Actions of melatonin mixed with collagenized porcine bone versus porcine bone only on osteointegration of dental implants

Systemic administration with melatonin in the daytime has a better effect on promoting osseointegration of titanium rods in ovariectomized rats

Aims

This study examined whether systemic administration of melatonin would have different effects on osseointegration in ovariectomized (OVX) rats, depending on whether this was administered during the day or night.

Methods

In this study, a titanium rod was implanted in the medullary cavity of one femoral metaphysis in OVX rats, and then the rats were randomly divided into four groups: Sham group (Sham, n = 10), OVX rat group (OVX, n = 10), melatonin day treatment group (OVX + MD, n = 10), and melatonin night treatment group (OVX + MN, n = 10). The OVX + MD and OVX + MN rats were treated with 30 mg/kg/day melatonin at 9 am and 9 pm, respectively, for 12 weeks. At the end of the research, the rats were killed to obtain bilateral femora and blood samples for evaluation.

Results

Micro-CT and histological evaluation showed that the bone microscopic parameters of femoral metaphysis trabecular bone and bone tissue around the titanium rod in the OVX + MD group demonstrated higher bone mineral density, bone volume fraction, trabecular number, connective density, trabecular thickness, and lower trabecular speculation (p = 0.004) than the OVX + MN group. Moreover, the biomechanical parameters of the OVX + MD group showed higher pull-out test and three-point bending test values, including fixation strength, interface stiffness, energy to failure, energy at break, ultimate load, and elastic modulus (p = 0.012) than the OVX + MN group. In addition, the bone metabolism index and oxidative stress indicators of the OVX + MD group show lower values of Type I collagen cross-linked C-telopeptide, procollagen type 1 N propeptide, and malondialdehyde (p = 0.013), and higher values of TAC and SOD (p = 0.002) compared with the OVX + MN group.

Conclusion

The results of our study suggest that systemic administration with melatonin at 9 am may improve the initial osseointegration of titanium rods under osteoporotic conditions more effectively than administration at 9 pm. Cite this article: Bone Joint Res 2022;11(11):751–762.

Hormone and implant osseointegration: Elaboration of the relationship among function, preclinical, and clinical practice

As clusters of peptides or steroids capable of high-efficiency information transmission, hormones have been substantiated to coordinate metabolism, growth, development, and other physiological processes, especially in bone physiology and repair metabolism. In recent years, the application of hormones for implant osseointegration has become a research hotspot. Herein, we provide a comprehensive overview of the relevant reports on endogenous hormones and their corresponding supplementary preparations to explore the association between hormones and the prognosis of implants. We also discuss the effects and mechanisms of insulin, parathyroid hormone, melatonin, vitamin D, and growth hormone on osseointegration at the molecular and body levels to provide a foothold and guide future research on the systemic conditions that affect the implantation process and expand the relative contraindications of the implant, and the pre-and post-operative precautions. This review shows that systemic hormones can regulate the osseointegration of oral implants through endogenous or exogenous drug-delivery methods.

The effect of melatonin on the mouse ameloblast-lineage cell line ALCs

Melatonin plays a critical role in promoting the proliferation of osteoblasts and the growth and development of dental papilla cells. However, the effect and mechanism of melatonin on the growth and development of ALCs still need to be explored. CCK8 assay was used for the evaluation of cell numbers. qRT-PCR was used to identify the differentially expressed genes in ALCs after melatonin treatment. The number and morphology of ALCs were investigated by confocal microscopy. Alkaline phosphatase assay and Alizarin red S staining were used for measuring mineralization. Then, we focused on observing the crucial factors of the signaling pathway by RNA-seq and qRT-PCR. Melatonin limited the cell number of ALCs in a dose-dependent manner and promoted the production of actin fibers. A high concentration of melatonin significantly promoted the mRNA levels of enamel matrix proteins and the formation of mineralized nodules. RNA-seq data showed that Wnt signaling pathway may be involved in the differentiation of ALCs under the influence of melatonin. This study suggests that melatonin plays a regulatory role in the cell number, differentiation, and mineralization of the ALCs, and then shows the relationship between the Wnt signaling pathway with the ALCs under melatonin.

Melatonin-Medicated Neural JNK3 Up-Regulation Promotes Ameloblastic Mineralization

Introduction: Melatonin, an endogenous neurohormone, modulates the biological circadian rhythms of vertebrates. It functions have been reported in previous stomatological studies as anti-inflammation, antioxidant, osseointegration of dental implants and stimulation to dental pulp stem cells differentiation, but its role in ameloblastic differentiation and mineralization has been rarely studied. Objective: To reveal the effects of melatonin on the mineralization of ameloblast lineage cells (ALCs), and to identify the change in gene expression and the potential mechanism based on ribonucleic acid sequencing (RNA-seq) analysis. Method: ALCs were induced in melatonin-conditioned medium. After 7-days culture, Western blot, real-time PCR, alkaline phosphatase (ALP) activity test, RNA-seq were accordingly used to detect the change in molecular level. After 1-month odontogenic induction in melatonin medium, Alizarin Red-S (ARS) staining showed the changes of mineral nodules. Differentially expressed genes (DEGs), enrichment of functions and signaling pathways analysis based on Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) database were performed. The JNK3 antagonist (JNK3 inhibitor IX, SR3576) and β-arrestin1 (Arrb1) overexpression were applied to confirm the fluctuation of melatonin-medicated JNK3 and Arrb1 expression. Results: In this study, we found out melatonin contributed to the ameloblastic mineralization, from which we can observed the elevated expression of enamel matrix protein, and increased ALP activity and mineralized nodules formation. RNA-seq analysis showed the up-regulation of neural JNK3 and down-regulation of Arrb1 in ALCs. Meanwhile, phosphorylated JNK3 deficiency (phosphorylated JNK3 inhibitor---SR3576 added to culture medium) led to mineralization delay, and Arrb1 overexpression proved Arrb1 takes bridge between melatonin receptors (MTNR) and JNK3 in MAPK signaling pathway.

Bone Density around Titanium Dental Implants Coating Tested/Coated with Chitosan or Melatonin: An Evaluation via Microtomography in Jaws of Beagle Dogs

Peri-implant bone density plays an important role in the osseointegration of dental implants. The aim of the study was to evaluate via micro-CT, in Hounsfield units, the bone density around dental implants coated with chitosan and melatonin and to compare it with the bone density around implants with a conventional etched surface after 12 weeks of immediate post-extraction placement in the jaws of Beagle dogs. Six dogs were used, and 48 implants were randomly placed: three groups—melatonin, chitosan, and control. Seven 10 mm × 10 mm regions of interest were defined in each implant (2 in the crestal zone, 4 in the medial zone, and 1 in the apical zone). A total of 336 sites were studied with the AMIDE tool, using the Norton and Gamble classification to assess bone density. The effect on bone density of surface coating variables (chitosan, melatonin, and control) at the crestal, medial, and apical sites and the implant positions (P2, P3, P4, and M1) was analyzed at bivariate and multivariate levels (linear regression). Adjusted effects on bone density did not indicate statistical significance for surface coatings (p = 0.653) but did for different levels of ROIs (p < 0.001) and for positions of the implants (p = 0.032). Micro-CT, with appropriate software, proved to be a powerful tool for measuring osseointegration.

Sustained Release of Melatonin from GelMA Liposomes Reduced Osteoblast Apoptosis and Improved Implant Osseointegration in Osteoporosis

A reduction in bone mass around an implant is the main cause of implant loosening, especially in postmenopausal osteoporosis patients. In osteoporosis, excessive oxidative stress, resulting in osteoblast apoptosis, largely contributes to abnormal bone remodeling. Melatonin (MT) synthesized by the pineal gland promotes osteoblast differentiation and bone formation and has been effectively used to combat oxidative stress. Therefore, we hypothesized that MT attenuates osteoblast apoptosis induced by oxidative stress, promotes osteogenesis in osteoporosis, and improves bone mass around prostheses. Moreover, considering the distribution and metabolism of MT, its systemic administration would require a large amount of MT, increasing the probability of drug side effects, so the local administration of MT is more effective than its systemic administration. In this study, we constructed a composite adhesive hydrogel system (GelMA-DOPA@MT) to bring about sustained MT release in a local area. Additionally, MT-reduced apoptosis caused by hydrogen peroxide- (H₂O₂-) induced oxidative stress and restored the osteogenic potential of MC3T3-E1 cells. Furthermore, apoptosis in osteoblasts around the implant was significantly attenuated, and increased bone mass around the implant was observed in ovariectomized (OVX) rats treated with this composite system. In conclusion, our results show that GelMA-DOPA@MT can inhibit osteoblast apoptosis caused by oxidative stress, thereby promoting osteogenesis and improving bone quality around a prosthesis. Therefore, this system of local, sustained MT release is a suitable candidate to address implant loosening in patients with osteoporosis.

Bioactive poly (methyl methacrylate) bone cement for the treatment of osteoporotic vertebral compression fractures

Rationale: Poly (methyl methacrylate) (PMMA) bone cement is one of the most commonly used biomaterials for augmenting/stabilizing osteoporosis-induced vertebral compression fractures (OVCFs), such as percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP). However, its clinical applications are limited by its poor performance in high compressive modulus and weak bonding to bone. To address these issues, a bioactive composite bone cement was developed for the treatment of osteoporotic vertebral compression fractures, in which mineralized collagen (MC) was incorporated into the PMMA bone cement (MC-PMMA). Methods: The in vitro properties of PMMA and MC-PMMA composite bone cement were determined, including setting time, compressive modulus, adherence, proliferation, and osteogenic differentiation of rat bone mesenchymal stem cells. The in vivo properties of both cements were evaluated in an animal study (36 osteoporotic New Zealand female rabbits divided equally between the two bone cement groups; PVP at L5) and a small-scale and short-term clinical study (12 patients in each of the two bone cement groups; follow-up: 2 years). Results: In terms of value for PMMA bone cement, the handling properties of MC-PMMA bone cement were not significantly different. However, both compressive strength and compressive modulus were found to be significantly lower. In the rabbit model study, at 8 and 12 weeks post-surgery, bone regeneration was more significant in MC-PMMA bone cement (cortical bone thickness, osteoblast area, new bone area, and bone ingrowth %; each significantly higher). In the clinical study, at a follow-up of 2 years, both the Visual Analogue Score and Oswestry Disability Index were significantly reduced when MC-PMMA cement was used. Conclusions: MC-PMMA bone cement demonstrated good adaptive mechanical properties and biocompatibility and may be a promising alternative to commercial PMMA bone cements for the treatment of osteoporotic vertebral fractures in clinical settings. While the present results for MC-PMMA bone cement are encouraging, further study of this cement is needed to explore its viability as an ideal alternative for use in PVP and BKP.

Experimental Study on the Influence of Apigenin K and Melatonin in Socket Preservation as Bone Stimulators: An Experimental Study in Beagle Dogs

The aim is to evaluate whether apigenin K and melatonin M5250 were able to stimulate bone formation after tooth extraction at one, two, and three months follow-up. Six male beagle dogs were used. Apigenin K and melatonin M5250 immersed in hemostatic collagen sponges were placed in the third and fourth premolar and the first molar extracted sockets; the second premolar was used as control. At one, two, and three months, bone core biopsies were performed, and picrosirius–hematoxylin was used for the staining process. In the first month, a higher amount of calcified bone tissue was observed in the melatonin (77.87% ± 1.2%) and apigenin K (69.81% ± 1.8%) groups than the control group (57.27% ± 0.54%), with apparent discrepancies in values between the three groups (p < 0.04). In the second month, there was a considerable improvement in the results in the areas with melatonin (79.81% ± 0.11%) than in those of apigenin K (71.65% ± 0.52%) and control (64.77% ± 0.44%) (p < 0.04). In the third month, the number of mature bone was similar to all the groups. The creation of new bone was significant in the melatonin group (82.78% ± 0.87%), followed by the apigenin K group (78.76% ± 0.43%) and the control group (57.27% ± 0.11%). From this experimental study in dogs, it can be concluded that melatonin and apigenin K can accelerate the process of mineralization of the bone matrix, and thus the creation of laminae in the early stages of healing (1 month). Less reabsorption of the post-extraction sockets can be expected with the topical application of melatonin and apigenin K. It seems that the stimulatory effects of bone healing induced by the topical application of melatonin and apigenin K are defect-size-dependent, being more evident in small defects compared to larger defects.

Melatonin protects bone against cadmium-induced toxicity via activation of Wnt/β-catenin signaling pathway

Among heavy metals, cadmium (Cd) is one of the most toxic for health due to it accumulation in several tissues including bone. Since melatonin (MLT) favors new bone formation through several pathways including Wnt/β-catenin, here we assessed whether MLT has a protective role against Cd induced toxicity in the rat bone tissue. Adult male Wistar rats receiving 50 mg CdCl₂/L and/or 3 mg/L MLT were used and were sacrificed 30 days after the treatment. Femurs and plasma were collected and analyzed by various biochemicals, molecular and histological investigation. The results showed that Cd exposure induced bone disorder characterized by histopathological alterations, a decreased alkaline phosphatase activity and plasmatic concentration of osteocalcin. Moreover, also the expression levels of some osteogenic-related genes (Runx2, Ocn and Alp) were down-regulated after Cd treatment. Since mechanistically Cd toxicity reduced the Kinase activity of GSK3β and protein levels of Wnt3a and β-catenin, we observed that MLT administration significantly ameliorated the toxic effects induced by the metal. Our findings provide clues about a potential protective effect of MLT against Cd-induced bone metabolism destruction and that the protection was partially mediated via the Wnt/β-catenin signaling pathway.

Melatonin improves the osseointegration of hydroxyapatite-coated titanium implants in senile female rats

The aim of this study was to confirm the effect of the systemic administration of melatonin on hydroxyapatite-coated titanium (HA-Ti) implants in senile osteopenic rats. For this study 24-month-old female Sprague-Dawley rats were used. The animals were randomly divided into two groups: a control group and a melatonin group and the bilateral femurs of all the rats received HA-Ti implants. Animals in the melatonin group received treatment with melatonin (30 mg/kg day). After a 12-week healing period, rats in the melatonin group revealed improved osseointegration compared to the control group, with the bone area ratio (BAR) and bone to implant contact (BIC) increased by 1.87-fold and 1.65-fold in histomorphometry, the quantitative results of implant osseointegration and peri-implant trabeculae, such as a higher bone volume per total volume (BV/TV), trabecular number (Tb.N), the mean connective density (Conn.D), trabecular thickness (Tb.Th), and a lower trabecular spacing (Tb.Sp) in micro-computed tomography (CT) evaluation and the maximum push-out force by 1.75-fold in push out tests. Additionally, compared with the control group, melatonin could significantly up-regulate the expression of the runt-related transcription factor 2 (Runx2), osteocalcin (OC) and osteoprotegerin (OPG) genes and down-regulate the expression of the RANKL gene. These findings suggest that systemic administration with melatonin is useful to improve the fixation of HA-coated implants even in osteopenic rats through promoting Runx2, OC and OPG gene expression and inhibiting RANKL gene expression.

Melatonin Increases Bone Mass around the Prostheses of OVX Rats by Ameliorating Mitochondrial Oxidative Stress via the SIRT3/SOD2 Signaling Pathway

Bone mass loss around prostheses is a major cause of implant failure, especially in postmenopausal osteoporosis patients. In osteoporosis, excess oxidative stress largely contributed abnormal bone remodeling. Melatonin, which is synthesized from the pineal gland, promotes osteoblast differentiation and bone formation and has effectively been used to combat oxidative stress. Thus, we determined if melatonin can inhibit oxidative stress to promote osteogenesis and improve bone mass around prostheses in osteoporosis. In this study, we observed that received melatonin at 50 mg/kg body weight significantly increased periprosthetic bone mass as well as implant fixation intensity in ovariectomized (OVX) rats. Meanwhile, it decreased the expression of oxidative stress markers (NAPDH oxidase 2 and cytochrome c) and enhanced expressing level of the formation markers of bones (alkaline phosphatase, osteocalcin, and osterix) around prostheses compared to that in the control group. Additionally, melatonin decreased hydrogen peroxide- (H₂O₂-) induced oxidative stress and restored the osteogenesis potential of MC3T3-E1 cells. Mechanistically, melatonin clearly increased mitochondrial sirtuin 3 (SIRT3) expression and decreased the ratio of acetylated superoxide dismutase 2 (AC-SOD2)/SOD2 compared to the H₂O₂ group. SIRT3 inhibition counteracted the protective effects of melatonin on oxidative stress and bone formation. Together, the results showed that melatonin ameliorated oxidative stress in mitochondrial via the SIRT3/SOD2 signaling pathway, thereby promoting osteogenesis, improving bone mass around the prostheses, and increasing initial stability. Thus, melatonin might be a suitable candidate to decrease the rate of implant failure and lengthen the lifespan of prostheses after total joint arthroplasty.

The multiple functions of melatonin in regenerative medicine

Melatonin research has been experiencing hyper growth in the last two decades; this relates to its numerous physiological functions including anti-inflammation, oncostasis, circadian and endocrine rhythm regulation, and its potent antioxidant activity. Recently, a large number of studies have focused on the role of melatonin in the regeneration of cells or tissues after their partial loss. In this review, we discuss the recent findings on the molecular involvement of melatonin in the regeneration of various tissues including the nervous system, liver, bone, kidney, bladder, skin, and muscle, among others.

Daily melatonin administration improves osseointegration in pinealectomized rats

The hypothesis of this study was that the peri-implant bone healing of the group of pinealectomized rats would differ from the control group. The samples were subjected to immunohistochemical, microtomographic (total porosity and connectivity density), and fluorochrome (mineralized surface) analyses.

Melatonin levels in human diabetic dental pulp tissue and its effects on dental pulp cells under hyperglycaemic conditions

AIM

To investigate melatonin (MEL) levels in human dental pulp tissue (hDP) in type 2 diabetic (T2D) participants and the underlying molecular mechanisms of its effects in human dental pulp cells (hDPCs) under hyperglycaemia.

METHODOLOGY

The study included 16 healthy and 16 T2D participants who underwent vital pulp extirpation for hDP and four healthy participants undergoing third molar extraction for hDPCs analyses. MTT and NRU were used as tests for cytotoxicity. The pulp tissue levels of MEL, inducible NO synthase (iNOS) and superoxide dismutase (SOD) activity, as well as iNOS, histone acetyltransferase p300 (p300) and SOD activity levels in hDPCs incubated with MEL (0.1 and 1.0 mmol L^-1 ) under normoglycaemia and hyperglycaemia were measured by enzyme-linked immunosorbent assay. Comparisons between the two groups were made by unpaired t-tests or Mann-Whitney test whilst the chi-square test was used for dichotomous variables. To compare more groups, the Kruskal-Wallis test with Dunn's multiple comparison was used, whilst Spearman correlation was used to assess association between two variables.

RESULTS

Melatonin was decreased (124.30 ± 21.6 vs. 240.0 ± 19.1 pg mL^-1 , P < 0.01), whilst iNOS levels increased (0.92 ± 0.08 vs. 0.32 ± 0.09 ng mL^-1 , P < 0.01) in hDP from T2D compared to nondiabetic participants. In hDPCs, MEL (0.1 and 1.0 mmol L^-1 ) had no cytotoxicity. Incubation with 1.0 mmol L^-1 of MEL (24 h) decreased hyperglycaemia-induced increases of iNOS (0.34 ± 0.01 ng mL^-1 vs. 0.40 ± 0.01 ng mL^-1 , P < 0.01) and p300 (11.59 ± 0.58 ng mL^-1 vs. 16.12 ± 0.39 ng mL^-1 , P < 0.01), and also, increased SOD activity (87.11 ± 3.10% vs. 68.56 ± 3.77%, P < 0.01) to the levels comparable to the normoglycaemic; iNOS and p300 protein expression levels showed strong positive correlation under hyperglycaemia (Spearman r = 0.8242, P < 0.001).

CONCLUSION

Type 2 diabetic participants had decreased MEL in hDP. At pharmacological concentrations, MEL is not cytotoxic for hDPCs and normalizes iNOS and SOD activity levels in hyperglyceamic hDPCs suggesting its antioxidant and protective effects in human dental pulp tissue under hyperglycaemia.

Melatonin: A Review of Its Potential Functions and Effects on Dental Diseases

Melatonin is a hormone synthesised and secreted by the pineal gland and other organs. Its secretion, controlled by an endogenous circadian cycle, has been proven to exert immunological, anti-oxidant, and anti-inflammatory effects that can be beneficial in the treatment of certain dental diseases. This article is aimed at carrying out a review of the literature published about the use of melatonin in the dental field and summarising its potential effects. In this review article, an extensive search in different databases of scientific journals was performed with the objective of summarising all of the information published on melatonin use in dental diseases, focussing on periodontal diseases and dental implantology. Melatonin released in a natural way into the saliva, or added as an external treatment, may have important implications for dental disorders, such as periodontal disease, as well as in the osseointegration of dental implants, due to its anti-inflammatory and osseoconductive effects. Melatonin has demonstrated to have beneficial effects on dental pathologies, although further research is needed to understand the exact mechanisms of this molecule.

Melatonin attenuates titanium particle-induced osteolysis via activation of Wnt/β-catenin signaling pathway

Wear debris-induced inhibition of bone regeneration and extensive bone resorption were common features in peri-prosthetic osteolysis (PPO). Here, we investigated the effect of melatonin on titanium particle-stimulated osteolysis in a murine calvariae model and mouse-mesenchymal-stem cells (mMSCs) culture system. Melatonin inhibited titanium particle-induced osteolysis and increased bone formation at osteolytic sites, confirmed by radiological and histomorphometric data. Furthermore, osteoclast numbers decreased dramatically in the low- and high-melatonin administration mice, as respectively, compared with the untreated animals. Melatonin alleviated titanium particle-induced depression of osteoblastic differentiation and mineralization in mMSCs. Mechanistically, melatonin was found to reduce the degradation of β-catenin, levels of which were decreased in presence of titanium particles both in vivo and in vitro. To further ensure whether the protective effect of melatonin was mediated by the Wnt/β-catenin signaling pathway, ICG-001, a selective β-catenin inhibitor, was added to the melatonin-treated groups and was found to attenuate the effect of melatonin on mMSC mineralization. We also demonstrated that melatonin modulated the balance between receptor activator of nuclear factor kappa-B ligand and osteoprotegerin via activation of Wnt/β-catenin signaling pathway. These findings strongly suggest that melatonin represents a promising candidate in the treatment of PPO.

STATEMENT OF SIGNIFICANCE

Peri-prosthetic osteolysis, initiated by wear debris-induced inhibition of bone regeneration and extensive bone resorption, is the leading cause for implant failure and reason for revision surgery. In the current study, we demonstrated for the first time that melatonin can induce bone regeneration and reduce bone resorption at osteolytic sites caused by titanium-particle stimulation. These effects might be mediated by activating Wnt/β-catenin signaling pathway and enhancing osteogenic differentiation. Meanwhile, the ability of melatonin to modulate the balance between receptor activator of nuclear factor kappa-B ligand and osteoprotegerin mediated by Wnt/β-catenin signaling pathway, thereby suppressing osteoclastogenesis, may be implicated in the protective effects of melatonin on titanium-particle-induced bone resorption. These results suggested that melatonin can be considered as a promising therapeutic agent for the prevention and treatment of peri-prosthetic osteolysis.

Outcomes of topical applications of melatonin in implant dentistry: a systematic review

BACKGROUND

Due to its antioxidant properties and its ability to detoxify free radicals, melatonin may interfere in the function of osteoclasts and thereby inhibit bone resorption. This inhibition of bone resorption may be enhanced by a reaction of indolamine in osteoclastogenesis and this may contribute to certain benefits in implantology.

OBJECTIVE

This systematic literature review on the use of melatonin in implant dentistry aims to provide guidelines for clinicians.

MATERIALS AND METHODS

PubMed, Science Direct, ISI Web of Knowledge, and the Cochrane base databases were used to identify articles published between 1999 and 2013 on melatonin use in implant dentistry. Ten articles were selected consisting of 9 animal research studies and 1 review article, involving 60 Beagle dogs, 57 rats, and 30 rabbits and a total of 352 implants.

RESULTS

Melatonin, which is released into the saliva, has important implications in the oral cavity. To achieve dental implant stability, osseointegration involves a cascade of protein and cell apposition, vascular invasion, bone formation, and maturation. This process may be accelerated by local delivery of growth-promoting factors, as occurs with the topical application of melatonin over the implant surface.

CONCLUSIONS

The experimental evidence suggests that topical applications of melatonin may be useful in oral surgery and implant dentistry, increasing bone-to-implant contact values and new bone formation, and so improving the success and long-term survival of implant treatments.

Therapeutic potential of melatonin in oral medicine and periodontology

Melatonin (N-acetyl-5-methoxy tryptamine) is a substance secreted by multiple organs in vertebrates. In addition to playing a part in the circadian cycle of the body, melatonin is known to have antioxidant, antiinflammatory, and antioncotic effects on human tissues. Oral cavity is affected by a number of conditions such as periodontitis, mucositis, cancers, and cytotoxicity from various drugs or biomaterials. Research has suggested that melatonin is effective in treating the aforementioned pathologies. Furthermore, melatonin has been observed to enhance osseointegration and bone regeneration. The aim of this review is to critically analyze and summarize the research focusing on the potential of melatonin in the field of oral medicine. Topical administration of melatonin has a positive effect on periodontal health and osseointegration. Furthermore, melatonin is particularly effective in improving the periodontal parameters of diabetic patients with periodontitis. Melatonin exerts a regenerative effect on periodontal bone and may be incorporated into of periodontal scaffolds. The cytotoxic effect of various drugs and dental materials may be countered by the antioxidant properties of melatonin. Topical administration of melatonin promotes the healing of tooth extraction sockets and may also impede the progression of oral cancer. Although, there are a number of current and potential applications of melatonin, further long term clinical and animal studies are needed to assess its efficacy. Moreover, the role of melatonin supplements in the management of periodontitis should also be assessed.

Retracted: Histologic evaluation of new bone in post-extraction sockets induced by melatonin and apigenin: an experimental study in American fox hound dogs

OBJECTIVE

The aim of this study was to evaluate the effect of topical applications of melatonin and apigenin (4',5,7-trihydroxyflavone) on new bone formation in post-extraction sockets after 30, 60 and 90 days.

MATERIALS AND METHODS

Six American fox hounds were used in the study, extracting mandibular premolars (P2, P3 and P4) and first molar (M1). Melatonin or apigenin impregnated in collagen sponges were applied at P3, P4 and M1 sites in both hemimandibles; P2 sites were used as control sites. Bone biopsies were taken at 30, 60 and 90 days and stained with hematoxylin-eosin.

RESULTS

At 30 days, a higher percentage of immature bone was observed in the control group (58.11 ± 1.76%) than in the apigenin (34.11 ± 1.02%) and melatonin groups (24.9 ± 0.14%) with significant differences between the three groups (P < 0.05). At 60 days, results were significantly better at melatonin sites (10.34 ± 1.09%) than apigenin (19.22 ± 0.35%) and control sites (36.7 ± 1.11%) (P < 0.05). At 90 days, immature bone percentages were similar for all groups. New bone formation was higher in melatonin group (79.56 ± 1.9%) than apigenin (68.89 ± 1.5%) and control group (58.87 ± 0.12%).

CONCLUSIONS

Topical applications of either melatonin or apigenin have a potential to accelerate bone tissue in early healing stages; melatonin was seen to have stimulated bone maturation to a greater extent at the 60 days of follow-up.

Clinical and Radiographic Evaluation of Immediate Loaded Dental Implants With Local Application of Melatonin: A Preliminary Randomized Controlled Clinical Trial

Immediate loading of dental implants in situations where low bone density exist, such as the posterior maxillary region, became possible recently after the introduction of biomimetic agents. This 1-year preliminary clinical trial was carried out to clinically and radiographically evaluate immediate-loaded 1-piece implants with local application of melatonin in the osteotomy site as a biomimetic material. 14 patients with missing maxillary premolars were randomized to receive 14 implants of 1-piece type that were subjected to immediate loading after 2 weeks of initial placement. Group I included 7 implants with acid-etched surface while group II included 7 implants with acid-etched surface combined with local application of melatonin gel at the osteotomy site. Patients were recalled for follow up at 1, 3, 6, and 12 months after loading. All implants were considered successful after 12 months of follow-up. Significant difference (P &lt; 0.05) was found between both groups at 1 month of implant loading when considering the implant stability. At 1 and 3 months there were significant differences in the marginal bone level between the 2 groups. These results suggest that the local application of melatonin at the osteotomy site is associated with good stability and minimal bone resorption. However, more studies for longer follow-up periods are required to confirm the effect of melatonin hormone on osseointegration of dental implants.

Osseoinductive elements around immediate implants for better osteointegration: a pilot study in foxhound dogs

OBJECTIVE

The aim of this study was to evaluate the effects on osseointegration of topical applications of melatonin vs. vitamin D over surfaces of immediate implants.

MATERIALS AND METHODS

Mandibular premolar distal roots (P₂ , P₃ , P₄ ) were extracted bilaterally from six American Foxhound dogs. Three conical immediate implants were randomly placed bilaterally in each mandible. Three randomized groups were created: melatonin 5% test group (MI), vitamin D 10% test group (DI), and Control group implants (CI). Block sections were obtained after 12 weeks and processed for mineralized ground sectioning. Bone-to-implant contact (total BIC), new bone formation (NBF), inter-thread bone (ITB), and histological linear measurements (HLM) were assessed.

RESULTS

At 12 weeks, all implants were clinically stable and histologically osseointegrated. Total BIC values were 49.20 ± 3.26 for the MI group, 49.86 ± 1.89 for DI group and 45.78 ± 4.21 for the CI group (P < 0.018) with statistically significant difference between the three groups. BIC percentage were 42.44 ± 2.18 for MI, 44.56 ± 1.08 for DI, and 41.95 ± 3.34 for CI groups respectively (P > 0.05). Inter-thread bone formation values were MI 17.56 ± 2.01, for DI 19.87 ± 0.92, and CI 14.56 ± 1.24 (P > 0.05). Statistically significant differences in peri-implant new bone formation were found between the three groups: MI 28.76 ± 1.98, DI 32.56 ± 1.11 and CI 25.43 ± 4.67, respectively (P < 0.045). Linear measurements showed that the MI group showed significantly less lingual crestal bone loss (CBL) (MI 0.59 ± 0.71), compared to DI (0.91 ± 1.21) and CI (0.93 ± 1.21) (P < 0.042), and less lingual peri-implant mucosa (PIM) (MI 3.11 ± 1.34),(DI 3.25 ± 0.18 compared with CI 3.54 ± 1.81 (P = 0.429). Linear measurements of buccal CBL showed significantly less buccal bone loss in test DI (0.36 ± 0.12) than CI (1.34 ± 1.23) and MI (1.11 ± 1.38) (P = 0.078).

CONCLUSIONS

Within the limitations of this animal study, topical applications of 5% Melatonin or 10% vitamin D improved bone formation around implants placed immediately after extraction and helped to reduce CBL after 12 weeks osseointegration.

Xenografts Supplemented with Pamindronate placed in postextraction sockets to avoid crestal bone resorption. Experimental study in Fox hound dogs

OBJECTIVES

The aim of the study was to compare the effects of porcine xenografts (MP3(®)) with or without pamindronate for the healing of small and large defects of postextraction sockets.

MATERIALS AND METHODS

Six beagle dogs were used in the study; second premolars and first molars of the mandible were extracted, small defects (SD) and large defects (LD) were identified. Each defect was measured and randomly filled as follows: SC (small control defects filled with MP3(®) alone), ST (small test defects filled with MP3(®) modified with pamindronate), LC (large control defects filled with MP3(®) alone), LT (large test defects filled with MP3(®) modified with pamindronate). After 4 and 8 weeks, the animals were euthanized and the percentages of new bone formation (NB), residual graft (RG) and connective tissue (CT) were analysed by histology and histomorphometry of undecalcified samples.

RESULTS

After 4 weeks, NB formation was higher for ST compared to all groups and for LT compared to LC (P < 0.05); RG was significantly higher in both control groups compared to tests (P < 0.05); and CT was higher in large defects (LC and LT) compared to small defects. After 8 weeks, NB formation was higher for test groups (ST and LT) compared to controls (P < 0.05); RG was significantly higher in both control groups compared to tests (P < 0.05); and CT was higher in large defects (LC and LT) compared to small defects (P < 0.05).

CONCLUSIONS

Within the limitations of this experimental study, the findings suggest that porcine xenografts modified with pamindronate favours the new bone formation and increased the porcine xenograft substitution/replacement after 4 and 8 weeks of healing.

A Novel Porcine Graft for Regeneration of Bone Defects

Bone regeneration procedures require alternative graft biomaterials to those for autogenous bone. Therefore, we developed a novel porcine graft using particle sizes of 250–500 μm and 500–1000 μm in rabbit calvarial bone defects and compared the graft properties with those of commercial hydroxyapatite (HA)/beta-tricalcium phosphate (β-TCP) over eight weeks. Surgery was performed in 20 adult male New Zealand white rabbits. During a standardized surgical procedure, four calvarial critical-size defects of 5 mm diameter and 3 mm depth were prepared. The defects were filled with HA/β-TCP, 250–500 μm or 500–1000 μm porcine graft, and control defects were not filled. The animals were grouped for sacrifice at 1, 2, 4, and 8 weeks post-surgery. Subsequently, sample blocks were prepared for micro-computed tomography (micro-CT) scanning and histological sectioning. Similar bone formations were observed in all three treatment groups, although the 250–500 μm porcine graft performed slightly better. Rabbit calvarial bone tissue positively responded to porcine grafts and commercial HA/β-TCP, structural analyses showed similar crystallinity and porosity of the porcine and HA/β-TCP grafts, which facilitated bone formation through osteoconduction. These porcine grafts can be considered as graft substitutes, although further development is required for clinical applications.

Local drug delivery for enhancing fracture healing in osteoporotic bone

Fragility fractures can cause significant morbidity and mortality in patients with osteoporosis and inflict a considerable medical and socioeconomic burden. Moreover, treatment of an osteoporotic fracture is challenging due to the decreased strength of the surrounding bone and suboptimal healing capacity, predisposing both to fixation failure and non-union. Whereas a systemic osteoporosis treatment acts slowly, local release of osteogenic agents in osteoporotic fracture would act rapidly to increase bone strength and quality, as well as to reduce the bone healing period and prevent development of a problematic non-union. The identification of agents with potential to stimulate bone formation and improve implant fixation strength in osteoporotic bone has raised hope for the fast augmentation of osteoporotic fractures. Stimulation of bone formation by local delivery of growth factors is an approach already in clinical use for the treatment of non-unions, and could be utilized for osteoporotic fractures as well. Small molecules have also gained ground as stable and inexpensive compounds to enhance bone formation and tackle osteoporosis. The aim of this paper is to present the state of the art on local drug delivery in osteoporotic fractures. Advantages, disadvantages and underlying molecular mechanisms of different active species for local bone healing in osteoporotic bone are discussed. This review also identifies promising new candidate molecules and innovative approaches for the local drug delivery in osteoporotic bone.

Effects of local melatonin application on post-extraction sockets after third molar surgery. A pilot study

Objectives: The purpose of this study was to assess the anti-inflammatory, analgesic and osteogenic early effects of melatonin on post-extraction sockets ofpatients requiring third molars extraction. Study Design: A randomized, triple-blind clinical trial was made using a split-mouth design. Both lower third molars of 10 patients were extracted and 3 mg of local melatonin or placebo were applied. Concentrations of interleukin-6 and nitrotyrosine were determined on samples of the clot from the socket by independent ELISA tests. Radiographic bone density was evaluated by measuring Hounsfield Units in panoramic and cross sections obtained by digital scanner. Statistycal analysis by Kolmogorov-Smirnov test was performed for ELISA data. Bone density was analyzed by Shapiro-Wilk test. Subsequently t test was applied. P<0.05 was considered to be significant. Results: The concentration of interleukin-6 increased with the application of melatonin without statistically significance (361.32 ± 235.22 pg/ml vs 262.58 ± 233.92 pg/ml). Nitrotyrosine concentrations showed values below to the detectability pattern (<0.001 nM) in Optic Density curve. Bone density in panoramic sections at socket after melatonin application showed no significant difference (561.98 ± 105.92 HU vs 598.82 ± 209.03 HU). In cross sections, bone density in the alveolar region showed no significant difference(377.42 ± 125.67 HU vs 347.56 ± 97.02 HU). Conclusions: Within the limitations of this pilot study, no differences with the application of melatonin were found in terms of the concentration of interleukin-6 and bone density in post-extraction socket of retained mandibular third molars.

Key words:Melatonin, inflammation, pain, bone density, third molar surgery.

Bone formation in sinus augmentation procedures using autologous bone, porcine bone, and a 50 : 50 mixture: a human clinical and histological evaluation at 2 months

OBJECTIVES

The aim of this study was to perform a 2 months clinical and histological comparison of autologous bone, porcine bone, and a 50 : 50 mixture in maxillary sinus augmentation procedures.

MATERIALS AND METHODS

A total of 10 consecutive patients, undergoing two-stage sinus augmentation procedures using 100% autologous bone (Group A), 100% porcine bone (Group B), and a 50 : 50 mixture of autologous and porcine bone (Group C) were included in this study. After a 2-month healing period, at the time of implant insertion, clinical evaluation was performed and bone core biopsies were harvested and processed for histological analysis.

RESULTS

The postoperative healing was uneventful regardless of the materials used for the sinus augmentation procedures. The histomorphometrical analysis revealed comparable percentages of newly formed bone, marrow spaces, and residual grafted material in the three groups.

CONCLUSION

The clinical and histological results of this study indicated that porcine bone alone or in combination with autologous bone are biocompatible and osteoconductive materials and can be successfully used in sinus augmentation procedures.

Gene expression and morphometric parameters of human bone biopsies after maxillary sinus floor elevation with autologous bone combined with Bio-Oss® or BoneCeramic®

OBJECTIVES

Although the clinical success of Bio-Oss(®) and BoneCeramic(®) has been corroborated by histologic and histomorphometric findings, the biological events that occur during healing after maxillary sinus floor elevation (MSFE) are unknown. Here, we evaluated biopsies of grafted bone with a mixture of autologous bone and Bio-Oss(®) or BoneCeramic(®) after two different healing time periods to understand the molecular process underlying bone formation after MSFE.

MATERIAL AND METHODS

Seven patients, following a bilateral split-mouth design model and needing a MSFE to allow implant placement, were recruited for this study. Right or left sinuses were grafted with autologous maxillary bone combined either with Bio-Oss(®) or BoneCeramic(®) , respectively. Twenty biopsies were taken at the time of implant insertion after 4-5 months or 6-8 months of MSFE, and analyzed by micro-computed tomography (microCT) and gene-expression analysis.

RESULTS

MicroCT analysis revealed no differences in the morphometric parameters or BMD either after 4-5 months or 6-8 months of MSFE between Bio-Oss(®) and BoneCeramic(®) . At molecular level, a higher expression of bone forming gene Runx2 was observed after 4-5 months of MSFE in the Bio-Oss(®) compared with the BoneCeramic(®) group.

CONCLUSIONS

Our results indicate that differences found at the molecular level between Bio-Oss(®) and BoneCeramic(®) are not translated to important differences in the 3D microstructure and BMD of the grafted bone.

Melatonin in the oral cavity: physiological and pathological implications

BACKGROUND AND OBJECTIVES

The purpose of this article was to summarize what is known about the function of melatonin in the oral cavity.

MATERIAL AND METHODS

Databases were searched for the relevant published literature to 30 November, 2013. The following search items were used in various combinations: melatonin, gingiva, periodontium, inflammation, herpes, alveolar bone, periodontal ligament, dental implants, xerostomia, methacrylate, chlorhexidine, cancer. The literature uncovered is summarized herein.

RESULTS

Salivary melatonin levels exhibit a circadian rhythm with highest values at night. Melatonin has both receptor-mediated and receptor-independent actions in cells of the oral cavity. Melatonin is released into the saliva by the acinar cells of the major salivary glands and via the gingival fluid. Functions of melatonin in the oral cavity are likely to relate primarily to its anti-inflammatory and antioxidant activities. These actions may suppress inflammation of the gingiva and periodontium, reduce alveolar bone loss, abrogate herpes lesions, enhance osteointegration of dental implants, limit oral cancer, and suppress disorders that have a free radical component. Sublingual melatonin tablets or oral melatonin sprays and topical melatonin-containing gel, if used on a regular basis, may improve overall oral health and reduce mucosal lesions.

CONCLUSION

Collectively, the results indicate that endogenously-produced and exogenously-applied melatonin are beneficial to the oral cavity.

Melatonin enhances chondrogenic differentiation of human mesenchymal stem cells

Intramembranous ossification and endochondral ossification are two ways through which bone formation and fracture healing occur. Accumulating amounts of evidence suggests that melatonin affects osteoblast differentiation, but little is known about the effects of melatonin on the process of chondrogenic differentiation. In this study, the effects of melatonin on human mesenchymal stem cells (MSCs) undergoing chondrogenic differentiation were investigated. Cells were induced along chondrogenic differentiation via high-density micromass culture in chondrogenic medium containing vehicle or 50 nm melatonin. Histological study and quantitative analysis of glycosaminoglycan (GAG) showed induced cartilage tissues to be larger and richer in GAG, collagen type II and collagen type X in the melatonin group than in the untreated controls. Real-time RT-PCR analysis demonstrated that melatonin treatment significantly up-regulated the expression of the genes involved in chondrogenic differentiation, including aggrecan (ACAN), collagen type II (COL2A1), collagen type X (COL10A1), SRY (sex-determining region Y)-box 9 (SOX9), runt-related transcription factor 2 (RUNX2) and the potent inducer of chondrogenic differentiation, bone morphogenetic protein 2 (BMP2). And the expression of melatonin membrane receptors (MT) MT1 and MT2 were detected in the chondrogenic-induced-MSCs by immunofluorescence staining. Luzindole, a melatonin receptor antagonist, was found to partially block the ability of melatonin to increase the size and GAG synthesis of the induced cartilage tissues, as well as to completely reverse the effect of melatonin on the gene expression of ACAN, COL2A1, COL10A1, SOX9 and BMP2 after 7 days of differentiation. These findings demonstrate that melatonin enhances chondrogenic differentiation of human MSCs at least partially through melatonin receptors.

Melatonin effects on hard tissues: bone and tooth

Melatonin is an endogenous hormone rhythmically produced in the pineal gland under the control of the suprachiasmatic nucleus (SCN) and the light/dark cycle. This indole plays an important role in many physiological processes including circadian entrainment, blood pressure regulation, seasonal reproduction, ovarian physiology, immune function, etc. Recently, the investigation and applications of melatonin in the hard tissues bone and tooth have received great attention. Melatonin has been investigated relative to bone remolding, osteoporosis, osseointegration of dental implants and dentine formation. In the present review, we discuss the large body of published evidence and review data of melatonin effects on hard tissues, specifically, bone and tooth.

Sustained release of melatonin from poly (lactic-co-glycolic acid) (PLGA) microspheres to induce osteogenesis of human mesenchymal stem cells in vitro

Melatonin promotes bone formation and prevents bone degradation via receptor-dependent or receptor-independent actions. The aim of this study is to encapsulate melatonin into poly (lactic-co-glycolic acid) (PLGA) microspheres (PLGA-MEL-MS) and create a melatonin sustained release system, then to evaluate its effect on the osteogenesis of human mesenchymal stem cells (hMSCs) in vitro. PLGA-MEL-MS were prepared by single emulsion solvent evaporation technique. Scanning electron microscopy demonstrated the incorporation of melatonin did not disturb the conventional generation of PLGA microspheres in size and morphology. In vitro drug release assay showed that PLGA-MEL-MS exhibited a biphasic drug release pattern: a low initial burst release effect with approximately 40% drug release at the first 3 days and a relatively retarded and continuous release with about 85% drug release over the 25 days. Cell proliferation assay demonstrated that PLGA-MEL-MS had no apparent effect on proliferation of human MSCs. In an osteogenesis assay, PLGA-MEL-MS obviously enhanced alkaline phosphatase (ALP) mRNA expression and increased ALP activity compared to that in the control group. Meanwhile, several markers of osteoblast differentiation were also significantly upregulated, including runx2, osteopontin, and osteocalcin. Furthermore, quantificational alizarin red-based assay demonstrated that PLGA-MEL-MS significantly enhanced calcium deposit of hMSCs compared to the controls. Therefore, this simple melatonin sustained release system can control released melatonin to generate a microenvironment with a relatively stable concentration of melatonin for a period of time to support osteogenic differentiation of hMSCs in vitro. This suggests that this system may be used as bone growth stimulator in bone healing in vivo.

Systematic review of pre-clinical models assessing implant integration in locally compromised sites and/or systemically compromised animals

OBJECTIVE

The aim was to systematically search the dental literature for pre-clinical models assessing implant integration in locally compromised sites (part 1) and systemically compromised animals (part 2), and to evaluate the quality of reporting of included publications.

METHODS

A Medline search (1966-2011) was performed, complimented by additional hand searching. The quality of reporting of the included publications was evaluated using the 20 items of the ARRIVE (Animals in Research In Vivo Experiments) guidelines.

RESULTS

One-hundred and seventy-six (part 1; mean ARRIVE score = 15.6 ± 2.4) and 104 (part 2; 16.2 ± 1.9) studies met the inclusion criteria. The overall mean score for all included studies amounted to 15.8 ± 2.2. Housing (38.3%), allocation of animals (37.9%), numbers analysed (50%) and adverse events (51.4%) of the ARRIVE guidelines were the least reported. Statistically significant differences in mean ARRIVE scores were found depending on the publication date (p < 0.05), with the highest score of 16.7 ± 1.6 for studies published within the last 2 years.

CONCLUSIONS

A large number of studies met the inclusion criteria. The ARRIVE scores revealed heterogeneity and missing information for selected items in more than 50% of the publications. The quality of reporting shifted towards better-reported pre-clinical trials within recent years.

Biological response to porcine xenograft implants: an experimental study in rabbits

PURPOSE

The aim of this study was to evaluate the effect of a new porcine biomaterial and collagen paste in 20 New Zealand rabbits.

MATERIALS AND METHODS

Forty implants using a porcine xenograft made up of 80% corticocancellous collagenated bone particles of ≤300 μm in size were placed in the proximal metaphyseal area of both tibiae. Four periods of time were formed: 1h, 5, 8, and 15 months. After implantation, an anteroposterior and lateral radiological study was carried out. Samples were sectioned at 5 μm and stained using hematoxylin-eosin, Masson's trichromic, and Gordon-Switt reticulin stains.

RESULTS

These results confirmed the biocompatibility of this porcine biomaterial-collagen paste; only a few, occasional macrophages and scattered lymphocytes were observed. No fibrosis was observed between the implants and the bone. Moreover, the material was osteoconductive acting as a "scaffold" for bone cells, and there was a progressive increase in bone growth in and around the implants.

CONCLUSION

This new porcine biomaterial-collagen paste seemed to be biocompatible, bioresorbable, and osteoconductive.

A novel calcium aluminate-melatonin scaffold enhances bone regeneration within a calvarial defect

Over 500,000 bone graft or bio-implant procedures are performed annually in the United States. It has been reported that osseous autograft procurement may result in donor site complications and bio-implant allografts have been associated with disease transmission. Ceramic scaffolds are only osteoconductive, limiting their clinical use. The objective of this study was to create a bone filler substitute with regenerating properties similar to natural bone. Therefore, melatonin and platelet-rich plasma (PRP) were utilized for their known osteoinductive properties. It was hypothesized that melatonin and/or PRP would enhance the osteoinductive and osteoconductive properties of calcium aluminate (CA) scaffolds to promote bone regeneration in a model of calvarial defects. The biocompatibility of CA and CA-Mel scaffolds was tested in vitro and in vivo. Data show that CA-Mel scaffolds, in comparison with CA scaffolds, enhanced the adhesion, viability, and proliferation of normal human osteoblasts cells but not that of NIH3T3 fibroblasts. Data also showed that human adult mesenchymal stem cells grown on CA or CA-Mel scaffolds showed a time-dependent induction into osteoblasts over 14days revealed through scanning electron microscopy and by alkaline phosphatase analyses. Implantation of CA-Mel scaffolds into critical size calvarial defects in female, ovariectomized rats showed that the CA-Mel scaffolds were biocompatible, allowed for tissue infiltration, and showed evidence of scaffold biodegradation by 3 and 6months. Bone regeneration, assessed using fluorochrome labeling at 3 and 6months, was greatest in animals implanted with the CA-Mel scaffold. Overall, results from this study show that CA-Mel scaffolds were osteoconductive and osteoinductive.

Non-surgical periodontal therapy influences salivary melatonin levels

OBJECTIVES

Melatonin is a hormone, which is involved in the control of the circadian rhythm, but also acts as an antioxidant and immune modulator. Previous studies reported decreased salivary and serum melatonin levels in periodontitis. This prospective cohort trial assessed the effect of non-surgical periodontal therapy on melatonin levels.

METHODS

Salivary and serum samples of 60 participants (30 patients suffering from a severe generalized form of periodontitis, 30 healthy controls) were collected at baseline and 19 samples of periodontitis patients after treatment. Salivary and serum melatonin levels were determined by a commercially available ELISA kit and serum C-reactive protein (CRP) by a routine laboratory test.

RESULTS

At baseline, periodontitis patients showed significantly increased serum CRP values and significantly decreased salivary melatonin levels compared to the control group. Clinical periodontal parameters significantly correlated with salivary melatonin levels and serum CRP. Periodontal therapy resulted in a recovery of the decreased salivary melatonin levels and a negative correlation was detected for the changes of salivary melatonin and the inflammatory parameter bleeding on probing. Serum melatonin levels showed no significant differences.

CONCLUSIONS

Salivary melatonin levels recovered after periodontal therapy and correlated with a decrease of local periodontal inflammation. This may imply the local involvement of melatonin in the pathogenesis of periodontitis due to its antioxidant abilities. However, the exact role of melatonin in periodontal disease remains to be investigated in future trials.

CLINICAL RELEVANCE

The present results suggest salivary melatonin as a risk indicator for the severity of periodontal disease.

Melatonin and oral cavity

While initially the oral cavity was considered to be mainly a source of various bacteria, their toxins and antigens, recent studies showed that it may also be a location of oxidative stress and periodontal inflammation. Accordingly, this paper focuses on the involvement of melatonin in oxidative stress diseases of oral cavity as well as on potential therapeutic implications of melatonin in dental disorders. Melatonin has immunomodulatory and antioxidant activities, stimulates the proliferation of collagen and osseous tissue, and acts as a protector against cellular degeneration associated with aging and toxin exposure. Arising out of its antioxidant actions, melatonin protects against inflammatory processes and cellular damage caused by the toxic derivates of oxygen. As a result of these actions, melatonin may be useful as a coadjuvant in the treatment of certain conditions of the oral cavity. However, the most important effect of melatonin seems to result from its potent antioxidant, immunomodulatory, protective, and anticancer properties. Thus, melatonin could be used therapeutically for instance, locally, in the oral cavity damage of mechanical, bacterial, fungal, or viral origin, in postsurgical wounds caused by tooth extractions and other oral surgeries. Additionally, it can help bone formation in various autoimmunological disorders such as Sjorgen syndrome, in periodontal diseases, in toxic effects of dental materials, in dental implants, and in oral cancers.

Evaluation of periimplant bone neoformation using different scanning electron microscope methods for measuring BIC. A dog study

Objetives: The aim of this study was to determine which of three methods for measuring BIC (bone-to-implant contact), using vestibular and lingual scanning electron microscopy (SEM) for different implant systems at 15, 30 and 90 days post-surgery was the most precise. An elemental analysis with SEM was used to evaluate neoformed bone composition for three implant systems at the same study times. Material and Methods: 36 implants were placed in eighteen Beagle dogs mandible about one year old and weighing approximately 12-13 kg in order to evaluate bone apposition to three different implant surfaces. It was used the third and fourth premolar and first molar distal sockets in both quadrants of the mandible (3P3, 4P4 and 1M1). Teeth were hemi-sected and the distal roots were removed. The specimens were prepared for histological examination and each section surface was stained using Masson’s trichrome and hematoxylin and eosin stains. BIC evaluations were performed by the three methods, BIC I (the quantity of mineralized bone in direct contact with the implant’s titanium surface across the entire threaded area); BIC II (along a line that passes from apex to apex of the implant threads); BIC III (both in areas around and above the threads and in between threads). Results: Both BIC and bone content were analyzed for all implants placed in P3, P4 y M1 alveoli on both, the buccal and palatine sides (elemental analysis quantified Ca, P, O and C). It was seen it was only at the ninety-day mark that high percentages of calcium were present. Conclusions: This study suggest that BIC III evaluation is the most certain method for establishing the quantity of bone formed as the BIC area.

Key words:Bone-to-impant contact, dogs, extraction socket, implants.

Melatonin promotes osteoblastic differentiation through the BMP/ERK/Wnt signaling pathways

Although melatonin has a variety of biological actions such as antitumor, antiangiogenic, and antioxidant activities, the osteogenic mechanism of melatonin still remains unclear. Thus, in the present study, the molecular mechanism of melatonin was elucidated in the differentiation of mouse osteoblastic MC3T3-E1 cells. Melatonin enhanced osteoblastic differentiation and mineralization compared to untreated controls in preosteoblastic MC3T3-E1 cells. Also, melatonin increased wound healing and dose-dependently activated osteogenesis markers such as runt-related transcription factor 2 (Runx2), osteocalcin (OCN), bone morphogenic protein (BMP)-2 and -4 in MC3T3-E1 cells. Of note, melatonin activated Wnt 5 α/β, β-catenin and the phosphorylation of c-Jun N-terminal kinase (JNK), and extracellular signal-regulated kinase (ERK) in a time-dependent manner while it attenuated phosphorylation of glycogen synthase kinase 3 beta (GSK-3β) in MC3T3-E1 cells. Consistently, confocal microscope observation revealed that BMP inhibitor Noggin blocked melatonin-induced nuclear localization of β-catenin. Furthermore, Western blotting showed that Noggin reversed activation of β-catenin and Wnt5 α/β and suppression of GSK-3β induced by melatonin in MC3T3-E1 cells, which was similarly induced by ERK inhibitor PD98059. Overall, these findings demonstrate that melatonin promotes osteoblastic differentiation and mineralization in MC3T3-E1 cells via the BMP/ERK/Wnt pathways.