Tooth extraction is a procedure to pull a tooth out of its socket, and this process can cause damage to both hard and soft tissue, thus triggering the physiological response of the wound healing process. An ideal tooth extraction should lift all teeth without the pain and minimal trauma to adjacent tissues to allow healthy wound healing without complications. In some cases, complications from a tooth extraction can occur, such as pain, infection, heavy bleeding, and dry sockets.
The wound healing process plays an essential role in preventing complications after tooth extraction. Several drugs are commercially available to improve wound healing; However, most are not affordable and take a long time. This background led to several studies of natural remedies to promote wound healing or stop bleeding after tooth extraction. The rapid development of pharmaceutical technology is currently giving more focus on natural resources for various drugs, including to promote wound healing. Natural resources are considered less toxic compared to medicines made from chemicals, thus it can be an option for treating wound.
One of the herbs that can be used as an alternative medicine to promote wound healing is okra extract (Abelmoschus esculentus) which has beneficial properties, such as anti-diabetes, antioxidants, anti-plasmodia, anti-bacterial, anti-cancer, analgesia, anti-diarrhea, and anti-inflammation. The active ingredients contained in okra fruit extract are saponins, tannins, flavonoids, and alkaloids. Besides, the Okra fruit also contains quercetin, which has antioxidant properties that protect the body from degenerative diseases. Saponins included in Okra fruit act as anti-bacterial agents, and also stimulate angiogenesis.
Angiogenesis is the formation of new blood vessels from existing blood vessels, which are needed in the process of wound healing. This physiological response is initiated by the activation of endothelial cells in the inner lining of blood vessels mediated by proangiogenic factors and the hypoxic environment. Endothelial cells will then break down the surrounding extracellular matrix to begin cell migration and proliferation, creating new capillaries.
Laboratory experimental studies conducted on experimental animals using post-test control group designs. Eighteen male Wistar mice were used, with inclusion criteria as follows: 1) male mice aged 2-3 months, 2) weight 100-150 grams, 3) healthy. Mice that showed symptoms such as inactivity, low appetite, and diarrhea were excluded from this study. Samples were obtained from the Experimental Animal Unit, Biochemistry Laboratory, Faculty of Veterinary Medicine Universitas Airlangga.
Rats were randomly divided into two groups, namely the control group and the treatment group. 0.1 ml of okra fruit extract in gel form at a concentration of 30% was applied to the socket of the treatment group, while the control group did not receive treatment.
Fresh okra obtained from Materia Medica Farm (Batu, Indonesia) is rinsed using tap water, and ground with a blender (Phillips, Jakarta, Indonesia), and kept in a closed glass jar for 24 hours. The mixture is shaken at 50 rpm, filtered using clothes, and collected into the Erlenmeyer tube further. The liquid extract was evaporated using a rotary evaporator for 90 minutes and stored.
Mice from both groups (treatment and control) were anesthetized using 0.1 mL peritoneal injection of ketamine. After 1-1.5 hours after injection, the lower left central incisor is extracted using a scalpel and needle holder, and no roots remain in the confirmed socket. The socket is irrigated using a salt solution. The control group was allowed to heal without treatment because normal wounds healed. As for the treatment group, 30% okra extract in gel form was applied in the socket as much as 0.1 mL.
Mice were killed on day 3, day 5, and day seven after tooth extraction through intraperitoneal injection of ketamine at lethal doses (four times the anesthetic dose, or 0.4 mL/kg bw). The entire mandible is collected, including the temporomandibular joint. The mice were buried according to the instructions of the experimental animals. The mandible in the incision area is cut vertically and made into paraffin blocks.
The mandible is cut and fixed using 10% formaldehyde at room temperature for 24 hours. The tissue is then dehydrated using gradual ethanol, cleaned using xylene, and made into paraffin blocks. The paraffin block is cut 6 mm thick, is inserted into the slide, and the paraffin is removed. The slides are then stained using hematoxylin and eosin (HE). The level of angiogenesis was observed under a light microscope at 400x magnification. Histopathological observation of Wistar rat tooth socket was carried out on the 3rd day, 5th day, and 7th day after extraction of the teeth.
There was an increase in capillaries that had just formed in the two experimental groups from day 3 to day 5. Further observations in both groups also showed a decrease in angiogenesis from day 5 to day 7. Fluctuations are explained in Figure 1.
Observations showed that newly formed capillaries from the control group (4.67 ± 1.53) on the 3rd day were lower than the treatment group (9.00 ± 1.00). Continuous observation also resulted in the same way, newly formed capillaries were recorded from the control group, both on the 5th day (9.33 ± 1.53) and the 7th day (8.67 ± 1.53) lower than the group treatment, which began to decrease from the 5th day (13.67 ± 1.53) to the 7th day (12.33 ± 0.58).
Okra gel extract at a concentration of 30% can increase angiogenesis in the tooth socket after extraction of Wistar rats in the wound healing process
Author: Dr. Muhammad Luthfi, drg., M. Kes
Link: http://revista.uepb.edu.br/index.php/pboci/article/view/5087/pdf Muhammad Lutfi, Wisnu Setyari Juliastuti, Yuniar Aliyah Risky (2020). Angiogenesis of Extracted Tooth Wound on Wistar Rats After the Application of Okra (Abelmoschus esculentus) Gel Extract. Pesquisa Brasileira em Odontopediatria e Clínica Integrada 2020; 20: e5087 https://doi.org/10.1590/pboci.2020.037
