title: Enamel matrix derivative and bone grafts for periodontal regeneration of intrabony defects. A systematic review and meta-analysis.
abstract: OBJECTIVE
  The aim of the present systematic review and meta-analysis was to assess the clinical efficacy of regenerative periodontal surgery of intrabony defects using a combination of enamel matrix derivative (EMD) and bone graft compared with that of EMD alone.
  
  
  METHODS
  The Cochrane Oral Health Group specialist trials, MEDLINE, and EMBASE databases were searched for entries up to February 2014. The primary outcome was gain of clinical attachment (CAL). Weighted means and forest plots were calculated for CAL gain, probing depth (PD), and gingival recession (REC).
  
  
  RESULTS
  Twelve studies reporting on 434 patients and 548 intrabony defects were selected for the analysis. Mean CAL gain amounted to 3.76 ± 1.07 mm (median 3.63 95 % CI 3.51-3.75) following treatment with a combination of EMD and bone graft and to 3.32 ± 1.04 mm (median 3.40; 95 % CI 3.28-3.52) following treatment with EMD alone. Mean PD reduction measured 4.22 ± 1.20 mm (median 4.10; 95 % CI 3.96-4.24) at sites treated with EMD and bone graft and yielded 4.12 ± 1.07 mm (median 4.00; 95 % CI 3.88-4.12) at sites treated with EMD alone. Mean REC increase amounted to 0.76 ± 0.42 mm (median 0.63; 95 % CI 0.58-0.68) at sites treated with EMD and bone graft and to 0.91 ± 0.26 mm (median 0.90; 95 % CI 0.87-0.93) at sites treated with EMD alone.
  
  
  CONCLUSIONS
  Within their limits, the present results indicate that the combination of EMD and bone grafts may result in additional clinical improvements in terms of CAL gain and PD reduction compared with those obtained with EMD alone. The potential influence of the chosen graft material or of the surgical procedure (i.e., flap design) on the clinical outcomes is unclear.
  
  
  CONCLUSIONS
  The present findings support the use of EMD and bone grafts for the treatment of intrabony periodontal defects.
authors.affiliation: Department of Periodontology, Federico II University of Naples, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Matarasso
authors.forename: V
authors.initials: V
authors.lastname: Iorio-Siciliano
authors.forename: A
authors.initials: A
authors.lastname: Blasi
authors.forename: L
authors.initials: L
authors.lastname: Ramaglia
authors.forename: G E
authors.initials: GE
authors.lastname: Salvi
authors.forename: A
authors.initials: A
authors.lastname: Sculean
mesh_terms: D000328:Adult; D000368:Aged; D001861:Bone Regeneration / Q000187:drug effects*; D016025:Bone Transplantation; D055113:Chronic Periodontitis / Q000188:drug therapy* / Q000601:surgery; D003746:Dental Enamel Proteins / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D003746:Dental Enamel Proteins; C109069:enamel matrix proteins