Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects

Marco Esposito; Maria Gabriella Grusovin; Paul Coulthard; Helen V Worthington

doi:10.1002/14651858.CD003875.pub2

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Analysis 1.1

Comparison 1 Emdogain versus Control: 1 year, Outcome 1 Tooth Loss.

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Analysis 1.2

Comparison 1 Emdogain versus Control: 1 year, Outcome 2 PAL.

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Analysis 1.3

Comparison 1 Emdogain versus Control: 1 year, Outcome 3 PAL < 2 mm.

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Analysis 1.4

Comparison 1 Emdogain versus Control: 1 year, Outcome 4 PPD.

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Analysis 1.5

Comparison 1 Emdogain versus Control: 1 year, Outcome 5 REC.

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Analysis 1.6

Comparison 1 Emdogain versus Control: 1 year, Outcome 6 Marginal bone level.

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Analysis 1.7

Comparison 1 Emdogain versus Control: 1 year, Outcome 7 Postoperative infection.

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Analysis 1.8

Comparison 1 Emdogain versus Control: 1 year, Outcome 8 Aesthetics.

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Analysis 2.1

Comparison 2 Emdogain versus GTR: 1 year, Outcome 1 Tooth loss.

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Analysis 2.2

Comparison 2 Emdogain versus GTR: 1 year, Outcome 2 PAL.

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Analysis 2.3

Comparison 2 Emdogain versus GTR: 1 year, Outcome 3 PPD.

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Analysis 2.4

Comparison 2 Emdogain versus GTR: 1 year, Outcome 4 REC.

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Analysis 2.5

Comparison 2 Emdogain versus GTR: 1 year, Outcome 5 Postoperative infection.

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Analysis 2.6

Comparison 2 Emdogain versus GTR: 1 year, Outcome 6 Postoperative complications.

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Table 1. Results of quality assessment after correspondence with authors

Study	Allocation	Blinding of assessor	Withdrawals	Risk of bias
Heijl 1997	Adequate	Yes	Yes	A
Pontoriero 1999	Unclear	Yes	Yes	B
Okuda 2000	Unclear	Yes	Yes	B
Silvestri 2000	Inadequate	No	Yes	B
Tonetti 2002	Adequate	No	Yes	B
Zucchelli 2002	Unclear	Yes	Yes	B
Silvestri 2003	Unclear	No	Yes	B
Francetti 2004	Adequate	No	Yes	B
Sanz 2004	Adequate	No	No	B
Rösing 2005	Adequate	Yes	Yes	A

Table 1. Results of quality assessment after correspondence with authors

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Table 2. Random‐effects metaregression analysis of outcomes PAL, PPD, REC

Characteristic	Outcome	No. studies	Slope estimate (SE)	95% CI	Slope	P‐value
Parallel versus split mouth	PAL	8	‐0.95 (0.55)	(‐2.02, 0.13)	Emdogain in parallel group trials has higher effect	0.08
Parallel versus split mouth	PPD	8	‐0.94 (0.66)	(‐2.24, 0.36)	Emdogain in parallel group trials has higher effect	0.16
Parallel versus split mouth	REC	5	‐0.33 (0.38)	(‐1.09, 0.41)	Emdogain in parallel group trials has higher effect	0.38

Table 2. Random‐effects metaregression analysis of outcomes PAL, PPD, REC

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Comparison 1. Emdogain versus Control: 1 year

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Tooth Loss Show forest plot	8	418	risk ratio (Random, 95% CI)	0.0 [0.0, 0.0]

1.1 Parallel group	4	270	risk ratio (Random, 95% CI)	0.0 [0.0, 0.0]
1.2 Split mouth	4	148	risk ratio (Random, 95% CI)	0.0 [0.0, 0.0]
2 PAL Show forest plot	8	412	mean difference (Random, 95% CI)	1.20 [0.71, 1.69]

2.1 Parallel group	4	270	mean difference (Random, 95% CI)	1.72 [0.81, 2.62]
2.2 Split mouth	4	142	mean difference (Random, 95% CI)	0.76 [0.48, 1.04]
3 PAL < 2 mm Show forest plot	5	332	risk ratio (Random, 95% CI)	0.48 [0.29, 0.80]

4 PPD Show forest plot	8	412	Mean difference (Fixed, 95% CI)	0.77 [0.54, 1.00]

4.1 Parallel group	4	270	Mean difference (Fixed, 95% CI)	0.86 [0.55, 1.17]
4.2 Split mouth	4	142	Mean difference (Fixed, 95% CI)	0.66 [0.31, 1.00]
5 REC Show forest plot	5	298	mean difference (Random, 95% CI)	0.04 [‐0.32, 0.40]

5.1 Parallel group	3	246	mean difference (Random, 95% CI)	0.15 [‐0.35, 0.66]
5.2 Split mouth	2	52	mean difference (Random, 95% CI)	‐0.15 [‐0.57, 0.26]
6 Marginal bone level Show forest plot	2	90	mean difference (Random, 95% CI)	1.08 [‐0.72, 2.89]

6.1 Parallel group	0	0	mean difference (Random, 95% CI)	0.0 [0.0, 0.0]
6.2 Split mouth	2	90	mean difference (Random, 95% CI)	1.08 [‐0.72, 2.89]
7 Postoperative infection Show forest plot	7	388	risk ratio (Random, 95% CI)	0.0 [0.0, 0.0]

7.1 Parallel group	4	270	risk ratio (Random, 95% CI)	0.0 [0.0, 0.0]
7.2 Split mouth	3	118	risk ratio (Random, 95% CI)	0.0 [0.0, 0.0]
8 Aesthetics Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

8.1 Parallel group	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Emdogain versus Control: 1 year

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Comparison 2. Emdogain versus GTR: 1 year

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Tooth loss Show forest plot	4	216	risk ratio (Random, 95% CI)	0.0 [0.0, 0.0]

1.1 Parallel group	4	216	risk ratio (Random, 95% CI)	0.0 [0.0, 0.0]
1.2 Split mouth	0	0	risk ratio (Random, 95% CI)	0.0 [0.0, 0.0]
2 PAL Show forest plot	5	263	mean difference (Fixed, 95% CI)	‐0.20 [‐0.59, 0.20]

2.1 Parallel group	5	263	mean difference (Fixed, 95% CI)	‐0.20 [‐0.59, 0.20]
2.2 Split mouth	0	0	mean difference (Fixed, 95% CI)	0.0 [0.0, 0.0]
3 PPD Show forest plot	5	263	mean difference (Random, 95% CI)	‐0.49 [‐1.23, 0.26]

3.1 Parallel group	5	263	mean difference (Random, 95% CI)	‐0.49 [‐1.23, 0.26]
3.2 Split mouth	0	0	mean difference (Random, 95% CI)	0.0 [0.0, 0.0]
4 REC Show forest plot	4	167	mean difference (Random, 95% CI)	0.39 [0.13, 0.66]

4.1 Parallel group	4	167	mean difference (Random, 95% CI)	0.39 [0.13, 0.66]
4.2 Split mouth	0	0	mean difference (Random, 95% CI)	0.0 [0.0, 0.0]
5 Postoperative infection Show forest plot	4	218	risk ratio (Random, 95% CI)	0.20 [0.01, 4.09]

5.1 Parallel group	4	218	risk ratio (Random, 95% CI)	0.20 [0.01, 4.09]
5.2 Split mouth	0	0	risk ratio (Random, 95% CI)	0.0 [0.0, 0.0]
6 Postoperative complications Show forest plot	1	64	Risk Ratio (M‐H, Fixed, 95% CI)	0.08 [0.02, 0.25]

6.1 Parallel group	1	64	Risk Ratio (M‐H, Fixed, 95% CI)	0.08 [0.02, 0.25]

Comparison 2. Emdogain versus GTR: 1 year

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