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| Title |
The Application of Emdogain (EMD) During Implant Surgery Can Result in Increased Soft Tissue Thickness and Keratinized Mucosa Width |
| Clinical Question |
For patients undergoing second stage implant surgery, does the application of Enamel Matrix Derivatives (EMD) under the flap, compared to no additional materials, lead to an increase in mucosal thickness? |
| Clinical Bottom Line |
For patients undergoing implant surgery, the application of Emdogain (EMD) can improve early soft tissue healing and lead to an increase in keratinized mucosa width, with evidence of increased soft tissue thickness. This is supported by a split-mouth randomized controlled trial of 30 patients in which peri-implant sites treated with Emdogain showed faster wound healing and increased keratinized tissue gain compared to controls. The trial was relatively small; however, the results are biologically plausible and clinically applicable, and the intervention is feasible for routine practice in dentistry. Preclinical animal studies also demonstrated enhanced soft tissue thickness and angiogenesis with EMD use. |
| 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) 37491613 | Jung 2023 | 18 female Wistar rats | Animal study | | Key results | In a rat dorsal model, connective tissue thickness was significantly greater in the EMD-liquid with collagen matrix compared to both collagen matrix alone and collagen matrix with EMD-gel. At 2 weeks, mean connective tissue thickness was 930.7 ± 86.6 µm with EMD-liquid versus 482.2 ± 37.3 µm in controls (p<0.001) and 595.1 ± 42.5 µm with EMD-gel (p=0.041). At 4 weeks, EMD-liquid again showed the greatest tissue thickness (316.4 ± 31.1 µm) compared to control (207.0 ± 15.2 µm) and compared to EMD-gel (216.1 ± 17.1 µm) (p=0.011 and p=0.023, respectively). The number of blood vessels was also highest in the EMD-liquid group at 4 weeks (17.8 ± 1.6 per 0.1 mm²) compared to control (12.8 ± 0.6) and EMD-gel (13.7 ± 1.1) (p=0.009 and p=0.036). No significant differences were observed among groups for multinucleated giant cells. | | #2) 37471155 | Cardaropoli 2024 | 30 human adult patients undergoing implant surgery | Randomized Controlled Trial | | Key results | At peri-implant sites, wound healing at days 1, 3, and 7 post-implant surgery based on the Healing Index (HI) was significantly higher in the Emdogain gel group compared to the control group (p<0.05). Regarding keratinized tissue width, both groups averaged 2.9 mm at baseline. After 1 year, the Emdogain group increased to 3.2 + 0.8 mm, while the control group decreased to 2.7 + 0.8 mm (0.5 mm difference, p<0.05). Additionally, Emdogain gel significantly improved peri-implant probing depth, bleeding on probing, and patient-reported esthetic satisfaction (p<0.05 for all). | |
| Evidence Search |
Emdogain, enamel matrix derivative, mucosal thickness, soft tissue augmentation |
Comments on
The Evidence |
Jung et al. conducted an experimental study using 18 rats with randomized allocation of treatment groups. Outcomes were assessed histologically at 2 and 4 weeks including connective tissue thickness, multinucleated giant cells, and blood vessel counts. Randomization and blinded digital measurements strengthen internal validity, and appropriate statistical test with correction were applied. Due to short follow-up and the rat model there was limited external validity. The materials used were supplied by the manufacturers, which may introduce bias. Cardaropoli et al. was a split-mouth randomized controlled trial, which has shown to be a strong research design for minimizing confounding variables and controlling for patient-level variability. In this study, randomization was achieved with sealed envelopes and each patient represented both a test and control site (implant). The examiner measuring outcomes was also blinded, and the study had complete follow up of all 30 patients for 1 year. However, as the study was conducted at a single private practice with only 30 patients and had a relatively short follow-up period this limits generalizability and does not establish longer-term effects of Emdogain. Overall, the quality of evidence is moderate. This study received a grant from Institute Straumann, which may introduce potential bias. |
| Applicability |
Considering applicability to patient care, the findings from animal studies such as Jung et al. are limited by the use of a rat subcutaneous model and short follow-up. The liquid EMD formulation used is not currently the marketed product and may not be readily available for patient use. However, animal studies like this one bring to light the potential effectiveness of Emdogain in humans. If similar effects on soft tissue thickness and angiogenesis are confirmed in human trials, this approach could improve treatment options and outcomes. The Cardaropoli et al. study included healthy human adult patients requiring two single unit implants in the premolar/molar regions and who did not require major bone augmentations. Therefore, this evidence mostly applies to healthy adult patients requiring straitforward implants in posterior regions. Emdogain is a user-friendly, chairside-applied biologic gel with no reported adverse effects or patient reported negative effects. Therefore, applicability is favorable for the use of Emdogain to help improve peri-implant soft tissues and other clinical parameters. Some limitations that should be weighted against potential benefits in practice include the additional cost of the product and lack of long-term data. |
| Specialty/Discipline |
(Periodontics) |
| Keywords |
Emdogain, enamel matrix derivative, mucosal thickness, soft tissue augmentation
|
| ID# |
3585 |
| Date of submission: |
10/13/2025 |
| E-mail |
lotowski@uthscsa.edu |
| Author |
Margaret Lotowski, DMD |
| Co-author(s) |
Anne Miller, DDS |
| Co-author(s) e-mail |
millera15@uthscsa.edu |
| Faculty mentor/Co-author |
Angela Palaiologou Gallis, D.D.S., M.S. |
| Faculty mentor/Co-author e-mail |
PalaiologouA@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
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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