Enamel Matrix Derivative Use in Dentistry: An Update

After most cases of non-surgical or surgical periodontal therapy, reparative wound healing occurs with the formation of a long junctional epithelium, reduction in inflammation, and maturation of the collagen in the periodontal connective tissue. However, this fails to replicate the previous healthy periodontal architecture and function. Regenerative periodontal techniques aim to replicate the original form and function of the periodontium, by allowing key elements, such as cementum, the periodontal ligament and bony architecture, to reform.¹

It is now well understood that periodontal health is a balance between the microbial biofilm (Figure 1) and the host response, and bacterial dysbiosis, or a change in this balance, may lead to both hard and soft tissue destruction.

In 1976, Melcher suggested that wound healing following periodontal treatment was determined by the first type of cell to repopulate the root surface. This cell type would then determine the nature of the clinical attachment that forms.² In a series of studies carried out by Lindhe and Karring on periodontally compromised teeth, it was shown that, if the first cell to populate the root surface was epithelium, reparative healing occurred and a new attachment was formed, creating a long junctional epithelium (Figure 1).³ Nyman expanded on these findings and established that cells from the periodontal ligament held the key to regeneration of the periodontium.⁴ This understanding of periodontal healing methods led to the development of surgical periodontal regeneration therapy, where practitioners have explored the use of graft types and inhibition methods, such as guided tissue regeneration (GTR), and the introduction of enamel matrix proteins (Emdogain, Straumann, Basel, Switzerland), to optimize periodontal healing (Figure 2).