Enamel matrix derivative monotherapy versus combination therapy with bone grafts for periodontal intrabony defects: An updated review

Abstract

This systematic review evaluated the effectiveness of combining enamel matrix derivative (EMD) with various bone grafts in periodontal regenerative surgery, specifically targeting intrabony defects. Randomized controlled trials with 12-month follow-ups were included. Clinical outcomes assessed included clinical attachment level, probing depth, gingival recession, and radiographic defect fill. Meta-analysis showed that adding bone grafts to EMD does not provide additional benefits in periodontal tissue examination, with improvement observed only in radiographic defect fill. Subgroup analyses examined the impact of different bone graft types, revealing that alloplastic bone grafts are effective in radiographic defect fill. The risk of bias assessment indicated a moderate risk across studies, with challenges in blinding owing to the nature of the surgical treatment. Furthermore, a minimal intervention surgical approach may not require additional bone grafts for optimal periodontal regeneration. These findings contribute to the ongoing dialogue in the field and guide clinicians toward evidence-based decisions for optimal periodontal outcomes, emphasizing the judicious use of bone grafts.

Keywords: Bone graft; EMD; Enamel matrix derivative; Periodontitis; Regeneration; Systematic review.

Fig. 1

Flowchart of the review process.

Fig. 2

Forest plot of probing depth (PD) reduction in mm.

Fig. 3

Forest plot of clinical attachment level (CAL) gain in mm.

Fig. 4

Forest plot of gingival recession (REC) increase in mm.

Fig. 5

Forest plot of radiographic examination: (a) Defect fill in millimeters. (b) Defect fill in percentage.

Fig. 6

Risk of bias of the studies included in this review: the green symbol represented a low risk of bias, whereas the yellow symbol represented a high risk of bias.