Preclinical | Histology | Clinical 1 | Clinical 2
We have gone to great lengths to provide investigative evidence to determine the ability of the enamel matrix proteins to promote the supporting growth of the lost periodontal tissue.
Consequently, studies were done on the preclinical, histological and clinical levels as shown in the charts.
Preclinical - clinically relevant model
| Evidence for | Indications | Method/ Material |
Results | Conclusion(s) |
Periodontal regeneration1 |
Peridontal defects in baboons |
Flap surgery with or without enamel matrix proteins |
Significant regeneration of cementum, periodontal ligament with sharpey’s fibers, new bone tissue Greater tissue formation with Straumann® Emdogain |
Regeneration is superior to repair No dependence on exogenous growth factors, bone replacement grafts, barrier membranes or combination |
Human Histology
| Evidence for | Indications | Method/ Material |
Results | Conclusion(s) |
Periodonal regeneration2 |
Human teeth affected by periodontitits |
Treatment with Enamel Matrix Derivative 6 weeks before extraction |
New vital bone-like tissue and de novo formation of mineralized connective tissue with EMD |
Immediate vital autogenous tissue growth in a time-critical situation |
Clinical
| Evidence for | Indications | Method/ Material |
Results | Conclusion(s) |
Periodontal pocket depth (PPD) reduction3 |
Angular osseous defects |
Flap surgery with or without Straumann® Emdogain |
Up to 8mm PPD reduction, 3 times greater defect fill with Straumann® Emdogain |
Treatment with Straumann® Emdogain superior to flap surgery alone |
Clinical attachment level (CAL) gain8 |
Angular osseous defects |
Flap surgery with or without Straumann® Emdogain |
> 4.5 mm CAL gain with Straumann® Emdogain and 1.5 mm more compared to flap surgery |
Treatment with Straumann® Emdogain superior to flap surgery alone |
Bone fill4 and regeneration of periodontal attachment 5 |
1-and 2-wall defects |
Modidfied Widman flap (MWF) with Straumann® Emdogain or placebo |
36 % gain of initial bone loss and 60-70 % bone fill |
Straumann® Emdogain regenerates periodonotal attachment and promotes bone gain even in advanced periodontal defects |
Root coverage and increased keratinized tissue6 |
Miller Class I, II and III recession defects |
CAF with or without Straumann® Emdogain |
80 -96% root coverage and significant increase of keratinized tissues |
Better results in the treatment of recession with Straumann® Emdogain |
Degree of root coverage7 |
Recession defects of ≥ 4 mm |
CAF with subepithelial connective tissue or CAF with Straumann® Emdogain |
4 – 8mm root coverage and better early healing in the test group |
Addition of Straumann® Emdogain to CAF results in root coverage similar to subepithelial graft but without morbididity and complications |
Clinical
| Evidence for | Indications | Method/ Material |
Results | Conclusion(s) |
Better results compared to GTR8 |
Class II mandibular furcation defects |
Straumann® Emdogain or bioresorbable membrane |
Significantly greater reduction in horizontal furcation depth with Emdogain |
Better clinical results following enamel matrix derivative compared to membrane therapy |
Long-term results9,10 |
Intrabony defects |
Treatment with Straumann® Emdogain Re-entry |
stable results after 7/9 years |
Effects of Straumann® Emdogain last at least 4 and up to 9 years |
Increased effect over time11 |
Deap intrabony defect (PD ≥ 5mm, CAL ≥ 6mm, ≥ 3mm intrabony defect) |
Prospective case series |
4.3 mm CAL gain after 1 year, further 0.3 mm CAL gain after 5 years, reduction of 0.3 mm after 5 years 4.9 mm PD reduction, further 1.1 mm after 5 years |
Clinical gain with Straumann® Emdogain stable over time and demonstrate further improvement |
Customer and patient satisfaction7 |
Recession defects of ≥ 4 mm |
CAF with subepithelial connective tissue or CAF with Straumann® Emdogain |
Same results without the intervention and potential complication to gain connective tissue |
Easy to use, less time consuming, no risk of complications |
Higher quality of life for patient12 |
Class II mandibular furcation defects |
Straumann® Emdogain or bioresorbable membrane |
50% less postoperative pain/swelling following enamel matrix derivative |
Higher quality of life for patients compared to membrane therapy |
Complication free treatment13 |
Intrabony defects of ≥ 3 mm |
Straumann® Emdogain or GTR membrane |
94% less complications occurred in the patients treated with Straumann® Emdogain |
Straumann® Emdogain displayed safer compared to GTR membranes |
Better wound healing7,14 |
Recession defects of ≥ 4 mm |
CAF with subepithelial connective tissue or CAF with Straumann® Emdogain |
Better early healing in the test group at 1 week |
Straumann® Emdogain has a beneficial effect on the early wound healing |
Better predictability and outcome15 |
Deep intrabony defects ≥ 3 mm |
Prospective multicentre randomized controlled study of papilla preservation flap surgery |
Significant higher CAL and better pocket reduction |
Straumann® Emdogain increased the predictability of clinically significant results and decreased the probability of obtaining negligible or no gains in CAL |
| 1 | Cochrane D.L. et al, The Effect of Enamel Matrix Proteins on Periodontal Regeneration as Determinded by Histolgical Analyses, J. Periodontol 2003; 74: 1043-1055 | |
| 2 | Bosshardt D.D. et al, Effects of Enamel Matrix Proteins on tissue formation along the roots of human teeth, Periodont Res 2005; 40: 158-167 | |
| 3 | Froum SJ.et al, A comparative study utilizing open flap debeidement with and without enamel matrix derivative in the treatment of periodontal intrabony defects, a 12 month re-entry, J. Periodontology 2001; 72: 25-34 | |
| 4 | Heden G. et al, Periodontal tissue alterations following Emdogain treatment of periodontal sites with angular bone defects, a series of case reports J. Periodontology 1999; 26: 855-860 | |
| 5 | Heijl L. et al, Enamel meatrix derivative (Emdogain)in the treatment of intrabony periodontal defects, J Clin Periodontol, 1997; 24: 705-714 | |
| 6 | Cueva M.A.et al. A comparative study of coronally advanced flaps with and without the addition of Enamel Matrix Derviatve in the treatment of marinal tissue recession, J. Periodontology 2004; 75: 949-956 | |
| 7 | McGuire et. al Evaluation of Human Recession Defects Treated with Coronally Advanced Flaps and Either Enamel Matrix Derivative or Connective Tissue. Part 1: Comparison of Clinical Parameters: J Periodontol 2003; 74: 1110-1125 | |
| 8 | Jepsen S, et al A Randomized Clinical Trial Comparing Enamel Matrix Derivative and Membrane Treatment of Buccal Class II Furcation Involvement in Mandibular Molars. Part I: Study Design and Results for Primary Outcomes J. Periodontol 2004; 75: 1150-1160 | |
| 9 | Rasperini et al, Long-term clinical observation of treatment of infrabony defects with enamel matrix derivative (Emdogain): surgical reentry. Int J Periodontics Restorative Dent, 2005; 25(2): 121-127 | |
| 10 | Sculean et al. 9-year results following treatment of intrabony periodontal defects with an enamel matrix derivative: report of 26 cases. Int J Periodontics Restorative Dent 2007; 27(3): 221-229 | |
| 11 | Heden G. et al, Five-Year Follow-Up of Regenerative Periodntal Therapy with Enamel Matix Derivative at Sites With Angular Bone Defects, J Periodontol February 2006; Vol 77, Number 2, 295-301 | |
| 12 | Meyle J, et al A Randomized Clinical Trial Comparing Enamel Matrix Derivative and Membrane Treatment of Buccal Class II Furcation Involvement in Mandibular Molars. Part II: Secondary Outcomes. J Periodontol 2004; 75: 1188-1195 | |
| 13 | Sanz M, et al Treatment of intrabony defects with Enamel Matrix Proteins or Barrier MembranesJ Periodontol, 2004; 75: 726-733 | |
| 14 | Wennstrom JL, Lindhe J. Some effects of enamel matrix proteins on wound healing in the dento-gingival region. J Clin Periodontol. 2002; 29(1): 9-14 | |
| 15 | Tonetti M.S. et al, Enamel matrix proteins in the regenerative therapy of deep intrabony defects, J Clin Periodontol. 2002 Apr; 29(4):317-25 |
