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Title Enamel Matrix Derivative (EMD) Regenerative Treatment in Cases of Severe Bone Loss Can Improve the Prognosis of That Tooth and Provide an Additional Treatment Option Rather Than Extraction and Tooth Replacement
Clinical Question In patients with severe periodontitis and bone loss >50%, can regenerative therapy using EMD be a viable treatment option rather than extraction?
Clinical Bottom Line EMD with regenerative therapy should be considered as a viable alternative to extraction when treatment planning teeth with severe bone loss or furcation involvement.
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) 222050544Koop/2012Human subjects of 27 randomized controlled trialsSystematic Review
Key resultsIntrabony defects showed significant additional clinical attachment level (CAL) gain of 1.3mm and improvement in radiographic bone levels of 1.04mm when using EMD compared to control (OFD/EDTA/placebo) at 1 year follow up. Use of bovine porous bone mineral (BPBM) with EMD gave significant additional CAL gain (0.9mm). Reduction in horizontal furcation defects (HFD), recession, and post op complications was significant when EMD was used.
#2) 21777268Cortellini/201150 human subjectsRandomized Controlled Trial
Key results92% of hopeless teeth treated using EMD in regenerative therapy were in good health and function at 5 year examination showing increases in attachment levels and bone levels and decreased probing depths and mobility.
Evidence Search EMD OR Emdogain AND hopeless teeth OR furcation defects Filters: Systematic Reviews, Randomized controlled trials
Comments on
The Evidence
Koop et al., performed MEDLINE search for publications up to May 2010. The Systematic Review used defined inclusion and exclusion criteria to filter and compare 27 of the original 432 articles. Individual studies were assessed for validity and Meta-analysis was completed for this review. Patients selected from private practice in Cortellini’s study were diagnosed with generalized severe periodontitis. The follow up has been completed at 5 years and the study is ongoing. The subject and provider could not be blinded to the treatments and no subgroups were used. In both cases sited it was specified that no competing interests apply.
Applicability New viable treatment option using EMD in patients presenting with severe bone loss to the apex and/or furcation involvement with hopeless long-term prognosis. Patients and providers can choose regeneration rather than feeling forced into extraction and tooth replacement. This gives the general practitioner and specialist additional options when treatment planning with a patient reluctant to have extractions completed in cases of >50% bone loss or furcation involvement.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords EMD, Emdogain, enamel matrix proteins, enamel matrix derivatives, intrabony defects, furcation involvement
ID# 2304
Date of submission: 08/03/2012spacer
E-mail shoffl@livemail.uthscsa.edu
Author Lisa J. Shoff
Co-author(s) e-mail
Faculty mentor/Co-author David Lasho, DDS, MSD
Faculty mentor/Co-author e-mail lasho@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
by Lisa Shoff (San Antonio, TX) on 09/16/2012
Enamel matrix derivative (EMD) contributes in a variety of ways to the clinical improvement seen in wound healing (publication PMID: 22070552). This review looked at 60 studies evaluating the effects of EMD on various cell types in vitro to obtain a better understanding of the pathways and mechanisms thru which EMD improves healing on the cellular level. Proliferation, differentiation, migration, gene-expression, and protein production are enhanced in PDL cells, as well as, osteoblastic and cementoblastic cells. The altered gene expression in bone cells increased production of TGF-β, IL-6, OPG, collagen, and bone sialoprotein. Proliferation, endogenous production of TGF-β and stimulation of TIMP-3 is noted in gingival fibroblasts. A cytostatic effect that seems to occur in epithelial cells is attributed to TGF-β production. Angiogenic activity is stimulated in endothelial cells with increased proliferation, migration, and expression of certain growth factors (e.g. VEGF -A, -B, and -C) and adhesion molecules (e.g. ICAM-1 and E-selectin). The complete cellular interactions of EMD still require more investigation and classification; however, a greater knowledge of the mechanisms of action complement and guides its use clinically.
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