Carbonate Apatite Containing Statin Enhances Bone Formation in Healing Incisal Extraction Sockets in Rats

Prevalence and Risk Factors of Oral Lesions in a Portuguese Subpopulation: A Retrospective Study

Background/Objectives: Oral cancer is a significant global public health concern. Understanding the prevalence and associated risk factors of oral lesions is essential for developing effective preventive strategies. This study aimed to assess the prevalence and risk factors of oral lesions submitted for biopsy in a Portuguese subpopulation. A retrospective cross-sectional analysis was conducted using data from patients who sought dental care at the Egas Moniz Dental Clinic (EMDC) in the Lisbon metropolitan area. Methods: Data analysis was performed on a sample of 264 patients who attended the EMDC between October 2016 and December 2019 to ascertain the presence of oral lesions, their different types, and their correlation with potential risk factors. The analysis included all patients who underwent biopsy, and their pathology reports were reviewed. Results: The prevalence of oral lesions was 10.3%, affecting 58.7% females and 41.3% males, with a mean age of 55 years. The most frequently biopsied site was the buccal mucosa (23.5%). Non-neoplastic lesions accounted for 75.0% of cases, while mesenchymal lesions were the most common neoplastic category (58.5%). The most prevalent diagnosis was fibroepithelial hyperplasia (36.7%). A statistically significant association was observed between neoplastic lesions and statin use, as well as between both neoplastic and non-neoplastic lesions and the use of antidiabetic medications. Conclusions: Oral lesions are prevalent, with non-neoplastic lesions being the most frequent. Understanding their nature, prevalence, and associated risk factors is crucial for early and accurate diagnosis, aiding in disease prevention and management.

Efficacy of statins in tissue healing following tooth extraction: a systematic review of animal studies

Background

Statins, with their unique ability to stimulate bone formation and soft tissue healing, hold the potential to revolutionize dental care. The present study aims to delve into the profound effects of statins on bone and soft tissue healing in dental extraction sockets, offering a promising future for dental professionals and patients alike.

Methods

This systematic review aimed to understand the role of stains in tissue healing following dental extraction. This study was registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO; CRD42022299247). A comprehensive electronic database search yielded 412 manuscripts. After a rigorous screening process, nine manuscripts met the eligibility criteria. The study sample consisted of 403 animals, with eight studies utilizing rat animal models and one conducted on mongrel dogs.

Results

Overall, the application of statin drugs holds promise for improving tissue healing outcomes following tooth extraction. The primary outcome variables across all studies were residual ridge height and width, messenger ribonucleic acid (mRNA) expression of transforming growth factor-beta 1 (TGF-β1), bone morphogenetic protein-2 (BMP-2), and vascular endothelial growth factor (VEGF), bone and gingival healing, inflammatory response, and bone turnover (BT), bone formation in tooth extraction socket, and osteogenic healing in a tooth extraction socket.

Conclusions

The findings of this study underscore the significant potential of statin drugs to enhance tissue healing outcomes following tooth extraction. This discovery opens new and exciting possibilities for improving dentistry patient care, potentially transforming how we approach post-extraction healing.

A systematic review of a novel alloplast carbonate apatite granules

The objectives of this study are to provide a systematic review of a novel alloplastic hard-tissue grafting material, carbonate apatite granules (CO3Ap-granules), to provide a clinical case presentation of CO3Ap-granules in periodontal surgery. The following three electronic databases were searched independently by two of the authors (MN) and (CR): National Library of Medicine [MEDLINE (PubMed) and ClinicalTrials.gov], EMBASE (OVID) and the Cochrane Central Register of Controlled Trials (CENTRAL). After searching electronic databases, select journals in periodontics and implantology were also manually searched. Of the 43 studies identified from the systematic review, the following classifications were determined: (1) in vitro studies - 5 studies, (2) animal studies - 28 studies, (3) clinical studies - 7 studies, (4) reviews - 3 studies. Results from selected animal studies and all human studies were summarized. These results demonstrate that the novel alloplast CO3Ap-granules has the potential ability to stimulate new bone formation while CO3Ap-granules simultaneously resorb over time. Replacement of CO3Ap-granules with new bone formation has been shown to be comparable to autogenous bone grafting with one study showing superior results to a bovine-derived xenograft.

Bioactive Materials for Bone Regeneration: Biomolecules and Delivery Systems

Novel tissue regeneration strategies are constantly being developed worldwide. Research on bone regeneration is noteworthy, as many promising new approaches have been documented with novel strategies currently under investigation. Innovative biomaterials that allow the coordinated and well-controlled repair of bone fractures and bone loss are being designed to reduce the need for autologous or allogeneic bone grafts eventually. The current engineering technologies permit the construction of synthetic, complex, biomimetic biomaterials with properties nearly as good as those of natural bone with good biocompatibility. To ensure that all these requirements meet, bioactive molecules are coupled to structural scaffolding constituents to form a final product with the desired physical, chemical, and biological properties. Bioactive molecules that have been used to promote bone regeneration include protein growth factors, peptides, amino acids, hormones, lipids, and flavonoids. Various strategies have been adapted to investigate the coupling of bioactive molecules with scaffolding materials to sustain activity and allow controlled release. The current manuscript is a thorough survey of the strategies that have been exploited for the delivery of biomolecules for bone regeneration purposes, from choosing the bioactive molecule to selecting the optimal strategy to synthesize the scaffold and assessing the advantages and disadvantages of various delivery strategies.

Alveolar Bone Preservation Using a Combination of Nanocrystalline Hydroxyapatite and Injectable Platelet-Rich Fibrin: A Study in Rats

Alveolar bone resorption is a post-extraction complication wherein there is a reduction in the dimensions and quality of the alveolar bone. This study aimed to examine the effects of implantation of a combination of nanocrystalline hydroxyapatite (nHA) and injectable platelet-rich fibrin (IPRF) on the expression of tartrate-resistant acid phosphatase (TRAP), alkaline phosphatase (ALP), osteocalcin (OCN), and new bone formation. A total of 32 male rats had their upper right incisors extracted under general anesthesia and were then divided into a control group, nHA group, IPRF group, and nHA-IPRF group. Decapitation was carried out on day 14 and day 28 in each group and the jaws of each rat were subjected to immunohistochemical and histological analysis. The results showed a decrease in TRAP expression in the nHA-IPRF group compared with the control group on day 14 (p = 0.074) and day 28 (p = 0.017). The study also showed an increase in ALP and OCN in the HA-IPRF group on day 14 and day 28 compared with the control group. New bone formation suggested a significant increase in the nHA-IPRF group compared with the control group on day 14 (p = 0.001) and day 28 (p = 0.001). nHA-IPRF implantation can suppress alveolar bone resorption, which is indicated by decreased TRAP expression, and it can increase bone growth, as indicated by increased expression of ALP, OCN, and new bone formation.

Preparation and Characterization of PLG Microparticles by the Multiple Emulsion Method for the Sustained Release of Proteins

Rapid release and diminished stability are two of the limitations associated with the growth factors that are essentially used in dental applications. These growth factors are employed to enhance the quality and quantity of tissue or bone matter during regeneration. Therefore, drug delivery devices and systems have been developed to address these limitations. In this study, bovine serum albumin (BSA), as a representative growth factor, was successfully sustained by encapsulation with the medium-absorbable copolymer, poly(L-lactide-co-glycolide) (PLG) 70:30% mol, via the multiple emulsion method. Different PLG, PVA, and BSA concentrations were used to investigate their effects on the BSA encapsulation efficiency. The suitable ratios leading to a better characterization of microparticles and a higher encapsulation efficiency in producing encapsulated PLG microparticles were 8% (w/v) of PLG, 0.25% (w/v) of PVA, and 8% (w/v) of BSA. Furthermore, an in vitro release study revealed a bursting release of BSA from the encapsulated PLG microsphere in the early phase of development. Subsequently, a gradual release was observed over a period of eight weeks. Furthermore, to encapsulate LL-37, different proteins were used in conjunction with PLG under identical conditions with regard to the loading efficiency and morphology, thereby indicating high variations and poor reproducibility. In conclusion, the encapsulated PLG microparticles could effectively protect the protein during encapsulation and could facilitate sustainable protein release over a period of 60 days. Importantly, an optimal method must be employed in order to achieve a high degree of encapsulation efficiency for all of the protein or growth factors. Accordingly, the outcomes of this study will be useful in the manufacture of drug delivery devices that require medium-sustained release growth factors, particularly in dental treatments.

Effects of Super-Activated Platelet Lysate on Early Healing of Tooth Extraction Sockets in Rats

Purpose

To evaluate the effect of super-activated platelet lysate (sPL) on wound healing of tooth extraction sockets in rats.

Methods

Rat models of the tooth extraction socket were established. Thirty-six rats were divided into control and sPL groups and sacrificed on days 7, 14, and 28 after tooth extraction. Bone formation in tooth extraction sockets were observed by microscopic computed tomography (micro-CT) and hematoxylin and eosin (HE) staining; osteoprotegerin (OPG), receptor activator of nuclear factor kappa-Β ligand (RANKL), interleukin 6(IL-6), and tumor necrosis factor-alpha (TNF-α) proteins were detected by immunohistochemistry; and chemokine and osteogenic gene expressions were detected by polymerase chain reaction (PCR).

Results

sPL accelerated soft tissue wound healing in the extraction socket of rats. Micro-CT showed that the amount of bone formation and bone volume fraction were higher in the sPL group than the control 14 days after extraction. HE staining showed promotion of the formation of bony trabeculae by sPL in the apical third of the extraction socket 7 days after extraction and more mature and organized bony trabeculae in the sPL group than the control 14 days after extraction; mature bony trabeculae filling most of the fossa with lesser bone porosity in the socket in the sPL group than the control 28 days after extraction. Immunohistochemistry showed that sPL induced OPG expressions 7 and 14 days after tooth extraction but did not affect the RANKL expression while transiently promoting the IL-6 expression 7 days after extraction. PCR showed that sPL promoted chemokine expressions 7 and 14 days after extraction. The expressions of osteogenesis-related factors were higher in the sPL group than the control 7 and 28 days after extraction, while the opposite trend was observed 14 days after extraction.

Conclusion

sPL has a transient pro-inflammatory effect and promotes soft tissue healing and bone formation during early wound healing of extraction sockets in rats.

Combination of Nanocrystalline Hydroxyapatite and Injectable Platelet-Rich Fibrin on Bone Graft Materials for Alveolar Bone Preservation

Alveolar bone resorption is one of post-extraction complications with a reduction in the dimensions and quality of the alveolar bone, which will make it challenging to install dental implants in the future. The resorption can be prevented by preserving the alveolar bone using bone grafts. Nanocrystalline hydroxyapatite (HA) is a widely developed material as a bone graft. However, there are still some limitations because it only has osteoconductive properties. The addition of injectable platelet-rich fibrin to HA can increase this material’s osteoinductive, antibacterial, and anti-inflammatory properties, making it suitable for use as bone graft material for the preservation of alveolar bone.

Nanofibrillated cellulose/glucosamine 3D aerogel implants loaded with rosuvastatin and bioactive ceramic for dental socket preservation

Recycling of agro-wastes presents a great economic and ecologic value. In this study, TEMPO-oxidized nanofibrillated cellulose (TONFC) originating from sugarcane bagasse pulp was exploited in regenerative medicine. TONFC in combination with glucosamine HCl (G) were used to prepare a 3D aerogel implant loaded with rosuvastatin as an integrative approach for extraction-socket healing. Comparing the prepared devices, aerogel composed of TONFC: G (4:1 wt ratio) had the best mechanical properties and integrity. Strontium borate-based bioactive ceramic particles were prepared and characterized for crystal structure, shape, porosity, and zeta potential. The particles had a crystalline diffraction pattern relative to Sr₃B₂O₆, and they were rod in shape with nanopores with a zeta potential value of -16 mV. The prepared bioactive ceramic (BC) was then added in different concentrations (3 or 6% w/w) to the selected aerogel implant. The BC had a concentration-dependent effect on the aerogel properties as it ameliorated its mechanical performance (compressive strength = 90 and 150 kPa for 3 and 6%, respectively) and retarded drug release (mean release time = 2.34 and 3.4 h for 3 and 6%, respectively) (p < 0.05). The microphotograph of the selected aerogel implant loaded with BC showed a rough surface with an interconnective porous structure. During cell biology testing, the selected implant loaded with the lower BC concentration had the highest ability to increase MG-63 cells proliferation. In conclusion, TONFC is a promising material to formulate rosuvastatin-loaded aerogel implant with the aid of glucosamine and bioactive ceramic for dental socket preservation.

The effects of statins on dental and oral health: a review of preclinical and clinical studies

The statin family of drugs are safe and effective therapeutic agents for the treatment of arteriosclerotic cardiovascular disease (CVD). Due to a wide range of health benefits in addition to their cholesterol lowering properties, statins have recently attracted significant attention as a new treatment strategy for several conditions, which are not directly related to normalizing a lipid profile and preventing CVD. Statins exert a variety of beneficial effects on different aspects of oral health, which includes their positive effects on bone metabolism, their anti-inflammatory and antioxidant properties, and their potential effects on epithelization and wound healing. Additionally, they possess antimicrobial, antiviral, and fungicidal properties, which makes this class of drugs attractive to the field of periodontal diseases and oral and dental health. However, to the best of our knowledge, there has been no comprehensive study to date, which has investigated the effects of statin drugs on different aspects of dental and oral health. Therefore, the primary objective of this paper was to review the effect of statins on dental and oral health. Results of our extensive review have indicated that statins possess remarkable and promising effects on several aspects of dental and oral health including chronic periodontitis, alveolar bone loss due to either extraction or chronic periodontitis, osseointegration of implants, dental pulp cells, orthodontic tooth movement, and orthodontic relapse, tissue healing (wound/bone healing), salivary gland function, and finally, anti-cancer effects. Hence, statins can be considered as novel, safe, inexpensive, and widely-accessible therapeutic agents to improve different aspects of dental and oral health.

Special Issue: Novel Advances and Approaches in Biomedical Materials Based on Calcium Phosphates

Research on calcium phosphate use in the development and clinical application of biomedical materials is a diverse activity and is genuinely interdisciplinary, with much work leading to innovative solutions for improvement of health outcomes. This Special Issue aimed to summarize current advances in this area. The nine papers published cover a wide spectrum of topical areas, such as (1) remineralisation pastes for decalcified teeth, (2) use of statins to enhance bone formation, (3) how dolomitic marble and seashells can be processed into bioceramic materials, (4) relationships between the roughness of calcium phosphate surfaces and surface charge with the effect on human MRC osteogenic differentiation and maturation being investigated, (5) rheological and mechanical properties of a novel injectable bone substitute, (6) improving strength of bone cements by incorporating reinforcing chemically modified fibres, (7) using adipose stem cells to stimulate osteogenesis, osteoinduction, and angiogenesis on calcium phosphates, (8) using glow discharge treatments to remove surface contaminants from biomedical materials to enhance cell attachment and improve bone generation, and (9) a review on how classically brittle hydroxyapatite based scaffolds can be improved by making fibre-hydroxyapatite composites, with detailed analysis of ceramic crack propagation mechanisms and its prevention via fibre incorporation in the hydroxyapatite.