Efficacy of Enamel Matrix Derivative in Periodontal Regeneration Defects: A Systematic Review and Meta-Analysis

Aim: To evaluate the efficacy of enamel matrix derivative (EMD) on periodontal regeneration defects. Materials and Methods: Four databases were searched until October 2021. Experimental animal studies evaluating the efficacy of EMD were used. The primary outcomes were bone formation (BF) and cementum formation (CF). The secondary outcomes were junctional epithelium (JE), gingival recession (GR), and clinical attachment level (CAL). Measures of effect were mean difference (MD) with 95% confidence intervals (CIs). Random‑effects model were used for all meta‑analyses. The Systematic Review Centre for Laboratory animal Experimentation tool was used to assess the risk of bias. Results: Seven experimental animal studies (n = 40) used with a maximum follow‑up period of 3 months. Compared to control, EMD did not significantly reduce BF (MD 0.02 mm; 95% CI − 1.91–1.96; I² = 89%). However, it increased CF (MD 1.38 mm; 95% CI 0.01–2.74; I² = 55%). For secondary outcomes it was found that compared to control, EMD only significantly reduced JE (MD − 0.54 mm; 95% CI − 1.06 to − 0.02; I² = 55%). However, the other secondary outcomes were not significant as in the case of GR (MD − 3. 88 mm; 95% CI − 68.29–60.53; I² = 82%), and in CAL (MD 0.02 mm; 95% CI − 0.29–0.39; I² = 38%). Finally, according to the risk of bias assessment, all included studies had a high risk of bias. Conclusion: EMD had no effect on BF values while it did not reduce CF. Otherwise, in the secondary outcomes, EMD only significantly reduced JE values and had no effect on GR and CAL.