Melatonin as a candidate therapeutic drug for protecting bone cells from chlorhexidine-induced damage

Antibiofilm potential of plant extracts: inhibiting oral microorganisms and Streptococcus mutans

Introduction

A range of disinfectant mouthwashes are available for oral hygiene. The gold standard is Chlorhexidine digluconate (CHX), which, like other available products, cannot be used without side effects in the long term. However, in recent years, therapy with herbal products, often considered antiquated, has regained considerable interest. Therefore, the search for plant compounds as an alternative to existing oral disinfectants is meaningful.

Methods

In this study, eleven Mediterranean plant extracts were tested for their antimicrobial effect in vitro. Methanol extracts of the following plants were produced by the pharmaceutical faculty of the University of Athens: Mentha aquatica, Mentha longifolia, Sideritis euboea, Sideritis syriaca, Stachys spinosa, Satureja parnassica, Satureja thymbra, Lavandula stoechas, Achillea taygetea, Phlomis cretica, and Vaccinium myrtillus. The extracts were dissolved for microdilution experiments at concentrations ranging from 10 to 0.019 mg/ml. The oral pathogens tested were Streptococcus mutans, Streptococcus oralis, Streptococcus sobrinus, Prevotella intermedia, Fusobacterium nucleatum, Parvimonas micra, Porphyromonas gingivalis, and Candida albicans. Enterococcus faecalis, Staphylococcus aureus, and Escherichia coli were used as references.

Results

All extracts, except the methanol extract of V. myrtillus, showed an antibacterial effect at concentrations ranging from 10 to 0.15 mg/ml. None of the extracts exhibited a significant antifungal effect. In general, the anaerobic pathogens could be inhibited and killed at lower concentrations compared to the aerobic pathogens. S. oralis also showed good susceptibility to the extracts. Additionally, the extracts' ability to inhibit biofilm formation by S. mutans was tested. L. stoechas at a concentration of 0.3 mg/ml showed a moderate inhibitory effect. The extracts of L. stoechas, S. thymbra, S. parnassica, and the methanol extract of V. myrtillus were effective at concentrations up to 1.25 mg/ml. P. cretica was able to inhibit and kill S. mutans at a concentration of 0.6 mg/ml, but its effectiveness in biofilm inhibition significantly decreased at 2.5 mg/ml.

Discussion

The study's hypothesis that all extracts would exhibit an antimicrobial effect was thus confirmed.

Evaluation of Anti-inflammatory and Antimicrobial Properties of Mustard Seed Extract-Based Hydrogel: An In Vitro Study

INTRODUCTION

Mustard has been regarded as one of the world's most extensively produced and useful plants as well as one of the oldest condiments ever. The aim of the study was to develop and analyse the anti-inflammatory and antimicrobial properties of mustard seed extract.

METHODS

The extract was prepared by using a double filtration technique and anti-inflammatory properties were checked using egg albumin assay and bovine serum albumin assay and diclofenac sodium was the control. The antimicrobial property was evaluated by the Kirby-Bauer test and chlorhexidine gel was the control. The species included were Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis and Candida albicans.

RESULTS

The results showed that the anti-inflammatory property of mustard seed extract is comparable to diclofenac sodium whereas the maximum zone of inhibition was seen against C. albicans.

CONCLUSION

 This study discovered that mustard seed extract has potent antimicrobial and anti-inflammatory activity against a variety of oral microorganisms. These findings indicate that this hydrogel was highly active against the tested pathogens and will be effective in the treatment of periodontitis.

Beneficial Effects of Melatonin on Periodontitis Management: Far More Than Oral Cavity

Periodontitis as a highly prevalent chronic infection/inflammatory disease can eventually lead to tooth loss and masticatory dysfunction. It also has a negative impact on general health and largely impairs quality of life. The tissue destruction during periodontitis is mainly caused by the excessive immune-inflammatory response; hence, how to modulate the host's reaction is of profound importance for effective periodontal treatment and tissue protection. Melatonin, as an endogenous hormone exhibiting multiple biological functions such as circadian rhythm regulation, antioxidant, and anti-inflammation, has been widely used in general healthcare. Notably, the past few years have witnessed increasing evidence for the application of melatonin as an adjunctive approach in the treatment of periodontitis and periodontitis-related systemic comorbidities. The detailed underlying mechanisms and more verification from clinical practice are still lacking, however, and further investigations are highly required. Importantly, it is essential to establish standard guidelines in the near future for the clinical administration of melatonin for periodontal health and general wellbeing.

Metabolic activity of hydro-carbon-oxo-borate on a multispecies subgingival periodontal biofilm: a short communication

Objective

This study evaluated the metabolic activity of hydro-carbon-oxo-borate complex (HCOBc) on a multispecies subgingival biofilm as well as its effects on cytotoxicity.

Materials and methods

The subgingival biofilm with 32 species related to periodontitis was formed in the Calgary Biofilm Device (CBD) for 7 days. Two different therapeutic schemes were adopted: (1) treatment with HCOBc, 0.12% chlorhexidine (CHX), and negative control group (without treatment) from day 3 until day 6, two times a day for 1 min each time, totaling 8 treatments and (2) a 24-h treatment on a biofilm grown for 6 days. After 7 days of formation, biofilm metabolic activity was determined by colorimetry assay, and bacterial counts and proportions of complexes were determined by DNA-DNA hybridization. Both substances’ cytotoxicity was evaluated by cell viability (XTT assay) and clonogenic survival assay on ovary epithelial CHO-K1 cells and an osteoblast precursor from calvaria MC3T3-E1 cells.

Results

The first treatment scheme resulted in a significant reduction in biofilm’s metabolic activity by means of 77% by HCOBc and CHX treatments versus negative control. The total count of 11 and 25 species were decreased by treatment with hydro-carbon-oxo-borate complex and CHX, respectively, compared with the group without treatment (p < 0.05), highlighting a reduction in the levels of Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, and Fusobacterium periodontium. CHX significantly reduced the count of 10 microorganisms compared to the group treated with HCOBc (p < 0.05). HCOBc and CHX significantly decreased the pathogenic red-complex proportion compared with control-treated biofilm, and HCOBc had even a more significant effect on the red complex than CHX had (p ≤ 0.05). For the second treatment scheme, HCOBc complex and CHX significantly decreased 61 and 72% of control biofilms’ metabolic activity and the counts of 27 and 26 species, respectively. HCOBc complex did not significantly affect the proportions of formed biofilms, while CHX significantly reduced red, orange, and yellow complexes. Both substances exhibited similar cytotoxicity results.

Conclusions

This short communication suggested that the HCOBc complex reduced a smaller number of bacterial species when compared to chlorhexidine during subgingival biofilm formation, but it was better than chlorhexidine in reducing red-complex bacterial proportions. Although HCOBc reduced the mature 6-day-old subgingival multispecies biofilms, it did not modify bacterial complexes’ ratios as chlorhexidine did on the biofilms mentioned above. Future in vivo studies are needed to validate these results.

Clinical relevance

HCOBc complex could be used to reduce red-complex periodontal bacterial proportions.

Antimicrobial Photoinactivation of In Situ Oral Biofilms by Visible Light Plus Water-Filtered Infrared A and Tetrahydroporphyrin-tetratosylate (THPTS)

The aim of this study was to examine the effect of aPDT with visual light (VIS) + water-filtered infrared A (wIRA) as a light source, and tetrahydroporphyrin-tetratosylate (THPTS) as a photosensitizer on in situ initial and mature oral biofilms. The samples were incubated, ex situ, with THPTS for two minutes, followed by irradiation with 200 mW cm − 2 VIS + wIRA for five minutes at 37 °C. The adherent microorganisms were quantified, and the biofilm samples were visualized using live/dead staining and confocal laser scanning microscopy (CLSM). The THPTS-mediated aPDT resulted in significant decreases in both the initially adherent microorganisms and the microorganisms in the mature oral biofilms, in comparison to the untreated control samples (>99.99% each; p = 0.018 and p = 0.0066, respectively). The remaining vital bacteria significantly decreased in the aPDT-treated biofilms during initial adhesion (vitality rate 9.4% vs. 71.2% untreated control, 17.28% CHX). Of the mature biofilms, 25.67% remained vital after aPDT treatment (81.97% untreated control, 16.44% CHX). High permeability of THPTS into deep layers could be shown. The present results indicate that the microbial reduction in oral initial and mature oral biofilms resulting from aPDT with VIS + wIRA in combination with THPTS has significant potential for the treatment of oral biofilm-associated diseases.

Melatonin is an effective protector of gingival cells damaged by the cytotoxic effect of glutamate and DL-buthionine sulfoximine

BACKGROUND AND OBJECTIVE

Cellular damage related to oxidative stress (OS) is implicated in periodontal diseases (PD). Melatonin (MEL) has multiple functions, and it has been described as a potential treatment for PD. We aim at evaluating the protective effects of MEL on an in vitro model of cellular damage triggered by glutamate (GLUT) and DL-buthionine sulfoximine (BSO), on gingival cells (GCs) in culture.

MATERIAL AND METHODS

A primary culture of GCs from Wistar rats was developed in order to test the protective property of MEL; BSO and GLUT were administered alone as well as in combination with MEL. The viability and apoptosis were measured with MTT assay and TUNEL, respectively, and the concentration of superoxide anion ( O 2 - ) was measured with the NBT method.

RESULTS

The combination of BSO and GLUT treatment resulted in a decreased viability of GCs. This was evidenced by the increase in both the production of superoxide anion and apoptosis. After MEL administration, the oxidant and pro-apoptotic effects of BSO and GLUT were totally counteracted.

CONCLUSIONS

These findings demonstrated that MEL has an effective protective role on GCs subjected to cellular damage in a model of OS and cytotoxicity triggered by BSO and GLUT. Consequently, MEL could be used as a therapeutic agent in PD which begin with a significative loss of GCs.

Melatonin Attenuates AlCl3-Induced Apoptosis and Osteoblastic Differentiation Suppression by Inhibiting Oxidative Stress in MC3T3-E1 Cells

Aluminum (Al) inhibits osteoblast-mediated bone formation by oxidative stress, resulting in Al-induced bone disease. Melatonin (MT) has received extensive attention due to its antioxidant and maintenance of bone health effect. To evaluate the protective effect and mechanism of MT on AlCl₃-induced osteoblast dysfunction, MC3T3-E1 cells were treated with MT (100 μM) and/or AlCl₃ (8 μM). First, MT alleviated AlCl₃-induced osteoblast dysfunction, presenting as the reduced apoptosis rate as well as increased cell viability, alkaline phosphatase (ALP) activity, and type I collagen (COL-1) level. Then, MT significantly attenuated AlCl₃-induced oxidative stress, presenting as the reduced reactive oxygen species and 8-hydroxy-2'-deoxyguanosine levels as well as increased glutathione level and superoxide dismutase activity. Finally, MT protected MC3T3-E1 cells against p53-dependent apoptosis and differentiation suppression, as assessed by Caspase-3 activity, protein levels of p53, Bcl-2-associated X protein (Bax), B cell lymphoma gene 2 (Bcl-2), cytosolic Cytochrome c, Runt-related transcription factor 2 (Runx2), and Osterix, as well as the mRNA levels of Bax, Bcl-2, Runx2, Osterix, ALP, and COL-1. Overall, our findings demonstrate MT attenuates AlCl₃-induced apoptosis and osteoblastic differentiation suppression by inhibiting oxidative stress in MC3T3-E1 cells.

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.

Antimicrobial effects of mustard oil-containing plants against oral pathogens: an in vitro study

Background

The present study examines the antimicrobial activity of nasturtium herb (Tropaeoli maji herba) and horseradish root (Armoraciae rusticanae radix) against clinically important oral bacterial pathogens involved in periodontitis, gingivitis, pulpitis, implantitis and other infectious diseases.

Methods

A total of 15 oral pathogens, including members of the genera Campylobacter, Fusobacterium, Prevotella, Parvimonas, Porphyromonas, Tanerella, Veillonella, and HACEK organisms, were exposed to [1] a combination of herbal nasturtium and horseradish using a standardized gas test and [2] a mixture of synthetic Isothiocyantes (ITCs) using an agardilution test. Headspace gas chromatography mass spectrometry was employed to quantify the amount of allyl-, benzyl-, and 2- phenyl- ethyl-ITC.

Results

With exception of Veillonella parvula, all tested species were highly susceptible to herbal nasturtium and horseradish in the gas test with minimal inhibitory concentrations (MICs) between 50/20 mg and 200/80 mg and to synthetic ITCs in the agardilution with MICs between 0.0025 and 0.08 mg ITC/mL, respectively. Minimal bactericidal concentrations extended from 0.005 mg ITC/mL to 0.34 mg ITC/mL.

Conclusions

ITCs may be considered an interesting alternative to antibiotics for prevention and treatment of oropharyngeal infections, periodontitis and related diseases. Furthermore, the suitability of ITCs for endocarditis prophylaxis in dental procedures might be worth further investigation.

Relationship between autophagy, apoptosis and endoplasmic reticulum stress induced by melatonin in osteoblasts by septin7 expression

Melatonin secreted by the pineal body is associated with the occurrence and development of idiopathic scoliosis. Melatonin has a concentration-dependent dual effect on osteoblast proliferation, in which higher concentrations can inhibit osteoblast proliferation and induce apoptosis; however, the underlying mechanism remains unclear. In the present study, flow cytometry was used to demonstrate that osteoblast cells treated with melatonin exhibited significantly increased early and late stage apoptotic rates as the concentration increased. Chromatin condensation in the nucleus and apoptotic body formation could be observed using fluorescent microscopy in osteoblast cells treated with 2 mM melatonin. Western blotting results showed that there was an upregulation in the expression of apoptosis marker proteins [poly (ADP-ribose) polymerase 1 (PARP-1)], endoplasmic reticulum stress [ERS; C/EBP homologous protein (CHOP) and glucose-regulated protein, 78 kDa (GRP78)] and autophagy [microtubule-associated protein 1 light chain 3β (LC3)-I/LC3II]. PARP-1 expression was not altered when treated with ERS inhibitor 4PBA and autophagy inhibitor 3MA, whereas 4PBA or 3MA in combination with 2 mM melatonin (or the three together) significantly increased PARP-1 expression. Furthermore, the use of septin7 small interfering RNA confirmed that increased expression of GRP78 and CHOP was related to septin7, and melatonin- mediated ERS was necessary for septin7 activation. These findings suggest that ERS and autophagy might occur in the early stage of treatment with a high concentration of melatonin, and each might play a protective role in promoting survival; in a later stage, ERS and autophagy might interact and contribute to the induction of apoptosis. Overall, the results indicated that septin7 may be a target protein of melatonin-induced ERS.

Antimicrobial Photoinactivation Using Visible Light Plus Water-Filtered Infrared-A (VIS + wIRA) and Hypericum Perforatum Modifies In Situ Oral Biofilms

Due to increasing antibiotic resistance, the application of antimicrobial photodynamic therapy (aPDT) is gaining increasing popularity in dentistry. The aim of this study was to investigate the antimicrobial effects of aPDT using visible light (VIS) and water-filtered infrared-A (wIRA) in combination with a Hypericum perforatum extract on in situ oral biofilms. The chemical composition of H. perforatum extract was analyzed using ultra-high-performance liquid chromatography coupled with high resolution mass spectrometry (UPLC-HRMS). To obtain initial and mature oral biofilms in situ, intraoral devices with fixed bovine enamel slabs (BES) were carried by six healthy volunteers for two hours and three days, respectively. The ex situ exposure of biofilms to VIS + wIRA (200 mWcm^-2) and H. perforatum (32 mg ml^-1, non-rinsed or rinsed prior to aPDT after 2-min preincubation) lasted for five minutes. Biofilm treatment with 0.2% chlorhexidine gluconate solution (CHX) served as a positive control, while untreated biofilms served as a negative control. The colony-forming units (CFU) of the aPDT-treated biofilms were quantified, and the surviving microorganisms were identified using MALDI-TOF biochemical tests as well as 16 S rDNA-sequencing. We could show that the H. perforatum extract had significant photoactivation potential at a concentration of 32 mg ml^-1. When aPDT was carried out in the presence of H. perforatum, all biofilms (100%) were completely eradicated (p = 0.0001). When H. perforatum was rinsed off prior to aPDT, more than 92% of the initial viable bacterial count and 13% of the mature oral biofilm were killed. Overall, the microbial composition in initial and mature biofilms was substantially altered after aPDT, inducing a shift in the synthesis of the microbial community. In conclusion, H. perforatum-mediated aPDT using VIS + wIRA interferes with oral biofilms, resulting in their elimination or the substantial alteration of microbial diversity and richness. The present results support the evaluation of H. perforatum-mediated aPDT for the adjunctive treatment of biofilm-associated oral diseases.

The multiple protective roles and molecular mechanisms of melatonin and its precursor N-acetylserotonin in targeting brain injury and liver damage and in maintaining bone health

Melatonin is a neurohormone associated with sleep and wakefulness and is mainly produced by the pineal gland. Numerous physiological functions of melatonin have been demonstrated including anti-inflammation, suppressing neoplastic growth, circadian and endocrine rhythm regulation, and its potent antioxidant activity as well as its role in regeneration of various tissues including the nervous system, liver, bone, kidney, bladder, skin, and muscle, among others. In this review, we summarize the recent advances related to the multiple protective roles of melatonin receptor agonists, melatonin and N-acetylserotonin (NAS), in brain injury, liver damage, and bone health. Brain injury, including traumatic brain injury, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and newborn perinatal hypoxia-ischemia encephalopathy, is a major cause of mortality and disability. Liver disease causes serious public health problems and various factors including alcohol, chemical pollutants, and drugs induce hepatic damage. Osteoporosis is the most common bone disease in humans. Due in part to an aging population, both the cost of care of fracture patients and the annual fracture rate have increased steadily. Despite the discrepancy in the pathophysiological processes of these disorders, time frames and severity, they may share several common molecular mechanisms. Oxidative stress is considered to be a critical factor in these pathogeneses. We update the current state of knowledge related to the molecular processes, mainly including anti-oxidative stress, anti-apoptosis, autophagy dysfunction, and anti-inflammation as well as other properties of melatonin and NAS. Particularly, the abilities of melatonin and NAS to directly scavenge oxygen-centered radicals and toxic reactive oxygen species, and indirectly act through antioxidant enzymes are disscussed. In this review, we summarize the similarities and differences in the protection provided by melatonin and/or NAS in brain, liver and bone damage. We analyze the involvement of melatonin receptor 1A (MT1), melatonin receptor 1B (MT2), and melatonin receptor 1C (MT3) in the protection of melatonin and/or NAS. Additionally, we evaluate their potential clinical applications. The multiple mechanisms of action and multiple organ-targeted properties of melatonin and NAS may contribute to development of promising therapies for clinical trials.

Is caffeic acid phenethyl ester more protective than doxycycline in experimental periodontitis?

BACKGROUND AND OBJECTIVES

Host modulation therapies (anti-inflammatory drugs, bone-stimulating agents, anti-proteinase etc.) target the inhibition or stabilization of tissue breakdown. The aim of the present study was to evaluate the effects of caffeic acid phenethyl ester (CAPE) and/or low dose doxycycline (LDD) administrations on alveolar bone loss (ABL), serum cytokines and gingival apoptosis, as well as the levels of oxidants and anti-oxidants in rats with ligature-induced periodontitis.

MATERIAL AND METHODS

The animals were randomly divided into five groups: Group C (periodontally healthy), Group PC (Periodontitis+CAPE), Group PD (Periodontitis+LDD), Group PCD (Periodontitis+CAPE+LDD), Group P (Periodontitis). Experimental periodontitis was induced for 14days. Levels of ABL, and the serum cytokines, interleukin (IL)-1 β, IL-6, tumor necrosis factor-α (TNF-α) and IL-10 were assessed as were the levels of the oxidants and anti-oxidants, malondialdehyde (MDA), glutathione (GSH) and glutathione peroxidase (GSH-Px), and levels of gingival apoptosis.

RESULTS

The lowest ABL levels was evident in the PC group, among the experimental groups. There was also less inflammatory infiltration in the PC group than the PD group. IL-1β, IL-6, and IL-10 were lower in the PC group and higher in the P group in comparison to the levels in the other experiment groups. TNF-α levels in the PD group were higher than levels in the PC and PCD groups. The PC and PCD groups did not differ from the C group in regard to MDA levels. The highest GSH-Px level was found in the PC group. Gingival apoptosis in the PC group was not only lower than the PD and PCD groups, but also lower than in the C group.

CONCLUSION

The present study suggests that CAPE has more anti-inflammatory, anti-oxidant and anti-apoptotic effects than LDD, with no additive benefits of a CAPE+LDD combination being evident in rats with periodontitis.

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.

Antiseptic solutions modulate the paracrine-like activity of bone chips: differential impact of chlorhexidine and sodium hypochlorite

AIM

Chemical decontamination increases the availability of bone grafts; however, it remains unclear whether antiseptic processing changes the biological activity of bone.

MATERIALS AND METHODS

Bone chips were incubated with four different antiseptic solutions including (1) povidone-iodine (0.5%), (2) chlorhexidine diguluconate (0.2%), (3) hydrogen peroxide (1%) and (4) sodium hypochlorite (0.25%). After 10 min. of incubation, changes in the capacity of the bone-conditioned medium (BCM) to modulate gene expression of gingival fibroblasts was investigated.

RESULTS

Conditioned medium obtained from freshly prepared bone chips increased the expression of TGF-β target genes interleukin 11 (IL11), proteoglycan4 (PRG4), NADPH oxidase 4 (NOX4), and decreased the expression of adrenomedullin (ADM), and pentraxin 3 (PTX3) in gingival fibroblasts. Incubation of bone chips with 0.2% chlorhexidine, followed by vigorously washing resulted in a BCM with even higher expression of IL11, PRG4 and NOX4. These findings were also detected with a decrease in cell viability and an activation of apoptosis signalling. Chlorhexidine alone, at low concentrations, increased IL11, PRG4 and NOX4 expression, independent of the TGF-β receptor I kinase activity. In contrast, 0.25% sodium hypochlorite almost entirely abolished the activity of BCM, whereas the other two antiseptic solutions, 1% hydrogen peroxide and 0.5% povidone-iodine, had relatively no impact respectively.

CONCLUSION

These in vitro findings demonstrate that incubation of bone chips with chlorhexidine differentially affects the activity of the respective BCM compared to the other antiseptic solutions. The data further suggest that the main effects are caused by chlorhexidine remaining in the BCM after repeated washing of the bone chips.