Enamel Matrix Derivatives in Dentistry - An Overview

Introduction

Periodontitis is a chronic dental disease affecting both the gums and the jaw bone. It is an infectious disease of the gums, caused primarily by bacterial pathogens present in dental plaque that are responsible for the disease process.

Enamel matrix derivatives (EMD) was first approved in 1996 by the United States Food and Drug Administration (USFDA) to treat defects in the periodontium and also soft tissue or gingival recessions. These were derived from porcine teeth (swine or a pig) and were first introduced as a biological medium that aims to enhance periodontal tissue regeneration. The role of EMD, just like other methods of regenerative periodontal therapy, is to reconstitute the lost periodontal structures through regeneration or re-formation of root cementum, periodontal ligament, alveolar bone, etc.

Why Enamel Matrix Derivatives Are Part of Periodontal Regeneration Therapies?

• Periodontitis is often accompanied by alveolar bone loss or resorption wherein there is a breakdown of the tooth-supporting apparatus. Dental treatment through timely management and oral prophylaxis or gum surgeries may be indicated for arresting the disease progression and in order to regenerate the lost tissues. Several surgical techniques have also been developed in the last few decades that aim to regenerate lost periodontal tissues.

• The techniques such as guided tissue regeneration (GTR), bone grafting (BG), the use of enamel matrix derivative (EMD), etc have revolutionized the current treatment in periodontal therapies.

• EMD is one of the treatment strategies adopted for regaining periodontal tissues. These are extracts of enamel matrix and contain amelogenins of differing molecular weights. Amelogenins (a group of proteins) are primarily involved in enamel formation as well as in periodontal tissue attachment formation during the course of tooth development. More than 95 % of EMD is represented by amelogenins which are hydrophobic proteins that markedly are the unique active component responsible for a number of biological functions. These include regulation of fibroblast cells and osteoblasts, stimulation or activation of these cells, and also their cellular activity. Other components of EMD further are called non-amelogenins which include ameloblastin, tufted-in, enamelin, amelotin, etc.

What Is the Function and Scope Of Enamel Matrix Derivatives?

• EMD induces the periodontal apparatus attached to the tooth which is the main supporting cushion and shock absorber for the tooth.

• EMD can also be used alongside surgical procedures such as tooth root conditioning, the use of autograft, allograft, xenografts, etc, and even along with barrier membranes for guided tissue regeneration and in the field of implant dentistry. In correlation to EMD, surgical procedures are also shown to have successful regenerative outcomes according to current dental research.

• EMD material tends to mimic the biological process that occurs during tissue growth. When the tooth root forms or develops, the enamel matrix proteins are formed in the root surface by the structures called Hertwig's epithelial root sheath (HERS) cells through a process called cementogenesis.

• The enamel matrix is mainly responsible for the following phases that occur during tooth formation such as regulation or initiation, propagation, termination, and maturation of hydroxyapatite crystallites.

• These enamel matrix proteins that are temporarily deposited onto the dentinal root surface during tooth formation mainly provide an essential base for the formation of cellular cementum on the tooth root.

What Is Its Application in Dentistry?

• EMD as per dental and implant research has been extensively investigated in dental practice. It is found to be one of the safest and most efficacious methods for the regeneration of periodontium.

• During the last two decades, multiple animal studies and clinical trials that have evaluated the use of EMD either alone or in combination with other agents for tooth regeneration have demonstrated great clinical success and are still an ongoing novel concept in dentistry that further proposes more applications in the near future.

• According to recent periodontal research, EMD has demonstrated positive clinical features such as initiation of tooth root coverage and also in promoting or stimulating the soft and hard tissues surrounding the tooth region to get regenerated.

• EMD is currently considered for orthodontics-based applications and is quite known for its effective results in orthodontic therapies.

• EMD has also been widely used in periodontal regeneration therapies for intrabody defects to improve the regeneration of all the supporting apparatus that anchors the tooth including the alveolar bone, the periodontal ligament, and the newly formed or regenerated cementum. Deep intrabony (within or inside the bone) periodontal abnormalities can be easily corrected with the use of EMD-stimulating periodontal regeneration therapy.

• EMD has been demonstrated to accelerate wound healing along with a reduction in the gingival fibroblasts that are responsible for inducing localized inflammation.

• Randomized clinical trials have focused on the use of EMD and platelet-rich fibrin together for treating patients with chronic periodontitis accompanied by intrabony defects. This approach has exhibited excellent clinical outcomes because platelet-rich fibrin facilitates tissue healing when combined with EMD and improves periodontal healing as well as the regeneration of bone.

• Studies further show that EMD can be applied while opening or in flap debridement procedures for treating tooth impairments. Research shows that EMD in combination with bone graft material can be used in a wide intrabony defect with significant regenerative potential.

• The EMD surface rather acts as a coating of a scaffold biomaterial which would help increase the thickness of enamel matrix proteins. Current research establishes the fact that a liquid formulation could better form a coating of porous alloplastic graft materials compared to the gel in combination with EMD.

Conclusion

EMD has greater evidence clinically compared with other biomaterials in the field of present-day periodontal therapy. It is not only beneficial as a part of the guided tissue regeneration technique but is also used in combination with diverse materials or treatment strategies. It promises encouraging results that need further scope and research in implementing it in various dentistry fields.