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.”