Nanohydroxyapatite-Chitosan Hydrogel Scaffold with Platelet Rich Fibrin and Buccal Fat Pad derived Stem Cell for Aggressive Periodontitis Treatment: A Narrative Review

Abstract

Periodontal disease is oral health problem which attacks 20-50% of the global population. In Indonesia, 60% population suffers periodontal disease and become the second most common disease in the oral cavity. Aggressive periodontitis (AP) is one of periodontal disease, mainly attacks individual under 30 years-old, with rapid alveolar bone destruction. Bone graft implantation surgery is the current treatment for AP, but it is invasive and high risk infection. Nanohydroxyapatite-chitosan (nHPA-CS) hydrogel injectable scaffold is non-invasive treatment that contains bone mineral hydroxyapatite that derived from bovine bone and chitosan (CS) biopolymer with low immunogenicity. Platelet-Rich-Fibrin (PRF) contains huge amount growth factor which is biodegradable to human body. Buccal-Fat-Pad Stem-Cell (BFPSC) was chosen because it is easy to harvest and able to differentiate into mesenchymal lineage tissue. The aim of this narrative review is to describe the potential combination of nanohydroxyapatite-chitosan hydrogel scaffold, platelet-rich-fibrin, and buccal-fat-pad stem-cells for regenerating alveolar bone in aggressive-periodontitis patients. Data was obtained by literature study scientific research articles. In patients with AP, BFPSC can differentiate into osteoblast to improve osteogenesis, nHPA-CS scaffold creates host like tissue microenvironment to stimulate osteoinduction and osteoconduction activity of BFPSC, while PRF stimulates osteogenic differentiation and proliferation of BFPSC with insulin growth-factor, platelets derived growth-factor, transforming growth-factor, fibroblast growth-factor, vascular endothelial growth-factor. this combination increasing runt-related transcription-factor2, osterix, bone alkaline phosphatase, and controls pro-inflammatory cytokines such as interleukin-1beta (IL-1b) and tumor necrosis factor-alpha (TNF-a) so it can enhance bone regeneration and avoid bone destruction. The combination of nHPA-CS, PRF, BFPSC has the potential for alveolar bone regeneration in Aggressive-Periodontitis patients.

Inhibitory test of andaliman (Zanthoxylum achantopodium DC) extract mouthwash against dental plaque bacteria

“…3 Supragingival plaque plays an important role in the growth, accumulation, and pathogenesis of subgingival plaque, especially in the early stages of the periodontal diseases gingivitis and periodontitis. 4 Supragingival plaque formation is mediated by bacteria that can form extracellular polysaccharides that allow these bacteria to attach to teeth and interact with other bacteria, 5 i.e., Streptococcus sanguinis and Staphylococcus aureus.…”