Combination of Enamel Matrix Derivatives with Bone Graft vs Bone Graft Alone in the Treatment of Periodontal Intrabony and Furcation Defects: A Systematic Review and Meta-Analysis

Abstract

Purpose: To compare the clinical performance of the combination of enamel matrix derivatives and bone substitutes (EMD+BG) with bone substitutes (BG) alone in the surgical treatment of periodontal intrabony and furcation defects.

Materials and methods: Electronic databases (Medline, Embase and Web of Science) were searched for randomised controlled trials in humans that investigated the combination of EMD+BG vs BG alone in either intrabony or furcation defects with a minimal follow-up of 6 months. A random-effect meta-analysis was conducted according to the type of defect (intrabony or furcation defects) and the follow-up time (6 or ≥ 12 months).

Results: From a total of 1583 entries, 9 randomised controlled clinical trials (RCTs) were retrieved and included in the qualitative and quantitative synthesis. All of them were included in the meta-analysis. The meta-analysis detected an additional clinical attachment level (CAL) gain in intrabony defects treated with EMD+BG compared to BG alone in studies with ≥ 12-month follow-up (mean difference = 0.67 mm, 95% CI [0.44 ; 0.90], p 0.00001). No additional benefit was found in furcation defects in terms of CAL gain or probing depth (PD) reduction.

Conclusion: The addition of EMD may improve the clinical outcomes of intrabony defects treated with bone substitutes. These findings may support the use of this combined therapy, particularly in large and non-contained defects.

Keywords: bone substitutes; enamel matrix derivatives; furcation defects; intrabony defects; periodontal regeneration.

Fig 1

PRISMA flow diagram.

Fig 2

Risk of bias ROB 2.0 of included studies. D1: Randomisation process; D2: Deviations from the intended interventions; D3: Missing outcome data; D4: Measurement of the outcome; D5: Selection of the reported result.

Fig 3

Meta-analysis assessing the benefits of combined therapy for clinical attachment level gain in the regeneration of periodontal defects. 3a. Clinical attachment level gain in intrabony defects at 6 months; 3b. Clinical attachment level gain in furcation defects at 6 months; 3c. Clinical attachment level gain in intrabony defects at 12 months; 3d. Clinical attachment level gain in furcation defects at 12 months.

Fig 4

Meta-analysis assessing the benefits of combined therapy for probing depth reduction in the regeneration of periodontal defects. 4a. Probing depth reduction in intrabony defects at 6 months; 4b. Probing depth reduction in furcation defects at 6 months; 4c. Probing depth reduction in intrabony defects at 12 months; 4d. Probing depth reduction in furcation defects at 12 months.