This systematic review on EMD aims to: 1) provide the biological background necessary to understand the rational for the use of EMD (commercial name: Straumann® Emdogain®) for periodontal regeneration, 2) present animal and human histological evidence of periodontal regeneration following EMD application, 3) provide clinically relevant indications for the use of EMD and 4) discuss future avenues of research including key early findings leading to the development of Osteogain, a new carrier system for EMD specifically developed with better protein adsorption to bone grafting materials. The review is dedicated to Professor Lars Hammarström, to honour his landmark and pioneering work in discovering the regenerative capacities of enamel matrix proteins.

Richard J. Miron, Anton Sculean, David L. Cochran, Stuart Froum, Giovanni Zucchelli, Carlos Nemcovsky, Nikos Donos, Staale Petter Lyngstadaas, James Deschner, Michel Dard, Andreas Stavropoulos, Yufeng Zhang, Leonardo Trombelli, Adrian Kasaj, Yoshinori Shirakata, Pierpaolo Cortellini, Maurizio Tonetti, Giulio Rasperini, Søren Jepsen, Dieter D. Bosshardt: Twenty years of enamel matrix derivative: the past, the present and the future. Journal of Clinical Periodontology: Volume 43, Issue 8, August 2016, pages 668–683.

A great contribution to our understanding of how biologics can act as mediators for periodontal regeneration

On June 5th, 2015 at Europerio 8, a group of leading experts were gathered to discuss what has now been 20 years of documented evidence supporting the clinical use of enamel matrix derivative (EMD). Original experiments led by Lars Hammarström demonstrated that enamel matrix proteins could serve as key regenerative proteins capable of promoting periodontal regeneration including new cementum, with functionally oriented inserting new periodontal ligament fibers, and new alveolar bone formation. This pioneering work and vision by Lars Hammarström has paved the way to an enormous amount of publications related to its biological basis and clinical use. 20 years later it is clear that all these studies have greatly contributed to our understanding of how biologics can act as mediators for periodontal regeneration and have provided additional clinical means to support tissue regeneration of the periodontium.


“EMD has remained one of the gold standards for periodontal regeneration using biologics and it remains of interest to discover how the next 20 years of intensive research will further improve EMD clinical outcomes.” Dr. Richard Miron


Looking forward to the next 20 years of research
Dr. Miron’s final remarks: “It remains hard to believe that over 20 years have now passed since enamel matrix derivative was first introduced as a regenerative agent for periodontal tissues. Equally as surprising, it remains one of the only biomaterials still available for clinical use capable of histologically demonstrating true periodontal regeneration with new cementum formation, periodontal ligament and alveolar bone along with inserting Sharpeys fibers spanning the periodontal apparatus. It is clear that over the years, we have learned a great deal regarding the biological roles of specific enamel matrix proteins and future investigation is constantly underway to further characterize their effects on cell and tissue behavior. It also becomes clinically important to further investigate the use of EMD in both carrier systems described to determine if regenerative outcomes can be even further improved by slight modifications in EMD-carrier systems or through minimally invasive surgeries. During these 20 years over 900 publications have documented the use of EMD for a variety of in vitro and in vivo studies as well as numerous clinical trials. EMD has remained one of the gold standards for periodontal regeneration using biologics and it remains of interest to discover how the next 20 years of intensive research will further improve EMD clinical outcomes.”

Dr. Richard Miron, BMSC, MSc, PhD, DDS

Dr. Richard Miron
BMSC, MSc, PhD, DDS

Nova Southeastern University, Florida

Dr. Richard Miron is an Adjunct Faculty in the Department of Periodontology, Nova Southeastern University, Fort Lauderdale, Florida, USA. He completed his undergraduate degree in Medical Science and a Masters in Cell Biology at the University of Western Ontario in Canada, a PhD in Molecular and Cell Biology at the University of Bern, Switzerland and a Doctor of Dental Surgery degree at the University of Laval, Canada. In 2015, while serving as the Head of the Cell Biology Laboratory at the University of Bern, he concurrently completed his dr. med. dent degree. He has previously performed numerous short stay post-doctoral research fellowships at the University of Wuhan in China in 2011, 2012 and 2014 and has since co-supervised numerous Master and PhD candidates as an external visiting scholar. He has authored and co-authored over 90 peer-reviewed scientific publications mostly connected to his main research interests including enamel matrix proteins for bone and periodontal regeneration, bioactive growth factors, osteoinductive bone grafting materials and guided bone regeneration in implant dentistry. He has recently been awarded many internationally recognized top young investigators awards including the Andre Schroeder Research Prize from the International Team for Implantology (ITI) (2016), The Robert Frank Award (2015), the International Association of Dental Research (IADR) Young investigator of the Year in the field of Implant Dentistry (2015), the Canadian IADR Hatton Award recipient (2015), and the American Academy of Implant Dentistry Young Investigator Grant Award (2014).

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