Non-Cochrane · intervention · PM41463593
Evaluation of Long-Term Outcomes of Enamel Matrix Derivative in the Treatment of Peri-Implant Disease: A Systematic Review and Meta-Analysis.
Song Hye-Jung, Jang Ki-Jung, Han Sung-Hoon, et al. · Bioengineering (Basel, Switzerland) · 2025 · PubMed · doi:10.3390/bioengineering12121296
Findings
16 findings
| Population | ||||
|---|---|---|---|---|
| Patients with peri-implantitis (peri-implant disease) | Adjunctive enamel matrix derivative (EMD) with non-surgical or surgical treatment | Same treatment without EMD | Bone level gain (marginal bone level, mm) Mixed · Peri-implantitis treatment · Trim-and-fill adjusted estimate (publication bias sensitivity analysis) Unresolved: the two extractors disagree on this row. | MD 0.67 [0.10, 1.24] GRADE not reported Studies not reported |
| Patients with peri-implantitis (peri-implant disease) | Adjunctive enamel matrix derivative (EMD) with non-surgical or surgical treatment | Same treatment without EMD | Probing depth change (mm) 3 months · Peri-implantitis treatment · Short-term follow-up (3 months) | MD 1.61 [1.07, 2.15] GRADE not reported 2 studies · 82 participants |
| Patients with peri-implantitis (peri-implant disease) | Adjunctive enamel matrix derivative (EMD) with non-surgical or surgical treatment | Same treatment without EMD | Bone level gain (marginal bone level, mm) 12 months · Peri-implantitis treatment · Mid-term follow-up (1 year) | MD 0.67 [0.04, 1.30] GRADE not reported 2 studies · 61 participants |
| Patients with peri-implantitis (peri-implant disease) | Adjunctive enamel matrix derivative (EMD) with non-surgical or surgical treatment | Same treatment without EMD | Probing depth change (mm) Mixed (3 months and 12 months) · Peri-implantitis treatment · All studies pooled | MD 0.88 [-0.26, 2.02] GRADE not reported 4 studies · 143 participants |
| Patients with peri-implantitis (peri-implant disease) | Adjunctive enamel matrix derivative (EMD) with non-surgical or surgical treatment | Same treatment without EMD | Decrease in bleeding on probing (%) Mixed · Peri-implantitis treatment · Trim-and-fill adjusted estimate (publication bias sensitivity analysis) Unresolved: the two extractors disagree on this row. | MD 9.41 [-13.95, 36.77] GRADE not reported Studies not reported |
| Patients with peri-implantitis (peri-implant disease) | Adjunctive enamel matrix derivative (EMD) with non-surgical or surgical treatment | Same treatment without EMD | Decrease in bleeding on probing (%) Mixed (3 months to 5 years) · Peri-implantitis treatment · All studies pooled | MD 16.70 [-4.93, 38.32] GRADE not reported 5 studies · 175 participants |
| Patients with peri-implantitis (peri-implant disease) | Adjunctive enamel matrix derivative (EMD) with non-surgical or surgical treatment | Same treatment without EMD | Probing depth change (mm) 12 months · Peri-implantitis treatment · Mid-term follow-up (1 year) Unresolved: the two extractors disagree on this row. | MD -0.13 [-1.32, 1.06] GRADE not reported 2 studies · 61 participants |
| Patients with peri-implantitis (peri-implant disease) | Adjunctive enamel matrix derivative (EMD) with non-surgical or surgical treatment | Same treatment without EMD | Decrease in bleeding on probing (%) 3 months · Peri-implantitis treatment · Short-term follow-up (3 months) | MD 50.0 [36.10, 63.90] GRADE not reported 2 studies · 82 participants |
| Patients with peri-implant disease (peri-implantitis, including peri-implant mucositis in non-surgical trials) | Adjunctive enamel matrix derivative (EMD) with any treatment protocol | Same treatment without EMD | Probing depth change (mm) Peri-implant disease around dental implants · Trim-and-fill adjusted (2 added studies; 6 total) | MD 1.62 [0.18, 3.06] GRADE not reported 4 studies |
| Patients with peri-implantitis (peri-implant disease) | Adjunctive enamel matrix derivative (EMD) with non-surgical or surgical treatment | Same treatment without EMD | Bone level gain (marginal bone level, mm) Mixed (1 to 5 years) · Peri-implantitis treatment · All studies pooled | MD 0.59 [-0.01, 1.19] GRADE not reported 3 studies · 93 participants |
| Patients with peri-implantitis (peri-implant disease) | Adjunctive enamel matrix derivative (EMD) with non-surgical or surgical treatment | Same treatment without EMD | Decrease in bleeding on probing (%) 12 months · Peri-implantitis treatment · Mid-term follow-up (1 year) | MD 9.51 [0.70, 18.33] GRADE not reported 2 studies · 61 participants |
| Patients with peri-implant disease (peri-implantitis, including peri-implant mucositis in non-surgical trials) treated non-surgically | Non-surgical mechanical debridement with adjunctive EMD | Non-surgical debridement without EMD | Probing depth change (mm) 3 months · Peri-implant disease around dental implants · Non-surgical approach | MD 1.61 [1.07, 2.15] GRADE not reported 2 studies · 82 participants |
| Patients with peri-implantitis (peri-implant disease) | Non-surgical debridement plus EMD | Non-surgical debridement alone | Decrease in bleeding on probing (%) 3 months · Peri-implantitis treatment · Non-surgical approach | MD 50.0 [32.34, 67.66] GRADE not reported 2 studies · 82 participants |
| Patients with peri-implantitis (peri-implant disease) | Surgical treatment (flap surgery) plus EMD, with or without adjuncts | Surgical treatment without EMD | Probing depth change (mm) 12 months · Peri-implantitis treatment · Surgical approach | MD -0.13 [-1.32, 1.06] GRADE not reported 2 studies · 61 participants |
| Patients with peri-implantitis (peri-implant disease) | Flap surgery plus EMD only (no adjuncts) | Flap surgery without EMD | Decrease in bleeding on probing (%) 12 months to 5 years · Peri-implantitis treatment · Surgical approach, EMD only (Isehed 2016 and Isehed 2018 at 3 and 5 years) | MD -1.63 [-13.45, 10.19] GRADE not reported 2 studies · 57 participants |
| Patients with peri-implantitis (peri-implant disease) | Flap surgery plus EMD only (no adjuncts) | Flap surgery without EMD | Bone level gain (marginal bone level, mm) 12 months to 5 years · Peri-implantitis treatment · Surgical approach, EMD only (Isehed 2016 and Isehed 2018 at 3 and 5 years) | MD 0.45 [-0.40, 1.29] GRADE not reported 2 studies · 57 participants |
Included primary studies 9
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Faramarzi 2015 Microbiological and clinical effects of enamel matrix derivative and sustained-release micro-spherical minocycline application as an… PMID:26339576 | 2015 | this review only | not stated | not extracted yet |
| Isehed 2016 Effectiveness of enamel matrix derivative on the clinical and microbiological outcomes following surgical regenerative treatment of… DOI:10.1111/jcpe.12583 | 2016 | this review only | not stated | not extracted yet |
| Isehed 2016 Effectiveness of enamel matrix derivative on the clinical and microbiological outcomes following surgical regenerative treatment of… PMID:27418458 | 2016 | this review only | not stated | not extracted yet |
| Isehed 2018 Surgical treatment of peri‐implantitis using enamel matrix derivative, an <scp>RCT</scp>: 3‐ and 5‐year follow‐up DOI:10.1111/jcpe.12894 | 2018 | this review only | not stated | not extracted yet |
| Isehed 2018 Surgical treatment of peri-implantitis using enamel matrix derivative, an RCT: 3- and 5-year follow-up. PMID:29574866 | 2018 | this review only | not stated | not extracted yet |
| Kashefimehr 2017 Effects of enamel matrix derivative on non-surgical management of peri-implant mucositis: a double-blind randomized clinical trial DOI:10.1007/s00784-016-2033-7 | 2016 | this review only | not stated | not extracted yet |
| Kashefimehr 2017 Effects of enamel matrix derivative on non-surgical management of peri-implant mucositis: a double-blind randomized clinical trial. PMID:28039545 | 2017 | this review only | not stated | not extracted yet |
| Regidor 2025 Enamel Matrix Derivative in the Reconstructive Surgical Therapy of Peri‐Implantitis: A Randomized Clinical Trial DOI:10.1111/jre.13396 | 2025 | this review only | not stated | not extracted yet |
| Regidor 2025 Enamel Matrix Derivative in the Reconstructive Surgical Therapy of Peri-Implantitis: A Randomized Clinical Trial. PMID:40143584 | 2026 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with peri-implant disease (peri-implantitis) with dental implants | Adults with peri-implantitis or peri-implant mucositis (n=5 RCTs) |
| Intervention | Adjunctive enamel matrix derivative (EMD) with mechanical and/or chemical implant decontamination | EMD after non-surgical debridement (n=2) or flap surgery with or without bone graft and membrane (n=3) |
| Comparison | Treatment without EMD | Same procedure without EMD (n=5) |
| Outcomes | Probing depth change, bone level gain, bleeding on probing, plaque index, pus discharge | Probing depth (n=4); bleeding on probing (n=5); marginal bone level (n=3) |
| Study designs | RCTs with sufficient quantitative data for meta-analysis | RCTs (n=5) |
| Timing | Not specified (long-term outcomes) | 3 months (n=2); 6 months to 1 year (n=3); 3 and 5 years (n=1) |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Partial Yes · NRSI: N/A | NRSI: N/A · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Moderate | Low | no |