|Year : 2021 | Volume
| Issue : 1 | Page : 1-5
Human placental extract a miracle that heals the wound faster
Ankita Katkurwar1, Dipali Chaudhari1, Swapna Mahale1, Arunkumar Mahale2, Pooja Kadam1
1 Department of Periodontology, MGVM K.B.H. Dental College and Hospital, Nashik, Maharashtra, India
2 Vinay Heart Clinic, Nashik, Maharashtra, India
|Date of Submission||20-Nov-2019|
|Date of Decision||13-Feb-2020|
|Date of Acceptance||14-Apr-2020|
|Date of Web Publication||15-Feb-2021|
Department of Periodontology, MGVM K.B.H. Dental College and Hospital, Nashik, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Human placental extract gel contains extract of human placenta and total nitrogen not more than 0.25% w/w. It is natural vitamins, peptides, nucleotides and amino acid gel. It enhances wound healing significantly; increases collagen synthesis and improves tensile strength of healing tissue. It brings about maximum increases in the percent of DNA, total protein and epithelialisation. It also has anti-inflammatory and analgesic effects. Aim and Objective: Clinical and histological evaluation of depigmented gingival epithelium on application of human placental extract gel. Material and Method: 10 healthy patients in the age group of 18-35 yrs. who were indicated for depigmentation procedure were selected for the study. Depigmentation was done with scalpel technique on maxillary and mandibular anterior region. In group A human placental extract gel was applied on the wound and non-eugenol pack was placed whereas group B was covered with non-eugenol pack only. Wound Healing index and Visual Analogue Score was assessed after 7 and 15 days. Epithelisation of wound was assessed by using toluidine blue after 7 days of surgery. Result: Application of human placental extract gel showed a statistically significant improvement clinically and histologically. Conclusion: Application of human placental extract can be a successful approach to protect the raw wound area of depigmented gingiva with better patient comfort and faster healing. Introduction: In today's era, increased aesthetic concerns have increased the number of patients receiving gingival depigmentation surgeries to create an aesthetically pleasing appearance of gingiva. Human placental extract gel contains extract of human placenta and total nitrogen not more than 0.25% w/w. It is natural vitamins, peptides, nucleotides and amino acid gel. It enhances wound healing significantly; increases collagen synthesis and improves tensile strength of healing tissue. It brings about maximum increases in the percent of DNA, total protein and epithelialisation. It also has anti-inflammatory and analgesic effects. Aim and Objective: Clinical and histological evaluation of depigmented gingival epithelium on application of human placental extract gel. Material and Method: 10 healthy patients in the age group of 18-35 yrs. who were indicated for depigmentation procedure were selected for the study. Depigmentation was done with scalpel technique on maxillary and mandibular anterior region. In group A human placental extract gel was applied on the wound and non-eugenol pack was placed whereas group B was covered with non-eugenol pack only. Wound Healing index and Visual Analogue Score was assessed after 7 and 15 days. Epithelisation of wound was assessed by using toluidine blue after 7 days of surgery. Result: Application of human placental extract gel showed a statistically significant improvement clinically and histologically. Conclusion: Application of human placental extract can be a successful approach to protect the raw wound area of depigmented gingiva with better patient comfort and faster healing.
Keywords: Depigmentation, placental extract, Visual analogue scale
|How to cite this article:|
Katkurwar A, Chaudhari D, Mahale S, Mahale A, Kadam P. Human placental extract a miracle that heals the wound faster. J Oral Res Rev 2021;13:1-5
|How to cite this URL:|
Katkurwar A, Chaudhari D, Mahale S, Mahale A, Kadam P. Human placental extract a miracle that heals the wound faster. J Oral Res Rev [serial online] 2021 [cited 2021 Feb 24];13:1-5. Available from: https://www.jorr.org/text.asp?2021/13/1/1/309440
| Introduction|| |
The harmony of the smile is determined not only by the shape, the position, and the color of the teeth but also by the gingival tissue. Gingival health and appearance are the essential components for an attractive smile, and the removal of unsightly pigmented gingiva is the need for a pleasant and confident smile. Melanin, a brown pigment, is the most common natural pigment contributing to endogenous pigmentation of the gingiva. It is a nonhemoglobin-derived pigment formed by cells called melonocytes that are dendritic cells of neuroectodermal origin in the basal and spinous layers. Gingival hyperpigmentation is one of the esthetic problems and requires the removal of gingival melanin pigmentation by various methods such as gingivectomy, gingivectomy with free gingival autografts, electrosurgery, cryosurgery, application of chemical agents such as 90% phenol and 95% alcohol, abrasion with diamond bur, neodymium-doped yttrium aluminum garnet laser, semiconductor diode laser, and CO2 laser.
The use of placenta as a therapeutic agent has been prevalent for a long time. It is an immunologically privileged organ and has unique pharmacological effects such as enhancement of wound healing, anti-inflammatory action, and analgesic effect. A variety of substances with biological and therapeutic activity present in human placenta have been isolated and identified as hormones, proteins, glycosaminoglycans, nucleic acids, and polydeoxyribonucleotides (PDRNs). The composition of placental extract thus depends on the method of its placenta extract – the magical wound healer, next milestone in the healing of periodontal surgery preparation.
Consequently, it shows different therapeutic activities. In many countries, intramuscular and topical use of the extract for burn injuries, chronic wounds, and as postsurgical dressing are an age-old practice. Under such conditions, an effective tissue-regenerative agent needs to take care of the prevention of secondary bacterial or fungal infection. Recently, the presence of biologically active NADPH and fibronectin type III-like peptide in the extract has been demonstrated.
Further, different spectroscopic and chromatographic analyses have revealed a high degree of consistency among the different batches of the extract. Another form of attack the placenta uses is its various growth abilities, such as the ability to accelerate the growth of the liver, as observed in the regrowth of cells and organs. This liver regenerative effect alone has been shown in animal testing to be effective for almost all diseases other than cancer, such as hepatitis, cirrhosis of the liver, heart disease, stroke, and renal failure. The placenta is now viewed by many as a substance which will revolutionize modern medicine. The aim of this study is to evaluate the clinical and histological characteristics of depigmented gingival epithelium on the application of human placental extract gel.
| Materials and Methods|| |
The patients included in the study were aged at least 18–35 years, had moderate-to-severe physiologic gingival melanin hyperpigmentation in the maxillary and mandibular arch (as given by Dummett and Gupta in 1964), with well-maintained oral hygiene, with esthetic concern, systemically healthy, and those willing to undergo minor surgical procedures. Ten healthy patients were selected for the study.
The patients excluded from the study were with any systemic disease associated with pathological hyperpigmentation or improper delayed wound healing (uncontrolled diabetes, autoimmune diseases, etc.), with nontreated periodontal disease, chronic smokers, and noncompliant patients. Depigmentation was done with the scalpel technique on the maxillary and mandibular anterior region.
| Methods|| |
Local anesthesia was obtained with infiltration (2% lidocaine with adrenaline 1:80,000) in relation to the surgical site. The gingival epithelium was excised with Bard-Parker blade number 15. The excision involved the entire pigmented area extending from the free gingival margin to the mucogingival junction from the midline extending up to the first premolar, with the blade placed almost parallel to the long axis of the teeth with care taken not to expose the underlying bone.
The entire epithelium was removed in one piece. Orban's knife was used to remove the residual epithelium in the interdental areas. This was followed by careful examination of the exposed connective tissue surface, and any remaining tissue tags were removed by the surgical scissors. In Group A, human placental extract gel was applied on the wound and noneugenol pack was placed [Figure 1], whereas Group B was covered with noneugenol pack only [Figure 2].
Wound Healing Index (Huang et al. (2005) and Visual Analog Score were assessed after 7 and 15 days. Epithelization of wound was assessed by using toluidine blue after 7 days of surgery [Figure 3].
The histological analysis was carried after 1 month through punch biopsy from the depigmented gingival epithelium. At 1 month after the surgical procedure, a section of tissue from the lateral incisor region in the maxillary arch and mandibular arch was taken through punch biopsy from all the treated sites. Hematoxylin and eosin-stained slides were prepared from all the tissues
The data obtained were analyzed using the SPSS software (Statistical Package for the Social Sciences), version 19, for Windows OS. Mean and standard deviations were calculated for the clinical parameter (pain).
| Results|| |
The final results were statistically analyzed and significance evaluated. Difference in pain was assessed using the Visual Analog Scale (VAS) scores in both the groups after the 7th day and 15thday. A statistically significant difference was found between the groups (P = 0.001, 0.203) [Figure 4]. Difference in wound healing was assessed using the Wound Healing Index scores in both the groups after the 7th day and 15thday. Statistically significant difference was found between the groups (P = 0.001) [Figure 5].
On the 7th day, the maxillary right and left quadrant and mandibular anterior sextant was substantially stained with toluidine blue. Ten individuals with 90.90% in the Group B quadrant and six individuals 54.50% in Group A had taken the mild staining, which was statistically significant with P < 0.001. It denoted the presence of less inflammatory cells in the placental extract group.
At 1 month after the surgical procedure, a section of tissue from the lateral incisor region in the maxillary and mandibular arches was taken through punch biopsy from all the treated sites. Hematoxylin and eosin-stained slides were prepared from all the tissues. At ×40 magnification, the inflammatory cell infiltrates were observed. Seven individuals in Group A had shown a distinct parakeratinized stratified squamous epithelium with fibrous connective tissue with nil inflammatory cell infiltrates, and eight individuals in Group B had demonstrated moderate inflammatory cell infiltrate [Figure 6].
| Discussion|| |
Oral pigmentation occurs in all races of human, and the gingiva is the most frequently pigmented intraoral site (Dummett and Gupta 1964). This pigmentation may be seen across all the races and at any age, and it is without a gender predilection. Melanin pigmentation of the gingiva is completely benign and does not present a medical problem. Complaints of “black gums” are common and demand for depigmentation is usually made for esthetic reasons. Many techniques have been tried in the past to treat gingival pigmentation, which include chemical cauterization, gingivectomy, abrasion of the gingiva, cryotherapy, free gingival autograft, and laser therapy.
Gingival depigmentation performed in this study with a blade was precise, definite, and under control. With this technique, it was possible to appreciate the depigmented areas immediately and did not leave room for any residual pigments. However, this technique required the use of local anesthesia, resulted in hemorrhage and required immense care while excising the epithelium in order not to expose the bone or to create a gingival recession. It was necessary to cover the surgical site with periodontal dressing for 7–10 days to protect the site from food debris, foreign irritants, thermal stimuli, and infection. Comparatively, the use of the scalpel technique for depigmentation is the most economical as compared with other techniques that require more advanced armamentarium.
Wound healing is a very complex process that includes inflammation, cell migration, extracellular matrix deposition, and cell maturation. Several cytokines and growth factors are involved in inducing different cell types for healing.
Among all the extracts of placenta that have been prepared, only the aqueous extract has been shown to have potent clinical efficacy in terms of healing. Aqueous extract from the placenta is used as a licensed drug for wound healing under different trade names in India. This could be due to the fact that the aqueous extract is a rich source of various bioactive peptides with tissue regeneration potential. In addition, the extract also retains amino acids, nucleotides, PDRNs, and carbohydrates that might be responsible for wound healing. Placental extract plays a beneficial role as a topical agent in the management of chronic nonhealing wounds.
In addition, several studies have evaluated the effect of human placental extract (HPE) on wound healing, and a considerable amount of data suggests that HPE promotes wound healing. According to O'Keefe et al., keratinocytes culture far better when mixed with HPE than with insulin or EGF. In HPE cultures with keratinocytes, the promotion of keratinocyte proliferation has been observed. Muratore et al. reported the promotion of fibroblast proliferation by HPE. Tiwary et al. in 2006 reported that placental-extract gel and cream are both effective topical agents for chronic nonhealing wounds. However, there is less pain and discomfort during dressing change with the placental-extract cream.
It has been demonstrated that one or more peptides from human placental extract including fibronectin type III stabilize trypsin activity after strong association, which is reversible in nature. Trypsin and similar proteolytic enzymes help in debridement and prevent keloid formation during wound healing, and therefore, the regulation of its activity is an important criterion.
Healing is generally uneventful, and complete epithelial healing is achieved in 7–14 days. Depigmentation allows the denuded connective tissue to heal by secondary intention. Thus, new epithelium is formed without melanin pigmentation.
The postoperative experience of pain is a complex phenomenon, influenced by psychological, environmental, and physical factors. VAS is a reliable method to assess pain in clinical settings when compared with the Verbal Rating Scale. VAS scores are sensitive to treatment effects, and the data derived can be analyzed using the parametric statistical techniques. The pain perception was less in the placental extract used Group A.
The histological analysis done at 1 month has observed a statistically significant difference in the placental extract group. The reason behind the absence of inflammatory cell infiltrates in Group A was due to its robust and rapid release of growth factors for a shorter period of time. Jong Won Hong et al. in 2010 concluded that locally administration of HPE directly onto wound margins promotes wound healing due to an increase in the amount of transforming growth factor in the early phase of wound healing and vascular endothelial growth factor in the late phase.
Melanocytes have a reproductive self-maintaining system of cells. When locally depleted, they repopulate and keratinocyte-derived growth factors. Fibroblast growth factor-β acts as a mitogen. These cells lack desmosomes and possess long dendritic processes that extend between keratinocytes. Melanin is synthesized in the melanocytes in small structures called melanosomes. These melanosomes are injected into the keratinocytes by the dendritic processes. All individuals, whether lightly or darkly pigmented, have the same number of melanocytes in any given region of the mucosa. However, it has been observed that cells with melanin are present in connective tissue in the case of individuals who have a very high melanin pigment. These cells are actually macrophages that have engulfed the melanin pigment. Dumett and Bolden observed a partial recurrence of hyperpigmentation in six out of eight patients after gingivectomy at 1–4 months. The recurrence of pigmentation can be due to the nature of the melanocytes. These cells arise from the neural crest ectoderm and enter the epithelium as melanocytes from about the 8th gestational week and by the 14th week, these cells may have reached densities of 2000/mm2 in some regions.
Shetty and Vanka reported that depigmentation by scalpel and laser have shown better results than bur and electrocautery techniques. Although the scalpel was most economical, with regard to healing and recurrence of pigmentation, all four techniques were at par with each other.
The success of the depigmentation procedure may be weighed only by the extent of depigmentation achieved and by the time taken for the reappearance of pigments, prolonged follow-up is necessary. As the postoperative follow-up of the present study was short, it is proposed that further studies be taken up for a longer period of monitoring along with histopathological assessment to understand the process of repigmentation.
| Conclusion|| |
Thus, the application of placental extract gel in the present study has shown a successful approach to protect the raw wound area of depigmented sites with better patient comfort and faster healing than the use of periodontal pack alone.
Ethical approvals were obtained the University Ethical Committee (Institutional ethical committee MGVM KBH dental college MGV/KBHDC/860/2019-20 approved the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Deepak P, Sunil S, Mishra R, Sheshadri. Treatment of gingival pigmentation: A case series. Indian J Dent Res 2005;16:171-6.
Doshi Y, Khandge N, Byakod G, Patil P. Management of gingival pigmentation with diode laser: Is it a predictive tool? Int J Laser Dent 2012;2:29-32.
Thangavelu A, Elavarasu S, Jayapalan P. Pink esthetics in periodontics-gingival depigmentation: A case series. J Pharm Bioallied Sci 2012;4 Suppl 2:186-90.
Gupta V, Sinha A, Jithendra KD, Chauhan SS, Singh S. Placenta extract -the magical wound healer, next milestone in the healing of periodontal surgery. IOSR J Dent Med Sci 2016;15:73-9.
Dummett CO, Gupta OP. Estimating the epidemiology of oral pigmentation. J Natl Med Assoc 1964;56:419-20.
Roshna T, Nandkumar K. Anterior esthetic gingival depigmentation and crown lenthening: Report of a case. J Contemp Dent Pract 2005;6:139-47.
Kaarthikeyan G, Jayakumar ND, Padmalatha O, Varghese S, Kapoor R. Pain assessment using a visual analog scale in patients undergoing gingival depigmentation by scalpel and 970 nm diode laser surgery. J Laser Dent 2012;20:20-3.
O'Keefe EJ, Payne RE, Russell N. Keratinocyte growth-promoting activity from human placenta. J Cell Physiol 1985;124:439-45.
Vivek Vardhan JP, Nagateja MV. A comparative analysis of the merits of topical placental extract over conventional methods of dressings for diabetic foot ulcers. J Evol Med Dent Sci 2017;12:963-6.
Tiwary SK, Shukla D, Tripathi AK, Agrawal S, Singh MK, Shukla VK. Effect of placental-extract gel and cream on non-healing wounds. J Wound Care 2013;15:325-8.
Suchetha A, Shahna N, Bhat D, Mand AS, Sapna N. A review on gingival depigmentation procedures and repigmentation. Int J Applied Dent Sci 2018;4:336-41.
Dumett CO, Bolden TE. Post surgical clinical repigmentation of the gingiva. Oral Surg Oral Med Oral Pathol 1963;16:353-7.
Shetty S, Vanka A. Comparative evaluation of healing following gingival depigmentation procedures using four techniques: A report of 5 cases. Int J Case Rep 2018;2:24.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]