Abstract
Data sources Sources were the Cochrane Oral Health Group's Trials Register (to January 2003), the Cochrane Central Register of Controlled Trials, Medline (1966 to January 2003) and EMBASE (1980 to January 2003). The International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, Journal of Dental Research, Journal of Periodontal Research, Journal of Periodontology and the bibliographies of papers and review articles were searched by hand. Authors, personal contacts and manufacturers were contacted in an attempt to identify unpublished or ongoing trials. There were no language restrictions.
Study selection The studies included were clinical randomised controlled trials (RCT) that considered enamel matrix derivative (EMD; Emdogain) [Biora, Malmö, Sweden] with at least 1 year follow-up.
Data extraction and synthesis Data were extracted by two reviewers independently, using specially designed data extraction forms. Results were expressed as random-effect models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was investigated including both clinical and methodological factors.
Results No difference in tooth loss was observed. Meta-analysis of eight trials showed that EMD-treated sites displayed statistically significant probing attachment level (PAL) improvements (mean difference, 1.3 mm; 95% CI: 0.8–1.8) and probing pocket depth (PPD) reduction (1 mm; 95% CI: 0.5–1.4) compared with flap surgery. Six trials compared EMD with guided tissue regeneration (GTR), GTR showing a statistically significant reduction of PPD (0.6 mm) and increase of gingival recession (0.5 mm). No difference in postoperative infections was observed.
Conclusions EMD is able to significantly improve PAL levels (1.3 mm) and PPD reduction (1 mm) compared with flap surgery, but these results may not have a great clinical impact since it has not been shown that more periodontally compromised teeth could be saved. There was no evidence of clinically important differences between GTR and EMD.
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Address for correspondence: Emma Tavender, Review Group Co-ordinator, Cochrane Oral Health Group, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK. E-mail: emma.tavender@man.ac.uk
Esposito M, Coulthard P, Worthington HV. Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects (Cochrane Review). The Cochrane Library. 2003, Issue 2, Oxford: Update Software
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Baelum, V., Lopez, R. Weak evidence for a benefit of Emdogain in the treatment of intrabony defects. Evid Based Dent 4, 66 (2003). https://doi.org/10.1038/sj.ebd.6400205
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DOI: https://doi.org/10.1038/sj.ebd.6400205
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