#Patientcomfort 09. Apr 2021

Wearing different hats – an interview with Dr. Richard Miron on the 25 years anniversary of Emdogain®

You can’t buy experience – you earn it. In its 25 years of commercial availability, Straumann® Emdogain® has earned the respect of thousands of periodontists, oral surgeons, implantologists and dentists around the world. Yes, in 2020 we celebrate its 25th anniversary from the first clinical use of Emdogain®. Since then, respected leaders in the field of regenerative dentistry have counted on Straumann® Emdogain® to improve the clinical outcome in various treatment indications. Some of them shared with us their experiences and personal consideration about the concepts of expertise and experience in this series of anniversary interviews. Our interview partner of today is Dr. Richard Miron, USA.

Currently you live in Florida, USA. Have you and your family always been based here?

No, I was born and raised in a small city in Northern Canada (North Bay, Ontario). It is a small city, very cold winters routinely experiencing colder than -40 degrees Celsius weather. When my parents retired, they moved to Florida and when I found out I would no longer freeze during the winter months, I moved as well.

What is one of your first childhood memories?

Honestly it sounds a bit cliché but playing hockey with my dad and brother on the lake out back of my house. Owing to the colder climate, every Canadian grows up playing hockey – it’s just part of our culture and I enjoyed these moments with my family and friends very much.

Did the little Richard Miron want to become a dentist?

Actually yes. When I was a kid, I used to draw images of me growing up to be a dentist any time I would have a tooth pulled. It was a bit strange granted none of my family members are dentists or even work in the dental industry but for whatever reason I always wanted to become a dentist.

I also enjoyed research and conducted many science fair projects as a young teenager competing both nationally and internationally (https://esemag.com/archive/0103/stockholm.html). This was the start of this enjoyable ride which continues as both a dentist and researcher.

“My early career was devoted primarily to research projects and I now work 3 days per week in private practice. It’s a nice blend and lifestyle and something I really enjoy. But most importantly, I’ve had great mentors to sort of ‘teach me’ how to balance this act.” R. Miron

What were the first obstacles you faced as student?

I’ve done a lot of schooling in my lifetime. It is something I truly enjoy and hope to continue to study all my life. Probably one of the most difficult things has been learning languages. I’ve studied in 4 different countries (and 4 different languages) and I was always more gifted in sciences and mathematics than in arts. It was tricky to always understand coursework but thankfully I got by.

You wear many hats: you’re a dentist and a molecular biologist; a clinician and a research investigator. How do you reconcile them all?

I’ve had many great mentors for which I could model my career after. They too wear many hats. In the majority of their careers, they also spent a good part of their early life (late 20s and 30s) doing research and developing new projects and research tracks that they could pursue throughout their careers. I did much the same where my early career was dedicated/devoted primarily to research projects and I now work 3 days per week in private practice. It’s a nice blend and lifestyle and something I really enjoy but most importantly I’ve had great mentors to sort of ‘teach me’ how to balance this act. Naturally, nevertheless, I work many hours, but I truly enjoy my work!

Looking back to your past projects, which ones bring back a proud smile?

Probably my textbook “Next Generation Biomaterials for Bone and Periodontal Regeneration” written with one of my best friends Dr. Yufeng Zhang and published by Quintessence in 2019. It reached the number 1 most sold textbook in the world last year – something we are both extremely proud of but more importantly it gathered 15 years of research that we have conducted. I met and collaborated with many great people during its writing which was also lots of fun.

“I believe biologics are the future of medicine. From this point of view, there is no protein-based product more utilized in dentistry than Emdogain®.” R. Miron

You have authored and co-authored over 200 publications and 5 years ago, you coordinated the review of the first 2 decades of Emdogain's clinical use. Why did you choose to explore Emdogain®?

I believe biologics are the future of medicine. From this point of view, there is no protein-based product more utilized in dentistry than Emdogain®. Thus early in my career, it was something that fully interested me and as a trained cell biologist, the effects of enamel matrix proteins on periodontal ligament cells were pronounced. At that time, one author who had published many articles in that field was Professor Dr. Anton Sculean. After meeting him, I had the opportunity of working within his department whereby I also collaborated on a number of projects with histologist Professor Dr. Dieter Bosshardt. Together, I believe we had one of the most experienced teams in the world researching enamel matrix derivative. When we met for the 20 year anniversary of Emdogain® at EuroPerio 2015 with some of the best researchers and clinicians around the world, it only made sense to summarize all that research in a publication on that topic1. That too was one of the highlights of my career as was personally meeting so many of the greats in our profession.

What do you think is the secret of Emdogain®’s success? Uniqueness, originality, experience?

Its scientific basis. Emdogain® was developed as a result of the histological observation that enamel matrix proteins were found at the dentinocemental junction prior to root development. Many years of research concluded that these proteins (those found in EMD) were responsible for cementogenesis and root formation during embryogenesis. A group of scientists then mimicked these events by using EMD for periodontal regenerative procedures by coating the root surface in a similar fashion to root development with positive outcomes. This work has been the basis for over 1000 peer-reviewed publications on the topic to date.

I believe what separates Emdogain® from the number of ‘novel’ or ‘newer’ but maybe less successful biomaterials/regenerative agents has been the accumulation of evidence and scientific data that supports Emdogain®. What I truly admire about Straumann is the continued commitment to scientific evidence and not simply launching biomaterials without adequate evidence to support their use.


Results from the early 90s demonstrated that enamel matrix proteins (which until then were considered enamel-specific proteins) were found also localized at the DCJ were the hypothesis for numerous subsequent investigations characterizing the role of EMPs in periodontal tissue differentiation (C = cementum, D = dentin, DCJ = dentinocemental junction, black arrow = EMD deposited on the root surface (ex vivo experiment), red arrow = enamel matrix proteins found localized at the DCJ). Reprinted with permission from Miron et al. 2016


What would you recommend to a dental specialist that just starts her/his career?

Follow the things that make you happy and that you are passionate about. Dentistry is a tough profession but also one with endless opportunities. My best advice is to pursue the areas of dentistry that you enjoy the most. This might be clinical activity, teaching, lecturing, research, mentoring or any combination of the above. Dentistry is an awesome profession, but you have to find what makes you happy!

And what would be one of the best advices that you received?

Experience living in other countries. Many cultures are different, practice dentistry differently, live differently, etc. Each journey is unique and will shape individuals, and this collection of ‘lessons learned’ will help as one progresses through life.

I’ve truly enjoyed living in many parts of the world and was mentored to go to Switzerland from Canada many years ago by one of my first supervisors. This changed my life dramatically and I can’t imagine my life otherwise.

Quick quiz:

Talent or experience?

Respect and work ethic! Talent will only get you so far…

Work hard or work smart?

Both!

Going faster alone or going far with a team?

Teamwork!


NBM particles were coated with A) EMD for 300 minutes (positive control); B) EMD for 5 minutes; C) EMD for 15 minutes, followed by addition of blood for 120 minutes; D) a premixture of EMD and blood in equal volumes for 30 minutes; E) blood for 15 minutes, followed by addition of EMD for 120 minutes; and F) NBM alone (negative control). Higher osteoblast and PDL cell attachment on EMD-coated surfaces when compared with control and blood-coated surfaces8. Reprinted with permission from Miron et al. 2012


Straumann® Emdogain® is a unique gel containing enamel matrix derivative of porcine origin. The main component is amelogenin, which has demonstrated the ability to stimulate certain cells types involved in the healing process of soft and hard tissues towards a regenerative pattern, thus leading to true periodontal regeneration2 and accelerated oral wound healing3. Emdogain® has a respected legacy as an irreplaceable tool for periodontology backed by extensive and long-term clinical documentation including studies with 10 years follow-up4,5. Over the past 25 years it has been used in over 2.5 million patients6 and it is documented in over 1,000 scientific publications, including over 600 clinical papers7 on various indications. For more information: click here.

References

  1. Miron RJ, Sculean A, Cochran DL, et al. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol 2016;43:668-683.
  2. Bosshardt DD. Biological mediators and periodontal regeneration: a review of enamel matrix proteins at the cellular and molecular levels. J Clin Periodontol. 2008;35(8 Suppl):87‐105.doi:10.1111/j.1600-051X.2008.01264.x.
  3. Miron RJ, Dard M, Weinreb M. Enamel matrix derivative, inflammation and soft tissue wound healing. J Periodontal Res. 2015 Oct;50(5):555-69.
  4. Sculean A, Kiss A, Miliauskaite A, Schwarz F, Arweiler NB, Hannig M. Ten-year results following treatment of intra-bony defects with enamel matrixproteins and guided tissue regeneration. J Clin Periodontol. 2008 Sep;35(9):817-24.
  5. McGuire MK, Scheyer ET, Nunn M. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue: comparison of clinical parameters at 10 years. J Periodontol. 2012 Nov;83(11):1353-62.
  6. Based on the number of syringes sold to date, globally.
  7. According to PUBMED search for “Emdogain” OR “enamel matrix derivative”.
  8. Miron RJ, Bosshardt DD, Hedbom E, et al. Adsorption of enamel matrix proteins to a bovine-derived bone grafting material and its regulation of cell adhesion, proliferation, and differentiation. J Periodontol 2012;83:936-947.