Natural Polyphenols From Moringa and Centella Extracts as Collagen Cross-Linkers and Matrix Metalloproteinase (MMP) Inhibitors in Dentin Preservation: An In Vitro Study.

Background In adhesive dentistry, creating a long-lasting bond between resin composite and dentin is crucial. The durability of this bond dramatically depends on the structural integrity of collagen fibrils present in the hybrid layer. However, matrix metalloproteinases (MMPs) can degrade collagen fibrils, compromising the bond's longevity. Aim The objective is to evaluate the potential effectiveness of natural extracts from Moringa and Centella in preventing collagen degradation caused by MMPs. Material and methods The phenol and flavonoid content of the extracts were evaluated. Dentin beams were demineralized and pre-treated with 1% or 5% Moringa, 1% or 5% Centella, or 2% chlorhexidine (CHX) (five minutes), with untreated beams as control. Beams were incubated in calcium- and zinc-containing media (CM) at pH 7.2 and 37°C for one, 10, 20, and 30 days, and C-terminal cross-linked telopeptide of type I collagen (ICTP) release (collagen telopeptide) was assessed using an enzyme-linked immunosorbent assay (ELISA) kit after 30 days. Results Data were analyzed with a one-way analysis of variance (ANOVA). All test groups showed a different dry mass loss. The control group had the highest loss, followed by CHX, with the least loss in the 5% Moringa and Centella groups. ICTP release ranged from 1.781 ± 0.319 to 3.146 ± 0.684, with 5% Moringa showing the most negligible release. Conclusion The group that received 5% Moringa exhibited the most effective reduction in collagen degradation compared to all the other groups.

Clinical Assessment of Moringa oleifera as a Natural Crosslinker for Enhanced Dentin Bond Durability: A Randomized Controlled Trial.

BACKGROUND: Dentin biomodification is a biomimetic approach that strengthens the collagen network, making it less susceptible to enzymatic degradation and improving the durability of bonded restorative materials, using collagen crosslinkers. OBJECTIVE: This study aimed to assess the effectiveness of Moringa oleifera as a natural crosslinker in improving the clinical success of resin-dentin restorations. METHOD: A double-blind, controlled, randomized clinical trial was conducted in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines, with 50 adult participants with initial carious lesions (ICDAS 4 and 5) enrolled. Participants were randomly assigned to either the experimental group (which received Moringa oleifera as a pretreatment liner) or the control group (standard restorative procedures without a liner). Functional and biological outcomes were assessed at baseline, six months, and 12 months using the FDI criteria. Statistical analysis included Fisher's exact test, Wilcoxon sign rank test, and Mann-Whitney U test. RESULTS: Both groups exhibited excellent functional properties and marginal adaptation at baseline and six months. At the 12-month mark, the test group displayed clinically better functional properties (97.9%, n=47) compared to the control group (95.8%, n=46), but there was no significant difference (p-value>0.05). Marginal gaps were observed in both groups at six and 12 months (8.3%, n=4), with no significant inter-group variation (p-value>0.05). Radiographic examination showed a harmonious restoration-to-tooth transition. Patient satisfaction remained high, with the test group 4.2% (n=2) and control 2.1% (n=1) reporting minor issues at 12 months, though not statistically significant (p-value>0.05). Postoperative sensitivity was minimal, and tooth integrity was well-preserved. CONCLUSION: Moringa oleifera, as a pretreatment liner, showed promise in enhancing the clinical success of resin-dentin restorations. Despite minor reported issues, the groups had no statistically significant differences regarding functional and biological outcomes.

Influence of two natural cross-linkers on microtensile bond strength durability ­ An in vitro study / Influência de dois reticuladores naturais na durabilidade da resistência de união à microtração ­ Um estudo in vitro

Objective: to investigate the effect of two natural cross-linkers on microtensile bond strength (µTBS) and evaluate their influence on the durability of the resin dentin bonds. Material and Methods: the Moringa oleifera and Centella asiatica plant extracts were qualitatively tested with high-performance thin layer chromatography (HPTLC) for the presence of phenols. The phenolic content ranged from 27 to 30 gallic acid equivalents (GAE), µg/mg of dry weight. After etching, two concentrations (5% and 1%) of these two extracts were prepared and used as pretreatment liners on dentin. They were applied for a min. After restoration with resin composite, dentin resin beams were prepared. The study groups were 5% Moringa, 1% Moringa 5% Centella 1% Centella, and control (without cross-linker application). For each group, half of the samples underwent µTBS testing after 24 hours, while the remaining half were immersed in artificial saliva to assess the bond's longevity after 6 months of ageing. Statistical analysis was performed using one-way ANOVA followed by Tukey's post hoc test. Results: both 5% and 1% Moringa showed a significant difference (p<0.05) compared to the other groups at both intervals. However, after ageing, the specimens in the control and 1% Centella groups resulted in a significant decrease in µTBS. Conclusion: overall, both concentrations of Moringa (5% and 1%) were effective in stabilising the bond during both intervals.(AU)

Objetivo: investigar o efeito de dois reticuladores naturais na resistência de união (µTBS) à microtração e avaliar sua influência na durabilidade da adesão da resina à dentina. Material e Métodos: extratos das plantas Moringa oleifera e Centella asiatica foram qualitativamente testados através de cromatografia em camada fina de alta performance (HPTLC) para a presença de fenóis. O conteúdo fenólico alcançou entre 27 a 30 equivalentes de ácido gálico (GAE), µg/mg de peso seco. Após o condicionamento, duas concentrações (5% e 1%) dos extratos foram preparadas e utilizadas como forros de pré-tratamento em dentina. Eles foram aplicados por um minuto. Após a restauração com resina composta, palitos de dentina e resina foram preparados. Os grupos foram 5% Moringa, 1% Moringa, 5% Centella, 1% Centella e controle (sem aplicação de reticulador). Para cada grupo, metade das amostras foram submetidas ao teste µTBS após 24 horas, enquanto a outra metade foi imersa em saliva artificial para avaliar a longevidade adesiva após 6 meses de envelhecimento. Foi realizada análise estatística através de ANOVA 1-fator, seguido do teste post hoc de Tukey. Resultados: ambas as concentrações de 5% e 1% de Moringa demonstraram diferença significativa (p<0.05) comparadas aos outros grupos em ambos os intervalos. No entanto, após o envelhecimento, os espécimes dos geupos controle e 1% de Centella resultaram em uma redução significativa de µTBS. Conclusão: no geral, ambas as concentrações de Moringa (5% e 1%) foram efetivas em estabelecer a adesão em ambos os intervalos (AU)

Role of Natural Cross Linkers in Resin-Dentin Bond Durability: A Systematic Review and Meta-Analysis.

BACKGROUND: The role of endogenous Matrix Metallo Proteinases in resin dentin bond deterioration over time has been well documented. The present study aimed to systematically review the literature; in vitro and ex vivo studies that assessed the outcomes of natural cross-linkers for immediate and long-term tensile bond strength were included. METHODS: The manuscript search was carried out in six electronic databases-PubMed/MEDLINE, LILACS, SciELO, Cochrane, Web of Science and DOAJ, without publication year limits. Only manuscripts in English (including the translated articles) were selected, and the last search was performed in December 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. RESULTS: From the 128 potentially eligible studies, 48 full-text articles were assessed for eligibility. After eligibility assessment and exclusions, 14 studies were considered for systematic review and seven studies for meta-analysis. Amongst the selected studies for meta-analysis, three had a medium and four had a low risk of bias. CONCLUSIONS: It was evidenced by the available data that Proanthocyanidin is the most efficient natural cross-linker to date, in preserving the bond strength even after ageing.

Glanzmann thrombasthenia associated with human immunodeficiency virus-positive patient.

Glanzmann's thrombasthenia (GT) is an autosomal recessive inherited platelet function defect characterized by normal platelet count, prolonged bleeding time and abnormal clot retraction. This disease typically presents in infancy or early childhood and has proven to have very good prognosis. In this case study, a 22-year-old GT patient who also developed human immunodeficiency virus (HIV) infection after sometime is reported. The patient showed oral manifestations of gingival hyperplasia and petechial lesions. Unfortunately the detection of both thrombasthenia and HIV were done at considerably late stages which contributed to a poor prognosis. The patient died of cardiopulmonary arrest secondary to HIV, thrombasthenia and thrombocytopenia. The importance of early detection, supportive care and communication between the general and oral physician in management of the GT is also discussed.

Clinical and radiological assessment of effects of long-term corticosteroid therapy on oral health.

BACKGROUND: Corticosteroids (Cs) are used widely for their anti-inflammatory and immunosuppressive properties. They have the potential to cause dramatic improvement as well as produce equally dramatic adverse effects. The clinical misuse like over prescription of the drug should be avoided. Long-term administration may cause many adverse effects leading to impaired oral health. Oral health is usually not considered during management of patients on long-term corticosteroid therapy. The aim of this study was to assess the oral health status and radiological changes in the jaw bones of the patients under long-term corticosteroid therapy. MATERIALS AND METHODS: Oral health of 100 patients under long-term corticosteroid therapy with a minimum of 3 months duration was compared with sex- and age-matched 100 healthy controls. The clinical examination included complete examination of the mouth and periodontal status. Radiographic evaluation of bone with the help of intra oral periapical radiograph and digital orthopantomograph and levels of serum calcium, alkaline phosphatase, and random blood sugar were assessed. 'Chi-square test', 'Kolmogorov-Smirnov test' and 'Mann-Whitney U test' were used for statistical analysis. P > 0.05 was considered significant. RESULTS: Patients on steroids exhibited significantly higher levels of candidiasis and clinical attachment loss of the periodontal ligament, probing pocket depth. Bone density was significantly lower in the study group than that in the control group. Random blood glucose was significantly higher and significant lower levels of calcium were observed in patients on steroids. CONCLUSION: Long-term use of Cs may affect oral health adversely leading to candidiasis as well as impair bone metabolism leading to a considerable decrease in the mandibular bone mineral density.