Enamel matrix derivative

Enamel matrix derivative (EMD) or enamel matrix proteins are proteins that have been found to play a key role in the development of tooth-supporting tissues. For clinical use in regenerative periodontal procedures, they are derived from developing porcine teeth based on the high degree of homology between porcine and human enamel proteins. It was introduced in 1996 and marketed as Emdogain by the Swedish company Biora, until Straumann acquired Biora in 2003 and began producing it under the Straumann name.

Mechanism of action

It is still unclear how EMD participates in the regeneration process. It has been suggested that EMD, and certainly the amelogenin component of it, works to induce formation of acellular cementum and contribute to the regeneration of the periodontal tissues by stimulating proliferation of mesenchymal cells, inhibiting proliferation of epithelial cells and promoting the secretion of certain growth factors, such as TGF-β1, by periodontal ligament cells.

Cost-effectiveness

For treatment of periodontal intraosseous defects and on basis of currently available evidence, it has been suggested that that the use of EMD is cost-efficient if the decision maker's willingness-to-pay (WTP) is at least 150-175 EUR per additional mm of pocket probing depth reduction and clinical attachment level gain, respectively (in comparison to flap operation without EMD). Moreover, if available monetary resources enable EMD application, EMD in conjunction with either bioactive glass or bovine bone substitutes appears to be more cost-effective than EMD alone.

External links

• Straumann - Emdogain