Pre-Clinical Study: Immunohistochemical evaluation of matrix metalloproteinase-13 on rabbit (Oryctolagus cuniculus) socket healing after application of platelet-rich fibrin with and without hydroxyapatite

Background: Tissue engineering technology has been used globally and proven to accelerate wound healing. This study aimed to analyse the effect of adding hydroxyapatite (HA) as a scaffold to platelet-rich fibrin (PRF) as a growth factor in accelerating the wound healing process as seen from the expression of matrix metalloproteinase-13 (MMP-13). Methods: This research is an animal experiment conducted on 18 rabbits (Oryctolagus cuniculus). Rabbits were randomly divided into the following three groups of treatment: (G1) the application of PRF group, (G2) the application of PRF+HA group and (C) the control group without any application. Furthermore, each treatment group was split randomly into three groups of observation time. Periodontal tissue biopsy was performed to analyse the histopathological features that were examined on the basis of the level of MMP-13 immunoexpression. Results: MMP-13 immunoexpression in the PRF+HA group showed better histoscore results, indicating a substantial reduction in MMP-13 values compared with other groups. The healing process was shown to increase with increasing observation time (p<0.05), and the PRF+HA group outperformed the PRF and control groups. On day 3, MMP-13 exhibited a dark brown colour of Immunohistochemistry (IHC), which indicated an increase in the expression value of MMP-13 in the early stages of healing, namely, inflammation. On day 14, light brown IHC was seen, especially in group 2, as a reference that the remodeling process had begun. Conclusions: This study indicates that the application of HA can accelerate the socket healing process by decreasing the level of immunoexpression of MMP-13. HA is an alloplastic material that has inherent bioactive properties that support osteoconduction, which functions as a scaffold in the form of a fibrin matrix that can bind MMPs so that it can accelerate the wound healing process.

Mechanism of bisphosphonate-related osteonecrosis of the jaw (BRONJ) revealed by targeted removal of legacy bisphosphonate from jawbone using equilibrium competing inert hydroxymethylene diphosphonate

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) presents as a morbid jawbone lesion in patients exposed to a nitrogen-containing bisphosphonate (N-BP). Although it is rare, BRONJ has caused apprehension among patients and healthcare providers and decreased acceptance of this anti-resorptive drug class to treat osteoporosis and metastatic osteolysis. We report here a novel method to elucidate the pathological mechanism of BRONJ by the selective removal of legacy N-BP from the jawbone using an intra-oral application of hydroxymethylene diphosphonate (HMDP) formulated in deformable nanoscale vesicles (DNV). After maxillary tooth extraction, zoledronate-treated mice developed delayed gingival wound closure, delayed tooth extraction socket healing and increased jawbone osteonecrosis consistent with human BRONJ lesion. Single cell RNA sequencing of mouse gingival cells revealed oral barrier immune dysregulation and unresolved pro-inflammatory reaction. HMDP-DNV topical applications to nascent mouse BRONJ lesions resulted in accelerated gingival wound closure and bone socket healing as well as attenuation of osteonecrosis development. The gingival single cell RNA sequencing demonstrated resolution of chronic inflammation by increased anti-inflammatory signature gene expression of lymphocytes and myeloid-derived suppressor cells. This study suggests that BRONJ pathology was predominantly induced by the oral N-BP and demonstrates the potential of HMDP-DNV as an effective BRONJ therapy.

Physics Forceps in Tooth Extraction—A Systematic Review of Randomized Controlled Trials

The present systematic review aims to evaluate the efficiency of Physics forceps over the conventional forceps for the extraction of a tooth. The study began with targeted electronic searches of MEDLINE, PubMed, Cochrane, Science Direct and Google Scholar databases. All selected articles were reviewed by four independent reviewers for eligibility. The Cochrane Risk of Bias tool was used to analyze the studies for bias. Due to heterogeneity of the selected studies, a meta-analysis of the current systematic review was not possible. A total of five studies were considered for the final analysis. The risk of bias showed high risk for all five included articles. Various parameters, such as fracture of the root, dry socket, healing, pain, postoperative infection, crown fractures, buccal bone fractures, extraction time, gingival and marginal bone loss, gingival laceration, bleeding and healing were assessed. Based on the data available, there is an insufficient quality of evidence to conclude the superiority of the Physics forceps over conventional forceps.

The effect of Persea americana Mill. seed extract on inflammatory cells and fibroblast formation in tooth extraction socket healing

Background: Inflammatory cells and fibroblasts have an essential role in the wound healing process. Persea americana Mill. seed categorises as a waste; it contains rich nutrients that can accelerate wound healing activity. Purpose: This study aims to determine the effect of Persea americana Mill. seed against inflammatory cells and fibroblast formation in tooth extraction socket healing. Methods: Ninety-six Sprague Dawley rats had their lower left molars removed. Forty-eight rats tested for inflammatory cells were divided into four groups: negative control group (IC1), positive control group (IC2), Persea americana Mill. seed extract concentrations of 50% (IE1) and 90% (IE2). Another 48 rats used for fibroblast were divided into three groups: the control group (FC1), Persea americana Mill. seed concentrations of 50% (FE1) and 90% (FE2). The gel was applied to the socket under general anaesthesia. Four rats from each group were decapitated for histopathological tissue preparations with Haematoxylin Eosin (HE) staining on the 3rd, 5th and 7th days for inflammatory cells and the 3rd, 5th, 7th and 14th days for fibroblast formation. The preparations for each research were scored under the microscope at 40x magnification. The obtained data was analysed using the Kruska—Wallis and the Mann—Whitney test. Results: A significant decrease (p<0.05) of inflammatory cells in IE2 on the 5th and 7th day. A significant increase (p<0.05) of fibroblast formation between treatment and control groups and no significant difference (p>0.05) between FE1 and FE2 was based on the interval days. Conclusion: Persea americana Mill. seed extract can decrease the inflammatory cells and accelerate the fibroblast formation in tooth extraction socket healing.

Platelet-rich fibrin to manage different periodontal defects combine with Flap surgery and other uses in dentistry. A descriptive review

In these days, periodontal diseases are very much common in Asian subcontinent especially in Bangladesh, due to some relevant factors that is more prevalent in this country. Most of the time patient neglect their condition and ultimately loss their teeth. Even after doing phase 1 therapy that is scaling, polishing with antimicrobial agents, it could not heal the periodontal condition with advanced bone destruction or clinical attachment loss. Therefore, after proper oral hygiene maintenance therapy, different flap surgery should consider. . In recent study, it is found that platelet rich fibrin (PRF) PREPARED From the patient’s Own blood and then placement within defect could enhance the early healing procedure. This PRF membrane is also used in a variety of discipline in dentistry, including regenerative surgery. This PRF membrane is now used in a variety of disciplines in dentistry, including regenerative surgery and enhancing early healing. The goal of this study is to critically analyze and appraise the currently available research with an emphasis on the use of PRF in regenerative periodontal surgery. An electronic search was conducted (PubMed/MEDLINE, Google Scholar, BanglaJOL, Cochrane library). Various combinations of the following keywords were used: ‘prf’, ‘prf membrane’, ‘periodontal regenerative surgery’, ‘prf in dentistry’, ‘systemic diseases and periodontitis’, ‘drawback of prf’, ‘platelet-derived growth factors’, ‘prf in oms’, ‘prf in orthodontics’. Articles were searched until August 2021 All of these studies reveal that the PRF membrane enhances the healing of various defects in a variety of periodontal diseases and in several fields of dentistry. Studies are going on pulp regeneration and socket healing after extraction with PRF in dentistry. More emphasis should have to give to the prevention of periodontal diseases as well as more concern should have to give on PRF with flap surgery to enhance healing and improve the social health of the general population by preventing tooth loss and for different research purposes on PRF in different other fields of dentistry in Bangladesh. Update Dent. Coll. j: 2021; 11(2): 43-51

Alveolar socket healing in 5-lipoxygenase knockout aged female mice treated or not with high dose of zoledronic acid

This study investigated the role 5-lypoxigenase (5-LO) on alveolar socket healing in aged female mice treated with zoledronic acid (ZL). Forty 129/Sv female mice (64–68 weeks old), 20 wild type (WT) and 20 5-LO knockout (5LOKO) were equally distributed according to ZL treatment: WT Control, WT ZL, 5LOKO Control, and 5LOKO ZL. ZL groups were treated with an intraperitoneal injection of 250 µg/Kg of ZL, while controls were treated with saline. Treatments were administered once a week, starting four weeks before surgery for tooth extraction and until 7 and 21 days post-surgery. Mice were euthanized for a comprehensive microscopic analysis (microCT, histomorphometry and immunohistochemistry). WT ZL mice presented intense inflammatory infiltrate (7 days), delayed bone formation (21 days), reduced collagenous matrix quality, and a deficiency in Runx-2 + , TRAP + , and macrophages as compared to controls. 5LOKO ZL animals presented decreased number of Runx-2 + cells in comparison to 5LOKO Control at 7 days, but no major changes in bone healing as compared to WT or 5LOKO mice at 21 days. The knockout of 5LO favored intramembranous bone healing in aged female mice, with a direct impact on inflammatory response and bone metabolism on the development of ONJ-like lesions.

Effect of Propolis Paste and Mouthwash Formulation on Healing after Teeth Extraction in Periodontal Disease

This study investigated the antimicrobial effects of a mouthwash containing propolis and the effect of a propolis paste formulation on dental healing after teeth extraction in patients with periodontal disease. In the mouthwash experience, the population comprised 40 patients, which were divided as follows: the control mouthwash, 0.2% chlorhexidine (v/v) mouthwash, 2% (w/v) propolis mouthwash, and propolis + chlorhexidine mouthwash. The study of the propolis paste comprised a population of 60 patients with periodontal disease, and a total of 120 symmetric tooth extractions were performed. Propolis showed antimicrobial activity by itself, and especially with the chlorhexidine association. Three days after surgery in the teeth treated with control paste, only 13.4% had completely healed; however, with propolis paste, in 90% of the periodontal sockets, healing was complete. In addition, a reduction in Mutans Streptococci and Lactobacilli cfu was observed with propolis, and especially with the association of chlorhexidine + propolis. Propolis mouthwash reduced bacterial proliferation, especially in association with chlorhexidine. Propolis paste is a viable alternative for socket healing after dental extraction. The knowledge gained from these findings will provide a foundation for similar propolis therapies in order to improve the healing process after dental surgery.

Ridge preservation applying a novel hydrogel for early angiogenesis and osteogenesis evaluation: an experimental study in canine

Ridge preservation is universally acknowledged as the conventional method for the post-extraction healing yet there are no standard materials for the ideal healing outcome. Herein, a composite gel comprising gelatin nanoparticles (GNPs) and injectable platelet-rich-fibrin (i-PRF) as the potential candidate for extracted socket healing is introduced. The combination of GNPs and i-PRF not only possesses favorable mechanical properties to withstand external force but also accelerate the blood clotting time significantly. In addition, six beagle dogs were adopted to assess the angiogenic and osteogenic capacity of GNPs+i-PRF gel in vivo. The GNPs+i-PRF gel significantly produced the most blood vessels area, woven bone and low osteoclast activity in extracted sockets at 2 weeks postoperation and remarkably generated corticalization on the alveolar ridge crest at 8 weeks postoperation according to histological results. Therefore, GNPs+i-PRF gel can be recommended as the candidate grafting material regarding ridge preservation for its cost effectiveness, excellent biocompatibility, facilitation of blood clotting and favorable capacity of promoting angiogenesis and osteogenesis.

Utilization of biphasic calcium sulfate as socket preservation grafting as a prelude to implant placement, a case report

Extraction of the natural tooth may be a prelude to implant placement. This may be done using an immediate placement protocol or require a delayed approach depending on multiple factors that include; residual infection related to the failed tooth being extracted, availability of bone to stabilize the implant at placement or soft tissue issues. Socket preservation is recommended when the delayed approach is selected to create an osseous bed that can accommodate the implant that is planned. This also helps preserve what crestal bone remains following the extraction that may resorb in the absence of socket preservation during the extraction socket healing phase. The use of osseous graft materials and guided bone-regeneration has demonstrated enhancement of socket healing by potentially modifying the resorption process, yielding preservation of the crestal bone while limiting resorption potential during healing. Various graft materials have been reported including, allografts, xenografts, non-biologics and synthetics. Calcium sulfate as a graft material has been used for many decades in maxillofacial surgeries, plastic surgery, oncologic and orthopedics in the treatment of osseous voids, traumatic or inflammatory bone deficiencies. This article will review a case using biphasic calcium sulfate with a delayed implant protocol and the histology demonstrating conversion of the graft material to host bone following healing.