Miron Richard J, Shirakata Yoshinori, Ahmad Paras, Romandini Mario, Estrin Nathan E, Farshidfar Nima, Bosshardt Dieter D, Sculean Anton
Department of Periodontology, University of Bern, Bern, Switzerland.
Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Periodontol 2000. 2025 Jun 3. doi: 10.1111/prd.12635.
The use of growth factors (GFs) has become a cornerstone of modern regenerative periodontology. While the extent to which GFs enhance tissue regeneration compared to other biomaterials was initially uncertain, it is now well established that GFs play a critical role in the regeneration of various tissue types. In the context of periodontal regeneration, enamel matrix derivative (EMD/Emdogain) has been a key biomaterial for over 30 years. Pioneering work by Lars Hammarström in the mid-1990s led to a wealth of publications on the clinical concept of mimicking tooth development to promote periodontal regeneration. This approach has been shown to induce the formation of new cementum, with functionally oriented periodontal ligament fibers and new alveolar bone. This review begins with an overview of the biological basis of EMD, highlighting its role as a protein (primarily amelogenins) and growth factor complex that initiates and mimics tooth development. Subsequently, histological evidence from animal and human studies using EMD is presented, alongside a discussion of ongoing research avenues. Clinical outcomes are then narratively reviewed, focusing on EMD safety, early wound healing properties, and applications in various scenarios, including non-surgical periodontal therapy, intra-bony and furcation defects, periodontal regeneration, and as an adjunct to soft-tissue grafting. The use of EMD has gained tremendous evidence over the past 30 years as a GF capable of enhancing both hard and soft tissue regeneration in periodontal therapy.
生长因子（GFs）的应用已成为现代再生牙周病学的基石。虽然与其他生物材料相比，生长因子在多大程度上能增强组织再生最初并不确定，但现在已明确生长因子在各种组织类型的再生中起着关键作用。在牙周再生领域，釉基质衍生物（EMD/Emdogain）在过去30多年里一直是一种关键的生物材料。20世纪90年代中期拉尔斯·哈马斯特伦的开创性工作引发了大量关于模仿牙齿发育以促进牙周再生这一临床概念的出版物。这种方法已被证明能诱导形成新的牙骨质，并伴有功能导向的牙周韧带纤维和新的牙槽骨。本综述首先概述EMD的生物学基础，强调其作为一种启动和模仿牙齿发育的蛋白质（主要是釉原蛋白）和生长因子复合物的作用。随后，展示了使用EMD的动物和人体研究的组织学证据，并讨论了正在进行的研究途径。接着对临床结果进行叙述性综述，重点关注EMD的安全性、早期伤口愈合特性以及在各种情况下的应用，包括非手术牙周治疗、骨内和根分叉缺损、牙周再生以及作为软组织移植的辅助手段。在过去30年里，作为一种能够增强牙周治疗中软硬组织再生的生长因子，EMD的应用已获得了大量证据。
