed search for relevant trials was performed. These studies were assessed individually for validity. Strong evidence supports that the use of Emdogain is beneficial for the treatment of periodontal defects, but the patient's overall esthetic improvement may not be significant.
Applicability Patients exhibiting periodontal attachment loss and intra-bony defects.
Specialty/Discipline (Periodontics)
Keywords "Emdogain" and "Attachment Loss"
ID# 2115
Date of submission: 09/21/2011spacer
E-mail gallowayp@uthscsa.edu
Author Patrick Galloway
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author e-mail finlaysonr@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
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Dr. Peter Gakunga (San Antonio, Texas) on 08/24/2012
in vitro observations have determined that Enamel Matrix Derivative (EMD) upregulates proliferation of periodontal ligament (PDL) fibroblasts, cementoblasts, follicle cells, and osteoblasts. This is the biological basis for the positive effect of EMD on periodontal regeneration. However, the specific mechanisms for the synergistic or additive effects of the association of EMD with other extra cellular matrix components are not fully understood.
by Lisa Shoff (San Antonio, TX) on 07/09/2012
An recent meta-analysis confirmed the use of emdogain in combination with other regenerative therapies performed better than using emdogain alone. Tu Y. A Bayesian network meta-analysis on comparisons of enamel matrix derivatives, guided tissue regeneration and their combination therapies. PubMed ID: 22393565
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