Oral Health Prev Dent. 2022 Jul 13;20:233-242. doi: 10.3290/j.ohpd.b3125655.
The aim of the present systematic review with meta-analysis was to investigate the clinical effectiveness of EMD (enamel matrix derivative) using a minimally invasive surgical technique (MIST) or flapless approach for the treatment of severe periodontal probing depths.
A systematic review of the literature including searches in PubMed/Medline, Cochrane Library, Google Scholar, and Grey Literature databases as well as manual searches was performed on September 1st, 2021. Studies utilising EMD in a non-surgical or minimally invasive approach were included. The eligibility criteria comprised randomised controlled trials (RCTs) comparing minimally-invasive/flapless approaches with/without EMD for the treatment of probing depths >5 mm.
From 1525 initial articles, 7 RCTs were included and 12 case series discussed. Three studies investigated a MIST approach, whereas 3 studies utilised a flapless approach. One study compared EMD with either a MIST or a flapless approach. The RCTs included ranged from 19-49 patients with at least 6 months of follow-up. While 5 of the studies included smokers, patients smoking >20 cigarettes/day were excluded from the study. The meta-analysis revealed that EMD with MIST improved recession coverage (REC) and bone fill (BF) when compared to MIST without EMD. However, no difference in CAL or PD was observed between MIST + EMD vs MIST without EMD. No statistically significant advantage was found for employing the EMD via the flapless approach.
Implementing EMD in MIST procedures displayed statistically significant improvement in REC and BF when compared to MIST alone. These findings suggest that MIST in combination with EMD led to improved clinical outcomes while EMD employed in nonsurgical flapless therapy yielded no clinical benefits when compared to nonsurgical therapy alone without EMD. More research is needed to substantiate these findings.
本系统评价和荟萃分析的目的是研究使用微创外科技术（MIST）或无瓣技术治疗重度牙周探诊深度的 EMD（釉基质衍生物）的临床疗效。
于 2021 年 9 月 1 日对文献进行了系统评价，包括在 PubMed/Medline、Cochrane 图书馆、Google Scholar 和灰色文献数据库中进行检索以及手动检索。纳入了使用 EMD 进行非手术或微创治疗的研究。纳入标准包括比较微创/无瓣方法与有无 EMD 治疗探诊深度>5mm 的随机对照试验（RCT）。
从 1525 篇初始文章中，纳入了 7 项 RCT 和 12 项病例系列讨论。3 项研究调查了 MIST 方法，3 项研究使用了无瓣方法。一项研究比较了 EMD 与 MIST 或无瓣方法。纳入的 RCT 范围从 19 到 49 例患者，随访时间至少 6 个月。虽然 5 项研究包括吸烟者，但每天吸烟>20 支的患者被排除在研究之外。荟萃分析显示，与不使用 EMD 的 MIST 相比，使用 EMD 的 MIST 可改善退缩覆盖（REC）和骨填充（BF）。然而，在 MIST+EMD 与 MIST 之间，CAL 或 PD 没有观察到差异。通过无瓣技术使用 EMD 没有发现统计学上的优势。
与单独使用 MIST 相比，在 MIST 中使用 EMD 可显著改善 REC 和 BF。这些发现表明，MIST 联合 EMD 可改善临床结局，而与单独使用非手术治疗相比，在无瓣治疗中使用 EMD 并未带来临床获益。需要更多的研究来证实这些发现。
