Comparative Analysis of Enamel Matrix Proteins in Dental Development and Regenerative Applications: A Systematic Review and Meta-analysis

Background: Dental development, together with regenerative dentistry, depends heavily on three main enamel matrix proteins, including amelogenin, enamelin, and ameloblastin.The purpose of this systematic review and meta-analysis was to examine the effectiveness of enamel matrix derivative (EMD) proteins as a factor in periodontal regenerative therapy, specifically in terms of their effects on probing pocket depth (PPD) and clinical attachment level (CAL), in patients with chronic periodontitis who received these proteins. Methods: The literature search across databases was conducted up to June 2024. There were six randomized control trials (RCTs). The extraction of data was carried out independently, and the Cochrane Risk of Bias tool was utilized to measure the quality. The inverse variance method of meta-analysis was done with a random-effects model. Standardized mean difference (SMDs) at 95% confidence interval (CI) was calculated. Results: For PPD, the pooled SMD was 0.11 (95% CI: -0.20 to 0.42), with no statistically significant difference observed between the experimental and control groups. No major heterogeneity was noticed. In the case of CAL, there was no statistically significant difference as the pooled SMD was 0.06 (95% CI: -0.60 to 0.71). However, heterogeneity was substantial (I² = 84%, p < 0.01), reflecting inconsistent findings across studies. Discussion: There is no statistically significant benefit of EMD in comparison with traditional therapies in the enhancement of PPD or CAL. Although the results for PPD seem reliable, the high heterogeneity in CAL outcomes limits the transferability of findings.