J Clin Periodontol. 2003 Apr;30(4):359-63.
Enamel matrix derivative and titanium implants.
Franke Stenport V, Johansson CB.
Department of Biomaterials/Handicap Research, Institute of Surgical Sciences, Goteborg University, Box 412, S-405 30 Goteborg, Sweden. victoria.franke-stenport@hkf.gu.se
AIM: The aim of present study was to evaluate if an enamel matrix derivative (Emdogain) may enhance bone formation and osseointegration of titanium implants, using a well-documented rabbit model. MATERIAL AND METHODS: Thirty-six threaded commercially pure titanium (cp.ti.) implants were inserted in six New Zealand white rabbits. One implant was placed in each femur and two in each tibia. Prior to implant insertion approximately 0.5 mL of Emdogain (EMD) (test) or the vehicle gel (PGA: propylene glycol alginate) (control) was injected into the surgically prepared implant site. The follow-up time was 6 weeks. Biomechanical evaluations by resonance frequency analysis (RFA) and removal torque measurements (RTQ) were performed. Histomorphometrical quantifications were made on ground sections by measurements of the percentage of bone-to-metal contact, bone area inside the threads as well as outside the threads (mirror image). Bone lengths along the implant surface were also measured and used for shear strength calculations. RESULTS: The results demonstrated no beneficial effects from the EMD treatment on bone formation around titanium implants in any of the tested parameters. Significant differences were demonstrated with removal torque test and shear force calculations for the control implants. No other parameter demonstrated a statistically significant difference. CONCLUSION: The results of the present study may indicate that EMD does not contribute to bone formation around titanium implants. This observation may indicate that the bone formation that occurs after EMD treatment in periodontal defects is the result of functional adaptation. However, further research is required to evaluate the effect of EMD treatment on bone formation.
J Periodontol. 2002 Jul;73(7):789-96.
Enamel matrix derivative and bone healing after guided bone regeneration in dehiscence-type defects around implants. A histomorphometric study in dogs.
Casati MZ, Sallum EA, Nociti FH Jr, Caffesse RG, Sallum AW.
Department of Prosthodontics and Periodontics, School of Dentistry at Piracicaba, UNICAMP, Sao Paulo, Brazil.
BACKGROUND: The goal of this investigation was to histometrically evaluate the effect of enamel matrix derivative (EMD) on bone healing after guided bone regeneration (GBR) in dehiscence-type osseous defects around dental implants; i.e., in the absence of periodontal ligament cells. METHODS: Six mongrel dogs were used. The second, third, and fourth mandibular premolars (p2, p3, and p4) and first molars (ml) were extracted. After 3 months, 2 implant osteotomies were prepared in each side of the mandible, dehiscence-type defects were created on the buccal aspect of each implant osteotomy (3.5 mm x 5.0 mm), and titanium implants were placed (3.75 mm x 8.5 mm). The surgically-created defects were randomly assigned to one of the treatments: EMD, GBR, EMD+GBR, or control. After 2 months, 4 additional defects were created and treated. The animals were sacrificed 3 months after the placement of the first implants, thus allowing the healing periods of 1 and 3 months. Undecalcified sections were obtained for the histometric evaluation including the percentage of bone-to-implant contact and new bone area on the implant threads related to the defect. RESULTS: No statistically significant differences were observed among the groups in the evaluated parameters after 1 month of healing. After 3 months, no statistically significant differences were observed among the groups for the percentage of bone-to-implant contact. The values for the new bone area were: 55.5+/-11.8, 53.8+/-16.3, 62.1+/-18.4, and 36.9+/-25.1 for EMD, GBR, EMD+GBR, and control, respectively. The difference between EMD+GBR and control was statistically significant (P <0.05). CONCLUSIONS: Within the limits of this study, it can be concluded that EMD may positively influence bone healing after GBR around titanium implants. EMD alone, however, had no statistically significant effect.
J Biomed Mater Res. 2002 May;60(2):269-76.
Effects of enamel matrix derivative to titanium implantation in rat femurs.
Shimizu-Ishiura M, Tanaka S, Lee WS, Debari K, Sasaki T.
Department of Oral Histology, School of Dentistry, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan.
The effects of enamel matrix derivative (EMD; Emdogain) on new trabecular bone induction after pure bioinert titanium (Ti) implantation in the rat femur were examined by means of routine light and transmission electron microscopy, immunohistochemistry, and backscattered electron image analysis. Newly designed mini-Ti implants (3.5 mm in length and 1.6 mm in diameter) were placed in the corticotrabecular area of the femur with either EMD or its carrier, propylene glycol alginate, as control. On post-implantation days 4, 7, 14, and 30, the dissected femur was examined in the transverse direction through Ti implants. In both control and EMD-applied femurs, trabecular bone formation was recognized over the implant surfaces and within medullary cavities even at 4 days post-implantation. These newly formed bone trabeculae around the Ti implants were immunoreactive for bone sialoproteins as a bone matrix marker, and osteoclastic bone resorption became evident in these bone trabeculae after 7 days post-implantation. Although trabecular bone area around the implants was markedly decreased at 30 days post-implantation compared with those at 14 days, the trabecular bone areas in EMD-applied femurs were significantly greater than those in propylene glycol alginate-applied femurs at both 14 and 30 days post-implantation. Our results suggest that EMD is an effective biological matrix for enhancing new trabecular bone induction and resulting attachment of orthopedic prostheses to the recipient bone.
So it seems that Emdogain combined with graft material "may" help in regeneration but further studies are needed to determine if there is a statistical advantange