title: Does enamel matrix derivative application provide additional clinical benefits in residual periodontal pockets associated with suprabony defects? A systematic review and meta-analysis of randomized clinical trials.
abstract: OBJECTIVE
  To review the effectiveness of enamel matrix derivative (EMD) in the treatment of periodontal pockets of suprabony defects.
  
  
  METHODS
  Randomized Clinical Trials comparing open flap debridement (OFD) versus EMD in periodontal suprabony defects were identified through electronic and manual search. Screening, data extraction and quality assessment were conducted. The primary outcome measures were tooth survival (TS) and clinical attachment level (CAL) gain. Pocket probing depth (PPD) reduction and recession (REC) increase were secondary outcome measures. Information concerning clinical and radiological bone gain was also collected.
  
  
  RESULTS
  The search identified 1170 studies, three articles reporting on (99 subjects/358 teeth) met the inclusion criteria and were included. No tooth was lost during follow-up (8-12 months). The adjunctive mean benefit of EMD was: 1.2 mm for CAL gain [confidence interval (CI): (0.9, 1.4), p < 0.00001, I(2) = 66%], 1.2 mm for the PPD reduction (CI: [0.8, 1.5], p < 0.0001, I(2) = 0%), -0.5 mm for the REC increase (CI: [-0.8, -0.2], p = 0.003, I(2) = 0%). Potential risk of bias was identified.
  
  
  CONCLUSIONS
  No differences were noted in TS but EMD application resulted in clinical and radiographic additional benefits compared to OFD alone. Nevertheless, the paucity of data, the risk of methodological and potential publication bias suggests caution in interpreting these results while supporting multicenter studies for this specific application.
authors: Department of Surgical Medicine, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy; University Hospital of Pisa, Sub-Unit of Periodontology and Periodontal Medicine, Pisa, Italy.
authors: Filippo
authors: F
authors: Graziani
authors: Stefano
authors: S
authors: Gennai
authors: Silvia
authors: S
authors: Cei
authors: Francesco
authors: F
authors: Ducci
authors: Nicola
authors: N
authors: Discepoli
authors: Alessandro
authors: A
authors: Carmignani
authors: Maurizio
authors: M
authors: Tonetti
mesh_terms: D016301:Alveolar Bone Loss / Q000601:surgery*; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D005889:Gingival Recession / Q000601:surgery; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D017622:Periodontal Attachment Loss / Q000601:surgery; D010514:Periodontal Pocket / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D013524:Surgical Flaps / Q000601:surgery; D016388:Tooth Loss / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D003746:Dental Enamel Proteins; C109069:enamel matrix proteins
keywords: access flap; amelogenins; enamel matrix derivatives; meta-analysis; suprabony defects