Effect of the plant-based hemostatic agent Ankaferd Blood Stopper® on the biocompatibility of mineral trioxide aggregate

Abstract

Background: Due to the detrimental effect of blood contamination on the physico-chemical properties of mineral trioxide aggregate (MTA), obtaining an effective hemostasis in the surgical crypt during apical surgery is of paramount importance. The purpose of this in vivo study was to analyze the effect of Ankaferd Blood Stopper® (ABS) contamination on the biocompatibility of MTA.

Methods: Forty of 56 Wistar-Albino rats were divided randomly and equally into two groups (MTA and MTA-ABS) according to whether or not a hemostatic agent was used. The remaining 16 rats were designated as the control group. Rats in the experimental groups received freshly mixed MTA-Angelus in polyethylene tubes, which were inserted into monocortical bore holes created in their tibias. In the MTA-ABS group only, 0.5 mL of ABS solution was administered topically on the defect sites followed by implantation of MTA tubes. Inflammation, foreign-body reaction (FBR), necrosis, fibrosis, and new bone formation (NBF) were studied 7, 30, 60, and 90 days after implantation.

Results: On day7, statistically significant differences were found in tissue reactions with regard to NBF and necrosis (p = 0.044 and p = 0.024, respectively), the latter being observed in 40 % of the samples only in the MTA-ABS group. Slight inflammation in all groups was confined to day-7 only. Mild necrosis was present in the MTA-ABS group only on day-7. Severity of the foreign body reaction and fibrosis was limited. New bone formation increased gradually over time in all groups, reaching a maximum on day-90.

Conclusions: MTA and ABS-contaminated MTA are equally biocompatible. ABS does not impair the properties of MTA.

Keywords: Ankaferd blood stopper; Biocompatibility; Mineral trioxide aggregate.

Fig. 1

The mean and standart deviation of reaction scores in all groups at time intervals. a Inflammation; b Foreign body reaction; c Fibrosis and d New bone formation

Fig. 2

Tissue reactions in the control group. 7 days: a Thin trabeculae of new bone (arrow) was observed at the open end of the tube (H&E,x400). 30 days: b New bone formation (arrows) adjacent to the tube end (H&E,x400). 60 days: c New bone became lamellar (arrow) at the open end of the tube. Normocellular bone marrow (bold arrow) is seen under the bone (H&E,x200). 90 days: d Lamellar bone (arrows) surrounding fatty bone marrow (bold arrow) getting into the tube (H&E,x40)

Fig. 3

Tissue reactions in the MTA group. 7 days: a Fibrous connective tissue (bold arrow) and new bone trabeculae (arrows) were seen at the open end of the tube (H&E,x200). 30 days: b Lamellar bone formation (arrow) and residual MTA (bold arrow) were observed (H&E,x100). 60 days: c New bone formation (arrow) and normocellular bone marrow (bold arrow) were seen at the open end (H&E,x200). 90 days: d Mature lamellar bone (arrow) and normocellular bone marrow (bold arrow) (H&E,x200)

Fig. 4

Tissue reactions in the MTA-ABS group. 7 days: a Fibrous band of connective tissue (bold arrow) and tiny bone trabeculae (arrow) adjacent to the open end (H&E,x100). 30 days: b Lamellar bone (arrow) and bone marrow (bold arrow) at the open end of the tube (H&E,x200). 60 days: c Mature lamellar bone (arrow) surrounding the open end of the tube (H&E,x200). 90 days: d Mature lamellar bone (arrow) and bone marrow (bold arrow) (H&E,x100)