Enamel matrix derivative in the prevention and treatment of medication-related osteonecrosis of the jaws in rats.

The aim of this study was to evaluate the effectiveness of enamel matrix derivative (EMD) in preventing and treating medication-related osteonecrosis of the jaws (MRONJ). The study included 60 rats divided into five equal-sized groups. The preventive effect of EMD was evaluated in groups 1 (healthy control), 2 (bisphosphonate control), and 3 (bisphosphonate + EMD), and treatment efficacy was examined in groups 4 (osteonecrosis control) and 5 (osteonecrosis + EMD). Intraperitoneal zoledronic acid was administered to induce MRONJ, and the left mandibular molar teeth were extracted in all groups. Saline-impregnated absorbable collagen sponges (ACS) were placed in the extraction sockets of the control groups, and EMD-impregnated ACS were placed in the study groups. After 8 weeks of healing, histomorphometry, immunohistochemistry, and micro-CT analyses were performed. The rate of complete mucosal closure in the extraction socket was significantly higher in the EMD groups compared to the controls (P = 0.015 , P = 0.009). VEGF, OPG, and RANKL expression levels were higher in the EMD groups compared to their respective controls; however, this was only significant for group 3 vs group 2 (all P < 0.01). Micro-CT examinations demonstrated significantly improved values in the EMD groups compared to the controls. EMD administration may enhance soft and hard tissue healing in MRONJ cases, promoting angiogenesis and bone apposition and increasing levels of VEGF and OPG. EMD may be a potential agent for the prevention and treatment of osteonecrosis.