dentistry Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions o ...

, enamel matrix derivative (EMD) is an extract of

porcine The pig (''Sus domesticus''), often called swine, hog, or domestic pig when distinguishing from other members of the genus '' Sus'', is an omnivorous, domesticated, even-toed, hoofed mammal. It is variously considered a subspecies of ''Sus ...

fetal A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal develo ...

tooth material used to

biomimetic Biomimetics or biomimicry is the emulation of the models, systems, and elements of nature for the purpose of solving complex human problems. The terms "biomimetics" and "biomimicry" are derived from grc, βίος (''bios''), life, and μίμησ ...

ally stimulate the soft and hard tissues surrounding

teeth A tooth ( : teeth) is a hard, calcified structure found in the jaws (or mouths) of many vertebrates and used to break down food. Some animals, particularly carnivores and omnivores, also use teeth to help with capturing or wounding prey, tear ...

to regrow (in a process known as regeneration) following tissue destruction.

Discovery of EMP's role in cementogenesis

There are three hard tissues that comprise human teeth: enamel,

dentin Dentin () (American English) or dentine ( or ) (British English) ( la, substantia eburnea) is a calcified tissue of the body and, along with enamel, cementum, and pulp, is one of the four major components of teeth. It is usually covered by ena ...

and

cementum Cementum is a specialized calcified substance covering the root of a tooth. The cementum is the part of the periodontium that attaches the teeth to the alveolar bone by anchoring the periodontal ligament.Illustrated Dental Embryology, Histology, a ...

. The majority of the tooth structure is formed from dentin, and the enamel serves as the superficial layer of the

crown A crown is a traditional form of head adornment, or hat, worn by monarchs as a symbol of their power and dignity. A crown is often, by extension, a symbol of the monarch's government or items endorsed by it. The word itself is used, partic ...

while the cementum serves to cover the root. In the mid-1990s, however, it was discovered that a very thin layer of enamel 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 by

Hertwig's epithelial root sheath The Hertwig epithelial root sheath (HERS) or epithelial root sheath is a proliferation of epithelial cells located at the cervical loop of the enamel organ in a developing tooth. Hertwig epithelial root sheath initiates the formation of dentin ...

serve as precursors to acellular cementum during its formation, known as

cementogenesis Cementogenesis is the formation of cementum, one of the three mineralized substances of a tooth. Cementum covers the roots of teeth and serves to anchor gingival and periodontal fibers of the periodontal ligament by the fibers to the alveolar bone ( ...

. The presence of acellular cementum acts to signal the development of

periodontal ligament The periodontal ligament, commonly abbreviated as the PDL, is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits. It inserts into root cementum one side and onto alveolar b ...

(PDL) fibers, followed by new

alveolar bone The alveolar process () or alveolar bone is the thickened ridge of bone that contains the tooth sockets on the jaw bones (in humans, the maxilla and the mandible). The structures are covered by gums as part of the oral cavity. The synonymous t ...

, thus leading to the formation of the tissues of the

periodontium The periodontium is the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. The word comes from the Greek terms περί ''peri''-, meaning "around" and -''odont'', meaning "tooth" ...

Enamel matrix protein and its derivative

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 of

amelogenin Amelogenins are a group of protein isoforms produced by alternative splicing or proteolysis from the ''AMELX'' gene, on the X chromosome, and also the ''AMELY'' gene in males, on the Y chromosome. They are involved in amelogenesis, the developme ...

and has been shown to promote PDL fibroblast proliferation and growth.Sculean A, ''et al.'' The application of an enamel matrix protein derivative (Emdogain) in regenerative periodontal therapy: A review. ''Med Princ Pract'' 2007;16:167-80. Based on the high degree of

homology Homology may refer to: Sciences Biology *Homology (biology), any characteristic of biological organisms that is derived from a common ancestor * Sequence homology, biological homology between DNA, RNA, or protein sequences *Homologous chrom ...

between porcine and human enamel proteins, it was decided to produce the EMD from fetal pigs. It was marketed as Emdogain by the

Swedish Swedish or ' may refer to: Anything from or related to Sweden, a country in Northern Europe. Or, specifically: * Swedish language, a North Germanic language spoken primarily in Sweden and Finland ** Swedish alphabet, the official alphabet used by ...

company Biora, until Straumann acquired Biora in 2003 and began producing it under the Straumann name.

Mechanism of action

It is still unclear exactly how EMD participates in the regeneration process. But it has been demonstrated that EMD serves to ''promote'' periodontal ligament fibroblast proliferation and growth and ''inhibit'' epithelial cell proliferation and growth; this is a key feature in EMD-promoted periodontal tissue regeneration, because the faster-growing

epithelium Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellul ...

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 of

autocrine Autocrine signaling is a form of cell signaling in which a cell secretes a hormone or chemical messenger (called the autocrine agent) that binds to autocrine receptors on that same cell, leading to changes in the cell. This can be contrasted with p ...

growth factor A growth factor is a naturally occurring substance capable of stimulating cell proliferation, wound healing, and occasionally cellular differentiation. Usually it is a secreted protein or a steroid hormone. Growth factors are important for regu ...

s from periodontal ligament undifferentiated mesenchymal cells. EMD also stimulates

osteoprotegerin Osteoprotegerin (OPG), also known as osteoclastogenesis inhibitory factor (OCIF) or tumour necrosis factor receptor superfamily member 11B (TNFRSF11B), is a cytokine receptor of the tumour necrosis factor (TNF) receptor superfamily encoded by the ...

, serving to trigger

osteoblast Osteoblasts (from the Greek language, Greek combining forms for "bone", ὀστέο-, ''osteo-'' and βλαστάνω, ''blastanō'' "germinate") are cell (biology), cells with a single Cell nucleus, nucleus that synthesize bone. However, in the p ...

s and indirectly inhibit both osteoclastogenesis and

osteoclast An osteoclast () is a type of bone cell that breaks down bone tissue. This function is critical in the maintenance, repair, and remodeling of bones of the vertebral skeleton. The osteoclast disassembles and digests the composite of hydrated pro ...

ic function, both of which are important in attaining alveolar bone growth in the area of desired regeneration.He J, ''et al.'' Emdogain promotes osteoblast proliferation and differentiation and stimulates osteoprotegerin expression. ''Oral Surg Oral Med Oral Pathol Oral Radiol Endod'' 2004;97:239-45

References

External links

Straumann - Emdogain
{{Periodontology Periodontology