The Effects of Chitosan on the Healing Process of Oral Mucosa: An Observational Cohort Feasibility Split-Mouth Study

Abstract

The healing process is a dynamic process accompanied by some classical symptoms of inflammation such as redness, swelling, pain, and loss of function. Chitosan is a natural polymer with properties that contribute to tissue healing, with properties that could be applied in periodontal therapy, such as the wound healing of oral mucosa. This experimental split-mouth study aims to assess the possibilities of chitosan influencing the healing process of oral mucosa in eight patients, where the studied group was subjected to two oral surgeries: one with chitosan hydrogel into the socket and other without the biomaterial. A semi-quantitative analysis of the data was performed. Some classic signs of inflammation in a short period of time were observed where chitosan acted, compared to the control. An absence of bleeding was observed in the chitosan cases. According to the literature, chitosan recruits and activates neutrophils and macrophages and stimulates angiogenesis. Hemostatic and antimicrobial activity of chitosan also play an important role in wound healing. Chitosan seems to improve the postoperative quality of patients, allowing rapid wound healing with less complications.

Regenerative Approaches in Gingival Tissue Engineering

“…It contains reactive amine groups amenable to chemical modification and crosslinking into porous scaffolds using freezing/lyophilization or particulate leaching techniques. Chitosan supports gingival fibroblast adhesion and matrix synthesis while having mucoadhesive and hemostatic properties beneficial for wound healing [55]. Composite chitosan-collagen scaffolds promoted gingival tissue regeneration better than either component alone in vivo.…”

“…Ultrafine chitosan fibers produced by electrospinning also facilitated gingival cell proliferation. The combination of tunable mechanical properties, biocompatibility, and bioactivity make chitosan a promising biomaterial for gingival scaffolds [55].…”

Characteristics and cellular mechanism of the wound healing process in the oral mucosa

“…Endothelial cells secrete inhibitors, including nitric oxide and prostacyclin [9]. Following a rupture of the blood vessels, the blood extravasates into the injury site coming in contact with collagen and another extracellular matrix (ECM) elements leading to the activation of platelets and their release of clotting factors, causing the formation of the blood clot [10]. Fibronectin, fibrin, vitronectin, and thrombospondin comprise the blood clot [5].…”

“…Common symptoms of inflamed wound sites are pain, redness, and oedema. Neutrophils are the first cells to be attracted to the wound [10]. They appear within 24-36 hours of injury [5], and they immediately begin phagocytosis and secrete proteolytic enzymes to eliminate bacteria and irreversibly destroyed tissue.…”

“…They are concerned with breaking down elastin, fibronectin, laminin, vitronectin, and collagen IV [6,16]. Neutrophils also produce reactive oxygen species (ROS) [10] that help further sterilise the wound by combining with chlorine [4]. They also initiate NETosis, which is a process of creating neutrophil extracellular traps (NETs), that are chromatin filaments enriched with bactericidal proteins extending into the extracellular space.…”