RESULTS OF CLINICAL STUDY OF COMPLEX TREATMENT OF GENERALIZED PERIODONTITIS WITH THE USE OF STRONTIUM DRUGS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

The most significant periodontal disorders associated with diabetes mellitus are due to changes in bone tissue. It has become necessary for specific osteotropic therapy that can normalize metabolic processes in the alveolar bone. In turn, currently the most promising in terms of improving osteogenic activity are strontium ions. Strontium ranelate is used to treat osteoporosis due to its antiresorptive and osteoanabolic action. However, its effectiveness against alveolar bone has not been sufficiently studied. The purpose of the work is to conduct a clinical study of complex treatment of generalized periodontitis, supplemented with strontium ranelate, in patients with type 2 diabetes mellitus. Materials and methods of the research. The study included 60 patients with generalized periodontitis of I-II degree of severity, chronic course, aged 35-45 years. Type 2 diabetes mellitus was diagnosed and two groups were formed. The traditional treatment regimen was used in the group of comparison (main group) where Strontium Ranelate was prescribed additionally. The treatment was evaluated according to the dynamics of clinical observations, orthopantomography and computed tomography data, the results of biochemical studies. As markers of bone resorption, tartrate-resistant acid phosphatase (TRAP) activity was determined in blood serum and the content of β-CrossLaps fragments was determined in urine. As markers of osteogenesis, the concentration of C-terminal propeptide type I procollagen (CICP) was detected in blood plasma, bone alkaline phosphatase (BAP) and osteocalcin were detected in serum. Serum parathyroid hormone concentrations, total blood calcium and total inorganic phosphorus in the blood were studied as indicators of mineral metabolism. Results of the research. In the earliest possible timeframe the complex treatment of generalized periodontitis was conducted during the observation which led to clinical stabilization of the inflammatorydestructive process in the periodontal tissues without a significant difference between the experimental groups (p ˃ 0.05). However, the condition of periodontal tissues in patients of the experimental groups differed in a year after treatment. In 16.7% of patients from the comparison group, recurrence of the inflammatory-destructive process in periodontal tissues was diagnosed, while the cases the deterioration of the pathological process was not detected in the main group. A significant difference was found for complex periodontal indices (Ramfjord, PI and SPITN) (p <0.05). Clinical and radiological stabilization was observed in 83.3% of patients of the comparison group and in 100% in the main group. According to the results of computed tomography of the alveolar bone, an increase in bone mineral density was established in both groups, but only in the main group the difference between indices before and after treatment was significant (p˂0.05). In patients of the main group a more pronounced decrease in the activity of tartrate-resistant acid phosphatase (TRAP) was found in the serum and the concentration of β-CrossLaps was found in the urine, indicating inhibition of bone resorption, as well as markers of bone formation the concentration of C-terminal propeptide (CICP) was found in blood plasma, bone alkaline phosphatase (BAP) was found in serum, osteocalcin (p <0.05). Indicators of mineral metabolism in bone tissue, both during treatment and for experimental groups, almost did not differ (p> 0.05). Thus, the use of strontium drugs in the complex treatment of generalized periodontitis in patients with type 2 diabetes mellitus provides a longer and more stable clinical and radiological stabilization of the pathological process in periodontal tissues, primarily by inhibiting bone resorption and enhancing osteogenesis. So, they can be recommended for the wide use in stomatological practice.

Implications of the use of Strontium Ranelate (SRAN) in periodontics, dental implantology, oral surgery, orthodontics and endodontics and its possibility of application as storage media for avulsed teeth

Dental avulsion is still public health problem and tooth replantation has important unsuccess rates due to root resorption. Strontium ranelate (SRAN) presents antiresorptive property on the bone tissue and stimulates bone formation. So we aimed to comprehensively review the literature to 1- understand the mechanism of action of SRAN regarding to its propaedeutic in periodontics, dental implantology, oral surgery, orthodontics and endodontics, 2- present the current scientific knowledge about the SRAN efficiency on tooth avulsion; 3- observe fails and gaps in the literature and open up for unexplored ideas for SRAN uses and applications. An electronic search was performed crossing the key words ‘strontium ranelate’, ‘periodontics’, ‘dental implantology’, ‘oral surgery’, ‘orthodontics’ and ‘endodontics’, PubMed/Medline, Lilacs and BBO electronic databases were searched for research articles, reviews of literature, animal laboratory studies and laboratory studies, which had been published in English until July 2020. Twenty-five articles fulfilled the inclusion and exclusion criteria. The available literature demonstrates that SRAN provides a really better propaedeutic on the bone tissue and that the topical applications show a lower risk of side effects. That open up new perspectives and for the use of SRAN as a potential storage media for avulsed teeth.

COMPARISON BETWEEN STRONTIUM RANELATE AND METAL SUBSTITUTED HYDROXYAPATITE AS GRAFTING MATERIALS IN TREATMENT OF PERI-IMPLANT BONY DEFECTS WITH IMMEDIATE IMPLANTS (CLINICAL AND EXPERIMENTAL STUDY)

Objective:The aim of this study is to compare between both of strontium ranelate and metallic substitute of hydroxyapatite as grafting materials in the treatment of peri-implant bony defects with immediate placement of dental implant in type I extraction sites within maxillary esthetic zone among clinical and experimental levels. This assessment was based on clinical, radiographic and histological studies. Subjects and Methods: The present study was carried on two types of population among both experimental levels on experimental white albinus rabbits and on clinical level among human patients for replacement of non-restorable maxillaryanterior and/or premolar teeth within esthetic zone by immediate implant. A written informed consent was obtained from all patients before their participation in this study.Patients were classified into two groups: the first one was with five patients with non-restorable maxillary anterior or premolar tooth that was treated by an immediately placed implant in conjunction with metallic substituted hydroxyapatite while the second one was treated by an immediately placed implant in conjunction with strontium ranelate as grafting material.The second sample population of study was carried out among ten male white (newzland) experimental rabbits with average body weight between 2.5 and 3 KG and within suitable environmental conditions in Medical Experimental Research Center (MERC) in faculty of medicine, Mansoura University. All rabbits sample was also divided equally and randomly in two groups with five rabbits within each one by the same criteria as mentioned where the first group was composed of five rabbits that received dental implant within intentionally made defect in tibia by trephine bur in conjunction with metallic substituted hydroxyl apatite as grafting material within gap between implant and defect and the second group was with the same criteria and procedures with strontium ranelategafting material within the defect. Pre-oparative photographs and cone beam computed topography (CBCT) were taken for study sample population. Within clinical patients, immediately paced dental implant have been placed in anterior esthetic zone with bone grafting around dental implant according to each group, Immediate CBCT and implant stability measurements has been taken after surgery followed by six months follow-up period to evaluate marginal bone loss, bone density, papillary esthetic score, implant stability and probing depth around dental implants. While within experimental animals trephine bur was used to intentionally create the bony defect that will simulate defect around immediate dental implant with grafting material around according to each group with six months follow-up to evaluate marginal bone loss, implant stability,bone density and for histological examination around implant within grafted area. All data were collected and statistically analyzed. Results:Generally among both clinical and experimental levels within both of clinical patients and experimental rabbits, metal substituted hydroxyl apatite (MSHAP) showed better results with significant difference than that presented in other group that has received Strontium ranelate (Sr) as a grafting material to fill the bony marginal gap around immediate dental implant during six months follow-up study period. Results presented high difference of significance between two groups in experimental and clinical levels in concern with both implant stability, marginal bone loss and even in bone quality and denisty when measured after six months follow-up. On the other hand there was no significant difference in concern with soft tissue response after six months in relation with peri-implant probing depth and MSHAP showed slight better results than that of Sr in records of papillary esthetic scores among clinical patients. Histological results showed better response of surrounding bony tissues towards MSHAP than that of Sr with more affinity of osteoblasts and osteocytes to the site of the grafted area. Conclusions:Metallic substituted hydroxyl-apatite (MSHAP) with its additive magnetic molecules within hydroxyapatite structure has better bony response from surrounding bony tissues than that provided by Strontium Ranelate (Sr) according to bone filling and preservation with less marginal loss, more affinity of new osteoblasts and mature osteocytes, long term implant stability after grafting and better bone density and quality at the grafted area around immediate dental implants in anterior maxillary area.

Elemental Mapping Of Bone Strontium In Rats Treated With Strontium Ranelate And Strontium Citrate Using 2D Micro-XRF And 3D Dual Energy K-edge Subtraction X-ray Imaging

Strontium-based medications, such as strontium ranelate, have been shown to have therapeutic effects in the treatment of osteoporosis, other strontium salts are assumed to have similar effects on bone health. The objective of this study was to compare the distribution of strontium in animal bones following administration of strontium ranelate and strontium citrate. Humerus bones were collected from female Sprague-Dawley rats that were dosed daily over ten weeks with strontium ranelate and strontium citrate, and no strontium (control). Bones were imaged using 2D micro-XRF and 3D dual energy KES X-ray imaging. The 2D imaging revealed differences in strontium and calcium levels between samples from treated and non-treated animals (푝 < 0.001). 3D images obtained showed that strontium was observed to be largely present in the trabecular regions under the epiphyseal plate with concentrations of approximately 5 to 15 mg/cm3 in the bones of both strontium treated groups. The thickness of the strontium layers below the growth plate in both the strontium ranelate and strontium citrate sample were not significantly different (푝 = 0.9201). Both imaging studies performed in this work showed that strontium from both salts is heterogeneously distributed in newly formed bone during treatment.

Elemental Mapping Of Bone Strontium In Rats Treated With Strontium Ranelate And Strontium Citrate Using 2D Micro-XRF And 3D Dual Energy K-edge Subtraction X-ray Imaging

Strontium-based medications, such as strontium ranelate, have been shown to have therapeutic effects in the treatment of osteoporosis, other strontium salts are assumed to have similar effects on bone health. The objective of this study was to compare the distribution of strontium in animal bones following administration of strontium ranelate and strontium citrate. Humerus bones were collected from female Sprague-Dawley rats that were dosed daily over ten weeks with strontium ranelate and strontium citrate, and no strontium (control). Bones were imaged using 2D micro-XRF and 3D dual energy KES X-ray imaging. The 2D imaging revealed differences in strontium and calcium levels between samples from treated and non-treated animals (푝 < 0.001). 3D images obtained showed that strontium was observed to be largely present in the trabecular regions under the epiphyseal plate with concentrations of approximately 5 to 15 mg/cm3 in the bones of both strontium treated groups. The thickness of the strontium layers below the growth plate in both the strontium ranelate and strontium citrate sample were not significantly different (푝 = 0.9201). Both imaging studies performed in this work showed that strontium from both salts is heterogeneously distributed in newly formed bone during treatment.