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Shehabeldin M, Saleh MHA, Shih-Chang Tseng E, Sirinirund B, Zalucha J, Chan HL, Wang HL. Intrasocket reactive tissue: The state of current knowledge. Int J Oral Implantol (Berl) 2023; 16:95-103. [PMID: 37158179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This review focuses on intrasocket reactive tissue and its impact on extraction socket healing. It summarises the current knowledge about intrasocket reactive tissue from a histopathological and biological perspective and discusses the mechanisms by which residual intrasocket reactive tissue can have a positive or negative effect on healing. Additionally, it provides an overview of the various hand and rotary instruments that are currently used for intrasocket reactive tissue debridement. The review also discusses preserving intrasocket reactive tissue as a socket sealing material and the benefits this may offer. It presents clinical cases where either removal or preservation of intrasocket reactive tissue was adopted following extraction and prior to alveolar ridge preservation. Future studies are needed to investigate the suggested beneficial effects of intrasocket reactive tissue on socket healing outcomes.
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Abstract
A vital and healthy dental pulp (DP) is required for teeth to remain functional throughout a lifespan . Appreciating its value for the tooth, the regeneration of the DP is a highly researched goal. While inflammation of the DP marks the beginning of an eventual necrosis, it is also the prerequisite for the regenerative events of neovascularisation, stem cells mobilisation and reparative dentine deposition. In the light of a pro-regenerative inflammatory process, the present review discusses the role of macrophage population shift from pro- to anti-inflammatory in reversible versus irreversible pulpitis, while also analysing the overlooked contribution of pulp innervation and locally derived neuropeptides to the process. Then, the currently practiced (pulp capping and revascularisation) and researched (cells transplantation and cell homing) approaches for DP regeneration are discussed. Focusing on the role of cell homing in modulating inflammation, some potential strategies are highlighted to harness the inflammatory process for DP regeneration, mainly by reversing inflammation through macrophage induction. Next, some potential clinical applications are discussed - especially with capping materials - that could boost macrophage polarisation and complement system activation. Finally, current challenges facing the regeneration of the DP are presented, while underlining the importance of promoting an anti-inflammatory environment conducive to a regenerative process.
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Affiliation(s)
| | | | | | - C Sfeir
- Centre for Craniofacial Regeneration, University of Pittsburgh, 501 Salk Pavilion, 335 Sutherland Drive, Pittsburgh, PA, 15213,
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Patel SK, Greene AC, Desai SM, Rothstein S, Basha IT, MacPherson JS, Wang Y, Zou Y, Shehabeldin M, Sfeir CS, Little SR, Rohan LC. Biorelevant and screening dissolution methods for minocycline hydrochloride microspheres intended for periodontal administration. Int J Pharm 2021; 596:120261. [PMID: 33486044 DOI: 10.1016/j.ijpharm.2021.120261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
Currently, there is no compendial-level method to assess dissolution of particulate systems administered in the periodontal pocket. This work seeks to develop dissolution methods for extended release poly(lactic-co-glycolic acid) (PLGA) microspheres applied in the periodontal pocket. Arestin®, PLGA microspheres containing minocycline hydrochloride (MIN), is indicated for reduction of pocket depth in adult periodontitis. Utilizing Arestin® as a model product, two dissolution methods were developed: a dialysis set-up using USP apparatus 4 and a novel apparatus fabricated to simulate in vivo environment of the periodontal pocket. In the biorelevant method, the microspheres were dispersed in 250 μL of simulated gingival crevicular fluid (sGCF) which was enclosed in a custom-made dialysis enclosure. sGCF was continuously delivered to the device at a biorelevant flow rate and was collected daily for drug content analysis using UPLC. Both methods could discriminate release characteristics of a panel of MIN-loaded PLGA microspheres that differed in composition and process conditions. A mechanistic model was developed, which satisfactorily explained the release profiles observed using both dissolution methods. The developed methods may have the potential to be used as routine quality control tools to ensure batch-to-batch consistency and to support evaluation of bioequivalence for periodontal microspheres.
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Affiliation(s)
- Sravan Kumar Patel
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA; Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Ashlee C Greene
- Department of Chemical Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stuti M Desai
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA; Magee-Womens Research Institute, Pittsburgh, PA, USA
| | | | - Iman Taj Basha
- Department of Chemical Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - James Scott MacPherson
- Department of Chemical Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yan Wang
- Office of Research and Standards, Office of Generic Drugs, CDER, U.S. Food & Drug Administration, Silver Springs, MD, USA
| | - Yuan Zou
- Office of Research and Standards, Office of Generic Drugs, CDER, U.S. Food & Drug Administration, Silver Springs, MD, USA
| | - Mostafa Shehabeldin
- Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles S Sfeir
- Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA; The McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA; The Center for Craniofacial Regeneration, School of Dental Medicine, University of Pittsburgh, PA, USA; Department of Periodontics and Preventive Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven R Little
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA; Department of Chemical Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA; The McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA; The Center for Craniofacial Regeneration, School of Dental Medicine, University of Pittsburgh, PA, USA; Department of Immunology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa C Rohan
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA; Magee-Womens Research Institute, Pittsburgh, PA, USA; Department of Obstetrics and Gynecology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Zhuang Z, Yoshizawa-Smith S, Glowacki A, Maltos K, Pacheco C, Shehabeldin M, Mulkeen M, Myers N, Chong R, Verdelis K, Garlet GP, Little S, Sfeir C. Induction of M2 Macrophages Prevents Bone Loss in Murine Periodontitis Models. J Dent Res 2018; 98:200-208. [PMID: 30392438 DOI: 10.1177/0022034518805984] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Periodontitis is characterized by the progressive destruction of tooth-supporting alveolar bone, which is mainly caused by chronic inflammation in response to persistent bacterial insult. It has recently become clear that the pathogenesis of periodontitis is associated with a high ratio of proinflammatory M1 (classically activated) macrophages to anti-inflammatory M2 (alternatively activated). To decrease the inflammatory activity, we locally delivered the C-C motif chemokine ligand 2 (CCL2) using controlled-release microparticles (MPs). CCL2 is known to promote chemotaxis of M0 or M2 phenotype macrophages to the inflamed site and induce M2 phenotype polarization locally. Our in vitro data showed that CCL2 increased the number of M2 phenotype macrophages, decreased TNF-α secretion, and enhanced chemotaxis of RAW264.7 cells toward CCL2 MPs. Moreover, we induced periodontal disease in 2 animal models through inoculation of Porphyromonas gingivalis and ligature around the murine molar. Micro-computed tomography analysis showed significant reduction of alveolar bone loss in the CCL2 MP treatment group when compared with a blank MP group and a no-treatment periodontitis group in both models. Immunohistologic analysis showed a significant increase in the M2 phenotype subset and a decrease in the M1 phenotype subset in the CCL2 MP group of the P. gingivalis-induced model. Also, in both models, tartrate-resistant acidic phosphatase staining showed significantly fewer numbers of osteoclasts in the CCL2 MP group in alveolar bone area. Moreover, quantitative polymerase chain reaction results showed a significant increase in IL-1RA (interleukin 1 receptor antagonist) mRNA expression and a decrease in RANKL (receptor activator of nuclear factor kappa-Β ligand) mRNA expression in the CCL2 MP group in the ligature model. In summary, manipulation of endogenous M2 phenotype macrophages with CCL2 MPs decreased the M1 phenotype:M2 phenotype ratio and prevented alveolar bone loss in mouse periodontitis models. The delivery of CCL2 MPs provides a novel approach to treat periodontal disease.
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Affiliation(s)
- Z Zhuang
- 1 Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA.,2 School of Medicine, Tsinghua University, Beijing, China
| | - S Yoshizawa-Smith
- 1 Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA.,3 Department of Periodontics and Preventive Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,4 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - A Glowacki
- 4 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,5 Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - K Maltos
- 1 Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - C Pacheco
- 1 Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Shehabeldin
- 1 Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Mulkeen
- 1 Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - N Myers
- 1 Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - R Chong
- 1 Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - K Verdelis
- 1 Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA.,4 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,6 Department of Endodontics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - G P Garlet
- 7 Department of Biological Sciences, School of Dentistry of Bauru, University of Sao Paulo, Bauru, Brazil
| | - S Little
- 4 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,5 Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - C Sfeir
- 1 Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA.,3 Department of Periodontics and Preventive Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,4 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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