Enamel matrix proteins and their application in bone tissue regeneration. A Review.

Current treatment options for skeletal repair (alloplastic materials, bone grafts, etc.) bave significant limitations, especially in elderly subjects. However, bone tissue engineering seems to provide a solution for reconstructing criticai size bone defects. Many of thè current regenerative medicine solutions developed rely on products that combine biological agents, such as cells or biomolecules (1). In dentistry, Enamel matrix proteins (EMP) bave been successfully employed to promote wound healing of severe infrabony periodontal defects with regeneration of periodontal ligament, cementimi and alveolar bone (2-4). The purpose of this review is to evaluate thè ability of enamel matrix proteins to promote bone tissue formation and shed light on their possible application in skeletal regenerative medicine. A systematic literature search in electronic databases (PubMed and Cochrane Library) was conducted, using thè following search term combination: 'Amelogenins' or 'Enamel Matrix Proteins' or 'Enamel Matrix Derivative' and Osteoblast' or 'Bone' or 'Mineralized Tissue' or 'Tissue Regeneration'. Publications were considered for systematic review if they were published beforel January 2015 in English language and were Hsted as reference in selected articles. Articles were excluded ìf they were without histomorphometric analysis or quantitative analysis of calcium deposits in vitro, written in languages other than English, clinical and/or animai periodontal regeneration studies, in vivo and in vitro tooth/root developmental studies (with ameloblasts or cementoblasts or odontoblast). Assessment of thè methodological quality of thè studies and data extraction were carried out by three authors. A total of 405 articles were found. Only 23 publications, 15 in vìvo and 8 in vitro studies, respected thè inclusion criteria and were used for this review. The EMD osteoinductive property appears to be questionable and unclear if thè produci is used in bone tissue regeneration. In thè in vivo reviewed articles, thè best results were recorded in thè presence of restraints and not in large or criticai size defects, whereas EMD showed some osteopromotion in thè early healing phases. Encouraging data are given on thè use of Synthetic Peptide (SP) and recombinant amelogenins. Based on these data, it is necessary to carry out further investigation usìng amelogeninbased compounds or with their active peptides with known composition and concentration. This would help to standardize thè results by increasing thè effectiveness of thè work in order to better clarify thè role and thè possible applications of amelogenins in bone tissue regeneration.