The role of enamel matrix derivatives in periodontal regeneration following tooth replantation/transplantation: a narrative review of post-reperfusion injury

Objective: The autogenous tooth transplantation and tooth replantation disrupt the original dental pulp and periodontal blood supply. Pulp necrosis post-reimplantation triggered inflammatory mediator leakage through the apical foramen, which stimulated periapical osteoclast activity and subsequent resorption of cementum, dentin, and alveolar bone. Successful outcomes thus depended critically on periodontal tissue regeneration. This review evaluated the therapeutic potential of enamel matrix derivatives (EMD) therein. Methods: A comprehensive search was conducted across multiple electronic databases, including PubMed, EMBASE (Ovid), Web of Science, EBSCO, Springer Link, Oxford Journals, and Science Direct. Following a comprehensive review of the literature, the authors subsequently summarized and evaluated: 1. Molecular mechanisms of EMD-mediated periodontal regeneration, 2. Preclinical and clinical validation in tooth transplantation/replantation models, and 3. Current limitations and future translational directions. EMD-key regulators of tooth root development-were known to mediate acellular cementum formation through conserved developmental pathways. Results: Emerging evidence confirmed that EMD promoted periodontal regeneration, particularly within the compromised healing microenvironment of transplanted/replanted teeth. EMD critically facilitated acellular cementum formation via established developmental pathways, thereby countering inflammatory resorption. Conclusion: EMD-based therapies showed potential to improve outcomes in autogenous tooth transplantation and replantation and replantation by mitigating inflammatory resorption and promoting functional periodontal regeneration.