Evaluation of osteogenic potential of Cissus quadrangularis on mandibular alveolar ridge distraction

Alaa Abdelqader Altaweel, Abdel Aziz Baiomy Abdullah Baiomy, Hazem Shawky Shoshan, Hisham Abbas, Ahmed Abdel-Shakour Abdel-Hafiz, Abd El-Hamid Gaber, Amr Abdelfatah Zewail, Marwa A M Elshiekh, Alaa Abdelqader Altaweel, Abdel Aziz Baiomy Abdullah Baiomy, Hazem Shawky Shoshan, Hisham Abbas, Ahmed Abdel-Shakour Abdel-Hafiz, Abd El-Hamid Gaber, Amr Abdelfatah Zewail, Marwa A M Elshiekh

Abstract

Background: This randomized clinical trial was designed to evaluate osteogenic potential of Cissus quadrangularis in alveolar distraction to facilitate implant installation.

Material and methods: Twenty patients with atrophic ridge were treated by alveolar distraction. After completing distractor activation, patients were randomly divided into two equal groups according to administered drug (placebo and Cissus quadrangularis group). After a consolidation period, distractors were removed and implants were inserted. Clinical evaluation was done to assess wound healing, and distractor and implant stability. Histological evaluation was performed at time of implant insertion. Radiographic evaluation was performed to assess bone volume and density after distraction, as well as, density and bone loss around implant.

Results: Radiographic and histological results showed that bone formation and maturation of study group were faster than that of control group. There was a significant increased bone density in distracted area and around implant in study group than control group. A significant bone loss at end of consolidation period, and around implant at end of the study was reported in control group than study group.

Conclusion: Cissus quadrangularis administration during the consolidation period is associated with increased osteogenic potential of distracted bone. The histological and radiographic findings of current study proved that Cissus quadrangularis not only enhances rate of new bone formation, but also bone density to withstand the biomechanical requirements of implant placement in a shorter time. Trial registration This study was retrospectively registered on www.ClinicalTrial.gov : NCT04669795-17\12\2020.

Keywords: Alveolar ridge; Cissus; Distraction; Osteogenic; Quadrangularis.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Distractor fixation after osteotomy of transport segment
Fig. 2
Fig. 2
CBCT shows implant after 6 months from its placement
Fig. 3
Fig. 3
Mean of serum calcium, phosphorous and alkaline phosphatase levels in both groups at different follow up intervals
Fig. 4
Fig. 4
mean of bone density (in HU) at distracted chamber between and inside both groups at different follow up intervals
Fig. 5
Fig. 5
Group (I) showing parallel-aligned woven bone (a), peripheral bone (b), dense fibrous tissue (c). Osteoblastic lining (black arrows), large areas of osteoid (asterisk) (H&E orig. mag. × 200)
Fig. 6
Fig. 6
Group (II) interconnected trabeculae; Peripheral (a) more mature than central (b) marrow spaces (black arrows), resting lines (yellow arrows). (H&E orig. mag. × 200)

References

    1. Ustun Y, Esen E, Toroglu MS, Akova T. Multidisciplinary approach for the rehabilitation of dentoalveolar trauma. Dent Traumatol. 2004;20(5):293–299. doi: 10.1111/j.1600-9657.2004.00251.x.
    1. Chappuis V, Engel O, Reyes M, Shahim K, Nolte LP, Buser D. Ridge alterations post-extraction in the esthetic zone: a 3D analysis with CBCT. J Dent Res. 2013;92(12 Suppl):195S–201S. doi: 10.1177/0022034513506713.
    1. Ashman A. Postextraction ridge preservation using a synthetic alloplast. Implant Dent. 2000;9(2):168–176. doi: 10.1097/00008505-200009020-00011.
    1. Ostler MS, Kokich VG. Alveolar ridge changes in patients congenitally missing mandibular second premolars. J Prosthet Dent. 1994;71(2):144–149. doi: 10.1016/0022-3913(94)90022-1.
    1. Fu JHWH. Horizontal bone augmentation; the decision tree. Int J Periodontics Restorative Dent. 2011;31:429–436.
    1. Schliephake HDM, Plank H, Hierlemann H, Stern U. Alveolar ridge repair using resorbable membrane and autogenous bone particles with simultaneous placement of implants. An experimental Pilot study in dogs. Int J Oral Maxillofac Implants. 2000;15:364–373.
    1. Zahrani AA. Augmentation in two stages of atrophic alveolar bone prior to dental rehabilitation: a case report. J Contemp Dent Pract. 2007;8(6):57–63. doi: 10.5005/jcdp-8-6-57.
    1. Schwartz-Arad D, Levin L. Intraoral autogenous block onlay bone grafting for extensive reconstruction of atrophic maxillary alveolar ridges. J Periodontol. 2005;76(4):636–641. doi: 10.1902/jop.2005.76.4.636.
    1. Caplanis N, Sigurdsson TJ, Rohrer MD, Wikesjo UM. Effect of allogeneic, freeze-dried, demineralized bone matrix on guided bone regeneration in supra-alveolar peri-implant defects in dogs. Int J Oral Maxillofac Implants. 1997;12(5):634–642.
    1. Hwang SJ, Jung JG, Jung JU, Kyung SH. Vertical alveolar bone distraction at molar region using lag screw principle. J Oral Maxillofac Surg. 2004;62(7):787–794. doi: 10.1016/j.joms.2004.01.011.
    1. van Strijen PJ, Breuning KH, Becking AG, Perdijk FB, Tuinzing DB. Complications in bilateral mandibular distraction osteogenesis using internal devices. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(4):392–397. doi: 10.1016/S1079-2104(03)00472-4.
    1. Rauch F, Lauzier D, Travers R, Glorieux F, Hamdy R. Effects of locally applied transforming growth factor-beta1 on distraction osteogenesis in a rabbit limb-lengthening model. Bone. 2000;26(6):619–624. doi: 10.1016/S8756-3282(00)00283-0.
    1. Cho BC, Moon JH, Chung HY, Park JW, Kweon IC, Kim IS. The bone regenerative effect of growth hormone on consolidation in mandibular distraction osteogenesis of a dog model. J Craniofac Surg. 2003;14(3):417–425. doi: 10.1097/00001665-200305000-00025.
    1. Hamdy RC, Amako M, Beckman L, Kawaguchi M, Rauch F, Lauzier D, et al. Effects of osteogenic protein-1 on distraction osteogenesis in rabbits. Bone. 2003;33(2):248–255. doi: 10.1016/S8756-3282(03)00154-6.
    1. Singh NSV. Singh RK et al Osteogenic potential of Cissus quadrangularis assessed with osteopontin expression. Natl J Maxillofac Surg. 2013;4(1):52–56. doi: 10.4103/0975-5950.117884.
    1. Srivastava MGS, Nagori BP. Pharmacological and therapeutic activity of cissus quadrangularis: an overview. Int J Pharm Tech Res CODE (USA) 2010;4:1298–1310.
    1. Rachmiel A, Shilo D, Aizenbud D, Emodi O. Vertical alveolar distraction osteogenesis of the atrophic posterior mandible before dental implant insertion. J Oral Maxillofac Surg. 2017;75(6):1164–1175. doi: 10.1016/j.joms.2017.01.013.
    1. Nayak TRK. An assessment of the osteogenic potential of cissus quadrangularis in mandibular fractures: a pilot study. J Maxillofac Oral Surg. 2020;19(1):106–112. doi: 10.1007/s12663-019-01230-z.
    1. Chiapasco M, Zaniboni M, Rimondini L. Autogenous onlay bone grafts vs. alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges: a 2–4-year prospective study on humans. Clin Oral Implants Res. 2007;18(4):432–440. doi: 10.1111/j.1600-0501.2007.01351.x.
    1. Pérez-Sayáns MM-MJ, Chamorro-Petronacci C, Gallas-Torreira M, Marichalar-Mendía X, García-García A. 20 years of alveolar distraction: a systematic review of the literature. Med Oral Patol Oral Cir Bucal. 2018;23:742–751.
    1. Chiapasco M, Lang NP, Bosshardt DD. Quality and quantity of bone following alveolar distraction osteogenesis in the human mandible. Clin Oral Implants Res. 2006;17(4):394–402. doi: 10.1111/j.1600-0501.2005.01247.x.
    1. Li G. Patient radiation dose and protection from cone-beam computed tomography. Imaging Sci Dent. 2013;43(2):63–69. doi: 10.5624/isd.2013.43.2.63.
    1. Abd-Elaal AZ, El-Mekawii HA, Saafan AM, El Gawad LA, El-Hawary YM, Abdelrazik MA. Evaluation of the effect of low-level diode laser therapy applied during the bone consolidation period following mandibular distraction osteogenesis in the human. Int J Oral Maxillofac Surg. 2015;44(8):989–997. doi: 10.1016/j.ijom.2015.04.010.
    1. Saulacic N, Zix J, Iizuka T. Complication rates and associated factors in alveolar distraction osteogenesis: a comprehensive review. Int J Oral Maxillofac Surg. 2009;38(3):210–217. doi: 10.1016/j.ijom.2009.01.002.
    1. Kim JCM, Kim S, Kim M. Alveolar distraction osteogenesis versus autogenous onlay bone graft for vertical augmentation of severely atrophied alveolar ridges after 12 years of long-term follow-up. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:540–549. doi: 10.1016/j.oooo.2013.06.037.
    1. Deka DKLL, Saikia J. Mukti A Effect of Cissus quadrangularis in accelerating healing process of experimentally fractured radius ulna of dog: a preliminary study. Indian J Pharmacol. 1994;26:44–45.
    1. Adell R, Eriksson B, Lekholm U, Branemark P, Jemt T. A long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral MaxillofacImpl. 1990;5:347–359.
    1. Bhagat PKBKM, Rao SM, Nampurath KG, Chamallamudi RM, Nayak RS, et al. Petrolium ether extract of cissus quadrangularis enhance bone marrow mesenchymal stem cell proliferation and facilitates osteoblastogenesis. J Clin Sao Paulo. 2009;64:10.
    1. Chidambara Murthy KN, Vanitha A, Mahadeva Swamy M, Ravishankar GA. Antioxidant and antimicrobial activity of Cissus quadrangularis L. J Med Food. 2003;6(2):99–105. doi: 10.1089/109662003322233495.
    1. Singh V, Singh N, Pal US, Dhasmana S, Mohammad S, Singh N. Clinical evaluation of Cissus quadrangularis and moringa oleifera and osteoseal as osteogenic agents in mandibular fracture. Natl J Maxillofac Surg. 2011;2(2):132–136. doi: 10.4103/0975-5950.94466.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir