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      FIBRIN ADHESIVE DERIVED FROM SNAKE VENOM IN PERIODONTAL SURGERY. HISTOLOGICAL ANALYSIS

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          Abstract

          Background:

          A new fibrin adhesive made of buffalo plasma-derived fibrinogen and a thrombin-like snake venom enzyme, has been successfully used to immobilize free gingival grafts. This case series histologically compared sutured grafts (control group) with others immobilized by using the fibrin adhesive (experimental group).

          Case Description:

          The grafts were placed in the contralateral mandibular bicuspids of 15 patients, so that each subject received one treatment of each type. Five biopsies of each group were collected at 7, 14 and 45 days of healing, which were histologically and morphometrically analyzed as regards the relative volume density of the different connective tissue components.

          Results:

          The sites in the control group presented a higher inflammatory cell density at 7 days and a tendency towards a lower collagen density. In the experimental group, the grafts had an appearance of more advanced healing. Tissue maturity characteristics progressed until 14 and 45 days, but no difference between groups could be noted at these times.

          Conclusions:

          Within the limits of the present study, it may be suggested that the alternative fibrin adhesive tested could represent an alternative to sutures in gingival grafts procedures.

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          Most cited references31

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          Method for the quantitative morphologic analysis of tissues

          HW Chalkley, H.W. Chalkley, H. W. Chalkley … (1943)
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            Fibroblast migration in fibrin gel matrices.

            K Tognazzi, Harold Dvorak, Karen A. Brown … (1992)
            In healing wounds and many solid tumors, locally increased microvascular permeability results in extravasation of fibrinogen and its extravascular coagulation to form a fibrin gel, with concomitant covalent cross-linking of fibrin by factor XIIIa. Subsequently, inflammatory cells, fibroblasts, and endothelial cells migrate into the gel and organize it into granulation tissue and later into mature collagenous connective tissue. To gain insight into some of the cell migration events associated with these processes, we developed a quantitative in vitro assay that permits the study of fibroblast migration in fibrin gels. Early passage human or rat fibroblasts were allowed to attach to tissue culture dishes and then were overlaid with a thin layer of fibrinogen that was clotted with thrombin. Fibroblasts began to migrate upwards into the fibrin within 24 hours and their numbers and the distance migrated were quantified over several days. The extent of fibroblast migration was affected importantly by the nature of the fibrin clot. Fibroblasts migrated optimally into gels prepared from fibrinogen at concentrations of -3 mg/ml; ie, near normal plasma fibrinogen levels. Migration was greatly enhanced by extensive cross-linking of the fibrin alpha-chains by factor XIIIa, as occurs when clotting takes place in vivo. When fibrinogen was clotted in Dulbecco's modified Eagle's medium, gamma-chains were cross-linked, but alpha-chain cross-linking was strikingly inhibited, and fibroblasts migrated poorly. Gels prepared from factor XIII-depleted fibrinogen exhibited neither alpha-nor gamma-chain cross-linking and did not support fibroblast migration. Further purification of fibrinogen by anion exchange high pressure liquid chromatography depleted fibrinogen of fibronectin, plasminogen, and other impurities; this purified fibrinogen clotted to form fibrin gels that supported reproducible fibroblast migration.
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              Fibrin adhesive derived from snake venom in periodontal surgery.

              Mônica Barbosa, Sebastião Gregh, Euloir Passanezi (2007)
              A new fibrin adhesive made of buffalo plasma-derived fibrinogen and a thrombin-like enzyme obtained from snake venom was evaluated in this case series with regard to its applicability in periodontal surgery. Free gingival grafts that were sutured (control group) were compared to others immobilized through the use of the adhesive (experimental group). The grafts were carried out in contralateral mandibular bicuspids of 15 patients so that each subject received one treatment of each type. The analysis included measurements of probing and vertical dimension of the grafts and photographic follow-up for 90 days. The patients answered a questionnaire concerning postoperative signs and symptoms. The decrease in the vertical dimension of the grafts was significant during the first 30 days and more dramatic for the control group. Probing depth and attachment level presented statistically significant decreases for both groups. The grafts of the experimental group presented better appearance during the first 14 postoperative days. Pain was observed more often in the control group. Within the limits of the present study, it is suggested that the alternative fibrin adhesive tested may represent an alternative to sutures in periodontal surgery. Nevertheless, randomized clinical trials should be performed to evaluate the clinical advantages and disadvantages of the material.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Appl Oral Sci
                Journal ID (iso-abbrev): J Appl Oral Sci
                Title: Journal of Applied Oral Science
                Publisher: Faculdade de Odontologia de Bauru da Universidade de São Paulo (Bauru )
                ISSN (Print): 1678-7757
                ISSN (Electronic): 1678-7765
                Publication date (Print and electronic): October 2008
                Publication date (Print): October 2008
                Volume: 16
                Issue: 5
                Pages: 310-315
                Affiliations
                [1 ]DDS, MSc, PhD, Associate Professor, School of Medicine and Public Health, Foundation for Sciences Development, Brazil
                [2 ]DDS, MSc, PhD, Associate Professor, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Brazil
                [3 ]DDS, MSc, PhD, Full Professor, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Brazil
                [4 ]DDS, MSc, PhD, Assistant Professor, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Brazil
                Author notes
                Corresponding address: Mônica Dourado Silva Barbosa - Rua Manoel Andrade, 296, Apartamento 405, Condomínio Pituba Ville, Pituba, Salvador-BA, Brazil - 41810-815 - Phone: 55 71 33543074 - Fax: 55 71 33594312 - e-mail: monicadourados@ 123456uol.com.br
                Article
                Publisher ID: S1678-77572008000500002
                DOI: 10.1590/S1678-77572008000500002
                PMC ID: 4327595
                PubMed ID: 19089226
                SO-VID: e587291d-20f9-45a2-b2dd-273ea5fa18c7
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 November 2007
                Date revision received : 27 February 2008
                Date accepted : 22 April 2008
                Page count
                Figures: 6, Tables: 4, Equations: 0, References: 14, Pages: 6
                Categories
                Subject: Original Article

                Keywords: fibrin tissue adhesive, therapeutic use,mouth mucosa,grafts, transplantation
                Data availability:
                Keywords: fibrin tissue adhesive, therapeutic use, mouth mucosa, grafts, transplantation

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