Enamel Matrix Derivative (Emdogain) as Pulpotomy Agent in Primary Teeth

Resident: Swan

Article Title: Histological Evaluation of Enamel Matrix Derivative as a Pulpotomy Agent in Primary Teeth.

Author: Sabbarini, et al.

Journal: Pediatric Dentistry

Volume (Number): 29(6) 2007

Major Topic: Effect of enamel matrix derivative as pulpotomy agent in primary canines.

Main Purpose: to determine if EMD can be used to regenerate reparative dentin and safely enclose remaining radicular pulp after a pulpotomy on deeply decayed primary canines

Overview of method of research: Ten carious primary canines that were planned for serial extraction were selected. Chambers de-roofed and coronal pulp was removed using spoon excavator. Hemostasis obtained, then amputated pulpal stumps were covered with Emdogain gel and then GI cement. 3 teeth extracted after 1 week, 3 after 2 weeks, and 4 after 6 months. Extracted teeth were fixed in formalin and cut into buccal-lingual sections and observed for 1) dentin bridge formation, 2) odontoblastic layer integrity, 3) pulp inflammation, and 4) pulp calcification.

Findings: teeth extracted after 1 week showed pulpal surfaces lined by a thin, nearly continuous cellular layer. Generalized congestion and increased angiogenesis noted in deeper parts of pulp tissue. Teeth extracted after 2 weeks showed small islands of dentin-like tissue at different stages of mineralization. These islands tended to coalesce together. The teeth extracted at 6 months showed different histological patterns; most demonstrated coalescing islands of dentin-like material trying to bridge the width of the coronal pulp. This was accompanied by deposition of reparative dentin along pulpal walls, narrowing the pulp canal. Some areas showed a thick, infiltrating layer of cellular condensation with massive distribution of reparative dentin. One tooth showed small dentin islands that didn’t completely bridge the site.

Key Points/Summary: In agreement with other studies, this study confirms that EMD initiates the process of pulpal regeneration and repair in the area of a wound. This process is similar to classic wound healing. The formation of new dentin starts some distance from the site of amputation.

EMD may

1) Act as a signal for induction of odontoblast differentiation, maturation, and mineralization

2) Form a stable extracellular matrix that provides a beneficial, protective environment for the pulp

Assessment of Article: The idea of renerating pulp tissue and inducing dentin formation is intriguing, and I appreciate the innovative concept at work here. But the real benefit of this treatment wasn’t clear to me because 1. There was no control to compare the Emdogain-treated teeth to (using either formo or some other agent) and 2. The sample size is so small (10 teeth). Future tests using similar inductive agents will hopefully clarify this.