The role of Vitamin D as an adjunct for bone regeneration: A systematic review of literature.

Background and objectives: In spite of bone's healing capacity, critical-size bone defect regeneration and peri-implant osseointegration are challenging. Tissue engineering provides better outcomes, but requires expensive adjuncts like stem cells, growth factors and bone morphogenic proteins. Vitamin D (Vit.D) regulates calcium and phosphorus metabolism, and helps maintain bone health. Vit.D supplements in deficient patients, accentuates bone healing and regeneration. Therefore the aim of this systematic review was to evaluate the role of adjunctive Vit.D on bone defect regeneration. Methods: Comprehensive database search of indexed literature, published between January 1990 and June 2022, was carried out. English language articles fulfilling inclusion criteria (clinical/in vivo studies evaluating bone regeneration including osseointegration and in vitro studies assessing osteogenic differentiation, with adjunct Vit.D) were identified and screened. Results: Database search identified 384 titles. After sequential title, abstract and full-text screening, 23 studies (in vitro - 9/in vivo - 14) were selected for review. Vit.D as an adjunct with stem cells and osteoblasts resulted in enhanced osteogenic differentiation and upregulation of genes coding for bone matrix proteins and alkaline phosphatase. When used in vivo, Vit.D resulted in early and increased new bone formation and mineralization within osseous defects, and better bone implant contact and osseointegration, around implants. Adjunct Vit.D in animals with induced systemic illnesses resulted in bone defect regeneration and osseointegration comparable to healthy animals. While systemic and local administration of Vit.D resulted in enhanced bone defect healing, outcomes were superior with systemic route. Conclusions: Based on this review, adjunct Vit.D enhances bone defect regeneration and osseointegration. In vitro application of Vit.D to stem cells and osteoblasts enhances osteogenic differentiation. Vit.D is a potentially non-invasive and inexpensive adjunct for clinical bone regeneration and osseointegration. Long term clinical trials are recommended to establish protocols relating to type, dosage, frequency, duration and route of administration.

The potential of the iron concentrated germinated wheat in wheat flour fortification: an alternative to the conventional expensive iron fortification.

Investigation of the effect of the Fe abiotic stress on the germination rate, iron accumulation, root and shoot elongation of wheat (Triticum aestivum) was carried out. The grains were exposed to different experimental concentrations of ferrous sulfate (FeSO4) (0-15 mM). The effect of the treatment on the shoot and root elongation of the seeds were reported. There is a linear relationship between the treatment and the inhibition of shoot elongation. The half-inhibition dose (ID50) of FeSO4 on inhibition of shoot elongation was 7.3 mM. Each treatment groups (3-15 mM) were used to fortify the wheat flour at 0.1 mg Fe/g. The effect of fortification on rheology (farinograph, extensograph, and amylograph), quality of pasta and iron bioavailability was studied. The pasta cooking properties, texture and sensory properties of 12 and 15 mM composite pasta were equally acceptable as wheat without fortification, or NaFeEDTA fortified pasta. The iron dialysability of 3-15 mM composite pasta was similar to the NaFeEDTA fortified pasta. The iron bioavailability (in vivo) of 15 mM group based pasta was evaluated in the anemic rats. The pasta at 4% (Fe 0.026 mg/g) in iron-deficient diet fed to anemic rats for 2 weeks showed percentage iron absorption (PIA) and hemoglobin regeneration efficiency (HRE) of 85.3% and 44.4% respectively which is higher than the NaFeEDTA. In conclusion, iron-fortified pasta is the promising food fortificant with more iron bioavailability in the prevention of iron deficiency anemia.

Donor site analgesia after anterior iliac bone grafting in paediatric population: a prospective, triple-blind, randomized clinical trial.

The aim of this study was to compare the efficacy of femoral nerve block with indwelling catheter-based multiple infiltrations of bupivacaine for postoperative pain management after iliac bone harvesting. Sixty paediatric patients undergoing iliac harvesting were randomized into three groups: group A, preoperative femoral nerve block; group B, multiple bolus infiltration of 0.5% bupivacaine via indwelling catheter at the donor site; group C, controls--single dose of 0.5% bupivacaine infiltration given subcutaneously. The primary outcome measure was postoperative pain intensity at rest and at function. The time to maximum pain score, time to ambulation, duration of analgesia, and length of hospital stay were also assessed. Group B patients had the best pain relief and return to function, however the duration of pain relief was longer in group A. Subjects in group A had concomitant motor blockade causing delayed ambulation. Group C showed the worst outcomes. Indwelling catheter-based infiltration of bupivacaine was the most efficient method for providing enhanced pain relief after iliac bone graft harvesting. There was no increase in operating time or hospital stay. Femoral nerve block provided the next best results, but had the significant disadvantage of motor nerve blockade.

Denture-induced fibrous hyperplasia. Treatment with carbon dioxide laser and a two year follow-up.

Denture-induced fibrous hyperplasia (DIFH) is a persistent lesion caused mostly by the prolonged wear of an ill-fitting, over-extended denture. Although the condition frequently coexists with denture stomatitis, it is a distinct entity with a different protocol for management. The article describes successful treatment for a case of DIFH using carbon dioxide laser and a two year follow-up. The inherent advantages of using carbon dioxide laser over conventional surgical techniques are discussed.