Acemannan, an extracted product from Aloe vera, stimulates dental pulp cell proliferation, differentiation, mineralization, and dentin formation

The Effect of Aloe vera on Skin and Its Commensals: Contribution of Acemannan in Curing Acne Caused by Propionibacterium acnes

Aloe vera is one of the most significant therapeutical plant species that belongs to the family Liliaceae. Aloe vera is composed of a high amount of water, with the remainder being dry matter. The dry matter contains a lot of bioactive compounds like carbohydrates, fats, and enzymes, with various therapeutic and antimicrobial properties. It can enhance the proliferation of cells and prevent cell damage by anti-oxidative properties (stimulating the secretion of superoxide dismutase and peroxidase). Human skin is colonized by microbes like fungi (Candida albicans), bacteria (Propionibacterium acnes, Staphylococcus aureus), and mites. These commensals are responsible for skin characteristics such as acidic pH, the pungent smell of sweat, etc. Human fetuses lack skin microbiota, and their skin is colonized after birth. Commensals present on the skin have a crucial role in training the human immune system against other pathogenic microbes. Propionibacterium acnes act as an opportunistic pathogen when the balance between the commensals is disturbed. We also emphasize the recent progress in identifying the aloe metabolite biosynthesis pathways and the associated enzyme machinery. The hyperproliferation of Propionibacterium acnes causes acne, and acemannan plays a significant role in its cure. Hence, we need to consider a new treatment approach based on the root cause of this dysbiosis.

Partial pulpotomy success in primary molars followed up for 24 months: A randomized controlled clinical trial using mineral trioxide aggregate, biodentine, and acemannan

BACKGROUND

Finding the best treatment approach and suitable capping materials in primary molars with deep carious lesions remains unresolved.

AIM

To compare the success rates of partial pulpotomy in deep caries lesions in primary molars treated with mineral trioxide aggregate (MTA), biodentine, or acemannan for 6-24 months.

DESIGN

A parallel-design, non-inferiority randomized controlled clinical trial was performed. Ninety mandibular primary molars from 65 children meeting the criteria, aged 3-8 years, were included. After inflamed pulp tissue removal and hemostasis, each tooth was randomly allocated into the MTA control group, or the biodentine or acemannan experimental group (N = 30 per group). All teeth were restored with a stainless steel crown. The outcomes were evaluated for 6-24 months. A generalized estimating equation model was used to compare the overall success rate in each group.

RESULTS

After 24 months, 58 children (83 teeth) were available for evaluation. The results indicated that the success rate in the MTA, biodentine, and acemannan groups was 83.3%, 76.9%, and 74.1%, respectively. No significant difference in success rates among groups, however, was observed at the 6- to 24-month follow-ups (at 24th month, p = .30).

CONCLUSION

There was no statistically significant difference between MTA, biodentine, or acemannan in the partial pulpotomy success after 24 months.

Acemannan-containing bioactive resin modified glass ionomer demonstrates satisfactory physical and biological properties

Background/purpose

Resin-modified glass ionomers (RMGIs) have been recommended as liner and cement to provide the teeth with mechanical support, a chemical barrier, and thermal insulation. Acemannan, the main polysaccharide extracted from Aloe vera, is a promising inductive material in vitro and in vivo. This study aimed to develop acemannan-containing bioactive resin-modified glass ionomers (RMGIs).

Materials and methods

Acemannan (3%, 5%, and 10%) was added to the three types of RMGIs (RU-HBM1/Fuji II LC/Vitrebond) to generate 3%, 5%, and 10% aceRMGIs (aceRU/aceFuji/aceVB). The materials were evaluated for depth of cure/flexural strength/cumulative fluoride ion release. Cell viability and vascular endothelial growth factor (VEGF) and bone morphogenetic protein-2 (BMP-2) secretion were determined using MTT/apoptosis/necrosis assays, and ELISA kits, respectively. RMGI without acemannan were used as controls.

Results

The aceRMGIs met the ISO requirements for depth of cure and flexural strength. Adding 10% acemannan increased the cumulative fluoride release in the RU and FJ groups, but slightly decreased it in the VB group (P < 0.05). The MTT assay revealed 10% aceRU and all aceFJ groups significantly increased cell viability compared with each control group (P < 0.05). Apoptosis/necrosis assay showed the biocompatibility of all aceRMGIs. Adding acemannan to RMGIs significantly induced VEGF expression in a dose dependent manner while 5% and 10% aceRU significantly induced BMP-2 expression compared with RU group (P < 0.05).

Conclusion

We conclude that 5-10% acemannan in RMGI is the optimal concentration based on its physical properties and ability to induce pulp cell proliferation and growth factor secretion.

Epigenetic therapeutics in dental pulp treatment: Hopes, challenges and concerns for the development of next-generation biomaterials

This opinion-led review paper highlights the need for novel translational research in vital-pulp-treatment (VPT), but also discusses the challenges in translating evidence to clinics. Traditional dentistry is expensive, invasive and relies on an outmoded mechanical understanding of dental disease, rather than employing a biological perspective that harnesses cell activity and the regenerative-capacity. Recent research has focussed on developing minimally-invasive biologically-based 'fillings' that preserve the dental pulp; research that is shifting the paradigm from expensive high-technology dentistry, with high failure rates, to smart restorations targeted at biological processes. Current VPTs promote repair by recruiting odontoblast-like cells in a material-dependent process. Therefore, exciting opportunities exist for development of next-generation biomaterials targeted at regenerative processes in the dentin-pulp complex. This article analyses recent research using pharmacological-inhibitors to therapeutically-target histone-deacetylase (HDAC) enzymes in dental-pulp-cells (DPCs) that stimulate pro-regenerative effects with limited loss of viability. Consequently, HDAC-inhibitors have the potential to enhance biomaterial-driven tissue responses at low concentration by influencing the cellular processes with minimal side-effects, providing an opportunity to develop a topically-placed, inexpensive bio-inductive pulp-capping material. Despite positive results, clinical translation of these innovations requires enterprise to counteract regulatory obstacles, dental-industry priorities and to develop strong academic/industry partnerships. The aim of this opinion-led review paper is to discuss the potential role of therapeutically-targeting epigenetic modifications as part of a topical VPT strategy in the treatment of the damaged dental pulp, while considering the next steps, material considerations, challenges and future for the clinical development of epigenetic therapeutics or other 'smart' restorations in VPT.

Biopolymer collagen-chitosan scaffold containing Aloe vera for chondrogenic efficacy on cartilage tissue engineering

The chondrogenic efficacy of aloe vera blended collagen-chitosan (COL-CS-AV) porous scaffold was investigated using articular chondrocytes in a standard condition. Cytocompatibility was analyzed using fluorescent dyes (calcein AM/ethidium bromide) and the viable cells were quantified by MTT assay. Glycosaminoglycan (GAG) content of ECM was estimated by using 1, 9-Dimethyl methylene Blue (DMMB). The total RNA content was quantified and the cartilage specific genes (col2a1, Acan) were amplified by reverse transcription-PCR from the cell lysate of the scaffolds. Histological examination was made using Haematoxylin and Eosin (H&E), safranin-O, masson's trichrome, alcian blue, and alizarin red to stain the specific component of ECM secreted on the construct. The cartilage specific collagen type II was estimated by immunohistochemistry using monoclonal type II collagen antibody. The results of these studies proved that COL-CS-AV scaffold has more chondrogenic efficacy than COL-CS, thus the aloe vera blend COL-CS-AV scaffold might be used as suitable candidate for cartilage tissue engineering.

A New Biomaterial Derived from Aloe vera-Acemannan from Basic Studies to Clinical Application

Aloe vera is a kind of herb rich in polysaccharides. Acemannan (AC) is considered to be a natural polysaccharide with good biodegradability and biocompatibility extracted from Aloe vera and has a wide range of applications in the biomedical field due to excellent immunomodulatory, antiviral, antitumor, and tissue regeneration effects. In recent years, clinical case reports on the application of AC as a novel biomedical material in tissue regenerative medicine have emerged; it is mainly used in bone tissue engineering, pulp-dentin complex regeneration engineering, and soft tissue repair, among other operations. In addition, multiple studies have proved that the new composite products formed by the combination of AC and other compounds have excellent biological and physical properties and have broader research prospects. This paper introduces the preparation process, surface structure, and application forms of AC; summarizes the influence of acetyl functional group content in AC on its functions; and provides a detailed review of the functional properties, laboratory studies, clinical cutting-edge applications, and combined applications of AC. Finally, the current application status of AC from basic research to clinical treatment is analyzed and its prospects are discussed.

Histologic and histomorphometric evaluation of Aloe vera adjunctive to β-tricalcium phosphate in class II furcation defects in dogs

Aloe vera has antimicrobial activity and enhances the osseointegration process, thus it may have the potential in treating periodontal defects. This study aimed to evaluate the effect of Aloe vera as an adjunction to Beta-tricalcium phosphate (β-TCP) bone graft in Grade II furcation defects. A randomized study was conducted on six healthy mongrel dogs' premolars. A total of twenty-four Grade II furcation critical-sized defects were surgically created after reflecting a full-thickness flap, twelve defects were filled with β-TCP while the other twelve defects were filled with Aloe vera mixed with β-TCP and both covered by collagen membrane. Animals were euthanized at the end of the fourth and eighth week and defects were analyzed histologically and histomorphometrically. Histologically, Aloe vera mixed with β-TCP resulted in more bone formation and new PDL fibers compared to β-TCP alone. After 2 and 4 weeks, the experimental group had significantly higher newly formed interradicular bone height (p < 0.0001, and p < 0.0001, respectively), bone thickness (p < 0.0001, and p < 0.0001, respectively), and percentage of the surface area (p = 0.009, and p = 0.023, respectively). Aloe vera gel adjunctive to β-TCP is an effective bioactive agent that enhances periodontal tissue regeneration and bone formation in critically sized defects.

Dentin regeneration based on tooth tissue engineering: A review

Missing or damaged teeth due to caries, genetic disorders, oral cancer, or infection may contribute to physical and mental impairment that reduces the quality of life. Despite major progress in dental tissue repair and those replacing missing teeth with prostheses, clinical treatments are not yet entirely satisfactory, as they do not regenerate tissues with natural teeth features. Therefore, much of the focus has centered on tissue engineering (TE) based on dental stem/progenitor cells to create bioengineered dental tissues. Many in vitro and in vivo studies have shown the use of cells in regenerating sections of a tooth or a whole tooth. Tooth tissue engineering (TTE), as a promising method for dental tissue regeneration, can form durable biological substitutes for soft and mineralized dental tissues. The cell-based TE approach, which directly seeds cells and bioactive components onto the biodegradable scaffolds, is currently the most potential method. Three essential components of this strategy are cells, scaffolds, and growth factors (GFs). This study investigates dentin regeneration after an injury such as caries using TE and stem/progenitor cell-based strategies. We begin by discussing about the biological structure of a dentin and dentinogenesis. The engineering of teeth requires knowledge of the processes that underlie the growth of an organ or tissue. Then, the three fundamental requirements for dentin regeneration, namely cell sources, GFs, and scaffolds are covered in the current study, which may ultimately lead to new insights in this field.

Characterization of a bioscaffold containing polysaccharide acemannan and native collagen for pulp tissue regeneration

Dental pulp regeneration exploits tissue engineering concepts using stem cells/scaffolds/growth-factors. Extracted collagen is commonly used as a biomaterial-scaffold due to its biocompatibility/biodegradability and mimics the natural extracellular matrix. Adding biomolecules into a collagen-scaffold enhanced pulp regeneration. Acemannan, β-(1-4)-acetylated-polymannose, is a polysaccharide extracted from aloe vera. Acemannan is a regenerative biomaterial. Therefore, acemannan could be a biomolecule in a collagen-scaffold. Here, acemannan and native collagen were obtained and characterized. The AceCol-scaffold's physical properties were investigated using FTIR, SEM, contact angle, swelling, pore size, porosity, compressive modulus, and degradation assays. The AceCol-scaffold's biocompatibility, growth factor secretion, osteogenic protein expression, and calcification were evaluated in vitro. The AceCol-scaffolds demonstrated higher hydrophilicity, swelling, porosity, and larger pore size than the collagen scaffolds (p < 0.05). Better cell-cell and cell-scaffold adhesion, and dentin extracellular matrix protein (BSP/OPN/DSPP) expression were observed in the AceCol-scaffold, however, DSPP expression was not detected in the collagen group. Significantly increased cellular proliferation, VEGF and BMP2 expression, and mineralization were detected in the AceCol-scaffold compared with the collagen-scaffold (p < 0.05). Computer simulation revealed that acemannan's 3D structure changes to bind with collagen. In conclusion, the AceCol-scaffold synergistically provides better physical and biological properties than collagen. The AceCol-scaffold is a promising material for tissue regeneration.

Aloe vera incorporated starch-64S bioactive glass-quail egg shell scaffold for promotion of bone regeneration

Simultaneous promotion of osteoconductive and osteoinductive characteristics through combining bioactive glasses with natural polymers is still a challenge in bone tissue engineering. Starch, 64S bioactive glass (BG), aloe vera (AV) and quail eggshell powder (QE) were utilized to achieve biodegradable, bioactive, biocompatible and mechanically potent multifunctional scaffolds, using freeze-drying mechanism. Cell viability for starch-BG-AV-QE scaffolds at 3 and 7 day intervals was reported to be over 95 %. Acridine orange staining was employed to study live/dead cells cultured on the scaffolds. The high sufficiency of starch-BG-AV-QE scaffolds in osteogenic differentiation and extracellular matrix mineralization was confirmed through alkaline phosphatase activity and alizarin red staining assessments after 7 and 14 days of cell culture. High compressive strength, managed biodegradability and expression of osteocalcin and osteopontin as late markers of osteogenic differentiation were also reached in the range of 30-75 % for starch-BG-AV-QE scaffolds. Hence, starch-BG-AV-QE scaffolds with ideal physico-mechanical and biological characteristics can be considered as promising candidates for promotion of bone regeneration.

The comparison of calcium hydroxide, curcumin, and Aloe vera antibacterial effects on 6-week-old Enterococcus faecalis biofilm as an intracanal medicament: An in vitro study

Background:

This study aimed to compare the antibacterial effects of calcium hydroxide, curcumin, and Aloe vera as an intracanal medicament on 6-week-old Enterococcus faecalis biofilm.

Materials and Methods:

In this in vitro study, the solution containing E. faecalis ATCC^® 29212™ was inserted into the canals of 72 single-rooted teeth to produce biofilm. The samples were divided into four groups, and the antibacterial agent as an intracanal drug was used for 1 week. Calcium hydroxide, curcumin, and A. vera were used as intracanal medicaments in three groups, respectively, and the fourth group was irrigated with normal saline. The collected debris was cultured by spread plate method for the bacterial count by colony count machine, and the number of bacteria in each sample per ml was reported in colony-forming unit per ml (CFU/ml). The data were analyzed using SPSS software. KruskalWallis and MannWhitney U-tests were used for comparison of CFU/ml between the study groups. P <0.05 was considered significant.

Results:

The mean CFU/ml in the groups of calcium hydroxide, curcumin, and A. vera were 749.44, 630.55, and 1529.16, respectively. Compared with the control group, curcumin, calcium hydroxide, and A. vera showed 99.5%, 99.41%, and 98.79% antimicrobial effects, respectively. All three groups were significantly effective than the control group (P = 0.023, P = 0.023, and P = 0.024, respectively) but were not significantly different from each other (P = 0.057).

Conclusion:

All three groups showed significant antibacterial activity compared to the control group, curcumin had the most significant effect, followed by calcium hydroxide and A. vera. Therefore, herbal materials can be considered safe alternatives to synthetic medicaments for intracanal usage.

The effect of acemannan in implant placement with simultaneous guided bone regeneration in the aesthetic zone: a randomized controlled trial

Acemannan, a linear polysaccharide produced by Aloe vera, has been shown to have important biological effects promoting wound healing and tissue regeneration. The aim of this randomized clinical trial was to investigate the impact of acemannan in guided bone regeneration (GBR) with simultaneous implant placement. Twenty patients were randomly allocated to a test group (deproteinized bovine bone with particulate acemannan (mean size 32.45 μm)) and a control group (deproteinized bovine bone only). Twenty implants were placed with simultaneous GBR. Radiographic measurements were conducted on cone beam computed tomography (CBCT) scans immediately post-surgery and at 3 and 6 months. Vertical and horizontal dimensions of the buccal bone were measured at the implant platform (0) and at points 2, 4, 6, and 8 mm apically. The dimensional reduction of vertical and horizontal buccal bone was significantly smaller in the test group at 3 months postoperative (P < 0.05) at every position measured (0, 2, 4, 6, 8 mm), but the difference was not statistically significant at 6 months. Acemannan was found to be a safe and predictable biomaterial for GBR, which resulted in enhanced dimensional stability of the regenerated tissue at 3 months. However, these results were not replicated at 6 months. Further studies are required to document the long-term efficacy and potential of acemannan use as a supplement in bone regeneration.

Acemannan-induced tooth socket healing: A 12-month randomized controlled trial

Background/purpose

Natural compounds have become alternatives for bone regeneration. Acemannan, the main polysaccharide extracted from Aloe vera, has been demonstrated as a promising osteoinductive material in vitro and in vivo. This clinical study investigated the effect of acemannan on tooth socket healing.

Materials and methods

Thirty-five otherwise healthy patients, 18–25 years old and diagnosed with horizontal or vertical partial impaction of the lower third molars, were enrolled in this randomized controlled trial. After removing the teeth, the sockets randomly received one of the following treatments: spontaneous blood-clotting (control), 20 mg acemannan sponge, or 50 mg acemannan sponge. Cone-beam computed tomography of the mandible was performed immediately (baseline), and at 3-, 6-, and 12-months postoperatively; the data were analyzed using the OsiriX MD program. Bone healing in the socket was determined measuring the socket volume. One-way ANOVA was used to analyze the differences within each group and between groups.

Results

Thirty-five patients with 43 partially impacted lower third molars participated in this study. No patients exhibited alveolar osteitis or secondary infection. Compared with baseline, all groups showed significant reduction in socket volume at all observation time-points (p < 0.05). The 50 mg acemannan group had a significantly greater reduction in socket volume compared with the control at all postoperative time-points (p < 0.05). The 20 mg group had a significantly greater reduction in socket volume compared with the control at 3-months postoperatively (p < 0.05).

Conclusion

We conclude that acemannan increases bone healing at 3-, 6-, and 12-months after removal of partially impacted mandibular third molars.

Clinical and Radiographic Evaluation of the Efficacy of Formocresol, Allium sativum Oil, and Aloe barbadensis Gel as Pulpotomy Medicaments in Primary Molars: A Randomized Controlled Trial

AIM

The aim of the study was to clinically and radiographically evaluate the efficacy of formocresol, Allium sativum oil, and Aloe barbadensis gel as pulpotomy medicaments in primary molars.

MATERIALS AND METHODS

Eighty-two primary molars indicated for pulpotomy were included in the study. The molars included were divided into three groups by simple random sampling, and treatment was done with formocresol as control, comparing it with Aloe barbadensis gel and Allium sativum oil.

RESULTS

The teeth were then followed up for 6 and 12 months clinically and radiographically. Chi-square test was used to compare the clinical and radiographic results between the groups. McNemar test was used to compare the clinical and radiographic results at 6 and 12 months. The results revealed that there was no significant difference between the groups when comparing the experimental groups to the control.

CONCLUSION

The study shows that Aloe barbadensis gel and Allium sativum oil may be used as an alternative to formocresol as pulpotomy medicaments.

HOW TO CITE THIS ARTICLE

Abirami K, Ramkumar H, Senthil D. Clinical and Radiographic Evaluation of the Efficacy of Formocresol, Allium sativum Oil, and Aloe barbadensis Gel as Pulpotomy Medicaments in Primary Molars: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2020;13(5):518-522.

Acemannan Used as an Implantable Biomaterial for Vital Pulp Therapy of Immature Permanent Teeth Induced Continued Root Formation

Direct pulp-capping, a vital pulp therapy, is used to protect and preserve pulp vitality by applying a biomaterial on the pulp exposure site. Acemannan, a polysaccharide extracted from Aloe vera, induces osteodentin-bridge formation to cover the exposure site in vivo. We evaluated the effect of acemannan sponges on partial pulpotomized permanent teeth with caries or accident-induced pulp exposure (n = 50). After removing infected dentin and inflamed pulp tissue, the teeth were randomly divided into acemannan or control (mineral trioxide aggregate (MTA) groups (n = 25). The teeth were examined immediately after treatment (baseline) and at 6- and 12-month follow-ups for clinical and cone beam computed tomography (CBCT) examination. The three-dimensional tooth length and root apex area were simulated to determine treatment success. We found that the overall success rate in the acemannan and MTA groups from baseline to 12-month follow-up was 90.91% and 95.65%, respectively, with no significant difference between the two groups (p > 0.05). In the success teeth in both groups, the root length increased, and the apex area significantly decreased (p < 0.05), indicating continued root formation. Our results suggest that acemannan is a promising low-cost biomaterial for partial pulpotomy treatment for immature permanent teeth requiring vital pulp therapy.

Evaluation of hydrophilic gel made from Acemannan and Moringa oleifera in enhancing osseointegration of dental implants. A preliminary study in rabbits

BACKGROUND

Hydrophilic implant surface has gained increasing interest as a factor to stimulate osseointegration.

PURPOSE

The study was done to formulate hydrophilic gel to be applied on to the dental implant surface, to enhance bone to implant contact (BIC).

MATERIALS AND METHODS

In first part of study, Acemannan and Moringa oleifera hydro gel formulated in different proportions were coated on the titanium disk and 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) assay was done to evaluate cell viability.Cytotoxicity of aqueous extracts of two plants were tested against UMR106 cells. In second part of study, the prototype titanium implants were placed in tibia and femur of 8 male rabbits. Hydrophilic gel formulated from Acemannan and Moringa oleifera were coated on the study groups of implants. Histomorphometric analysis was carried out of the enbloc sections specimens. Student's unpaired t-test was used to compare mean values between the two groups.

RESULTS

The alkaline phosphatase assay showed least cell inhibition for Acemannan and Moringa oleifera (2:1) as 4.45% and osteoblastic differentiation as 0.328 at 540 nm. Titamium disc coated with hydrogel of Acemannan and Moringa oliefera and seeded with Human MSC shows increased proliferation of osteoblast cells.Compare to study group implants, control group showed no new bone formation.

CONCLUSIONS

Hydrophilic implant surface showed new bone formation with increased bone to implant contact.There was absent of degenerative changes, necrotic changes, fibrosis, and inflammation at the new BIC.

Aloe vera-loaded nanofibrous scaffold based on Zein/Polycaprolactone/Collagen for wound healing

Recently, the use of nanofibers (NFs) for tissue engineering has been more developed. For this purpose, we fabricated the NFs (Zein/Polycaprolactone/Collagen) (Zein/PCL/Collagen) incorporated by zinc oxide NPs (ZnO NPs) and Aloe-vera (NFs/ZnO/Alv) using the electrospinning method. Prepared NFs were studied for their morphological, mechanical, thermal stability, and hydrophilic properties. Among the developed NFs, those loaded by ZnO (1 wt%) and Alv (8 wt%) and with Zein/PCL (70:30) displayed the suitable thermal stability and mechanical properties. The water contact angle of NFs improved by decreasing the Zein/PCL blending ratio. Cell culture results showed that the NFs had good cytocompatibility. The cell adhesion potential of this mats were certified with studying by fibroblast cells for various time intervals (24 h and 72 h). The NFs/ZnO/Alv sample revealed inhibition activity against S. aureus (19.23 ± 1.35 mm) and E. coli (15.38 ± 1.12 mm) bacteria. Thus, these results offered that the prepared NFs can be promised as an active scaffold for wound healing uses.

Extraction, Purification, Structural Characteristics, Biological Activities and Pharmacological Applications of Acemannan, a Polysaccharide from Aloe vera: A Review

Aloe vera is a medicinal plant species of the genus Aloe with a long history of usage around the world. Acemannan, considered one of the main bioactive polysaccharides of Aloe vera, possesses immunoregulation, anti-cancer, anti-oxidation, wound healing and bone proliferation promotion, neuroprotection, and intestinal health promotion activities, among others. In this review, recent advancements in the extraction, purification, structural characteristics and biological activities of acemannan from Aloe vera were summarized. Among these advancements, the structural characteristics of purified polysaccharides were reviewed in detail. Meanwhile, the biological activities of acemannan from Aloe vera determined by in vivo, in vitro and clinical experiments are summarized, and possible mechanisms of these bioactivities were discussed. Moreover, the latest research progress on the use of acemannan in dentistry and wound healing was also summarized in details. The structure-activity relationships of acemannan and its medical applications were discussed. Finally, new perspectives for future research work on acemannan were proposed. In conclusion, this review summarizes the extraction, purification, structural characteristics, biological activities and pharmacological applications of acemannan, and provides information for the industrial production and possible applications in dentistry and wound healing in the future.

The influence of Aloe vera with mesenchymal stem cells from dental pulp on bone regeneration: characterization and treatment of non-critical defects of the tibia in rats

OBJECTIVE

This study aimed to evaluate the inflammatory effect and bone formation in sterile surgical failures after implantation of a collagen sponge with mesenchymal stem cells from human dental pulp (hDPSCs) and Aloe vera.

MATERIAL AND METHODS

Rattus norvegicus (n=75) were divided into five experimental groups according to treatment: G1) control (blood clot); G2) Hemospon®; G3) Hemospon® in a culture medium enriched with 8% Aloe vera; G4) Hemospon® in a culture medium containing hDPSCs and G5) Hemospon® in a culture medium enriched with 8% Aloe vera and hDPSCs. On days 7, 15 and 30, the animals were euthanized, and the tibia was dissected for histological, immunohistochemistry and immunofluorescence analyses. The results were analyzed using nonparametric Kruskal-Wallis test and Dunn's post-test.

RESULTS

On days 7 and 15, the groups with Aloe vera had less average acute inflammatory infiltrate compared to the control group and the group with Hemospon® (p<0.05). No statistically significant difference was found between the groups regarding bone formation at the three experimental points in time. Osteopontin expression corroborated the intensity of bone formation. Fluorescence microscopy revealed positive labeling with Q-Tracker® in hDPSCs before transplantation and tissue repair.

CONCLUSION

The results suggest that the combination of Hemospon®, Aloe vera and hDPSCs is a form of clinical treatment for the repair of non-critical bone defects that reduces the inflammatory cascade's effects.

Healing potential of injectable Aloe vera hydrogel loaded by adipose-derived stem cell in skin tissue-engineering in a rat burn wound model

Adipose stem cells (ASCs) are a great promise in wound healing due to their potential in differentiating into various cell lineages and secreting growth factors. The purpose of this study is to evaluate the in vivo effects of Aloe vera hydrogel loaded by allogeneic ASCs on a rat burn wound model. The ASCs were isolated, cultured and mixed with 50% Aloe vera hydrogel and injected intradermally around the wound. Demineralized bone matrix (DBM) was used as dressing in the experiment. The burn wound-healing properties of different experimental groups were investigated by histopathological, molecular, scanning electron microscopic and biochemical analysis at the 7th, 14th and 28th days post-wounding. The Aloe vera and DBM-Aloe vera groups showed almost similar healing properties, while treatment by DBM-Aloe vera/ASCs significantly enhanced wound healing. The levels of transforming growth factor-β1 (TGF-β1) and interleukin-1β markedly decreased at the 7th day post-injury, in the DBM-Aloe vera/ASC-treated group, suggesting that this treatment regime subsided the inflammatory responses. Angiogenesis, re-epithelialization and the level of TGF-β1 in the wounds treated with DBM-Aloe vera/ASCs were also remarkably higher than those of other groups, at the 14th day post-injury. Besides, scar formation significantly decreased in the DBM-Aloe vera/ASC-treated wounds when compared with other groups. Our biochemical results were in agreement with the molecular and histopathological findings and strongly demonstrated that a DBM-Aloe vera/ASC composite can stimulate burn wound healing. These results suggest that the DBM-Aloe vera/ASC composite can be considered as a promising therapeutic strategy in the treatment of burn wounds.

Long-term clinical and radiographic evaluation of the effectiveness of direct pulp-capping materials

The aim of this review was to assess the effectiveness of different direct pulp-capping (DPC) materials for human pulp-exposed teeth. An electronic search was performed on 20 February 2018. Long-term clinical and radiographic evaluations of the effectiveness of different DPC materials for use on human pulp-exposed teeth were included. Risk-of-bias assessment and data extraction were performed. From the 496 identified articles, 15 met the eligibility criteria. Among the studies included in those articles, a total of 1,322 teeth were treated with 12 types of DPC materials, and 1,136 teeth were evaluated at a final follow-up examination. For mineral trioxide aggregate (MTA) and calcium hydroxide (CH), the number of included studies, the number of treated teeth, and the mean follow-up period of studies were almost equal, and the success rates of MTA was superior to CH. Therefore, MTA is likely to be a more effective and predictable material for DPC compared to CH. However, the results were based on the included studies, which were all judged to have a high risk of bias. Therefore, more long-term clinical and radiographic studies designed with lower risk of bias are needed. Moreover, the other 10 materials were only investigated by a small number of studies; therefore, further studies are required.

Improved Multicellular Response, Biomimetic Mineralization, Angiogenesis, and Reduced Foreign Body Response of Modified Polydioxanone Scaffolds for Skeletal Tissue Regeneration

The potential of electrospun polydioxanone (PDX) mats as scaffolds for skeletal tissue regeneration was significantly enhanced through improvement of the cell-mediated biomimetic mineralization and multicellular response. This was achieved by blending PDX ( i) with poly(hydroxybutyrate- co-valerate) (PHBV) in the presence of hydroxyapatite (HA) and ( ii) with aloe vera (AV) extract containing a mixture of acemannan/glucomannan. In an exhaustive study, the behavior of the most relevant cell lines involved in the skeletal tissue healing cascade, i.e. fibroblasts, macrophages, endothelial cells and preosteoblasts, on the scaffolds was investigated. The scaffolds were shown to be nontoxic, to exhibit insignificant inflammatory responses in macrophages, and to be degradable by macrophage-secreted enzymes. As a result of different phase separation in PDX/PHBV/HA and PDX/AV blend mats, cells interacted differentially. Presumably due to varying tension states of cell-matrix interactions, thinner microtubules and significantly more cell adhesion sites and filopodia were formed on PDX/AV compared to PDX/PHBV/HA. While PDX/PHBV/HA supported micrometer-sized spherical particles, nanosized rod-like HA was observed to nucleate and grow on PDX/AV fibers, allowing the mineralized PDX/AV scaffold to retain its porosity over a longer time for cellular infiltration. Finally, PDX/AV exhibited better in vivo biocompatibility compared to PDX/PHBV/HA, as indicated by the reduced fibrous capsule thickness and enhanced blood vessel formation. Overall, PDX/AV blend mats showed a significantly enhanced potential for skeletal tissue regeneration compared to the already promising PDX/PHBV/HA blends.

Photocrosslinked acemannan-based 3D matrices for in vitro cell culture

Photocrosslinking on acemannan is proposed as a green approach for the production of high added-value acemannan structures, enabling its biomedical exploitation.

Relative effectiveness of direct and indirect pulp capping in the primary dentition

INTRODUCTION

Carious or traumatised teeth with a normal pulp status or with reversible pulpitis need an indirect or direct pulp capping procedure to keep the pulp vital.

AIM

To evaluate the clinical outcome of both interventions for treating vital primary teeth.

STUDY DESIGN

Two reviewers on Pubmed and ISI Web of Science performed a comprehensive literature review of publications from 1966 until December 2017. Among PubMed abstracts, publications were selected according to the following criteria: prospective clinical study, correct indication for the performed treatment, and clear definition of clinical and/or radiographic success criteria. The strict selection criteria limited the amount of randomised controlled trials (RCT) or controlled clinical trials (CT); especially for "indirect pulp therapy", "direct pulp capping" and the number of RCTs was limited.

CONCLUSIONS

Based on a systematic review (20 controlled clinical studies or randomised controlled clinical studies), the following statements can be given: Due to the opportunity of tissue repair, indirect pulp treatment can be an acceptable procedure for reversible pulp inflammation. The use of adhesives for indirect pulp capping in a single-visit procedure after gentle caries removal can be recommended. Successful pulp capping is possible under defined conditions (symptom-free tooth, disinfection of pulp exposures, Class-I cavity) and appropriate sealing of the cavity with an effective dentine seal being a conditio sine qua non. There is maximum evidence for the use of disinfecting solutions prior to pulp capping and Dycal as pulp capping material. Longer follow-up periods, more clinical studies, comparable conditions, and clear definitions of evaluation criteria are needed to confirm the results of endodontic treatment in primary teeth.

Acemannan increased bone surface, bone volume, and bone density in a calvarial defect model in skeletally-mature rats

Background/purpose

Acemannan, a β-(1-4)-acetylated polymannose extracted from Aloe vera gel, has been proposed as biomaterial for bone regeneration. The aim of this study was to investigate the effect of acemannan in calvarial defect healing.

Materials and methods

Acemannan was processed to freeze-dried sponge form and disinfected by UV irradiation. Thirty-five female Sprague-Dawley rats were used in the in vivo study. Seven-mm diameter mid-calvarial defects were created and randomly allocated into blood clot control (C), acemannan 1 mg (A1), 2 mg (A2), 4 mg (A4), and 8 mg (A8) groups (n = 7). After four weeks, the calvarial specimens were subjected to microcomputed tomography (microCT) and histopathological analysis.

Results

MicroCT revealed a significant increase in bone surface and bone volume in the A1 and A2 groups, and tissue mineral density in the A4 and A8 groups compared with the control group (p < 0.05). Histologically, the acemannan-treated groups had denser bone matrix compared with the control group.

Conclusion

Acemannan is an effective bioactive agent for bone regeneration, enhancing bone growth as assayed in two- and three-dimensions.

One percent alendronate and aloe vera gel local host modulating agents in chronic periodontitis patients with class II furcation defects: A randomized, controlled clinical trial

AIM

Alendronate (ALN) has antiresorptive and osteostimulative properties. The major component of aloe vera (AV) gel is acemannan, which has been found to have osteogenic properties. The aim of the present study is to explore the effectiveness of 1% ALN and AV gel as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients with class II furcation defects.

METHODS

Ninety volunteers were randomly assigned to three treatment groups: (a) SRP plus placebo gel; (b) SRP plus 1% ALN gel; and (c) SRP plus AV gel. Clinical and radiographic parameters were recorded at baseline and at 6 and 12 months.

RESULTS

The mean probing depth reduction and relative horizontal clinical attachment level (CAL) and relative vertical CAL gains were greater in the ALN group than in the AV and placebo groups at 6 and 12 months. Furthermore, a significantly greater mean percentage of defect depth reduction (DDR) was found in the ALN group (38.09 ± 9.53, 44.86 ± 6.29) than the AV groups (11.94 ± 15.10, 14.59 ± 25.49) at 6 and 12 months, respectively.

CONCLUSION

ALN showed significant improvement in all clinical parameters, along with greater DDR, compared to AV in the treatment of class II furcation defects as an adjunct to SRP.

Avaliação da dissociação iônica do hidróxido de cálcio associado ao Aloe vera como veículo

Resumo Introdução O hidróxido de cálcio é considerado uma medicação intracanal padrão ouro e diferentes substâncias podem ser empregadas como veículo para melhorar suas propriedades. O Aloe vera é um fitoterápico popularmente conhecido por babosa e que se destaca pela sua capacidade imunorreguladora, antimicrobiana, cicatrizante e pela biocompatibilidade celular. Objetivo Avaliar a dissociação iônica do hidróxido de cálcio, tendo o Aloe vera como veículo. Material e método O extrato de Aloe vera foi obtido diretamente da folha, submetido à filtração e armazenado em tubo Falcon estéril. Foram preparados dois grupos de medicação intracanal: o grupo controle, com hidróxido de cálcio e soro fisiológico, e o grupo experimental, com hidróxido de cálcio e Aloe vera como veículo. Resultado Não foi verificada uma diferença estatisticamente significativa entre as médias de liberação de cálcio dos grupos (p=0,944). Quando comparados os valores de forma pareada, considerando as diferentes avaliações ao longo do tempo, foi identificada uma diferença estatisticamente significativa (p=0,015) para o grupo experimental, de modo que os valores médios da liberação de cálcio foram superiores até o 21º dia do estudo. Conclusão O hidróxido de cálcio, quando associado ao Aloe vera, apresentou maior dissociação iônica que quando utilizado com água destilada. Tal resultado, associado às propriedades inerentes deste fitoterápico, sugerem que a pasta de hidróxido de cálcio e Aloe vera pode ser uma alternativa viável e promissora como medicação intracanal, e melhorar o reparo apical e periapical.

Effect of iRoot Fast Set root repair material on the proliferation, migration and differentiation of human dental pulp stem cells in vitro

The present study investigated the effect of iRoot Fast Set root repair material (iRoot FS) on the proliferation, migration and differentiation of human dental pulp stem cells (hDPSCs). The hDPSCs were treated with eluates of iRoot FS at concentrations of 0.2 and 2 mg/mL, referred to as FS0.2 and FS2, respectively, and Biodentine (BD; Septodont, Saint Maur des Faussés, France) eluates at the corresponding concentrations as positive controls. A CCK8 assay was performed to determine cell proliferation. Wound healing and transwell assays were conducted to examine cell migration. Osteogenic differentiation was evaluated based on alkaline phosphatase activity, Alizarin Red S staining and quantitative real-time reverse-transcriptase polymerase chain reaction (qRT-PCR) to analyze the mRNA expression of differentiation gene markers. Cell proliferation was higher in the FS and BD groups than in the blank controls at 3 and 7 days. Moreover, FS0.2 enhanced cell migration and significantly promoted the osteogenic differentiation of hDPSCs. These findings suggested that iRoot FS is a bioactive material that promotes the proliferation, migration and osteogenic differentiation of hDPSCs.

Stimulation of Dentin Regeneration by Using Acemannan in Teeth with Lipopolysaccharide-induced Pulp Inflammation

INTRODUCTION

This study investigated the effects of acemannan, a polysaccharide from Aloe vera, on human deciduous pulp cells in vitro and the response after vital pulp therapy in dog deciduous teeth.

METHODS

Human primary dental pulpal cells were treated with acemannan in vitro and evaluated for proliferation, alkaline phosphatase activity, type I collagen, bone morphogenetic protein (BMP-2), BMP-4, vascular endothelial growth factor, and dentin sialoprotein expression and mineralization. Osteogenesis-related gene expression was analyzed by complementary DNA microarray. Pulpal inflammation was induced in dog teeth for 14 days. The inflamed pulp was removed, retaining the healthy pulp. The teeth were randomly divided into 3 treatment groups: acemannan, mineral trioxide aggregate, and formocresol. Sixty days later, the teeth were extracted and evaluated histopathologically.

RESULTS

Acemannan significantly increased pulp cell proliferation, alkaline phosphatase, type I collagen, BMP-2, BMP-4, vascular endothelial growth factor, and dentin sialoprotein expression and mineralization approximately 1.4-, 1.6-, 1.6-, 5.5-, 2.6-, 3.8-, 1.8-, and 4.8-fold, respectively, compared with control. In vivo, partial pulpotomy treatment using acemannan generated outcomes similar to mineral trioxide aggregate treatment, resulting in mineralized bridge formation with normal pulp tissue without inflammation or pulp necrosis. In contrast, the formocresol group demonstrated pulp inflammation without mineralized bridge formation.

CONCLUSIONS

Acemannan is biocompatible with the dental pulp. Furthermore, acemannan stimulated dentin regeneration in teeth with reversible pulpitis.

Aloe Vera for Tissue Engineering Applications

Aloe vera, also referred as Aloe barbadensis Miller, is a succulent plant widely used for biomedical, pharmaceutical and cosmetic applications. Aloe vera has been used for thousands of years. However, recent significant advances have been made in the development of aloe vera for tissue engineering applications. Aloe vera has received considerable attention in tissue engineering due to its biodegradability, biocompatibility, and low toxicity properties. Aloe vera has been reported to have many biologically active components. The bioactive components of aloe vera have effective antibacterial, anti-inflammatory, antioxidant, and immune-modulatory effects that promote both tissue regeneration and growth. The aloe vera plant, its bioactive components, extraction and processing, and tissue engineering prospects are reviewed in this article. The use of aloe vera as tissue engineering scaffolds, gels, and films is discussed, with a special focus on electrospun nanofibers.

Acemannan increases NF-κB/DNA binding and IL-6/-8 expression by selectively binding Toll-like receptor-5 in human gingival fibroblasts

Acemannan, an acetylated polymannose from Aloe vera, has immunomodulatory effects. We investigated whether acemannan induces IL-6 and -8 expression and NF-κB/DNA binding in human gingival fibroblasts. IL-6 and -8 expression levels were assessed via RT-PCR and ELISA. The NF-κB p50/p65-DNA binding was determined. The structures of acemannan mono-pentamers and Toll-like receptor 5 (TLR5) were simulated. The binding energies between acemannan and TLR5 were identified. We found that acemannan significantly stimulated IL-6/-8 expression at both the mRNA and protein level and significantly increased p50/DNA binding. Preincubation with an anti-TLR5 neutralizing antibody abolished acemannan-induced IL-6/-8 expression and p50/DNA binding, and co-incubation of acemannan with Bay11-7082, a specific NF- κB inhibitor, abolished IL-6/-8 expression. The computer modeling indicated that monomeric/dimeric single stranded acemannan molecules interacted with the TLR5 flagellin recognition sites with a high binding affinity. We conclude that acemannan induces IL-6/-8 expression, and p50/DNA binding in gingival fibroblasts, at least partly, via a TLR5/NF-κB-dependent signaling pathway. Furthermore, acemannan selectively binds with TLR5 ectodomain flagellin recognition sites.

Chitosan based nanofibers in bone tissue engineering

Bone tissue engineering involves biomaterials, cells and regulatory factors to make biosynthetic bone grafts with efficient mineralization for regeneration of fractured or damaged bones. Out of all the techniques available for scaffold preparation, electrospinning is given priority as it can fabricate nanostructures. Also, electrospun nanofibers possess unique properties such as the high surface area to volume ratio, porosity, stability, permeability and morphological similarity to that of extra cellular matrix. Chitosan (CS) has a significant edge over other materials and as a graft material, CS can be used alone or in combination with other materials in the form of nanofibers to provide the structural and biochemical cues for acceleration of bone regeneration. Hence, this review was aimed to provide a detailed study available on CS and its composites prepared as nanofibers, and their associated properties found suitable for bone tissue engineering.

Effects of Plants on Osteogenic Differentiation and Mineralization of Periodontal Ligament Cells: A Systematic Review

This systematic review aimed to evaluate the effects of plants on osteogenic differentiation and mineralization of human periodontal ligament cells. The included studies were selected using five different electronic databases. The reference list of the included studies was crosschecked, and a partial gray literature search was undertaken using Google Scholar and ProQuest. The methodology of the selected studies was evaluated using GRADE. After a two-step selection process, eight studies were identified. Six different types of plants were reported in the selected studies, which were Morinda citrifolia, Aloe vera, Fructus cnidii, Zanthoxylum schinifolium, Centella asiatica, and Epimedium species. They included five types of isolated plant components: acemannan, osthole, hesperetin, asiaticoside, and icariin. In addition, some active substances of these components were identified as polysaccharides, coumarins, flavonoids, and triterpenes. The studies demonstrated the potential effects of plants on osteogenic differentiation, cell proliferation, mineral deposition, and gene and protein expression. Four studies showed that periodontal ligament cells induce mineral deposition after plant treatment. Although there are few studies on the subject, current evidence suggests that plants are potentially useful for the treatment of periodontal diseases. However, further investigations are required to confirm the promising effect of these plants in regenerative treatments.

Acemannan accelerates cell proliferation and skin wound healing through AKT/mTOR signaling pathway

BACKGROUND

Acemannan is a bioactive polysaccharides promoting tissue repair. However, the roles of acemannan in skin wound healing and the underlying molecular mechanisms are largely unclear.

OBJECTIVE

The goal of this study is to investigate the positive role of acemannan in cutaneous wound healing and its mechanism.

METHODS

Mouse skin wound model and skin primary fibroblasts were used to demonstrate the positive effect of acemannan on cutaneous wound healing. The expressions of cell proliferation nuclear antigen ki-67, cyclin D1 and activity of AKT/mTOR signaling were analyzed in acemannan-treated fibroblasts and mice. Rapamycin and AKT inhibitor VIII were used to determine the key role of AKT/mTOR signaling in acemannan-promoting cutaneous wound healing.

RESULTS

We found that acemannan significantly accelerated skin wound closure and cell proliferation. Acemannan promoted the expression of cyclin D1 in cultured fibroblasts, which was mediated by AKT/mTOR signal pathway leading to enhanced activity of the eukaryotic translation initiation factor-4F (eIF4F) and increased translation of cyclin D1. In contrast, pharmaceutical blockade of AKT/mTOR signaling by mTOR inhibitor rapamycin or AKT inhibitor VIII abolished acemannan-induced cyclin D1 translation and cell proliferation. In vivo studies confirmed that the activation of AKT/mTOR by acemannan played a key role in wound healing, which could be reversed by rapamycin.

CONCLUSION

Acemannan promoted skin wound healing partly through activating AKT/mTOR-mediated protein translation mechanism, which may represent an alternative therapy approach for cutaneous wound.

Biomaterials based nano-applications of Aloe vera and its perspective: a review

In modern biomedical researches, theAloe veraextract has been engaged in the synthesis of various micro and nanoformulations based smart structures, which increased its competence in wound healing, tissue engineering and drug delivery applications.

Aloe vera as vehicle to mineral trioxide aggregate: study in bone repair

AIM: Mineral trioxide aggregate (MTA) was associated to Aloe vera to verify the coadjutant action of that medicinal plant in the bone neoformation process in tibia of rats.MATERIAL AND METHOD: 36 male rats (Rattus norvegicus) were used, divided into two groups of 18 rats each. Two circumferential bone defects with approximately 5 mm in diameter were made on the right tibia of each animal: the upper defect was filled with blood coagulates in both groups to serve as experimental control and the lower defect was filled with MTA and Aloe vera in experimental (group E1) and MTA and distilled water in experimental (group E2). Seven, 15 and 30 days after surgery, six animals from each group were euthanized and the right tibia of each animal was removed for histological analysis.RESULT: Histologically, experimental group E1 presented better results for the two variables, inflammation [at seven days (p=0.045)] and bone formation [at seven days (p=0.018) and 30 days (p=0.034)], compared to the E2 group.CONCLUSION: The association of MTA and Aloe vera showed potential to reduce the effects of the inflammatory cascade and promote bone neoformation making it to a promising proposal for future use in endodontic therapy.

Diffusion of hydroxyl ions from calcium hydroxide and Aloe vera pastes

This study evaluated the diffusion through the dentinal tubules of hydroxyl ions from different calcium hydroxide (CH) pastes containing Aloe vera. Sixty single-rooted bovine teeth were used. The tooth crowns were removed, the root canals were instrumented and the specimens were assigned to 4 groups (n=15) according to the intracanal medication: Group CH/S - CH powder and saline paste; Group CH/P - CH powder and propylene glycol paste; Group CH/A - calcium hydroxide powder and Aloe vera gel paste; Group CH/A/P - CH powder, Aloe vera powder and propylene glycol paste. After placement of the root canal dressings, the teeth were sealed coronally and apically with a two-step epoxy adhesive. The teeth were placed in identified flasks containing deionized water and stored in an oven with 100% humidity at 37 °C. After 3 h, 24 h, 72 h, 7 days, 15 days and 30 days, the deionized water in the flasks was collected and its pH was measured by a pH meter. The obtained data were subjected to statistical analysis at a significance level of 5%. The results demonstrated that all pastes provided diffusion of hydroxyl ions through the dentinal tubules. The combination of Aloe vera and CH (group CH/A) provided a constant release of calcium ions. Group CH/A/P showed the highest pH at 24 and 72 h. In conclusion, the experimental pastes containing Aloe vera were able to enable the diffusion of hydroxyl ions through the dentinal tubules.

Acemannan, an Extracted Polysaccharide from Aloe vera: A Literature Review

In this review, the composition, actions, and clinical applications of acemannan in medicine and its effectiveness as an adjunct in the treatment of diseases are presented. An electronic literature search was performed up to January 2014 for studies and research presenting data to validate the efficacy of acemannan. A total of 50 titles, abstracts and full-text studies were selected and reviewed. Acemannan has various medicinal properties like osteogenic, anti-inflammatory, and antibacterial, which accelerate healing of lesions. Also, acemannan is known to have antiviral and antitumor activities in vivo through activation of immune responses. It was concluded that Aloe vera has immense potential as a therapeutic agent. Even though the plant is a promising herb with various clinical applications in medicine and dentistry, more clinical research needs to be undertaken to validate and explain the action of acemannan in healing, so that it can be established in the field of medicine and a more precise understanding of the biological activities of these is required to develop Aloe vera as a pharmaceutical source.

Role of Ayurveda in management of oral health

Oral diseases continue to be a major health problem world-wide. Oral health is integral to general well-being and relates to the quality-of-life that extends beyond the functions of the craniofacial complex. The standard Western medicine has had only limited success in the prevention of periodontal disease and in the treatment of a variety of oral diseases. Hence, the search for alternative products continues and natural phytochemicals isolated from plants used in traditional medicine are considered to be good alternatives to synthetic chemicals. The botanicals in the Ayurvedic material medica have been proven to be safe and effective, through several hundred to several thousand years of use. The exploration of botanicals used in traditional medicine may lead to the development of novel preventive or therapeutic strategies for oral health. The present scientific evidence based review is focused on the possible role of Ayurveda in the management of various orofacial disorders.

Ginsenoside Rg1 of Panax ginseng stimulates the proliferation, odontogenic/osteogenic differentiation and gene expression profiles of human dental pulp stem cells

Ginsenoside Rg1 is one of the major active components of Panax ginseng C. A. Mey. Human dental pulp stem cells (hDPSCs) play an important role in the dentin formation, reparation and tooth tissue engineering. This study investigated the effects of ginsenoside Rg1 on the proliferation, odontogenic differentiation of hDPSCs and revealed the underlying molecular mechanisms. [³H]-thymidine incorporation assay and cell cycle analysis were applied to investigate the proliferation of hDPSCs after the treatment of ginsenoside Rg1. Immunocytochemistry analysis and fluorescent quantitative reverse transcriptase-polymerase chain reaction (FQ-PCR) were performed to evaluate the odontogenic differentiation of hDPSCs. Gene and protein expressions of bone morphogenetic protein-2 (BMP-2) and fibroblast growth factor 2 (FGF2) were detected by FQ-PCR and enzyme-linked immunosorbent assay. The Roche Nimblegen Whole Human Genome Expression profile microarray was used to detected representative gene expression profiles of hDPSCs by ginsenoside Rg1. The results indicated that ginsenoside Rg1 significantly increased hDPSCs proliferation (p<0.05). Gene expressions of DSPP, ALP, OCN, BMP-2, FGF2 and protein expressions of BMP-2 and FGF2 were increased compared with the untreated group (p<0.05). Gene expression profile analysis revealed that 2059 differentially expressed genes were detected by ginsenoside Rg1. Ginsenoside Rg1 promoted the proliferation and differentiation of hDPSCs through alteration of gene expression profiles.