Acemannan-induced tooth socket healing: A 12-month randomized controlled trial

Abstract

Background/purpose: Natural compounds have become alternatives for bone regeneration. Acemannan, the main polysaccharide extracted from Aloe vera, has been demonstrated as a promising osteoinductive material in vitro and in vivo. This clinical study investigated the effect of acemannan on tooth socket healing.

Materials and methods: Thirty-five otherwise healthy patients, 18-25 years old and diagnosed with horizontal or vertical partial impaction of the lower third molars, were enrolled in this randomized controlled trial. After removing the teeth, the sockets randomly received one of the following treatments: spontaneous blood-clotting (control), 20 mg acemannan sponge, or 50 mg acemannan sponge. Cone-beam computed tomography of the mandible was performed immediately (baseline), and at 3-, 6-, and 12-months postoperatively; the data were analyzed using the OsiriX MD program. Bone healing in the socket was determined measuring the socket volume. One-way ANOVA was used to analyze the differences within each group and between groups.

Results: Thirty-five patients with 43 partially impacted lower third molars participated in this study. No patients exhibited alveolar osteitis or secondary infection. Compared with baseline, all groups showed significant reduction in socket volume at all observation time-points (p < 0.05). The 50 mg acemannan group had a significantly greater reduction in socket volume compared with the control at all postoperative time-points (p < 0.05). The 20 mg group had a significantly greater reduction in socket volume compared with the control at 3-months postoperatively (p < 0.05).

Conclusion: We conclude that acemannan increases bone healing at 3-, 6-, and 12-months after removal of partially impacted mandibular third molars.

Keywords: Acemannan; Biomaterial; CBCT; Clinical study; Tooth socket healing.

Figure 1

Study flowchart.

Figure 2

Illustration and radiographic image (5x magnification) of the tooth socket. (A) Socket height was measured from the distal cemento-enamel junction of the adjacent molar to the socket apex of the impacted tooth to establish the examination area. (B) Representative CBCT axial images of the socket. The region of interest (grey line) is the outline of the tooth socket.

Figure 3

Representative radiographic images of the tooth socket: axial views of the control, 20 mg acemannan, and 50 mg acemannan groups at baseline and three, six, and twelve months postoperatively. Images were generated using the OsiriX MD Program.

Figure 4

Representative radiographic images of the tooth socket: coronal views of the control, 20 mg acemannan, and 50 mg acemannan groups at baseline and three, six, and twelve months postoperatively. Images were generated using the OsiriX MD Program.

Figure 5

Representative radiographic images of the tooth socket: sagittal views of the control, 20 mg acemannan, and 50 mg acemannan groups at baseline and 3-, 6-, and 12-months postoperatively. Images were generated using the OsiriX MD Program.

Figure 6

Acemannan reduced the average socket volume. The average socket volumes (mm³) of the control (n = 14), 20 mg acemannan sponge (n = 13), and 50 mg acemannan sponge (n = 16) groups at baseline and 3-, 6-, and 12-months postoperatively are shown. Significant differences were found within the groups. Data are presented as means ± standard error. ∗, #, † indicate significantly different compared with its baseline for the control, 20 mg acemannan sponge, and 50 mg acemannan sponge groups, respectively; (p < 0.05).