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Luo J, Liang C, Chen K, Zeng K, Bai R, Tang C, Li J, Nong X. Artesunate-loaded thermosensitive chitosan hydrogel promotes osteogenesis of maxillary tooth extraction through regulating T lymphocytes in type 2 diabetic rats. BMC Oral Health 2024; 24:356. [PMID: 38509482 PMCID: PMC10953264 DOI: 10.1186/s12903-024-04127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/09/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) causes severe bone loss after tooth extraction as a hyperglycemic environment causes aberrant bone homeostasis. Artesunate (ART) is known to possess anti-inflammation and osteogenic properties. However, its osteogenesis property in alveolar bone remains unclear. This study aimed to explore the osteogenic and immunoregulatory effects of artesunate-loaded thermosensitive chitosan hydrogel (ART-loaded TCH) on maxilla tooth extraction in T2DM rats. METHODS T2DM rats were induced by a high-fat diet and streptozotocin. Different concentrations of ART-loaded TCH were applied in tooth extraction sockets. Bone loss and the expression of osteogenic regulatory factors (OPG, ALP, RANK) were evaluated. The immunoregulatory effects of ART-loaded TCH were observed through detecting the infiltration of T lymphocytes and their cytokines. The underlying mechanisms were explored. RESULTS Results showed that the 150 mg/ml ART-loaded TCH group significantly ameliorated maxilla bone height and bone mineral density when compared with the T2DM group (p < 0.05). It also improved the expression of OPG, ALP, and RANK. Although the alteration of CD4+ T, CD8+ T, and CD4+:CD8+ T ratio has no significant difference among groups, the release of Th1 and Th2 in the 150 mg/ml ART-loaded TCH group has been significantly regulated than in the T2DM group (p < 0.05). Besides, ART-loaded TCH treatment inhibited the expression of p38 MAPK and ERK1 in T2DM maxilla. CONCLUSIONS Therefore, the results indicated that 150 mg/ml ART-loaded TCH could be an effective method to prevent bone loss in T2DM tooth extraction rats by modulating the immunoregulation of Th1 and Th2 and the MAPK signaling pathway.
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Affiliation(s)
- Jinghong Luo
- College & Hospital of Stomatology, Guangxi Medical University, No.10 Shuangyong Road, Nanning, Guangxi, 530021, China
| | - Chen Liang
- College & Hospital of Stomatology, Guangxi Medical University, No.10 Shuangyong Road, Nanning, Guangxi, 530021, China
| | - Kun Chen
- College & Hospital of Stomatology, Guangxi Medical University, No.10 Shuangyong Road, Nanning, Guangxi, 530021, China
| | - Kai Zeng
- College & Hospital of Stomatology, Guangxi Medical University, No.10 Shuangyong Road, Nanning, Guangxi, 530021, China
| | - Rui Bai
- College & Hospital of Stomatology, Guangxi Medical University, No.10 Shuangyong Road, Nanning, Guangxi, 530021, China
| | - Chan Tang
- College & Hospital of Stomatology, Guangxi Medical University, No.10 Shuangyong Road, Nanning, Guangxi, 530021, China
| | - Jiaquan Li
- Medical Science Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Life Science Institute, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Xiaolin Nong
- College & Hospital of Stomatology, Guangxi Medical University, No.10 Shuangyong Road, Nanning, Guangxi, 530021, China.
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Nanning, Guangxi, 530021, China.
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Lee JH, Lee KE, Kang SW, Park SH, Chae YK, Lee MH, Kweon DK, Choi SC, Nam OH. Effect of orodispersible hyaluronic acid film on palatal mucosa wound healing. Oral Dis 2024; 30:518-527. [PMID: 36691707 DOI: 10.1111/odi.14517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/23/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective of the study was to evaluate the healing effect of hyaluronic acid films on palatal wounds. MATERIALS AND METHODS After making 5-mm diameter palatal wounds, 72 rats were randomly assigned to three groups: control, hyaluronic acid gel, and hyaluronic acid film. The animals were sacrificed at 3, 7, and 21 days after the experiment. Clinical, histological, and RT-PCR analyses were performed. Human ex vivo oral mucosa models were used. Histological analysis and pan-cytokeratin staining were performed at 5 days after wound creation. RESULTS In rat model, both gels and films showed favorable healing on Days 3 and 7 compared with healing in the control (p < 0.05). Film showed remarkable VEGF and α-SMA expression than did the others (p < 0.05). Immunohistochemical analysis showed that film exhibited significantly lower CD68 and greater α-SMA and vimentin expression levels than those in the others (p < 0.05). In human model, re-epithelialization rate of film group was significantly higher than that of the others. Complete epithelial regeneration was confirmed only in film group using pan-cytokeratin staining. CONCLUSIONS Within the limits of this study, hyaluronic acid film outperformed gels in terms of palatal wound healing in both models.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Ko Eun Lee
- Department of Pediatric Dentistry, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, South Korea
| | - Sang Wook Kang
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Seung Hwan Park
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Yong Kwon Chae
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, South Korea
- Department of Pediatric Dentistry, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, South Korea
| | | | | | - Sung Chul Choi
- Department of Pediatric Dentistry, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, South Korea
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Ok Hyung Nam
- Department of Pediatric Dentistry, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, South Korea
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, South Korea
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Domic D, Bertl K, Lang T, Pandis N, Ulm C, Stavropoulos A. Hyaluronic acid in tooth extraction: a systematic review and meta-analysis of preclinical and clinical trials. Clin Oral Investig 2023; 27:7209-7229. [PMID: 37963982 PMCID: PMC10713798 DOI: 10.1007/s00784-023-05227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/16/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES To assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication management compared to any other treatment or no treatment. MATERIALS AND METHODS Three databases were searched until April 2022. The most relevant eligibility criteria were (1) local application of HyA as adjunct to tooth extraction or as treatment of alveolar osteitis, and (2) reporting of clinical, radiographic, histological, or patient-reported data. New bone formation and/or quality were considered main outcome parameters in preclinical studies, while pain, swelling, and trismus were defined as main outcome parameters in clinical studies. RESULTS Five preclinical and 22 clinical studies (1062 patients at final evaluation) were included. In preclinical trials, HyA was applied into the extraction socket. Although a positive effect of HyA was seen in all individual studies on bone formation, this effect was not confirmed by meta-analysis. In clinical studies, HyA was applied into the extraction socket or used as spray or mouthwash. HyA application after non-surgical extraction of normally erupted teeth may have a positive effect on soft tissue healing. Based on meta-analyses, HyA application after surgical removal of lower third molars (LM3) resulted in significant reduction in pain perception 7 days postoperatively compared to either no additional wound manipulation or the application of a placebo/carrier. Early post-operative pain, trismus, and extent of swelling were unaffected. CONCLUSIONS HyA application may have a positive effect in pain reduction after LM3 removal, but not after extraction of normally erupted teeth. CLINICAL RELEVANCE HyA application may have a positive effect in pain reduction after surgical LM3 removal, but it does not seem to have any impact on other complications or after extraction of normally erupted teeth. Furthermore, it seems not to reduce post-extraction alveolar ridge modeling, even though preclinical studies show enhanced bone formation.
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Affiliation(s)
- Danijel Domic
- Division of Oral Surgery, University Clinic of Dentistry, Medical University Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Kristina Bertl
- Department of Periodontology, Dental Clinic, Faculty of Medicine, Sigmund Freud University, Freudplatz 3, 1020, Vienna, Austria
- Periodontology, Faculty of Odontology, University of Malmö, Carl Gustafs Väg 34, 205 06, Malmö, Sweden
| | - Tobias Lang
- Division of Oral Surgery, University Clinic of Dentistry, Medical University Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Christian Ulm
- Division of Oral Surgery, University Clinic of Dentistry, Medical University Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Andreas Stavropoulos
- Periodontology, Faculty of Odontology, University of Malmö, Carl Gustafs Väg 34, 205 06, Malmö, Sweden.
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria.
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
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Efficacy of Hyaluronic Acid in Relieving Post-implantation Pain: A Split-Mouth Randomized Controlled Trial. Cureus 2023; 15:e36575. [PMID: 36968680 PMCID: PMC10035270 DOI: 10.7759/cureus.36575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 03/25/2023] Open
Abstract
Background Many patients suffer from some degree of pain following the surgical procedures of dental implantation. The fear of pain may be one reason for postponing such prosthodontic treatments. Many procedures have been suggested to control post-implantation pain. This trial evaluated the effectiveness of using hyaluronic acid (HA) during dental implantation on patients’ perceived pain during the postsurgical soft-tissue healing period. Methodology A split-mouth randomized controlled trial (RCT) was conducted. The trial sample consisted of 22 dental implants in 11 patients (five males and six females). Patients were selected from those attending the Department of Oral Medicine at the Faculty of Dentistry, University of Damascus between February 2021 and May 2022. The implants were performed in similar bone quality and density for each patient as the implants were inserted in the same jaw on both sides to ensure the same physiological conditions. The study sample was divided into two groups. The first group (the experimental group) consisted of 11 implants in which the implant site was drilled, following which HA was placed inside the implant site and on the surrounding bone before the flap was returned and sutured. The second group (the control group) comprised 11 implants following the conventional procedure without applying any material to the implant socket. The main outcome measure was pain perception which was assessed using the visual analog scale (VAS). Patients were asked to record their perceived pain on the first, third, and tenth days. Two-sample t-tests were used to detect significant differences. Results There were statistically significant differences in the mean pain intensity between the experimental and control groups on the first, third, and tenth days (p < 0.05). The mean values of perceived pain in the control group were 5.68, 1.72, and 0.56 on the first, third, and tenth days, respectively. In comparison, the mean values of perceived pain in the experimental group were 4.52, 1.14, and 0.18 on the first, third, and tenth days, respectively. The maximum perceived pain in the control group was 7.5 on the first day following implantation, whereas the maximum value recorded in the experimental group was 6.5. At the third assessment time (i.e., 10 days following the surgical intervention), the mean values were in the very mild category of pain intensity. Conclusions This study showed that applying HA in the implant cavity and on the surrounding bone effectively reduced pain after dental implant surgery in comparison with the control group. Patients had lower mean pain scores at one, three, and ten days following surgery compared to the conventional method. HA is suggested to be an adjunctive method to control postsurgical pain after dental implantation.
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Su N, Xu T, Li X, Zheng H, Wu B, Zhang S, Zhou Y, Du L, Zhao Y. Heparin and Related Substances for Treating Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:749368. [PMID: 35282468 PMCID: PMC8907383 DOI: 10.3389/fendo.2022.749368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetic foot ulcers are a major complication of diabetes mellitus (DM), when heparin and heparin related substances may be potentially used as an adjuvant treatment. We aimed to evaluate the efficacy and safety of heparin and heparin related substances for the treatment of diabetic foot ulcers. METHODS We searched up to March 2021 in the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; EBSCO CINAHL; VIP Chinese Science and Technique Journals Database; China National Knowledge Infrastructure (CNKI) Database and Wan Fang Database investigating heparin or heparin-related substances in patients with diabetic foot ulcers. The primary outcomes included proportion of ulcers completely healed and time to complete ulcer healing. We assessed each included study with the Cochrane 'Risk of bias' tool and used the GRADE approach to assess the overall quality of the evidence. RESULTS We included nine randomized studies involving 620 participants in the meta-analysis, involving two different heparin and heparin-related substances, low molecular weight heparin (LMWH) and hyaluronic acid. Our study did not show the benefits from LMWH on increasing chance of the ulcer healing (RR: 1.26; 95% CI: 0.78 to 2.04; P=0.35; very low) or shortening the time to complete ulcer healing (SMD: 0.13 d; 95% CI: -0.29 to 0.56; P=0.54; very low). Hyaluronic acid may improve the complete ulcer healing (RR: 1.57; 95% CI: 1.29 to 1.91; P˂0.00001; very low) and shorten the time to complete ulcer healing (SMD -0.84, 95% CI -1.15 to -0.53; P<0.00001; low). Hyaluronic acid and LMWH were generally well tolerated for treating diabetic foot ulcers in this review. CONCLUSION Hyaluronic acid may improve diabetic foot ulcer with very low quality evidence but not LMWH. However, the benefits and harms need further validation in larger trials with different population. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [PROSPERO, CRD42021269212].
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Affiliation(s)
- Na Su
- Department of Pharmacology, Key Laboratory of Drug Targeting and Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Xu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaodan Li
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Hanrui Zheng
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Wu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Shengzhao Zhang
- Department of Pharmacology, Key Laboratory of Drug Targeting and Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Yiling Zhou
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Du
- Chinese Cochrane Centre, Chinese Journal of Evidence Based Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yinglan Zhao
- Department of Pharmacology, Key Laboratory of Drug Targeting and Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
- *Correspondence: Yinglan Zhao,
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Yang S, Li Y, Liu C, Wu Y, Wan Z, Shen D. Pathogenesis and treatment of wound healing in patients with diabetes after tooth extraction. Front Endocrinol (Lausanne) 2022; 13:949535. [PMID: 36213270 PMCID: PMC9538860 DOI: 10.3389/fendo.2022.949535] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetes mellitus is a common systematic chronic disease amongst dental patients. The elevated glucose microenvironment can prolong the healing of tooth extraction sockets. Therefore, the promotion of healing up tooth extraction sockets is of great clinical importance to the patients with diabetes mellitus. The current evidence indicates the mechanism of the recovery period of extraction sockets in hyperglycaemia conditions from physiological, inflammation, immune, endocrine and neural aspects. New advancements have been made in varied curative approaches and drugs in the management of wound healing of tooth extraction sockets in diabetes. However, most of the interventions are still in the stage of animal experiments, and whether it can be put into clinical application still needs further explorations. Specifically, our work showed topical administration of plasma-rich growth factor, advanced platelet-rich fibrin, leukocyte- and platelet-rich fibrin and hyaluronic acid as well as maxillary immediate complete denture is regarded as a promising approach for clinical management of diabetic patients requiring extractions. Overall, recent studies present a blueprint for new advances in novel and effective approaches for this worldwide health ailment and tooth extraction sockets healing.
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Bone quality analysis of jaw bones in individuals with type 2 diabetes mellitus-post mortem anatomical and microstructural evaluation. Clin Oral Investig 2021; 25:4377-4400. [PMID: 33694028 DOI: 10.1007/s00784-020-03751-1] [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] [Received: 05/26/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES With the higher risk of dental implant failure with type 2 diabetes mellitus (T2DM), there is a need to characterize the jaw bones in those individuals. The aim of this post mortem study was to compare jaw bone quality of individuals with T2DM to healthy controls. MATERIAL AND METHODS Bone cores from the edentulous lower first molar region and the region of mandibular angle were collected from male individuals with T2DM (n = 10, 70.6 ± 4.5 years) and healthy controls (n = 11, 71.5 ± 3.8 years) during autopsy. Within the T2DM, a subgroup treated with oral antidiabetics (OAD) and one on insulin were identified. Bone quality assessment encompassed evaluation of bone microstructure, matrix composition, and cellular activity, using microcomputed tomography (micro-CT), quantitative backscattered electron imaging (qBEI), Raman spectroscopy, and bone histomorphometry. RESULTS In the mandibular angle, T2DM showed 51% lower porosity of the lingual cortex (p = 0.004) and 21% higher trabecular thickness (p = 0.008) compared to control. More highly mineralized bone packets were found in the buccal cortex of the mandibular angle in insulin-treated compared to OAD-treated T2DM group (p = 0.034). In the molar region, we found higher heterogeneity of trabecular calcium content in T2DM insulin compared to controls (p = 0.015) and T2DM OAD (p = 0.019). T2DM was associated with lower osteocyte lacunar size in the trabecular bone of the molar region (vs. control p = 0.03). CONCLUSIONS Alterations in microstructure, mineralization, and osteocyte morphology were determined in jaw bone of individuals with T2DM compared to controls. CLINICAL RELEVANCE Future studies will have to verify if the mild changes determined in this study will translate to potential contraindications for dental implant placements.
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Effect of Aging on Homeostasis in the Soft Tissue of the Periodontium: A Narrative Review. J Pers Med 2021; 11:jpm11010058. [PMID: 33477537 PMCID: PMC7831085 DOI: 10.3390/jpm11010058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/06/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Aging is characterized by a progressive decline or loss of physiological functions, leading to increased susceptibility to disease or death. Several aging hallmarks, including genomic instability, cellular senescence, and mitochondrial dysfunction, have been suggested, which often lead to the numerous aging disorders. The periodontium, a complex structure surrounding and supporting the teeth, is composed of the gingiva, periodontal ligament, cementum, and alveolar bone. Supportive and protective roles of the periodontium are very critical to sustain life, but the periodontium undergoes morphological and physiological changes with age. In this review, we summarize the current knowledge of molecular and cellular physiological changes in the periodontium, by focusing on soft tissues including gingiva and periodontal ligament.
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