Review Article

Evaluating the use of Erythropoietin Gel with Modified Apically Repositioned Flap in Augmentation of Keratinized Tissue: A Case Report

Dina Magdy Fadl¹*, Hala Kamal Abdelgaber² and Ahmed Elsayed Hamed Amr³

¹Teaching Assistant of Oral Medicine, Oral diagnosis and Periodontology, Faculty of Dentistry, Ain Shams University, Egypt
²Professor of Oral Medicine, Periodontology and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Egypt
³Associate Professor of Oral Medicine, Periodontology and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Egypt

*Corresponding Author: Dina Magdy Fadl, Teaching Assistant of Oral Medicine, Oral diagnosis and Periodontology, Faculty of Dentistry, Ain Shams University, Egypt.

Received: January 16, 2024; Published: February 13, 2024

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Abstract

Background: The keratinized tissue aids in the protection and maintenance of periodontal health and contributes to stabilization of the gingival margin against frictional forces and against gingival recession. Modified Apically Repositioned Flap (MARF) is a technique used for increasing KTW by using a partial thickness flap. The exposed periosteal bed left after the surgery is an open wound that may cause patients to experience postoperative pain, bleeding and discomfort during the healing process. EPO is one of the various biological materials that was introduced to accelerate wound healing and to control post-operative pain and discomfort. This study was carried out to investigate the effect of topical application of erythropoietin when combined with MARF technique.

Method: A 35 years old female patient diagnosed with miller class I recession and deficient keratinized tissue apical to the recession, had MARF technique performed to increase KTW combined with application of chitosan based erythropoietin gel. Visual analogue scale was used to assess patient’s postoperative pain and discomfort at day 1, day 5 and day 7 after the surgery. Healing index score was used at day 7 and day 14 to assess wound healing. The KTW was measured at baseline and 1 month after the surgery.

Results: Chitosan based erythropoietin gel controlled postoperative pain and improved wound healing at the surgical site. The KTW increased 2mm after the surgery.

Conclusion: The use of chitosan-based erythropoietin gel adjunct to modified apically repositioned flap (MARF) improved wound healing and decreased patient’s postoperative pain and discomfort during healing.

Keywords: Erythropoietin Gel; Apically Repositioned Flap; Augmentation; Keratinized Tissue

References

1. Friedman MT., et al. “The “Plaque-Free Zone” in Health and Disease: A Scanning Electron Microscope Study”. Journal of Periodontology 11 (1992): 890-896.
2. Lang NP and Löe H. “The Relationship between the Width of Keratinized Gingiva and Gingival Health”. Journal of Periodontology 10 (1972): 623-627.
3. Hall WB. “Establishing the Adequacy of Attached Gingiva”. 20034^th (1989): 106-107.
4. McCULLOCH CAG. “Basic considerations in periodontal wound healing to achieve regeneration”. Periodontology 20001 (1993): 16-25.
5. Lindhe J. “Text Book of Clinical Periodontology and Implant Dentistry. 5^th Edition, Wiley Blackwell, UK. (2008): 748-754.
6. Carnio J and Camargo PM. “The modified apically repositioned flap to increase the dimensions of attached gingiva: the single incision technique for multiple adjacent teeth”. International Journal of Periodontics and Restorative Dentistry 3 (2006): 265-269.
7. Carnio J., et al. “Surgical Techniques to Increase the Apicocoronal Dimension of the Attached Gingiva: A 1-Year Comparison Between the Free Gingival Graft and the Modified Apically Repositioned Flap”. International Journal of Periodontics and Restorative Dentistry 4 (2015): 571-578.
8. Galeano M., et al. “Recombinant human erythropoietin improves angiogenesis and wound healing in experimental burn wounds”. Critical Care Medicine 4 (2006): 1139-1146.
9. Bader A., et al. “Interactive role of trauma cytokines and erythropoietin and their therapeutic potential for acute and chronic wounds”. Rejuvenation Research 1 (2011): 57-66.
10. Rezazadeh M., et al. “A mucoadhesive thermosensitive hydrogel containing erythropoietin as a potential treatment in oral mucositis: in vitro and in vivo studies”. Drug Delivery and Translational Research 5 (2018): 1226-1237.
11. Landry RG., et al. “Effectiveness of benzydamyne HCl in the treatment of periodontal post-surgical patients”. Research and Clinical Forums 10 (1988): 105-118.
12. Hamed S., et al. “Erythropoietin, a novel repurposed drug: An innovative treatment for wound healing in patients with diabetes mellitus”. Wound Repair and Regeneration 1 (2014): 23-33.
13. Toleubayev M., et al. “Efficacy of erythropoietin for wound healing: A systematic review of the literature”. In: Annals of Medicine and Surgery (2021).
14. Rahimzadeh P., et al. “Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee”. Journal of Research in Medical Sciences 8 (2014): 696-702.
15. Hosseinjani H., et al. “The efficacy of erythropoietin mouthwash in prevention of oral mucositis in patients undergoing autologous hematopoietic SCT: A double-blind, randomized, placebocontrolled trial”. Hematological Oncology 1 (2017): 106-112.
16. Yaghobee S., et al. “Evaluation of topical erythropoietin application on the healing outcome of gingival graft recipient site; a randomized controlled clinical trial”. BMC Oral Health1 (2021): 578.

Citation

Citation: Dina Magdy Fadl., et al. “Evaluating the use of Erythropoietin Gel with Modified Apically Repositioned Flap in Augmentation of Keratinized Tissue: A Case Report".Acta Scientific Dental Sciences 8.3 (2024): 46-50.

Copyright

Copyright: © 2024 Dina Magdy Fadl., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.