The adjunctive use of enamel matrix derivatives in non-surgical periodontal therapy: A systematic review and meta-analysis of evidence from the last decade

Aim This review evaluates the evidence from the past decade on the use of enamel matrix derivative (EMD) as an adjunct to non-surgical periodontal therapy. Materials and methods A systematic review of the literature was conducted following PRISMA guidelines. Six randomized controlled trials involving 201 patients met the inclusion criteria. Qualitative synthesis was performed for all included studies, while quantitative meta-analysis was conducted for outcomes with sufficiently comparable data. Results The combination of EMD with scaling and root planing (SRP) yielded only modest improvements, primarily in clinical attachment level (CAL), bleeding on probing (BOP) reduction and occasional pocket closure. Outcomes for probing depth (PPD), inflammatory markers, microbiological parameters and radiographic bone loss were inconsistent and showed no clear benefit over SRP alone. Quantitative synthesis demonstrated small, non-significant effects for CAL and PPD outcomes, with heterogeneity varying across analyses. Conclusions The available evidence suggests that EMD as an adjunct to SRP may offer limited benefits, particularly in residual deep pockets. However, current data do not support its routine use as an alternative to surgical regeneration. Standardized, long-term studies are required to define its non-surgical regenerative potential.