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Wickström H, Öien RF, Midlöv P, Anderberg P, Fagerström C. Pain and analgesics in patients with hard-to-heal ulcers: using telemedicine or standard consultations. J Wound Care 2021; 30:S23-S32. [PMID: 34120467 DOI: 10.12968/jowc.2021.30.sup6.s23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment. METHOD This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann-Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-square test (χ2). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses. RESULTS The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ2, p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ2, p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation. CONCLUSION To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.
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Affiliation(s)
- Hanna Wickström
- Department of Clinical Sciences, Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden.,Blekinge Wound Healing Centre, Karlshamn, Sweden
| | - Rut F Öien
- Blekinge Wound Healing Centre, Karlshamn, Sweden.,Blekinge Centre of Competence, Karlskrona, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences, Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Cecilia Fagerström
- Blekinge Centre of Competence, Karlskrona, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Sweden
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2
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Wickström H, Öien RF, Midlöv P, Anderberg P, Fagerström C. Pain and analgaesics in patients with hard-to-heal ulcers: using telemedicine or standard consultations. J Wound Care 2020; 29:S18-S27. [PMID: 32804019 DOI: 10.12968/jowc.2020.29.sup8.s18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment. METHOD This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann-Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-square test (χ2). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses. RESULTS The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ2, p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ2, p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation. CONCLUSION To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.
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Affiliation(s)
- Hanna Wickström
- Department of Clinical Sciences, Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden.,Blekinge Wound Healing Centre, Karlshamn, Sweden
| | - Rut F Öien
- Blekinge Wound Healing Centre, Karlshamn, Sweden.,Blekinge Centre of Competence, Karlskrona, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences, Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Cecilia Fagerström
- Blekinge Centre of Competence, Karlskrona, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Sweden
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Mercado F, Hamlet S, Ivanovski S. A 3-year prospective clinical and patient-centered trial on subepithelial connective tissue graft with or without enamel matrix derivative in Class I-II Miller recessions. J Periodontal Res 2019; 55:296-306. [PMID: 31808142 DOI: 10.1111/jre.12715] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVE The study compared clinical and patient-centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of Class I-II Miller periodontal recession defects. MATERIAL AND METHODS This prospective clinical study evaluated 80 patients over a 3 years follow-up in a private periodontal practice. A total of 144 maxillary and mandibular anterior teeth were divided into two groups: group 1 (CTG with EMD-80 teeth) and group 2 (CTG only-64 teeth). Recession (REC), keratinized tissue (KT) width, % root overage, patient-centered outcomes, and pain visual analog scale (P-VAS) were compared between the two groups. RESULTS At 3 years follow-up at a patient level, statistically significant changes in REC were achieved in both group 1 (4.65 ± 1.84 to 0.39 ± 0.19 mm) and group 2 (4.43 ± 1.11 to 0.92 ± 0.43 mm). Complete root coverage (CRC) was achieved in 66.4% of group 1 and 50.1% of group 2. At both patient and tooth level, the 3-year outcomes were superior for group 1 compared with group 2 in terms of % root coverage, REC, and KT width. Clinical attachment loss (CAL) was reduced in group 1 compared with group 2 at the tooth level analysis only (<.01). Significantly less pain was reported using the pain visual analog Scale (P < .001) at the two weeks follow-up post-surgery in group 1. CONCLUSIONS Addition of EMD results in improved root coverage outcomes and higher amounts of keratinized tissue width 36 months after treatment of multiple adjacent recessions on maxillary and mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days after the surgery.
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Affiliation(s)
- Faustino Mercado
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia.,School of Dentistry, University of Queensland, Brisbane, Qld, Australia
| | - Stephen Hamlet
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia
| | - Sašo Ivanovski
- School of Dentistry, University of Queensland, Brisbane, Qld, Australia
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4
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Mercado F, Hamlet S, Ivanovski S. Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of multiple Class III-IV recessions in lower anterior teeth: A 3-year randomized clinical trial. J Periodontol 2019; 91:473-483. [PMID: 31561272 DOI: 10.1002/jper.19-0058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study compared clinical and patient-centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of multiple Class III-IV Miller periodontal recession (REC) defects on mandibular anterior teeth. METHODS This randomized clinical study evaluated 41 patients at 3 years follow-up. One hundred and fifty-six teeth were divided into two groups: test (CTG-EMD, 79 teeth) and control (CTG only, 77 teeth). Clinical REC, keratinized tissue (KT) width, percentage of root coverage, patient-centered outcomes were compared between the two groups. RESULTS At 36 months follow-up, patient level analysis showed that REC in the test group reduced significantly (5.71 ± 0.58 mm to 1.57 ± 0.85 mm) compared with the control group (5.94 ± 0.46 mm to 2.51 ± 0.62 mm) (P < 0.001), while KT width increased in the test group (1.51 ± 0.26 mm to 4.18 ± 0.34 mm) and was significantly greater than the control group (1.65 ± 0.21 mm to 2.90 ± 0.20 mm) (P < 0.001). At 36 months, tooth level analysis (Class III and Class IV groups) found less residual REC and increased KT in the test group compared with the control group (P < 0.01). Significantly less pain was reported at 2, 7, and 14 days follow-up post-surgery in the test group (P < 0.001). CONCLUSIONS The addition of EMD to CTG results in improved root coverage outcomes and higher amounts of KT width 36 months after treatment of Class III-IV REC on mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days post-surgery.
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Affiliation(s)
- Faustino Mercado
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia.,School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Hamlet
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Saso Ivanovski
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
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5
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Tzeravini E, Tentolouris A, Tentolouris N, Jude EB. Advancements in improving health-related quality of life in patients living with diabetic foot ulcers. Expert Rev Endocrinol Metab 2018; 13:307-316. [PMID: 30381974 DOI: 10.1080/17446651.2018.1541403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Diabetic foot ulcer (DFU) constitutes a burden to patients with diabetes deteriorating their quality of life. Health related quality of life (HRQoL) can now be quantified with the use of specific tools; some of them provide a holistic approach to patients' well-being, while others are disease specific or even region specific. Many of these tools are applicable to patients with DFU. This review will present current data about the impact different interventions in the management of DFU on quality of life related parameters. AREAS COVERED We performed a search of literature using keywords 'diabetes mellitus', 'diabetic foot ulcer', 'diabetic foot', 'health related quality of life', 'quality of life' and 'SF-36' to identify studies that contained data about the relationship between different interventions and quality of life of patients with diabetic foot ulcers. EXPERT COMMENTARY Available data are not sufficient to conclude on the impact of interventions aimed to heal DFU on HRQoL. There is need for more, better designed studies and meta-analysis to estimate the effect of treatments on HRQoL in patients with DFUs. The development of new, diabetic foot specific tools will help to improve our knowledge in this field.
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Affiliation(s)
- Evangelia Tzeravini
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Anastasios Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Nikolaos Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Edward B Jude
- b Department of Medicine, Diabetes Centre , Tameside Hospital NHS Foundation Trust , Ashton-under-Lyne , UK
- c Department of Medicine , Manchester University , Manchester , UK
- d Manchester Metropolitan University , Manchester , UK
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6
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Wickström HL, Öien RF, Fagerström C, Anderberg P, Jakobsson U, Midlöv PJ. Comparing video consultation with inperson assessment for Swedish patients with hard-to-heal ulcers: registry-based studies of healing time and of waiting time. BMJ Open 2018; 8:e017623. [PMID: 29449288 PMCID: PMC5829745 DOI: 10.1136/bmjopen-2017-017623] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate differences in ulcer healing time and waiting time between video consultation and inperson assessment for patients with hard-to-heal ulcers. SETTING Patients treated at Blekinge Wound Healing Centre, a primary care centre covering the whole of Blekinge county (150 000 inhabitants), were compared with patients registered and treated according to the Registry of Ulcer Treatment, a Swedish national web-based quality registry. PARTICIPANTS In the study for analysing ulcer healing time, the study group consisted of 100 patients diagnosed through video consultation between October 2014 and September 2016. The control group for analysing healing time consisted of 1888 patients diagnosed through inperson assessment during the same period. In the study for analysing waiting time, the same study group (n=100) was compared with 100 patients diagnosed through inperson assessment. PRIMARY AND SECONDARY OUTCOME MEASURES Differences in ulcer healing time were analysed using the log-rank test. Differences in waiting time were analysed using the Mann-Whitney U test. RESULTS Median healing time was 59 days (95% CI 40 to 78) in the study group and 82 days (95% CI 75 to 89) in the control group (P<0.001). Median waiting time was 25 days (range: 1-83 days) in the study group and 32 days (range: 3-294 days) for patients diagnosed through inperson assessment (P=0.017). There were no significant differences between the study group and the control group regarding age, gender or ulcer size. CONCLUSIONS Healing time and waiting time were significantly shorter for patients diagnosed through video consultation compared with those diagnosed through inperson assessment.
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Affiliation(s)
- Hanna L Wickström
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Blekinge Wound Healing Centre, Karlshamn, Sweden
| | - Rut Frank Öien
- Blekinge Wound Healing Centre, Karlshamn, Sweden
- Blekinge Centre of Competence, Karlskrona, Sweden
| | - Cecilia Fagerström
- Blekinge Centre of Competence, Karlskrona, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Ulf Jakobsson
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Patrik J Midlöv
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
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7
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Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, Donos N, Lyngstadaas SP, Deschner J, Dard M, Stavropoulos A, Zhang Y, Trombelli L, Kasaj A, Shirakata Y, Cortellini P, Tonetti M, Rasperini G, Jepsen S, Bosshardt DD. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol 2016; 43:668-83. [PMID: 26987551 DOI: 10.1111/jcpe.12546] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 12/27/2022]
Abstract
BACGROUND On June 5th, 2015 at Europerio 8, a group of leading experts were gathered to discuss what has now been 20 years of documented evidence supporting the clinical use of enamel matrix derivative (EMD). Original experiments led by Lars Hammarström demonstrated that enamel matrix proteins could serve as key regenerative proteins capable of promoting periodontal regeneration including new cementum, with functionally oriented inserting new periodontal ligament fibres, and new alveolar bone formation. This pioneering work and vision by Lars Hammarström has paved the way to an enormous amount of publications related to its biological basis and clinical use. Twenty years later, it is clear that all these studies have greatly contributed to our understanding of how biologics can act as mediators for periodontal regeneration and have provided additional clinical means to support tissue regeneration of the periodontium. AIMS This review article aims to: (1) provide the biological background necessary to understand the rational for the use of EMD for periodontal regeneration, (2) present animal and human histological evidence of periodontal regeneration following EMD application, (3) provide clinically relevant indications for the use of EMD and (4) discuss future avenues of research including key early findings leading to the development of Osteogain, a new carrier system for EMD specifically developed with better protein adsorption to bone grafting materials.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, Nova Southeastern University, Fort Lauderdale, Florida, USA.,Department of Periodontology, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - David L Cochran
- Department of Periodontics, Dental School, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stuart Froum
- Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, USA
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carlos Nemcovsky
- Department of Periodontology and Dental Implantology, Dental School, Tel-Aviv University, Tel-Aviv, Israel
| | - Nikos Donos
- Department of Periodontology, Queen Marry University of London, London, UK
| | | | - James Deschner
- Section of Experimental Dento-Maxillo-Facial Medicine, University of Bonn, Bonn, Germany
| | - Michel Dard
- New York University, College of Dentistry, New York, NY, USA
| | | | - Yufeng Zhang
- Department of Oral Implantology, Wuhan University, Wuhan, China
| | - Leonardo Trombelli
- Department of Periodotology, Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
| | - Adrian Kasaj
- Department of Operative Dentistry and Periodontology, University Medical Center, Mainz, Germany
| | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Maurizio Tonetti
- European Research Group on Periodontology (ERGOPerio), Genova, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Foundation IRCCS Ca' Granda Polyclinic, Milan, Italy
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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8
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Wang Y, Zhang Y, Jing D, Shuang Y, Miron RJ. Enamel matrix derivative improves gingival fibroblast cell behavior cultured on titanium surfaces. Clin Oral Investig 2015; 20:685-95. [PMID: 26269319 DOI: 10.1007/s00784-015-1558-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/31/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Although an extensive amount of research has demonstrated the positive effects of an enamel matrix derivative (EMD) on soft tissue wound healing around intrabony defects, little information is available describing its effect on peri-implant soft tissues, an area that has recently gained tremendous awareness due to the increasing prevalence of peri-implantitis. The aim of the present study was to assess the role of EMD when gingival fibroblasts were cultured on titanium surface with different surface topographies. METHODS Human primary gingival fibroblasts were cultured on pickled (PT) and sand-blasted with large grit followed by acid etching (SLA) surfaces and assessed for cell adhesion at 2, 4, and 8 h, cell morphology at 2, 4, 8, and 24 h as well as cell proliferation at 1, 3, and 5 days post-seeding. Furthermore, genes encoding collagen 1a1, vascular endothelial growth factor-A (VEGF-A), and fibronectin were assessed by real-time PCR. Human gingival fibroblasts were also quantified for their ability to synthesize a collagen matrix on the various titanium surfaces with and without EMD by immunofluorescence staining. RESULTS The results from the present study demonstrate that EMD significantly increased cell spreading at 2, 4, 8, and 24 h on PT surfaces and 4, 8, and 24 h on SLA surfaces. Furthermore, proliferation at 5 days on PT surfaces and 3 and 5 days on SLA surfaces was also increased for groups containing EMD. Real-time PCR results demonstrated that the culture of gingival fibroblasts with EMD significantly increased extracellular matrix synthesis of collagen 1 as well as improved mRNA levels of VEGF-A and fibronectin. Collagen1 immuno-fluorescent staining revealed a significantly higher area of staining for cells seeded on PT + EMD at 7 and 14 days and 14 days for SLA + EMD when compared to control samples. CONCLUSION The results from the present study favor the use of EMD for colonization of gingival fibroblasts on titanium surfaces by increasing cell growth, spreading, and synthesis of an extracellular matrix. The improvements were primarily irrespective of surface topography. Future animal and human studies are necessary to fully characterize the beneficial effects of incorporating EMD during soft tissue regeneration of implant protocols. CLINICAL RELEVANCE The use of EMD may speed up the quality of soft tissue integration around dental implants by facilitating gingival cell attachment, proliferation, and matrix synthesis of collagen 1.
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Affiliation(s)
- Yulan Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, People's Republic of China.,Department of Oral Implantology, School of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Yufeng Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, People's Republic of China. .,Department of Oral Implantology, School of Stomatology, Wuhan University, Wuhan, 430079, China.
| | - Dai Jing
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, People's Republic of China
| | - Yang Shuang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, People's Republic of China
| | - Richard J Miron
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, People's Republic of China.,Department of Periodontology, Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, Bern, 3010, Switzerland
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9
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Miron RJ, Dard M, Weinreb M. Enamel matrix derivative, inflammation and soft tissue wound healing. J Periodontal Res 2014; 50:555-69. [PMID: 25418917 DOI: 10.1111/jre.12245] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 12/17/2022]
Abstract
Over 15 years have now passed since enamel matrix derivative (EMD) emerged as an agent capable of periodontal regeneration. Following thorough investigation, evidenced-based clinical application is now established for a multitude of clinical settings to promote regeneration of periodontal hard tissues. Despite the large number of studies and review articles written on this topic, no single review has compiled the influence of EMD on tissue inflammation, an area of research that merits substantial attention in periodontology. The aim of the present review was to gather all studies that deal with the effects of EMD on tissue inflammation with particular interest in the cellular mechanisms involved in inflammation and soft tissue wound healing/resolution. The effects of EMD on monocytes, macrophages, lymphocytes, neutrophils, fibroblasts and endothelial cells were investigated for changes in cell behavior as well as release of inflammatory markers, including interleukins, prostaglandins, tumor necrosis factor-α, matrix metalloproteinases and members of the OPG-RANKL pathway. In summary, studies listed in this review have reported that EMD is able to significantly decrease interleukin-1b and RANKL expression, increase prostaglandin E2 and OPG expression, increase proliferation and migration of T lymphocytes, induce monocyte differentiation, increase bacterial and tissue debris clearance, as well as increase fibroplasias and angiogenesis by inducing endothelial cell proliferation, migration and capillary-like sprout formation. The outcomes from the present review article indicate that EMD is able to affect substantially the inflammatory and healing responses and lay the groundwork for future investigation in the field.
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Affiliation(s)
- R J Miron
- Department of Periodontology, Department of Oral Surgery, University of Bern, Bern, Switzerland.,Faculty of Dental Medicine, University of Laval, Quebec City, QC, Canada
| | - M Dard
- Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, USA
| | - M Weinreb
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
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10
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Harding K, Aldons P, Edwards H, Stacey M, Finlayson K, Gibb M, Jenkins L, Shooter G, Lonkhuyzen DV, Lynam E, Heinrichs E, Upton Z. Effectiveness of an acellular synthetic matrix in the treatment of hard-to-heal leg ulcers. Int Wound J 2014; 11:129-37. [PMID: 23834253 PMCID: PMC7950675 DOI: 10.1111/iwj.12115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hard-to-heal leg ulcers are a major cause of morbidity in the elderly population. Despite improvements in wound care, some wounds will not heal and they present a significant challenge for patients and health care providers. A multi-centre cohort study was conducted to evaluate the effectiveness and safety of a synthetic, extracellular matrix protein as an adjunct to standard care in the treatment of hard-to-heal venous or mixed leg ulcers. Primary effectiveness criteria were (i) reduction in wound size evaluated by percentage change in wound area and (ii) healing assessed by number of patients healed by end of the 12 week study. Pain reduction was assessed as a secondary effectiveness criteria using VAS. A total of 45 patients completed the study and no difference was observed between cohorts for treatment frequency. Healing was achieved in 35·6% and wound size decreased in 93·3% of patients. Median wound area percentage reduction was 70·8%. Over 50% of patients reported pain on first visit and 87·0% of these reported no pain at the end of the study. Median time to first reporting of no pain was 14 days after treatment initiation. The authors consider the extracellular synthetic matrix protein an effective and safe adjunct to standard care in the treatment of hard-to-heal leg ulcers.
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Affiliation(s)
- Keith Harding
- Wound Healing Research Unit, Institute for Translation, Innovation, Methodologies and Engagement (TIME)Cardiff UniversityCardiffUK
| | - Pat Aldons
- The Prince Charles HospitalChermsideAustralia
| | - Helen Edwards
- School of Nursing and MidwiferyQueensland University of TechnologyBrisbaneAustralia
| | - Michael Stacey
- Department of SurgeryFremantle Hospital, The University of Western AustraliaFremantleAustralia
| | - Kathleen Finlayson
- School of Nursing and MidwiferyQueensland University of TechnologyBrisbaneAustralia
| | - Michelle Gibb
- School of Nursing and MidwiferyQueensland University of TechnologyBrisbaneAustralia
| | - Liz Jenkins
- The Prince Charles HospitalChermsideAustralia
| | - Gary Shooter
- Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
| | - Derek Van Lonkhuyzen
- Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
| | - Emily Lynam
- Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
| | | | - Zee Upton
- Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
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11
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Fogh K, Nielsen CB, Dam W. Effect of amelogenin ECM protein on the healing of chronic leg ulcers with atrophie blanche. J Wound Care 2012; 21:612-4. [DOI: 10.12968/jowc.2012.21.12.612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K Fogh
- Department of Dermatology, Aarhus University Hospital, Denmark.
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12
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Brimson C, Nigam Y. The role of oxygen-associated therapies for the healing of chronic wounds, particularly in patients with diabetes. J Eur Acad Dermatol Venereol 2012; 27:411-8. [DOI: 10.1111/j.1468-3083.2012.04650.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Bonde JS, Bülow L. Use of human amelogenin in molecular encapsulation for the design of pH responsive microparticles. BMC Biotechnol 2012; 12:25. [PMID: 22630169 PMCID: PMC3403901 DOI: 10.1186/1472-6750-12-25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/25/2012] [Indexed: 11/16/2022] Open
Abstract
Background Proteins can be used in drug delivery systems to improve pharmacological properties of an active substance. Differences in pH between tissues can be utilized in order to achieve a targeted drug release at a specific location or tissue, such as a tumor. The enamel matrix protein amelogenin has a pH dependent solubility profile and self-assemble to form aggregates at neutral pH. This could make amelogenin useful in the design of pH responsive drug delivery systems. Results In this study amelogenin was evaluated as a pH responsive component in drug delivery applications. This was achieved by testing the ability of amelogenin to entrap/release other proteins upon changes in pH, and by testing if amelogenin could confer pH responsiveness to an existing and versatile drug delivery system, such as gelatin microparticles. Amelogenin was able to encapsulate bovine serum albumin and insulin, whichwere used as model target proteins. The composite aggregates of amelogenin and target protein were formed at neutral pH and could be reversibly solubilized at weakly acidic pH. Gelatin microparticles prepared in the presence of amelogenin, showed a modulated structure in response to pH change, when studied by scanning electron microscopy, compared to particles without amelogenin. At neutral pH amelogenin induced formation of pores in the particle surface, which were not present at acidic pH, or in particles lacking amelogenin. Conclusions The results from this study demonstrate that amelogenin can be a useful component in drug delivery systems in order to achieve a pH dependent response.
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Affiliation(s)
- Johan Svensson Bonde
- Department of Pure and Applied Biochemistry, Center for Chemistry and Chemical Engineering, Lund University, PO Box 124, SE-22100, Lund, Sweden
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14
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Karatas A, Ozben V, Aytac E, Can Karaca F, Salihoglu Z, Uzun H, Erdamar S, Ulualp K. An alternative sutureless repair technique with amelogenin for duodenal perforation. Acta Chir Belg 2012; 112:121-5. [PMID: 22571074 DOI: 10.1080/00015458.2012.11680809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Among the various sutureless techniques, fibrin glue has proved to be effective in the treatment of peptic ulcer perforation as an alternative to classical suture repair. Albeit rare, a potential disadvantage of fibrin glue use is viral transmission or anaphylaxis. The aim of this study is to introduce a new technique for the closure of duodenal perforation using a novel recombinant enamel protein called amelogenin. METHODS In this case-control experimental study, 32 adult male Wistar Albino rats weighing 250-300 g were randomly divided into four groups, each containing 8 rats. Duodenal perforation of 0.2 cm were performed in the postpyloric region in all rats. Each group received primary repair, primary repair with omentoplasty, fibrin glue, and amelogenin, respectively. All animals were killed on the postoperative day five and the bursting pressure measurements, hydroxyproline levels and histopathologic values of the wound site were evaluated. RESULTS Bursting pressure levels of the fibrin glue and amelogenin groups were significantly lower than the primary repair and primary repair with omentoplasty groups (P < 0.05) However, no significant difference existed between the fibrin glue and amelogenin groups in this respect (P > 0.05). There was also no statistically significant difference among all groups regarding tissue hydroxyproline levels and histopathologic values (P > 0.05). CONCLUSION Application of amelogenin as an alternative sutureless repair technique did not improve wound healing in this animal model of duodenal perforation.
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Affiliation(s)
- A. Karatas
- Department of General Surgery, Cerrahpasa Medical School, Istanbul, Turkey
| | - V. Ozben
- General Surgery Clinic, Surmene State Hospital, Surmene, Trabzon, Turkey
| | - E. Aytac
- Department of General Surgery, Cerrahpasa Medical School, Istanbul, Turkey
| | - F. Can Karaca
- Department of General Surgery, Cerrahpasa Medical School, Istanbul, Turkey
| | - Z. Salihoglu
- Department of Anesthesiology and Reanimation, Cerrahpasa Medical School, Istanbul, Turkey
| | - H. Uzun
- Department of Biochemistry, Cerrahpasa Medical School, Istanbul, Turkey
| | - S. Erdamar
- Department of Pathology, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
| | - K. Ulualp
- Department of General Surgery, Cerrahpasa Medical School, Istanbul, Turkey
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15
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Bond E, Barrett S, Pragnell J, Victoria R. Successful treatment of nonhealing wounds with Xelma®. ACTA ACUST UNITED AC 2009; 18:1404-9. [DOI: 10.12968/bjon.2009.18.22.45571] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Simon Barrett
- NHS East Riding of Yorkshire Primary Care Trust, Kingston-upon-Hull, UK
| | | | - Royal Victoria
- Newcastle Hospitals NHS Foundation Trust,Newcastle-upon-Tyne, UK
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16
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White R, McIntosh C. A review of the literature on topical therapies for diabetic foot ulcers. Part 2: advanced treatments. J Wound Care 2009; 18:335-41. [DOI: 10.12968/jowc.2009.18.8.43633] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - C. McIntosh
- Department of Podiatry, National University of Ireland, Galway, Ireland
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