Enamel matrix derivative: efficacy, indications and common drawbacks

Local application of enamel matrix derivative (EMD) for the resolution of intraosseous periodontal defects represents today a sound clinical reality. However, due to its gel consistency, EMD shows a limited space-making capacity, which may affect its regenerative potential in case of not-self-supportive intraosseous lesions. In order to overcome this drawback, the combination of EMD with graft materials to stabilize the clot and provide soft tissue support has been proposed. Among the available graft materials, autogenous bone graft (ABG) shows several ideal characteristics, since it is a low cost material, resorbable, easy to handle and potentially osteoinductive. The aim of the present review was to summarize the current knowledge regarding the use of EMD in adjunct to ABG in the treatment of intraosseous periodontal pockets. This combined approach has been recently investigated and encouraging clinical results in terms of a significant improvement of periodontal hard and soft tissue healing have been reported. However, very few controlled data are available to date, and preliminary results show only a limited, although significant, benefit compared to the use of EMD alone. Only further well designed randomized controlled trials, as well as human histologic studies, will be able to clarify whether and to what extent an EMD-ABG combined approach might affect the healing dynamics of deep periodontal defects and its real regenerative potential with respect to the mere EMD application.