Do the clinical effects of enamel matrix derivatives in infrabony defects decrease overtime? A systematic review and...

Area of Science:

• Periodontology
• Regenerative Dentistry

Background:

• Enamel matrix derivative proteins (EMDP) have shown promising results in managing infrabony periodontal defects (IPD) compared to open flap debridement (OFD).
• Systematic reviews indicate superior outcomes with EMDP, but the influence of study follow-up duration and methodological quality on these findings requires further investigation.

Purpose of the Study:

• To evaluate the impact of follow-up duration and study quality on the effectiveness of EMDP versus OFD for IPD treatment.
• To analyze changes in probing depth (PD), clinical attachment level (CAL), gingival recession (GR), and bone changes (BC).

Main Methods:

• A systematic review and meta-analysis of randomized clinical trials was conducted.
• Databases searched included Cochrane Central Register of Controlled Trials, Medline/PubMed, Lilacs, Embase, and Web of Science up to August 2013.
• Outcomes assessed were PD, CAL, GR, and BC, with subgroup analyses based on follow-up (12 months vs. ≥24 months) and risk of bias.

Main Results:

• Studies with 12-month follow-up showed significant improvements favoring EMDP for PD (0.97 mm) and CAL (1.19 mm).
• Studies with ≥24-month follow-up also favored EMDP for CAL (1.11 mm) and PD (0.83 mm).
• High-quality studies (low risk of bias) demonstrated smaller differences favoring EMDP for CAL (0.8 mm), with no significant difference in PD.

Conclusions:

• Follow-up duration (less than or greater than 2 years) significantly influences the reported treatment outcomes for EMDP in IPD.
• The risk of bias in studies impacts the observed differences between EMDP and OFD, suggesting that higher quality evidence may show more modest benefits.
• EMDP remains a viable treatment option for IPD, but careful consideration of study quality and follow-up period is crucial for interpreting results.