Evaluation of Long-Term Outcomes of Enamel Matrix Derivative in the Treatment of Peri-Implant Disease: A Systematic Review and Meta-Analysis

Enamel matrix derivative (EMD) has been proposed as an adjunctive treatment for peri-implantitis, a prevalent complication of dental implants characterized by inflammatory responses and progressive bone loss around the implant site. This study aimed to perform a systematic review and meta-analysis to evaluate the efficacy of EMD compared with control interventions in the treatment of peri-implantitis. A comprehensive literature search was conducted by two independent reviewers using a combination of Medical Subject Headings (MeSHs) and free-text terms. The search included three major electronic databases-Medline via PubMed, the Cochrane Library, and Embase-and studies published up to November 2024. The search aimed to identify relevant clinical trials assessing the long-term outcomes of EMD in peri-implantitis treatment. Out of an initial 54 articles identified, five met the inclusion criteria and were included in the meta-analysis. The pooled mean difference for probing depth reduction with EMD compared to controls was 0.88 (95% confidence of interval (CI): -1.26 to 2.02). The decrease in bleeding on probing yielded a pooled mean difference of 16.70 (95% CI: -4.93 to 38.32). For bone level gain, the pooled mean difference was 0.59 (95% CI: -0.01 to 1.19). This meta-analysis indicated that the most significant improvement with the use of EMD was observed in bone level gain with surgical approach. Moreover, the adjunctive use of EMD in the treatment of peri-implantitis may offer clinical benefits in reducing probing depth and bleeding on probing at the three-month evaluation. These findings support the consideration of EMD as a valuable adjunct in peri-implantitis treatment protocols, warranting further investigation through well-designed, long-term randomized controlled trials.