#Patientcomfort 04. Oct 2021

Mode of Action: Understanding the principle of “molecular mimicry” behind Emdogain®

Emdogain® achieves accelerated oral wound healing as well as real, predictable and reliable regeneration of the periodontium, which is demonstrated by the formation of new cement, new fibers of the periodontal ligament and bone tissue. [1]

How does Emdogain® promote tissue regeneration?

Emdogain® mimics the processes that take place during tooth development. The amelogenins support the formation of new cell-free cement. The protein matrix in enamel matrix derivatives, i.e., EMD, mimics the natural environment of the developing tissue which naturally stimulates cell differentiation and cell maturation as well as tissue regeneration. 2-5

Pictures courtesy of Prof. Eiji Funakoshi, Japan


25 years of Straumann® Emdogain: How matrix proteins led to the breakthrough in regenerative periodontal therapy


Antibacterial and accelerating fibroblast adhesion

In the first phase of wound healing, Emdogain® has an antibacterial effect and accelerates fibroblast adhesion to the root surface. The various proteins combine to form a matrix that mediates the formation of root cement during natural tooth development. A new periodontal attachment is created and the bone defect regenerates in the months and years that follow. This ‘biological maturation’ continues for up to three years. For this reason, a radiological result can be expected after at least eight months at the earliest.2-5 Prof. Dr. Anton Sculean is renowned for demonstrating the cellular effects of Emdogain® on humans. In a first study by Sculean on the mode of action, six months postoperatively, newly formed tissue such as cement with collagen fibers and in most cases also bone were observed histologically.6-9

Angiogenic effect

Emdogain® is a proven preparation with an angiogenic effect that reduces the tendency to bleed and signs of inflammation, promotes the accumulation of cells, the remodeling, consolidation and proliferation of tissue and induces bone healing deep in the defect during wound healing.10-12 Treatment with Emdogain® achieves a higher clinical gain in attachment and a more effective reduction in probing depth than open debridement alone.13, 14

Pictures courtesy of Prof. Carlos Nemcovsky (Israel)


You can’t buy respect – you have to earn it: What do international experts in periodontology think about Emdogain®?


Lasting success and stable long-term results

Emdogain® more effectively reduces horizontal defect depth in buccal grade II furcation defects on mandibular molars than barrier membranes.15 Emdogain® also achieves better root coverage in combination with coronally advanced flap (CAF), compared to CAF alone.16, 17 Histological studies show that Straumann® Emdogain® supports the formation of new periodontal tissue and a new periodontal attachment in conjunction with a coronally advanced flaps.18 The success is lasting and, based on the osseous defect filling19 as well as the root coverage, the use of Emdogain® leads to documented stable 10-year results.20

Pictures courtesy of Prof. Zucchelli (Italy)

References:

  1. Mellonig JT, Valderrama P, Gregory HJ, Cochran DL. Clinical and histologic evaluation of non-surgical periodontal therapy with enamel matrix derivative: a report of four cases. J Periodontol. 2009 Sep;80(9):1534-40. doi: 10.1902/jop.2009.090160.
  2. Hammarström L. Enamel matrix, cementum development and regeneration. J Clin Periodontol. 1997 Sep;24(9 Pt 2):658-68.
  3. Hammarström L, Heijl L, Gestrelius S.: Periodontal regeneration in a buccal dehiscence model in monkeys after application of enamel matrix proteins. J Clin Periodontol. 1997 Sep;24(9 Pt 2):669-77.]
  4. Hammarström L.: The role of enamel matrix proteins in the development of cementum and periodontal tissues. Ciba Found Symp. 1997;205:246-55; discussion 255-60.
  5. Heijl L. Periodontal regeneration with enamel matrix derivative in one human experimental defect. A case report. J Clin Periodontol. 1997 Sep;24(9 Pt 2):693-6.
  6. Sculean A, Chiantella GC, Windisch P, Donos N. Clinical and histologic evaluation of human intrabony defects treated with an enamel matrix protein derivative (Emdogain). Int J Periodontics Restorative Dent. 2000 Aug;20(4):374-81.
  7. Sculean A. In Kombination von Emdogain® und Gewebsersatzmaterial (EMD und BioOss und GTR).Int J Periodontics Restorative Dent. 2004 Aug;24(4):326-33.
  8. Sculean A, Windisch P, Szendröi-Kiss D, Horváth A, Rosta P, Becker J, Gera I, Schwarz F. Clinical and histologic evaluation of an enamel matrix derivative combined with a biphasic calcium phosphate for the treatment of human intrabony periodontal defects. J Periodontol. 2008 Oct;79(10):1991-9.
  9. Sculean A, Donos N, Schwarz F, Becker J, Brecx M, Arweiler NB. Five-year results following treatment of intrabony defects with enamel matrix proteins and guided tissue regeneration. J Clin Periodontol. 2004 Jul;31(7):545-9. doi: 10.1111/j.1600-051X.2004.00518.x. PMID: 15191590.
  10. Almqvist S, Kleinman HK, Werthén M, Thomsen P, Agren MS. J Wound Care. Effects of amelogenins on angiogenesis-associated processes of endothelial cells. 2011 Feb;20(2):68, 70-5
  11. Kasaj A, Meister J, Lehmann K, Stratul SI, Schlee M, Stein JM, Willershausen B, Schmidt M.The influence of enamel matrix derivative on the angiogenic activity of primary endothelial cells. J Periodontal Res. 2012 Aug;47(4):479-87. doi: 10.1111/j.1600-0765.2011.01456.x. Epub 2011 Dec 29.
  12. Kauvar AS, Thoma DS, Carnes DL, Cochran DL. In vivo angiogenic activity of enamel matrix derivative. J Periodontol. 2010 Aug;81(8):1196-201.
  13. Heijl L, Heden G, Svärdström G, Ostgren A. Enamel matrix derivative (EMDOGAIN) in the treatment of intrabony periodontal defects. J Clin Periodontol. 1997 Sep;24(9 Pt 2):705-14.
  14. Tonetti MS, Lang NP, Cortellini P, Suvan JE, Adriaens P, Dubravec D, Fonzar A, Fourmousis I, Mayfield L, Rossi R, Silvestri
  15. Jepsen S, Heinz B, Jepsen K, Arjomand M, Hoffmann T, Richter S, Reich E, Sculean A, Gonzales JR, Bödeker RH, Meyle J. A randomized clinical trial comparing enamel matrix derivative and mem-brane treatment of buccal Class II furcation involvement in mandibular molars. Part I: Study design and results for primary outcomes. J Periodontol. 2004 Aug;75(8):1150-60.
  16. Tonetti MS1, Jepsen S; Working Group 2 of the European Workshop on Periodontology. Clinical efficacy of periodontal plastic surgery procedures: consensus report of Group 2 of the 10th European Workshop on Periodontology. J Clin Periodontol. 2014 Apr;41 Suppl 15:36-43.
  17. Pilloni A, Paolantonio M, Camargo PM. Root coverage with a coronally positioned flap used in com-bination with enamel matrix derivative: 18-month clinical evaluation. J Periodontol. 2006 Dec;77(12):2031-9.
  18. McGuire MK, et al. A Prospective, Cased-Controlled Study Evaluating the use of Enamel Matrix Derivative on Human Buccal Recession Defects: A Human Histologic Examination. J Periodontol. 2016 Feb 1:1-34.
  19. Sculean A, Kiss A, Miliauskaite A, Schwarz F, Arweiler NB, Hannig M. Ten-year results following treatment of intra-bony defects with enamel matrix proteins and guided tissue regeneration. J Clin Periodontol. 2008 Sep;35(9):817-24.
  20. McGuire MK, Scheyer ET, Nunn M. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue: comparison of clinical parameters at 10 years. J Periodontol. 2012 Nov;83(11):1353-62.