Do bone grafts or barrier membranes provide additional treatment effects for infrabony lesions treated with enamel matrix derivatives? A network meta-analysis of randomized-controlled trials.
OBJECTIVE
Network meta-analyses of randomized-controlled trials were undertaken to investigate whether enamel matrix derivatives (EMD) in conjunction with other regenerative materials yield better treatment outcomes than EMD alone in the treatment of infrabony defects > or =3 mm.


METHODS
A literature search was conducted using the Medline, EMBASE, LILACS and CENTRAL databases up to and including December 2008. Treatment outcomes were changes in probing pocket depth (PPD), clinical attachment level (CAL) and infrabony defect depth. Different types of bone grafts (or barrier membranes) were first treated as a group and then separately.


RESULTS
Twenty-eight studies were included in the review. EMD plus bone grafts and EMD plus membranes attained 0.24 mm [95% high probability density (HPD) intervals: -0.38, 0.65] and 0.07 mm (95% HPD intervals: -1.26, 1.04) more PPD reduction than EMD alone, respectively. For CAL gain, EMD plus bone grafts and EMD plus membranes attained 0.46 mm (95% HPD intervals: -0.17, 0.83) and 0.15 mm (95% HPD intervals: -1.37, 0.30), respectively. When different types of bone grafts and barrier membranes were treated separately, EMD with bovine bone grafts showed greater treatment effects.


CONCLUSIONS
There was little evidence to support the additional benefits of EMD in conjunction with other regenerative materials.
Tu
Yu-Kang
YK
Department of Periodontology, Leeds Dental Institute, Leeds, UK. y.k.tu@leeds.ac.uk
Woolston
Andrew
A
Faggion
Clovis Mariano
CM
D000818:Animals; D002417:Cattle; D006801:Humans; D016301:Alveolar Bone Loss / Q000601:surgery; D000543:Alveoloplasty; D016025:Bone Transplantation; D003746:Dental Enamel Proteins / Q000627:therapeutic use; D016557:Guided Tissue Regeneration, Periodontal; D008567:Membranes, Artificial; D017622:Periodontal Attachment Loss / Q000601:surgery; D010514:Periodontal Pocket / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D014183:Transplantation, Heterologous; D016896:Treatment Outcome
D003746:Dental Enamel Proteins; C109069:enamel matrix proteins; D008567:Membranes, Artificial