The aim of the present study was the histological evaluation of ENAMEL MATRIX Derivative (EMD) effectiveness for regeneration of periodontal defects. EMD activates cementum synthesis, PDL and bone during the maturation stage of follicole. In this research, EMD was used in surgical defects of premolar teeth in four adult sheep. Muccoperiosteal flap was reflected in buccal site of teeth. The buccal bone plate was removed from mesial to distal in 4 mm depth. After eliminating the cementum by bur and its etching, EMD was applied on exposed dentine and flap was sutured. In opposite sites of those teeth (control sites) the same process was performed without etching. After 100 days, sheep were sacrificed and histological study through light microscopic was performed on black sections of operation sites. The results showed that in test sites, regeneration of cementum and bone was 62/5% and 42/5-50% respectively. But in control sites regeneration of cementum and bone was 37.5% and 32/5-42/5% respectively. Also the migration of junctional epithelium in control sites was 8-10% more than test sites. The important point is that in test sites, cementum was completely attached to undermining dentine. But, in control sites, the gap between cementum and dentine was visible. As a result, this study suggests that EMD promotes periodontal regeneration, and EMD application is a successful achievement in regenerative periodontal therapy.

Background and aim: Palatal groove as a growth-developmental anomaly can lead to periodontal problems, therefore diagnosis and treatment of its complications is of high importance.The aim of this study was to evaluate clinically the efficacy of ENAMEL MATRIX derivative (EMD) in the treatment of periodontal defects due to palatal groove.Materials and Methods: Ten patients with palatal groove on maxillary lateral incisor with pocket depth ≥4mm were chosen from those referred to department of periodontics, Faculty of Dentistry Tehran University of Medical Sciences, and private office (2002-2003). During the surgical procedure, a full thickness flap was elevated and respective root thoroughly planed. After groove saucerization, EMD was used to cover the defect. The flap was then coronally positioned and secured with 3-0 silk sutures.Clinical measurements were taken at baseline, 1 and 3 months post-surgery. These parameters included pocket probing depth (PPD) and clinical attachment level (CAL). Statistical analysis was performed by the test of difference between means.Results: mean PPD and CAL before surgery were 5.7mm and 6.2mm, respectively that changed to 1.5mm and 2.05mm at 3 months post-surgery-statistically significant gain of attachment (71.05%) was observed 3 months after surgery (p-value <0.000).Conclusion: The results of this study suggest that EMD can be used successfully for periodontal attachment gain in teeth with palatal groove.

Statement of Problem: Regenerative periodontal procedures are one mode of therapy that attempts to restore the lost supporting structures of the dentition around a previously diseased root surface. Purpose: The purpose of this study was comparison between ENAMEL MATRIX proteins (EMP) used alone or in combination with autogenous bone graft (ABG) in the treatment of human intrabony periodontal defects.Materials and Methods: This clinical trial study, was done on 8 pairs of matched two wall intrabony periodontal defects with 5 mm or more probing depth and 3 mm or more depth of intrabony component following phase I therapy. In control sites ENAMEL MATRIX proteins (EMP) and in test sites EMP with autogenous bone graft (ABG) was used.Results: No differences were found in terms of oral hygiene and defect characteristics, at baseline. Six months after treatment, both procedures significantly improved the clinical probing depth and clinical attachment level. Although bone fill was significant for both groups but EMP+ABG significantly showed more bone fill and defect resolution (bone fill 2.75mm versus 1.67mm). Crestal resorption was the same for both groups and its difference was not significant. Conclusion: The results of this study demonstrate that both procedures improve clinical parameters and combined use of EMP with autogenous bone graft will promote more bone fill and more defect resolution. A difficulty in obtaining sufficient amounts of autogenous bone from intra oral sites is one of the limitations of this procedure.

Introduction: Vital pulp therapy (VPT) aims to preserve the health and maintain life of the tooth pulp which has been compromised by caries, trauma or restorative procedures. Recently, ENAMEL MATRIX derivative (EMD) has been introduced as a material for vital pulp therapy. The aim of this review is to critically analyze and summarize the available literature on EMD for VPT.Methods and Materials: Online databases (PubMED/MEDLINE, Google Scholar, ISI Web of Science, and Wiley-Online) were searched by using the following keywords in various combinations: ENAMEL MATRIX Derivative, Emdogain, ‘Vital Pulp Therapy, ‘Apexogenisis’, Apexification, Pulp Capping, Endodontics, Dentineand Pulpotomy for studies indexed from January 1949 to April 2016. We used an Englishlimited search inGoogle.co.uk for the missing grey literature. All studies fulfilling the selection criteria were carefully reviewed for the focused question: “Does using EMD in VPT, compared with other materials, result in better clinical, radiographic and histological outcomes?.Results: The primary search resulted in 18 articles of which, 14 articles (including 6 animal studies and 6 clinical trials and 2 case reports) met the inclusion criteria for this review and hence were included. The number of teeth tested in the animal studies ranged from 8 to 144 including pigs, rats and dogs teeth. A number of studies used EMD in the experimental group in comparison with calcium hydroxide, propylene glycol alginate (PGA) and MTA as a control. The observation period ranged from 1 to 2 months and 4 out of 6 animal trials reported more favorable outcomes with EMD while two studies reported comparable outcomes.Conclusion: Although EMD has potential for various applications in endodontics, studies conducted to date have failed to demonstrate any significant advantage of EMD over conventional VPT materials. Additionally, the 5-year and 10-year survival rate of EMD-treated teeth is not yet known. Hence, studies with a longer follow-up periods are required to deduce the long-term viability of teeth treated with EMD.

ENAMEL MATRIX derivative Emdogain (EMD) is widely used in periodontal treatment in spite of the fact that its effect on the developing embryo has not been elucidated. The aim of this study was to investigate the teratogenic effect of EMD on the rat embryo neural crest cells. The neural crest is a unique population of cells that migrates from the dorsal neural tube along defined pathways and produces various cell types including the melanocytes, neuronal and glial cells of the sensory, autonomic and enteric nervous system as well as the chromaffin cells of the adrenal gland. These cells have been used extensively for in-vitro studies of neurogenesis. Cultured cells by micromass culture method derived from midbrain of six embryos (13 day postcoitum; 34-36 smites) and exposed to various concentrations of EMD for 5 days at 37°C and differentiated foci were counted. Retinoic Acid (20 mg/mL) was used as standard positive control. These cells were stained using Mayer’s hematoxylin which is specific for staining differentiated cell nucleus. Neutral red staining determines cell viability rather than related cell differentiation but is used for normalization of Mayer’s hematoxylin results. At the concentration as low as 8 mg/mL of EMD, no toxic effect on fetal cells was observed and it is suggested that EMD has no teratogenic effect at studied concentrations.

Background. One of the ever-increasing complications related to dental implants, with controversy over how to control it, is peri-implant disease. The aim of this study was to evaluate the adjunctive use of ENAMEL MATRIX derivative (EMD) to mechanical debridement (MD) in patients with these conditions in terms of clinical parameters and cytokine levels of peri-implant crevicular fluid (PICF). Methods. In the present double-blind clinical trial, 46 patients with peri-implant diseases (pocket depth (PD) ≥ 4mm and bone loss≤ 2mm) were randomly divided into control and test groups. Two different therapeutic protocols, consisting of non-surgical MD with and without the application of EMD were considered for the two groups. Clinical parameters and sampling from PICF were carried out before treatment and 3-month postoperative interval. ELISA was used for the analysis of PICF samples in relation to IL-6 and IL-17 cytokines levels. Results. After 3 months, no specific changes were observed in the control group in terms of bleeding on probing (BOP) and PD; however, in the test group, use of EMD resulted in a significant decrease in BOP (from 75%to25%) and PD (from 4. 5 to 3mm) (P Conclusions. The results showed that non-surgical MD alone cannot be effective in the treatment of severe peri-implant mucositis and initial peri-implantitis, and use of EMD can be considered an adjunct to MD in the non-surgical treatment of these lesions, although no complete recovery was achieved after 3 months.