Indentistry,enamel matrix derivative (EMD) is an extract ofporcinefetal tooth material used tobiomimetically stimulate the soft and hardtissues surroundingteeth to regrow (in a process known as regeneration) following tissue destruction.
There are three hard tissues that comprise human teeth:enamel,dentin andcementum. The majority of the tooth structure is formed from dentin, and the enamel serves as the superficial layer of thecrown while the cementum serves to cover the root. In the mid-1990s, however, it was discovered that a very thin layer ofenamel actually exists between the dentin and cementum on the roots of adult human teeth. This led researchers to conclude that enamel matrix proteins (or EMPs) laid down byHertwig's epithelial root sheath serve as precursors to acellular cementum during its formation, known ascementogenesis.[1] The presence of acellular cementum acts to signal the development ofperiodontal ligament (PDL) fibers, followed by newalveolar bone, thus leading to the formation of the tissues of theperiodontium.[2]
Making use of this finding, enamel matrix derivative (EMD) was introduced in 1996. A commercially prepared and purified extract of enamel matrix proteins, EMD is composed primarily ofamelogenin and has been shown to promote PDL fibroblast proliferation and growth.[3] Based on the high degree ofhomology between porcine and human enamel proteins, it was decided to produce the EMD from fetal pigs.[4]
It was marketed as Emdogain by theSwedish company Biora, untilStraumann acquired Biora in 2003 and began producing it under the Straumann name.
It is still unclear exactly how EMD participates in the regeneration process.[5] But it has been demonstrated that EMD serves topromote periodontal ligament fibroblast proliferation and growth andinhibit epithelial cell proliferation and growth;[3] this is a key feature in EMD-promoted periodontal tissue regeneration, because the faster-growingepithelium will ordinarily compete very successfully for the space once occupied by the periodontal ligament and alveolar bone, leading to tissue repair as opposed to regeneration.
EMD mimics normal root development by stimulating release ofautocrinegrowth factors from periodontal ligamentundifferentiated mesenchymal cells.[6] EMD also stimulatesosteoprotegerin, serving to triggerosteoblasts and indirectly inhibit both osteoclastogenesis andosteoclastic function, both of which are important in attaining alveolar bone growth in the area of desired regeneration.[7]