1
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Zahedi L, Mohammadi M, Kalantari M, Arabsolghar M, Ranjbar H. Horizontal ridge augmentation with particulate cortico-cancellous freeze-dried bone allograft alone or combined with injectable-platelet rich fibrin in a randomized clinical trial. Clin Implant Dent Relat Res 2024; 26:127-137. [PMID: 38093400 DOI: 10.1111/cid.13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVES The objective of this study is to assess the effectiveness of horizontal ridge augmentation using FDBA in combination with injectable-platelet rich fibrin (i-PRF) versus FDBA alone. To fulfill this aim, the radiographic and histomorphometric outcomes are compared. METHOD The study involved 41 patients who had horizontal alveolar ridge defects categorized as either B (2.5-7 mm) or C (0-2.5 mm). The control group received FDBA alone (n = 20), while the test group received FDBA in combination with i-PRF (n = 21). The horizontal dimensions of the alveolar ridge were measured at 0, 2, 4, and 6 mm from the bone crest using CBCT before and 6 months after alveolar ridge augmentation. In the second-stage surgery, 24 biopsies were taken from the augmented bone - 13 from the control group and 11 from the test group, and were examined histologically and histomorphometrically. The data were analyzed using Pearson correlation coefficient, chi-square, paired-t, and two-sample t tests. RESULTS There was no significant difference (p > 0.05) in the increase of mean ridge width between the test group and the control group after 6 months at distances of 0, 2, 4, and 6 mm from the crest, with differences of -0.28, 0.12, 0.52, and 1.04 mm, respectively. However, the amount of newly formed bone and material residues was significantly higher in the FDBA + i-PRF group compared to the FDBA alone group (45.01% and 13.06% vs 54.03% and 8.48%, respectively). There was no significant difference in the amount of soft tissue between the two groups (41.02% and 37.5%, p > 0.05). CONCLUSION The study found that there was no statistically significant difference in the increase of horizontal ridge width between the FDBA + i-PRF group and the FDBA group. However, the histomorphometric analysis revealed that the FDBA + i-PRF group had a higher proportion of newly formed bone, less connective tissue, and fewer residual particles. This suggests a superior quality of bone formation compared to the FDBA group.
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Affiliation(s)
- Leili Zahedi
- Oral and Dental Diseases Research Center, Department of Periodontics, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Mohammadi
- Oral and Dental Diseases Research Center, Department of Periodontics, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahsa Kalantari
- Department of Oral and Maxillofacial Pathology, Oral and Dental Diseases Research Center, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohaddeseh Arabsolghar
- Oral and Dental Diseases Research Center, Department of Periodontics, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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2
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Ponnaiyan D, Rughwani RR, Victor DJ, Shetty G. Stem Cells in the Periodontium-Anatomically Related Yet Physiologically Diverse. Eur J Dent 2024; 18:1-13. [PMID: 36588293 PMCID: PMC10959637 DOI: 10.1055/s-0042-1759487] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Periodontitis is a complex chronic disease discernible by the deterioration of periodontal tissue. The goal of periodontal therapy is to achieve complete tissue regeneration, and one of the most promising treatment options is to harness the regenerative potential of stem cells available within the periodontal complex. Periodontal ligament stem cells, gingival mesenchymal stem cells, oral periosteal stem cells, and dental follicle stem cells have structural similarities, but their immunological responses and features differ. The qualities of diverse periodontal stem cells, their immune-modulatory effects, and variances in their phenotypes and characteristics will be discussed in this review. Although there is evidence on each stem cell population in the periodontium, understanding the differences in markers expressed, the various research conducted so far on their regenerative potential, will help in understanding which stem cell population will be a better candidate for tissue engineering. The possibility of selecting the most amenable stem cell population for optimal periodontal regeneration and the development and current application of superior tissue engineering treatment options such as autologous transplantation, three-dimensional bioengineered scaffolds, dental stem cell-derived extracellular vesicles will be explored.
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Affiliation(s)
- Deepa Ponnaiyan
- Department of Periodontics and Oral Implantology, SRM Dental College and Hospital, Ramapuram, Chennai, Tamil Nadu, India
| | - Roshan R. Rughwani
- Department of Periodontics and Oral Implantology, SRM Dental College and Hospital, Ramapuram, Chennai, Tamil Nadu, India
| | - Dhayanand John Victor
- Department of Periodontics and Oral Implantology, SRM Dental College and Hospital, Ramapuram, Chennai, Tamil Nadu, India
| | - Ganesh Shetty
- Dental and Orthodontic Clinic, Bangalore, Karnataka, India
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3
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de Lima Barbosa R, Stellet Lourenço E, de Azevedo dos Santos JV, Rodrigues Santiago Rocha N, Mourão CF, Alves GG. The Effects of Platelet-Rich Fibrin in the Behavior of Mineralizing Cells Related to Bone Tissue Regeneration-A Scoping Review of In Vitro Evidence. J Funct Biomater 2023; 14:503. [PMID: 37888168 PMCID: PMC10607127 DOI: 10.3390/jfb14100503] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/12/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023] Open
Abstract
Platelet-rich fibrin (PRF) is a second-generation blood concentrate that serves as an autologous approach for both soft and hard tissue regeneration. It provides a scaffold for cell interaction and promotes the local release of growth factors. PRF has been investigated as an alternative to bone tissue therapy, with the potential to expedite wound healing and bone regeneration, though the mechanisms involved are not yet fully understood. This review aims to explore the in vitro evidence of PRF's effects on the behavior of mineralizing cells related to bone tissue regeneration. A systematic electronic search was conducted up to August 2023, utilizing three databases: PubMed, Web of Science, and Scopus. A total of 76 studies were selected, which presented in vitro evidence of PRF's usefulness, either alone or in conjunction with other biomaterials, for bone tissue treatment. PRF membranes' influence on the proliferation, differentiation, and mineralization of bone cells is linked to the constant release of growth factors, resulting in changes in crucial markers of bone cell metabolism and behavior. This further reinforces their therapeutic potential in wound healing and bone regeneration. While there are some notable differences among the studies, the overall results suggest a positive effect of PRF on cell proliferation, differentiation, mineralization, and a reduction in inflammation. This points to its therapeutic potential in the field of regenerative medicine. Collectively, these findings may help enhance our understanding of how PRF impacts basic physiological processes in bone and mineralized tissue.
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Affiliation(s)
- Renata de Lima Barbosa
- Clinical Research Unit, Antonio Pedro Hospital, Fluminense Federal University, Niteroi 24033-900, Brazil
- Graduate Program in Science and Biotechnology, Fluminense Federal University, Niteroi 24210-201, Brazil
| | - Emanuelle Stellet Lourenço
- Clinical Research Unit, Antonio Pedro Hospital, Fluminense Federal University, Niteroi 24033-900, Brazil
| | - Julya Vittoria de Azevedo dos Santos
- Clinical Research Unit, Antonio Pedro Hospital, Fluminense Federal University, Niteroi 24033-900, Brazil
- Graduate Program in Science and Biotechnology, Fluminense Federal University, Niteroi 24210-201, Brazil
| | - Neilane Rodrigues Santiago Rocha
- Clinical Research Unit, Antonio Pedro Hospital, Fluminense Federal University, Niteroi 24033-900, Brazil
- Graduate Program in Science and Biotechnology, Fluminense Federal University, Niteroi 24210-201, Brazil
| | - Carlos Fernando Mourão
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA
| | - Gutemberg Gomes Alves
- Clinical Research Unit, Antonio Pedro Hospital, Fluminense Federal University, Niteroi 24033-900, Brazil
- Graduate Program in Science and Biotechnology, Fluminense Federal University, Niteroi 24210-201, Brazil
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4
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Nugraha AP, Kamadjaja DB, Sumarta NPM, Rizqiawan A, Pramono C, Yuliati A, Hendrianto E, Rahman MZ. Osteoinductive and Osteogenic Capacity of Freeze-Dried Bovine Bone Compared to Deproteinized Bovine Bone Mineral Scaffold in Human Umbilical Cord Mesenchymal Stem Cell Culture: An In Vitro Study. Eur J Dent 2023; 17:1106-1113. [PMID: 36599452 PMCID: PMC10756842 DOI: 10.1055/s-0042-1758786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Freeze-dried bovine bone scaffold (FDBB) or decellularized FDBB (dc-FDBB) was developed as an ideal scaffold with osteoinductive properties. This research aims to compare the osteoinductive properties marked by the expression of runt-related transcription factor-2 (RUNX2) and Osterix (OSX) and the osteogenic capacity of these scaffolds imbued with human umbilical cord mesenchymal stem cells (hUCMSCs). MATERIALS AND METHODS This study was performed in five experimental groups: a negative control group (C-) of hUCMSCs with a normal growth medium, a positive control group (C + ) of hUCMSCs with an osteogenic medium, experimental group 1 (E1) with an FDBB conditioned medium (CM), and experimental group 2 (E2) with a dc-FDBB-CM, and a third experimental group (E3) consisting of a DBBM-CM. Alizarin red staining was performed to qualitatively assess osteoinductive capacity. RUNX2 and OSX expression was quantified using real-time quantification polymerase chain reaction with two replications on day six (D6) and day 12 (D12) as fold changes. RESULTS This experiment revealed that hUCMSCs were positively expressed by CD73, CD90, and CD105 but were not expressed by CD34. Alizarin red staining showed that E1 had the most calcium deposition on D6 and D12, followed by E3 and then E2 The RUNX2 and OSX expression was higher in E1 but this difference was not significant. The OSX expression in E1,E2,E3 was lower on D12 and C+ of OSX had the highest expression. There was a significant difference of fold change measured between all groups (p < 0.05), and there was no significant difference between any of the groups treated with OSX and RUNX2 on D6 and D12. CONCLUSION FDBB osteoinduction and osteogenic capacity were higher when compared with DBBM and dc-FDBB.
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Affiliation(s)
- Andreas Pratama Nugraha
- Magister Program of Clinical Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - David B. Kamadjaja
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ni Putu Mira Sumarta
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Andra Rizqiawan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Coen Pramono
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Anita Yuliati
- Departement of Dental Material, Faculty of Dental medicine Universitas Airlangga, Surabaya, Indonesia
| | - Eryk Hendrianto
- Stem Cell Research and Developmental Center, Universitas Airlangga, Surabaya, Indonesia
| | - Mohammad Zeshaan Rahman
- Department of Oral and Maxillofacial Surgery, Pioneer Dental College and Hospital, Dhaka, Bangladesh
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5
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Mourão CF, Lowenstein A, Mello-Machado RC, Ghanaati S, Pinto N, Kawase T, Alves GG, Messora MR. Standardization of Animal Models and Techniques for Platelet-Rich Fibrin Production: A Narrative Review and Guideline. Bioengineering (Basel) 2023; 10:482. [PMID: 37106669 PMCID: PMC10135737 DOI: 10.3390/bioengineering10040482] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Experimental research is critical for advancing medical knowledge and enhancing patient outcomes, including in vitro and in vivo preclinical assessments. Platelet-rich fibrin (PRF) is a blood by-product that has garnered attention in the medical and dental fields due to its potential for tissue regeneration and wound healing. Animal models, such as rabbits and rats, have been used to produce PRF and examine its properties and applications. PRF has demonstrated potential in the dental and medical fields for reducing inflammation, promoting tissue repair, and accelerating wound healing. This narrative review aims to compare existing evidence and provide guidelines for PRF animal research, emphasizing the importance of standardizing animal models, following ethical considerations, and maintaining transparency and accountability. The authors highlight the necessity to use the correct relative centrifugal force (RCF), standardize centrifugal calibration, and report detailed information about blood collection and centrifuge parameters for reproducible results. Standardizing animal models and techniques is crucial for narrowing the gap between laboratory research and clinical applications, ultimately enhancing the translation of findings from bench to bedside.
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Affiliation(s)
- Carlos Fernando Mourão
- Department of Periodontology, Division of Dental Research Administration, Tufts University School of Dental Medicine, Boston, MA 02111, USA
| | - Adam Lowenstein
- Department of Periodontology, Division of Dental Research Administration, Tufts University School of Dental Medicine, Boston, MA 02111, USA
| | | | - Shahram Ghanaati
- Frankfurt Oral Regenerative Medicine, Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, 60596 Frankfurt Am Main, Germany
| | - Nelson Pinto
- Department of Periodontics and Implant Dentistry, University of the Andes, Santiago 12455, Chile
| | - Tomoyuki Kawase
- Division of Oral Bioengineering, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
| | - Gutemberg Gomes Alves
- Clinical Research Unit, Antonio Pedro Hospital, Fluminense Federal University, Niterói 24033-900, Brazil
| | - Michel Reis Messora
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto 14040-904, Brazil
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6
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Wang J, Sun Y, Liu Y, Yu J, Sun X, Wang L, Zhou Y. Effects of platelet-rich fibrin on osteogenic differentiation of Schneiderian membrane derived mesenchymal stem cells and bone formation in maxillary sinus. Cell Commun Signal 2022; 20:88. [PMID: 35705970 PMCID: PMC9202141 DOI: 10.1186/s12964-022-00844-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/11/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The existence of mesenchymal stem cells (MSCs) in Schneiderian membrane has not been determined. The aim of this study is to investigate whether there are MSCs in Schneiderian membrane, and the effect of platelet-rich fibrin (PRF) on osteogenic differentiation of these cells and on new bone formation in maxillary sinus after maxillary sinus floor elevation. METHODS Schneiderian membrane derived mesenchymal stem cells (SM-MSCs) were isolated from rabbit maxillary sinus. Cells were identified by flow cytometry and multipotential differentiation. Real-time cell analysis assay, fluorescence staining, transwell assay, and wound healing assay were used to determine the effects of PRF stimulation on cell proliferation and migration. The osteogenic differentiation ability of cells stimulated by PRF or osteoinductive medium was evaluated by alkaline phosphatase staining, alizarin red staining, PCR and Western blot. Equivalent volume Bio-oss and the mixture of Bio-oss and PRF were used as bone graft materials for maxillary sinus floor elevation. Micro-CT, bone double-staining, HE staining, Masson staining, and toluidine blue staining were used to evaluate the osteogenic effect in 8 and 12 weeks after surgery. RESULTS The cell surface markers were positive for expression of CD90, CD105, and negative for expression of CD34, CD45. SM-MSCs had the ability of osteogenic, adipogenic and chondrogenic differentiation. PRF could stimulate proliferation, migration and osteogenic differentiation of SM-MSCs, which was achieved by up-regulating ERK 1/2 signaling pathway. PRF could accelerate the formation of new bone in maxillary sinus and increase the amount of new bone formation. CONCLUSIONS MSCs existed in Schneiderian membrane, and PRF stimulation could promote cell proliferation, migration and osteogenic differentiation. The application of PRF in maxillary sinus floor elevation could accelerate bone healing and increase the quantity and quality of new bone. PRF, as autologous graft materials, might offer a promising strategy for the clinical bone formation during MSFE procedure. Video Abstract.
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Affiliation(s)
- Jia Wang
- Department of Oral Implantology, Hospital of Stomatology, Jilin University, Changchun, 130021 China
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006 China
| | - Yue Sun
- Department of Oral Implantology, Hospital of Stomatology, Jilin University, Changchun, 130021 China
| | - Yiping Liu
- Department of Oral Implantology, Hospital of Stomatology, Jilin University, Changchun, 130021 China
| | - Jize Yu
- Department of Oral Implantology, Hospital of Stomatology, Jilin University, Changchun, 130021 China
| | - Xiaolin Sun
- Department of Oral Implantology, Hospital of Stomatology, Jilin University, Changchun, 130021 China
| | - Lin Wang
- Department of Oral Implantology, Hospital of Stomatology, Jilin University, Changchun, 130021 China
| | - Yanmin Zhou
- Department of Oral Implantology, Hospital of Stomatology, Jilin University, Changchun, 130021 China
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7
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Ardani IGAW, Budipramana M, Rachmawati E, Nugraha AP, Ardana IKKG, Budhy TI, Hassan R, Listyorini D, Sarno R. COL1A1 and FGFR2 Single-Nucleotide Polymorphisms Found in Class II and Class III Skeletal Malocclusions in Javanese Population. Eur J Dent 2022; 17:183-190. [PMID: 35672017 PMCID: PMC9949934 DOI: 10.1055/s-0042-1744371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The aim of this article is to analyze and compare the presence of single-nucleotide polymorphisms (SNPs) of COL1A1 and FGFR2 in class II and class III Javanese populations. MATERIALS AND METHODS Cephalometric radiographs from total 63 patients of class II and III were analyzed. SNP analysis was performed based on both COL1A1 and FGFR2 sequences amplified from total DNA of patients' fresh blood. Principal component analysis was done to calculate the data and find the correlation of the cephalometric indicators influenced by each mutation. t-test and Mann-Whitney analysis were performed to check the significance of differences occurred in each studied parameter (p < 0.05). RESULT There were three COL1A1 SNPs found in class II and only two in class III, while three FGFR2 SNPs found in both classes. Class II phenotype seemed to be strongly influenced by Y-axis and mandibular plane angle, while class III by lower gonial angle and mandibular plane angle. CONCLUSION Based on this study, we suggest that rs2249492 of COL1A1 and rs2981582 of FGFR2 play important roles in class III, while rs2277632 of COL1A1 and rs2981582 of FGFR2 play important role in class II skeletal malocclusion in Javanese population.
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Affiliation(s)
- I Gusti Aju Wahju Ardani
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia,Address for correspondence I Gusti Aju Wahju Ardani, DDS, MSc, MSc.Ort., PhD Department of Orthodontics, Faculty of Dental Medicine, Universitas AirlanggaSurabaya, Indonesia 10110
| | - Melisa Budipramana
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
| | - Erlina Rachmawati
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Alexander Patera Nugraha
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - I Kade Karisma Gita Ardana
- Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Negeri Malang, Malang, Indonesia
| | - Theresia Indah Budhy
- Department of Oral and Maxillofacial Pathology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Rozita Hassan
- Orthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Dwi Listyorini
- Department of Biotechnology, Faculty of Mathematics and Natural Sciences, Universitas Negeri Malang, Malang, Indonesia
| | - Riyanarto Sarno
- Department of Informatics, Institute Technology of Sepuluh Nopember, Surabaya, Indonesia
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8
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The Gingiva from the Tissue Surrounding the Bone to the Tissue Regenerating the Bone: A Systematic Review of the Osteogenic Capacity of Gingival Mesenchymal Stem Cells in Preclinical Studies. Stem Cells Int 2021; 2021:6698100. [PMID: 34234830 PMCID: PMC8218920 DOI: 10.1155/2021/6698100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/20/2020] [Accepted: 05/21/2021] [Indexed: 12/13/2022] Open
Abstract
The current review aims to systematically assess the osteogenic capacity of gingiva-derived mesenchymal stem cells (GMSCs) in preclinical studies. A comprehensive electronic search of PubMed, Embase, Web of Science, and Scopus databases, as well as a manual search of relevant references, was performed in June 2020 without date or language restrictions. Eligibility criteria were the following: studies that compared mesenchymal stem cells (MSCs) derived from the gingiva with other MSC sources (in vitro or in vivo) or cell-free scaffold (in vivo) and studies that reported at least one of the following outcomes: osteogenic potential and new bone formation for in vitro and in vivo, respectively. Moreover, the assessment of included studies was conducted using appropriate guidelines. From 646 initial retrieved studies, 35 full-text articles were subjected to further screening and 26 studies were selected (20 in vitro studies and 6 in vivo studies). GMSCs showed great proliferation capacity and expressed recognized mesenchymal stem cell markers, particularly CD90. In vitro, MSC sources including GMSCs were capable of undergoing osteogenic differentiation with less ability in GMSCs, while most in vivo studies confirmed the capacity of GMSCs to regenerate bony defects. Concerning the assessment of methodological quality, in vitro studies met the relevant guideline except in five areas: the sample size calculation, randomization, allocation concealment, implementation, and blinding, and in vivo publications had probably low risk of bias in most domains except in three areas: allocation concealment, attrition, and blinding items.
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Narmada IB, Putri PD, Lucynda L, Triwardhani A, Ardani IGAW, Nugraha AP. Effect of Caffeic Acid Phenethyl Ester Provision on Fibroblast Growth Factor-2, Matrix Metalloproteinase-9 Expression, Osteoclast and Osteoblast Numbers during Experimental Tooth Movement in Wistar Rats (Rattus norvegicus). Eur J Dent 2021; 15:295-301. [PMID: 33511599 PMCID: PMC8184315 DOI: 10.1055/s-0040-1718640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objectives
To investigate the effect of caffeic acid phenethyl ester (CAPE) provision on matrix metalloproteinase-9 (MMP-9), fibroblast growth factor-2 (FGF-2) expression, osteoclast and osteoblast numbers during experimental orthodontic tooth movement (OTM) in male Wistar rats (
Rattus norvegicus
).
Materials and Methods
Forty-eight healthy male Wistar rats (
R. norvegicus
), 16 to 20 weeks old with 200 to 250 g body weight (bw) were divided into several groups as follows: K1: OTM for 3 days; K2: OTM for 7 days; K3: OTM for 14 days; KP1: OTM and CAPE for 3 days; KP2: OTM and CAPE for 7 days; and KP3: OTM and CAPE for 14 days. A nickel titanium closed coil spring 8.0 mm long with 10 g/mm
2
was installed between the upper left first molar and upper central incisor to move molar mesially. CAPE provision with a dose of 20 mg/kg bw of animal studies was done per orally. Immunohistochemistry was done to examine MMP-9 expression and osteoclast number in compression side as well as FGF-2 expression and osteoblast number in tensile side of the OTM.
Statistical Analysis
One-way analysis of variance test and Tukey’s honest significant difference test were performed to determine the difference between the groups (
p
< 0.05).
Results
MMP-9 expression and osteoclast numbers in the compression side were significantly different between the groups. Similarly, FGF-2 expression and osteoclast numbers in the tensile side were significantly different between the groups.
Conclusions
CAPE provision during OTM increases the number of osteoblasts and the FGF-2 expression significantly in the tensile side. Osteoclast numbers and MMP-9 expression significantly decrease in the compression side.
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Affiliation(s)
- Ida Bagus Narmada
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Paristyawati Dwi Putri
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Lucky Lucynda
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ari Triwardhani
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - I Gusti Aju Wahju Ardani
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Alexander Patera Nugraha
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
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Alhasyimi AA, Suparwitri S, Christnawati C. Effect of Carbonate Apatite Hydrogel-Advanced Platelet-Rich Fibrin Injection on Osteoblastogenesis during Orthodontic Relapse in Rabbits. Eur J Dent 2020; 15:412-419. [PMID: 33368063 PMCID: PMC8382455 DOI: 10.1055/s-0040-1721234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective
This study aimed to determine the effect of carbonate apatite (CHA) hydrogel-aPRF on osteoblastogenesis during relapse in rabbits.
Materials and Methods
Forty-five rabbits were divided into three groups (
n
= 15): the control, CHA, and CHA-autologous platelet-rich fibrin (aPRF) groups. An open-coil spring was compressed between brackets to distalize the lower incisors of the rabbits by delivering a force of 50 cN for 1 week. The new position of the teeth was retained for 14 days, and CHA hydrogel-aPRF was injected every 7 days. The appliances were then debonded to allow relapse. On days 0, 3, 7, 14, and 21 after debonding, transforming growth factor (TGF)-β1 and bone morphogenetic protein (BMP)-2 expression was examined using immunohistochemistry staining and Runx-2 levels were analyzed by enzyme-linked immunosorbent assay. The data collected were analyzed using analysis of variance and a post hoc Tukey’s test (
p
< 0.05).
Results
Histomorphometric analysis revealed that TGF-β1 expression in the CHA-aPRF group is statistically higher than that in other groups on days 0, 3, and 7 after debonding (
p
< 0.05). BMP-2 expression in the CHA-aPRF group was also statistically higher than that in the other groups on days 3, 14, and 21 after debonding (
p
< 0.05). ELISA showed that Runx-2 levels are slightly higher in the CHA-aPRF group than in the other groups (
p
> 0.05).
Conclusion
Although injection of CHA-aPRF aids in osteoblastogenesis associated with enhancing TGF-β1 and BMP-2 expressions, it does not significantly upregulate Runx-2 levels.
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Affiliation(s)
- Ananto Ali Alhasyimi
- Department of Orthodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sri Suparwitri
- Department of Orthodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Saskianti T, Nugraha AP, Prahasanti C, Ernawati DS, Suardita K, Riawan W. Immunohistochemical analysis of stem cells from human exfoliated deciduous teeth seeded in carbonate apatite scaffold for the alveolar bone defect in Wistar rats ( Rattus novergicus). F1000Res 2020; 9:1164. [PMID: 33335716 PMCID: PMC7721066 DOI: 10.12688/f1000research.25009.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Stem cells from human exfoliated deciduous teeth (SHED) seeded in carbonate apatite scaffold (CAS) may have multiple functions that could be used to regenerate the alveolar bone defects. The purpose of this study is to examine the ability of SHED and CAS in alveolar bone defects using an immunohistochemical analysis. Methods: ten three-month-old healthy male Wistar rats
(R. novergicus) that weighed between 150–250 grams (g) were used as animal models. A simple blind random sampling method was used to select the sample that was assigned to the study group for CAS and SHED seeded in CAS (n=5). The animal study model of the alveolar bone was established by extracting the anterior mandible teeth. Rodent anesthesia was applied to relieve the pain during the procedure for all test animals. Immunohistochemistry was performed after seven days to facilitate the examination of the receptor activator of NF-κβ ligand (RANKL), osteoprotegrin (OPG), transforming growth factor-β (TGF-β), vascular endothelial growth factor (VEGF), runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), osteocalcin, and osteopontin expression. The data was analyzed using the unpaired t-test (p<0.01) and Pearson’s correlation test (p<0.05). Results: The OPG, RUNX2, TGF-β, VEGF, ALP, osteocalcin, and ostepontin expressions were higher in SHED seeded in CAS than CAS only with a significant difference between the groups (p<0.01). Furthermore, the RANKL expression was lower in SHED seeded in CAS compared to CAS only. There was a strong reverse significant correlation between OPG and RANKL expression (p<0.05). Conclusions: The number of osteogenic marker expressing cells, such as OPG, RUNX2, TGF-β, VEGF, ALP, osteocalcin, and ostepontin, increased. However, RANKL expression in the alveolar bone defects that were implanted with SHED seeded in CAS did not increase after seven days.
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Affiliation(s)
- Tania Saskianti
- Pediatric Dentistry Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Alexander Patera Nugraha
- Orthodontics Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Chiquita Prahasanti
- Periodontology Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Diah Savitri Ernawati
- Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Ketut Suardita
- Conservative Dentistry Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Wibi Riawan
- Biomolecular Biochemistry, Faculty of Medicine, Brawijaya University, Malang, Indonesia
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Nugraha AP, Rantam FA, Narmada IB, Ernawati DS, Ihsan IS. Gingival-Derived Mesenchymal Stem Cell from Rabbit (Oryctolagus cuniculus): Isolation, Culture, and Characterization. Eur J Dent 2020; 15:332-339. [PMID: 33260232 PMCID: PMC8184309 DOI: 10.1055/s-0040-1719213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This study aims to confirm whether the GDMSCs isolated from rabbit's (Oryctolagus cuniculus) gingiva are mesenchymal stem cells (MSCs). MATERIALS AND METHODS This study design was partly quasi-experimental with an observational design. GDMSCs were isolated from the gingiva of healthy male rabbits (O. cuniculus) (n = 2), 6 months old, and 3 to 5 kg of body weight. The specific cell surface markers of MSCs; clusters of differentiation (CD), namely, CD44, CD73, CD90, CD105, and CD200 expressions; and hematopoietic stem cell surface markers CD34 and CD45 were examined using flow cytometry and immunohistochemistry with immunofluorescence. The osteogenic differentiation of isolated GDMSCs was examined using alizarin red staining. RESULTS GDMSCs in the fourth passage showed a spindle-like formation and fibroblast-like cells that attached to the base of the culture plate. GDMSCs were MSCs that positively expressed CD44, CD73, CD90, CD105, and CD200 but did not express CD34 and CD45 when examined using flow cytometry and immunohistochemical analysis. GDMSCs had osteogenic differentiation confirmed by calcified deposits in vitro with a red-violet and brownish color after alizarin red staining. CONCLUSION GDMSCs isolated from the rabbits (O. cuniculus) were confirmed as MSCs in vitro documented using immunohistochemistry and flow cytometry. GDMSCs can differentiate into osteogenic lineage in vitro that may be suitable for regenerative dentistry.
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Affiliation(s)
- Alexander Patera Nugraha
- Department of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Fedik Abdul Rantam
- Laboratory of Virology and Immunology, Department of Microbiology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ida Bagus Narmada
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Diah Savitri Ernawati
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Igo Syaiful Ihsan
- Stem Cell Research and Development Center, Universitas Airlangga, Surabaya, Indonesia
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Saskianti T, Nugraha AP, Prahasanti C, Ernawati DS, Suardita K, Riawan W. Immunohistochemical analysis of stem cells from human exfoliated deciduous teeth seeded in carbonate apatite scaffold for the alveolar bone defect in Wistar rats ( Rattus novergicus). F1000Res 2020; 9:1164. [PMID: 33335716 PMCID: PMC7721066 DOI: 10.12688/f1000research.25009.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 12/01/2023] Open
Abstract
Background: Stem cells from human exfoliated deciduous teeth (SHED) seeded in carbonate apatite scaffold (CAS) may have multiple functions that could be used to regenerate the alveolar bone defects. The purpose of this study is to examine the ability of SHED and CAS in alveolar bone defects using an immunohistochemical analysis. Methods: ten three-month-old healthy male Wistar rats (R. novergicus) that weighed between 150-250 grams (g) were used as animal models. A simple blind random sampling method was used to select the sample that was assigned to the study group for CAS and SHED seeded in CAS (n=5). The animal study model of the alveolar bone was established by extracting the anterior mandible teeth. Rodent anesthesia was applied to relieve the pain during the procedure for all test animals. Immunohistochemistry was performed after seven days to facilitate the examination of the receptor activator of NF-κβ ligand (RANKL), osteoprotegrin (OPG), transforming growth factor-β (TGF-β), vascular endothelial growth factor (VEGF), runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), osteocalcin, and osteopontin expression. The data was analyzed using the unpaired t-test (p<0.01) and Pearson's correlation test (p<0.05). Results: The OPG, RUNX2, TGF-β, VEGF, ALP, osteocalcin, and ostepontin expressions were higher in SHED seeded in CAS than CAS only with a significant difference between the groups (p<0.01). Furthermore, the RANKL expression was lower in SHED seeded in CAS compared to CAS only. There was a strong reverse significant correlation between OPG and RANKL expression (p<0.05). Conclusions: The number of osteogenic marker expressing cells, such as OPG, RUNX2, TGF-β, VEGF, ALP, osteocalcin, and ostepontin, increased. However, RANKL expression in the alveolar bone defects that were implanted with SHED seeded in CAS did not increase after seven days.
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Affiliation(s)
- Tania Saskianti
- Pediatric Dentistry Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Alexander Patera Nugraha
- Orthodontics Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Chiquita Prahasanti
- Periodontology Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Diah Savitri Ernawati
- Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Ketut Suardita
- Conservative Dentistry Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Wibi Riawan
- Biomolecular Biochemistry, Faculty of Medicine, Brawijaya University, Malang, Indonesia
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Prahasanti C, Nugraha AP, Saskianti T, Suardita K, Riawan W, Ernawati DS. Exfoliated Human Deciduous Tooth Stem Cells Incorporating Carbonate Apatite Scaffold Enhance BMP-2, BMP-7 and Attenuate MMP-8 Expression During Initial Alveolar Bone Remodeling in Wistar Rats ( Rattus norvegicus). Clin Cosmet Investig Dent 2020; 12:79-85. [PMID: 32273773 PMCID: PMC7102906 DOI: 10.2147/ccide.s245678] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background Post-tooth extraction socket preservation is necessary due to alveolar bone resorptive patterns through regenerative dentistry approaches that involve the use of stem cells, scaffold and growth factor. Stem cells derived from human exfoliated deciduous teeth (SHED) are known to potentially possess the osteogenic ability. Meanwhile, carbonate apatite scaffold (CAS) can act as a biocompatible scaffold capable of supporting mesenchymal stem cells (MSCs) to proliferate and differentiate optimally. The aim of this study is to investigate the expression of bone morphogenic protein-2 and 7 (BMP2, BMP7) and Matrix Metalloproteinase-8 (MMP-8) after the transplantation of SHED-incorporated CAS during in vivo bone remodeling. Material and Methods A total of 14 healthy, male, Wistar rats, whose mandible anterior teeth were extracted by means of sterile needle holder clamps, constituted the subjects of this study of alveolar bone defects. Two research groups were created: a control group (CAS) as group I and an experimental group (CAS + SHED) as group II. SHED with a density of 106 cells were incorporated into CAS before being transplanted into the experimental group. After 7 days, all the animals were sacrificed and their mandible anterior region extracted. The BMP2, BMP7 and MMP-8 expression were subsequently analyzed by means of immunostaining. An unpaired t-test was conducted to analyze the treatment and control group (p<0.01) data. Results The expression of BMP-2 and BMP-7 was higher in group II compared to group I. Meanwhile, the level of MMP-8 was lower in group II than group I. There was greater significant increased expression of BMP-2 and BMP-7 expression in Group II compared to Group I. There was significant decreased expression of MMP-8 between group II than group I (p<0.01). Conclusion SHED-incorporated CAS can enhance BMP-2 and BMP-7 expression while attenuating MMP-8 expression during in vivo alveolar bone remodeling.
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Affiliation(s)
- Chiquita Prahasanti
- Department of Periodontology, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia
| | - Alexander Patera Nugraha
- Department of Orthodontics, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia.,Medical Science, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Tania Saskianti
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia
| | - Ketut Suardita
- Department of Conservative Dentistry, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia
| | - Wibi Riawan
- Department of Biomolecular Biochemistry, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Diah Savitri Ernawati
- Department of Oral Medicine, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia
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Platelet-Rich Fibrin as a Bone Graft Material in Oral and Maxillofacial Bone Regeneration: Classification and Summary for Better Application. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3295756. [PMID: 31886202 PMCID: PMC6925910 DOI: 10.1155/2019/3295756] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Abstract
Platelet-rich fibrin (PRF) is an autologous platelet concentrate that consists of cytokines, platelets, leukocytes, and circulating stem cells. It has been considered to be effective in bone regeneration and is mainly used for oral and maxillofacial bone. Although currently the use of PRF is thought to support alveolar ridge preservation, there is a lack of evidence regarding the application of PRF in osteogenesis. In this paper, we will provide examples of PRF application, and we will also summarize different measures to improve the properties of PRF for achieving better osteogenesis. The effect of PRF as a bone graft material on osteogenesis based on laboratory investigations, animal tests, and clinical evaluations is first reviewed here. In vitro, PRF was able to stimulate cell proliferation, differentiation, migration, mineralization, and osteogenesis-related gene expression. Preclinical and clinical trials suggested that PRF alone may have a limited effect. To enlighten researchers, modified PRF graft materials are further reviewed, including PRF combined with other bone graft materials, PRF combined with drugs, and a new-type PRF. Finally, we will summarize the common shortcomings in the application of PRF that probably lead to application failure. Future scientists should avoid or solve these problems to achieve better regeneration.
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Nugraha AP, Purwati 1, Susilowati H, Hendrianto E, Karsari D, Ertanti N, Dinaryanti A, Ihsan IS, Narmada IB, Ernawati DS, Rantam FA. Medicinal Signaling Cells Metabolite Oral Based as a Potential Biocompatible Biomaterial Accelerating Oral Ulcer Healing (In Vitro Study). Eur J Dent 2019; 13:432-436. [PMID: 31795007 PMCID: PMC6890501 DOI: 10.1055/s-0039-1693923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Medicinal signaling cells metabolite (MSCM) is often considered medical waste even though it contains abundant growth factors, and advantageous micro- and macromolecules that can accelerate healing in oral ulcer.The purpose of this experimental laboratory study was to analyze the biocompatibility and potential of MSCM, (oral based) to accelerate healing in oral ulcer (in vitro). MATERIALS AND METHODS MSCM (oral based) was obtained by mixing 10 mL of MSCM and 2% of carboxymethyl cellulose sodium. 3- (4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (or MTT assay) was obtained using human gingival somatic cell culture to examine cell viability treated with MSCM (oral based). Fourier transform infrared spectroscopy was performed to know the functional structure and composition of MSCM (oral based). To know the elemental composition of MSCM (oral based), energy-dispersive X-ray analysis was performed. Scratch test was performed to know the ability of MSCM (oral based) to increase human somatic cell proliferation. RESULTS MSCM (oral based) has good cell viability. MSCM (oral based) administration accelerated the proliferation of human somatic cell culture after 12-hours in vitro. MSCM (oral based) has carboxylic acids and derivatives chemical bond. MSCM (oral based) mostly contained carbon and potassium but did not contain heavy metal substances. CONCLUSIONS MSCM (oral based) has a biocompatible and potential ability to accelerate healing in oral ulcer in vitro. It would be useful in daily clinical practice in treating traumatic oral ulcer.
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Affiliation(s)
- Alexander Patera Nugraha
- Stem Cell Research and Development Center, Universitas Airlangga Surabaya, Indonesia
- Orthodontics Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
- Doctoral Student of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Helen Susilowati
- Stem Cell Research and Development Center, Universitas Airlangga Surabaya, Indonesia
| | - Eryk Hendrianto
- Stem Cell Research and Development Center, Universitas Airlangga Surabaya, Indonesia
| | - Deya Karsari
- Stem Cell Research and Development Center, Universitas Airlangga Surabaya, Indonesia
| | - Nora Ertanti
- Stem Cell Research and Development Center, Universitas Airlangga Surabaya, Indonesia
| | - Aristika Dinaryanti
- Stem Cell Research and Development Center, Universitas Airlangga Surabaya, Indonesia
| | - Igo Syaiful Ihsan
- Stem Cell Research and Development Center, Universitas Airlangga Surabaya, Indonesia
| | - Ida Bagus Narmada
- Orthodontics Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Diah Savitri Ernawati
- Oral Medicine Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Fedik Abdul Rantam
- Stem Cell Research and Development Center, Universitas Airlangga Surabaya, Indonesia
- Virology and Immunology Laboratory, Department of Microbiology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
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