Prognosis of Collagen Membrane with Xenograft versus Emdogain in the Treatment of Endo-Periodontal Lesions: A Systematic Review

Karina Esmeralda Aguilar-Salazar¹, Ahtziry Lisset Torres-Solis¹, Hugo Alejandro Bojórquez-Armenta², Oscar Eduardo Almeda-Ojeda³, Javier Antonio Garzón-Trinidad⁴, Ismael Duarte Velóz⁵, Lissett Herrera⁵, Yarely Guadalupe Ramos-Herrera^3*

¹Resident of Periodontics and Implantology Specialty Program, Faculty of Dentistry, Juarez University of Durango State, Durango 34000, México
²Department of Endodontics, Faculty of Dentistry, Juarez University of Durango State, Durango 34000, México
³School of Dentistry, Juarez University of the Durango State, Durango 34000, México
⁴Postgraduate Program in Endo-Periodontology, Faculty of Studies Iztacala, National Autonomous University of Mexico (UNAM). Tlalnepantla de Baz 54090, Estado de México, México
⁵Department of Periodontics and Implantology, Faculty of Dentistry, Juarez University of the State of Durango, México

*Correspondence author: Yarely Guadalupe Ramos-Herrera, DDS, MS, School of Dentistry, Juarez University of the State of Durango, Canoas s/n, Durango, Mexico; E-mail: [email protected]

Citation: Aguilar-Salazar KE, et al. Prognosis of Collagen Membrane with Xenograft versus Emdogain in the Treatment of Endo-Periodontal Lesions: A Systematic Review. J Dental Health Oral Res. 2025;6(2):1-9.

Copyright^© 2025 by Aguilar-Salazar KE, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Table 1: Characteristics of the included studies.

Discussion

Endo-periodontal defects represent a clinical challenge due to their complexity and the need for a comprehensive approach. These defects are difficult to treat because of their complex nature, involving both hard tissues (bone) and soft tissues (gingiva). The regeneration of both components is essential to restore the function and aesthetics of the affected teeth and therapies must address these two needs efficiently. The reviewed evidence confirms that both Emdogain® and collagen membranes with xenografts are effective, but their optimal indication varies depending on the type of defect and the clinical treatment objectives. The biomaterials used in regenerative therapy have been shown to significantly improve clinical outcomes and their selection should be based on individual criteria [9-11].  The use of collagen membranes combined with xenografts provides an ideal osteoconductive environment for hard tissue regeneration. Some studies highlight that this combination promotes the formation of new bone and improves long-term clinical stability [10-15,37-43]. This is particularly relevant in severe defects, where extensive bone loss occurs, as bone regeneration is crucial to prevent tooth loss and ensure long-term stability. Collagen membranes with xenografts have been extensively studied and their ability to stabilize clots, maintain space for regeneration and guide the formation of periodontal tissues has been well documented [12,42,43]. Their use is particularly indicated in complex defects, such as Type III and IV lesions, where structural bone regeneration is needed. In contrast, Emdogain®, derived from enamel matrix proteins, promotes regeneration by stimulating cementoblasts and periodontal fibroblasts, primarily acting on soft tissues and promoting periodontal regeneration through cellular activation and mineralization in the periodontal tissues. This has been widely documented, as evidenced by the works of Scuelan ,et al., and Bosshardt, [5-15]. Its application has shown aesthetic benefits and faster postoperative recovery, making it ideal for superficial defects or areas with aesthetic concerns or those requiring rapid healing [5,13,15,44]. A total of 24 clinical studies that met the inclusion criteria were analyzed. These studies compared the use of collagen membrane with xenografts versus the use of Emdogain® in the treatment of endo-periodontal defects, observing differences depending on the defect type and therapeutic modality.

Regarding the results based on the type of treatment:

• Collagen Membrane + Xenograft: In 12 included articles, a clinical attachment gain of 2 to 4 mm and a probing depth reduction of 2 to 5 mm were observed. Studies by Schwarz, et al., Artzi, et al., and Mellonig, et al., demonstrated new bone formation radiographically confirmed and in some cases, through cone beam computed tomography. Long-term stability (up to 36 months), less recurrence of periodontal pockets and structural bone regeneration, particularly in Type III and IV defects, were reported.
• Emdogain®: In 11 analyzed studies, Emdogain® achieved clinical improvements in attachment (1 to 3 mm) and reduced bleeding on probing. Additionally, healing was faster and patients reported greater postoperative comfort. According to Pilloni, et al., Froum, et al. and Zucchelli, et al., the regenerative effect was superior in superficial defects and more favorable aesthetic responses were observed compared to conventional techniques [1,9-15]

Results based on the type of defect treated:

• Type I and II Defects (superficial periodontal involvement): In 9 studies, Emdogain® showed higher effectiveness for achieving rapid healing and improving aesthetic and comfort parameters. The collagen membrane + xenograft was also effective, though with less impact on the soft tissues.
• Type III and IV Defects (deep lesions, angular bone loss and furcation involvement): In 14 studies, the use of collagen membrane with xenografts offered better bone regeneration, lower residual tooth mobility and greater clinical attachment gain compared to Emdogain® [10-15,37-44]

Although both treatments show promising results, the combination of both approaches could offer a synergistic solution, especially in defects involving both bone loss and soft tissue alterations. The choice between the two treatments may be influenced by factors such as gingival biotype, oral hygiene, probing depth, defect morphology and treatment cost [9-14]. Notably, some studies, such as those by Zucchelli, et al., and Trombelli, et al., propose the combined use of both strategies to leverage the synergistic benefits. These combined therapies may be especially useful in Type II-III defects, where both soft and hard tissue challenges coexist [33,45]. The main limitations of the studies include heterogeneity in methodologies, small sample sizes and the lack of unification in outcome variables. Additionally, the follow-up duration was variable, complicating long-term comparison. Therefore, randomized clinical trials with standardized follow-up and uniform clinical criteria for decision-making are recommended.

Conclusion

Both therapeutic modalities (Emdogain® and collagen membrane with xenograft) showed clinical efficacy in endo-periodontal defects, significantly improving parameters such as clinical attachment, probing depth and bleeding on probing. In severe defects (Type III and IV), the use of membranes with xenograft demonstrated better results in terms of bone regeneration, periodontal stability and long-term maintenance. In milder or superficial defects (Type I and II), Emdogain® proved to be more beneficial due to its rapid tissue integration, improved aesthetics and less postoperative inflammation. The choice of treatment should be individualized, considering the defect type, anatomical conditions, gingival biotype, aesthetic needs and patient expectations. It is recommended to conduct high-quality clinical studies with prospective designs and prolonged follow-up to establish more specific therapeutic guidelines and improve decision-making. Combined therapies could represent a promising alternative in complex defects, integrating the advantages of both bone and soft tissue regeneration.

Conflict of Interest

The authors declare that they have no conflicts of interest with the contents of the article.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Author Contributions

All authors contributed equally for this paper.

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