Herbal Extracts in Dental Implantology

(This is a part of the ‘Implant Dentistry– Updated Yet Simplified Series’by prosthodontist & implantologist Dr Nupur Shrirao)

Abstract

Herbal extracts have shown a significant potential in improving the quality in dental implantology is significant. Collaborative efforts blending traditional herbal knowledge with modern medical research have ushered in new, effective treatments for dental and orthopedic healing. By adopting these natural enhancements, dental practitioners can provide better care, promoting faster healing and long-term success of implants. This article explores the role of herbal extracts in dental implantology in three parts – bone regeneration, implant body material, and adjuncts in hygiene maintenance to prevent peri-implantitis.

Introduction

​Dental implants represent a revolutionary advancement in oral healthcare, providing reliable solutions for tooth loss. However, traditional materials often face challenges related to biocompatibility and patient acceptance.

Herbal extracts have gained attention in dental implantology due to their potential to promote bone regeneration. Rigorous clinical trials are essential to fully realize the therapeutic potential of herbal extracts in bone regeneration, but the beginning is here. Recently, novel dental implants incorporated with herbal composites were evaluated by research scientists and revealed abundant evidence on such materials. They found that herbal extracts enhanced bone healing, accelerates osseointegration, inhibits osteopenia, and inhibits inflammation.

​​In recent years, there has been a rising interest in the use of herbal medicine as an adjunct to conventional periodontal treatments. This growing trend reflects a shift towards natural remedies to address issues like dental caries, gingivitis, periodontitis, dentin hypersensitivity – and now even peri-implantitis.

​Let us see how herbal extracts play a role in the enhancement of dental implants.

Exploring Herbal Extracts for Bone Regeneration

Effective bone regeneration is critical for the success of dental implants. The quality of bone at the implant interface influences stability and osseointegration. Traditional methods include autografts, allografts, and synthetic materials, but these have limitations such as donor site morbidity and risk of body rejection. Herbal extracts present a promising alternative.

​Inducing the differentiation of cells or accelerating bone regeneration is possible with plant extracts. Coating these extracts on implant devices can improve cell attachment, differentiation, and proliferation.

Key Herbal Components in Bone Grafts

Various herbal extracts have shown potential in promoting bone health and regeneration:

Flavonoids: Flavonoids, found in many fruits and vegetables, are bioactive compounds that enhance bone mineral density. Studies suggest they help improve bone health, especially in individuals at risk of osteoporosis.

Traditional Chinese medicines: Traditional Chinese medicines like Drynaria fortunei and Carthami flos have shown to promote the proliferation of osteoprogenitor cells, aiding in bone healing. Compounds like naringin have demonstrated capabilities to promote bone formation. Extracts from buguzhi and collagen can be used as bone grafts

Ozonated plant extracts: Cyclosporin A (CsA) was used to assess osseointegration in ozonated plant extracts (herein called ozonated oil) in a study. The results suggest that topical ozonated oil and short-term administration of CsA may affect dental implant osseointegration and bone density. Hence, ozonated oil may improve osseointegration surrounding dental implants by topically applying it

Aloe vera: Known for its healing properties, Aloe vera and its polysaccharide, acemannan, have been used to enhance bone regeneration in dental procedures, such as sinus lift surgery.

Grape seed extract: Rich in proanthocyanidins, grape seed extract has been studied for its ability to improve bone healing and prevent osteoporosis-related bone loss, making it beneficial in implant osseointegration.

Benefits of Implementing Herbal Components in Bone Regeneration

Herbal extracts work through various conducive mechanisms on bone regeneration and have the following benefits:

1. Osteopromotion: They stimulate bone cell proliferation and differentiation.
2. Osteoinduction: These extracts enhance bone morphogenetic protein (BMP) pathways, encouraging new bone formation.
3. Antioxidative effects: By reducing oxidative stress, herbal extracts protect bone cells and enhance healing.

​Dental Implants Made using Herbal Composites

​Recent innovations incorporate herbal composites into implants, showcasing promising results in enhancing the functionality and acceptance of dental care solutions. Herbal composites in dentistry fabricated using biphospho-calcium phosphate, casein, chitosan, and certain herbal extracts of Cassia occidentalis, Terminalia arjuna bark, Myristica fragans also were reported to possess a higher ossification property, osteogenic property and were able to repair bone defects.

Key Herbal Components in Dental Implants

Several herbs are under investigation for their potential in enhancing dental materials. Here are a few noteworthy examples:

Cassia occidentalis

Cassia occidentalis is known for its ability to stimulate bone mineralization. It’s been shown to activate pathways that promote osteoblastic differentiation, vital for integrating implants with the jawbone.

Terminalia arjuna

This herb is recognized for its role in traditional medicine for fracture healing. Its inclusion in dental implants has been reported to enhance osteogenic properties, crucial for bone repair and implant stabilization.

Icariin

A traditional Chinese medicinal herb, Icariin strengthens bones and encourages healing. Its application in dental implants can lead to improved outcomes in patient recovery and implant success rates.

Benefits of Implementing Herbal Composites

Herbal composites in dentistry offer a unique approach to conventional dental implants. Integrating natural extracts and compounds into implant materials provides several benefits:

• Enhanced biocompatibility: Herbal components can improve the body’s acceptance of implants, reducing risks of rejection and inflammation.
• Accelerated osseointegration: Certain herbs, like Cassia occidentalis, promote quicker and more effective bonding between the implant and the bone.
• Anti-inflammatory properties: Herbal extracts often possess natural anti-inflammatory properties, minimizing post-operative discomfort and healing time.

Herbal Hygiene Aids to Promote Implant Healing

​Conventional treatments in promoting healing in implant patients include scaling, root debridement, and antimicrobial therapies. However, the potential side effects and the risk of developing antimicrobial resistance have prompted exploration into alternative solutions like herbal medicines. Plant-based phytochemicals have anti-inflammatory effects that could be used as an alternative to treat periodontal and peri-implant conditions.

Recent research on the different active components included show significant improvements in the clinical parameters. To suggest them as substitutes for the non-herbal elements, more research is necessary.

Key Herbal Components in Herbal Hygienic Aids

Herbal mouthwashes: Studies demonstrate that herbal mouthwashes containing ingredients like Triphala, Aloe Vera, and green tea can effectively reduce plaque index (PI), gingival index (GI), and bleeding on probing (BOP). Products such as Desmocare which include honey and guava leaf extracts have been effective in preventing peri-implantitis. They often compare favorably to traditional chlorhexidine (CHX) mouthwashes.

Plant extracts as agents for dental care: Research highlighted the effectiveness of curcumin, guava leaf extract, and Sambucus williamsii var. coreana in addressing periodontal issues, indicating these could serve as alternatives to synthetic compounds in oral hygiene products.

Herbal products for dentinal hypersensitivity: Products like Hi Ora K and Spinacia oleracea herbal toothpaste demonstrated significant efficacy in reducing tooth sensitivity compared to standard desensitizing toothpaste.

Benefits of Implementing Herbal Hygiene Aids

​Herbal medicines offer a promising adjunctive approach, providing additional antibacterial and anti-inflammatory benefits without the adverse effects sometimes associated with chemical mouthwashes.

• Reduced side effects: Herbal preparations tend to have fewer side effects compared to chemical alternatives, minimizing the risk of hypersensitivity and resistance.
• Enhanced patient compliance: Patients often appreciate natural remedies, leading to better adherence to oral hygiene routines.
• Cost-effectiveness: In many cases, herbal products can be more affordable and accessible, especially in developing regions.

Conclusion and Future Directions

The use of herbal composites in dental implants and for bony regeneration marks a significant step forward in the field of oral health. As research continues, the scope of herbal composites within dentistry will likely expand, offering even more innovative and effective solutions. However, further research is needed to understand optimal dosages and long-term effects.

Plant extract formulations present a viable option for preventing and managing peri-implant diseases. However, further clinical trials are necessary to confirm their long-term effectiveness and safety.

In summary, while many promising results have been observed in preliminary studies, with continued research, these natural compounds could play a vital role in advancing dental implantology and patient outcomes.​

References

1. Ashtiani RE, Hadi A, Nouri F, Rahimi S, Badkoobeh A, Abbasi K, Alam M. The role of current herbal extracts in bone regeneration through dental implants:in vitro/in vivo/clinical studies. Arch Med Sci. 2022 Sep 9;19(6):1653-1661. doi: 10.5114/aoms/153510. PMID: 38058728; PMCID: PMC10696976.
2. Sridevi G, Srividya S. Novel Dental Implants with Herbal Composites: A Review [Internet]. Dentistry. IntechOpen; 2022. Available from: http://dx.doi.org/10.5772/intechopen.101489
3. Abu Tamam A, Kukreja B, Ramachandra S, Reddy M, Souza J, Abdelmagyd H. Herbal Medicine as an Adjunct in the Treatment of Periodontal Diseases – A Systematic Review . Open Dent J, 2024; 18: e18742106295311.http://dx.doi.org/10.2174/0118742106295311240419074231