Novel Dental Implants with Herbal Composites: A Review

*Gopathy Sridevi and Seshadri Srividya*

## **Abstract**

Missing a permanent tooth is a miserable condition faced by a common man. A tooth decay, periodontitis, mechanical trauma, or any systemic complications lead to such a complication. These bone defects when left untreated lead to severe resorption of the alveolar bone. A proper dental filling with an appropriate bone substitute material could prevent such resorption and paves a way for subsequent implant placement. Dental implants are considered as the prime option by dentists to replace a single tooth or prevent bone resorption. A variety of bone substitutes are available differ in origin, consistency, particle size, porosity, and resorption characteristics. 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. C. occidentalis was reported to stimulate mineralization of the bone and osteoblastic differentiation through the activation of the PI3K-Akt/MAPKs pathway in MC3T3-E1 cells of mice. This implant proved better osteoconductivity and bioactivity compared to pure HAP and other BCP ratios. Terminalia Arjuna was also worked in the incorporation in the graft to enhance the osteogenic property of the implant and gave good results. Another implant bone graft was synthesized containing BCP, biocompatible casein, and the extracts of *Myristica fragans* and subjected to *in vitro* investigations and the results revealed the deposition of apatite on the graft after immersing in SBF and also the ALP activity was high when treated with MG-63 cells, NIH-3 T3, and Saos 2 cell lines. This study indicates that the inclusion of plant extract enhances the osteogenic property of the graft. Thus, these novel dental implants incorporated with herbal composites evaluated by researchers revealed an enhanced bone healing, accelerates osseointegration, inhibits osteopenia, and inhibits inflammation. This application of herbal composite inclusion in dentistry and its applications has a greater potential to improve the success rate of dental implants and allows the implications of biotechnology in implant dentistry.

**Keywords:** bone defect, dental filling, implant, hydroxyapatite, osseointegration, herb, osteoconducting

## **1. Introduction**

Human teeth are the hardest substance in the human body that enhances the beauty of a person. It is a highly important structure that helps in food chewing to mechanically break down the food by cutting and crushing them in preparation for swallowing

and digesting. It also aids in speech and its articulation of words. Human teeth consist of 20 primary (deciduous, "baby" or "milk") teeth in children and 32 permanent teeth in adults. Teeth are classified as incisors, canines, premolars, and molars. Incisors are primarily used for cutting the food into pieces, canines are used for tearing the tissues of the food, and molars help to grind the food into smaller substances [1].

Teeth are also important for cosmetic purposes as well. Many dental treatments are not purposefully dealt with filling and taking out a tooth, but indeed nowadays people turn out to esthetic dentistry to improve, straighten, lighten, reshape, and repair teeth as well. The field of esthetic dentistry includes the establishment of veneers, crown bridges, implants, tooth-colored filling, and teeth whitening procedures.

#### **1.1 Tooth loss**

Tooth exfoliation starts from childhood. A young boy or girl loses the baby teeth, and it gets exfoliated in response to permanent teeth that start developing beneath them. This loss of primary teeth begins around the age of six and continues till 12 years of age. The primary teeth that are vulnerable are the upper and lower lateral incisors that shed at 7–8 years and upper canines are that shed around 10–12 years of age. Only the upper and lower first molars shed at 9–11 years of age and upper and lower second molars shed at 10–12 years of age [2].

#### **1.2 Pathological tooth loss**

Tooth loss is a condition that advances with the increase of age. This occurs as a result of mechanical disturbances and abnormal forces that act during the chewing process of hard substances, traumatic injury, etc. Also, a few conditions such as untreated dental caries (tooth decay) and severe periodontal (gum) disease might lead to loss of permanent teeth. Tooth decay is the primary cause of tooth loss. It is caused by the increased plaque retention on the teeth followed by bacterial invasion of the plaque. This ultimately results in dental caries and the formation of cavities. Untreated tooth cavities for a chronic period of time lead to the breakdown of the tooth. This bacterial invasion and retention of plaque deposits also affects the gums and bones attached to the tooth and loses its ability to hold the tooth. Periodontal structures are tissues that support teeth and their attachment to the bone. Diseases of the gums and bones are caused by bacterial invasion of teeth and retention of plaque. It results in diseases of the gums leading to periodontitis and detachment of supporting structures of the teeth and eventually causes tooth loss. So, the ultimate care of oral hygiene is the only preventive measure to prevent tooth loss. Good oral hygiene is the process of maintaining proper brushing of teeth two times a day with fluoridated toothpaste and frequent flossing. Regular dental check-ups every 6 months can be availed to ensure good teeth and prevent tooth loss [3].

#### **1.3 Mechanical trauma and tooth loss**

There are a few conditions like bruxism otherwise called teeth grinding that occurs during sleep. This condition is very common in people who tend to be awake by profession at night. This tooth grinding increases the wear and tear action on the tooth and causes mechanical injury. The risk of tooth fractures is common in sportspeople, especially in football and goalie. Research reports claim that smoking is another important cause of tooth loss. Reports from countries, such as the United States, Germany, and

Japan, show a strong relationship between cigarette smoking and tooth loss. The habit of smoking weakens the body's immune response to infection and causes immunosuppression. This makes it harder to guard against a gum infection and takes a longer time to heal. Reports reveal that systemic diseases also relate to tooth loss. Conditions, such as cardiovascular diseases, diabetes mellitus, cancer, and osteoporosis, also lead to permanent tooth loss due to their secondary complications. Therefore, tooth loss is not restricted to poor oral hygiene but poor maintenance of overall health [4–6].

#### **1.4 Treatment options for missing tooth**

Missing a permanent tooth is a miserable condition. Years after years the treatment options for missing teeth are dental implants, fixed dental bridges, removable partial dentures. Dental implants are considered as the prime option by dentists to replace a single tooth. This procedure involves the surgical mounting of a titanium metal post or frame on the upper or lower jaw along with mounting the replaced missing tooth. This dental implant acts as a permanent base for the replaced tooth. This procedure is highly advantageous because the replaced dental implant resembles a natural tooth and can last for decades. It also acts independently and does not disturb the adjacent normal tooth. The next treatment option is a fixed dental bridge. This procedure provides bridging between the gaps caused by the lost tooth and involves the employment of a dental prosthesis or an artificial tooth. This dental prosthesis would be attached to adjacent teeth and bonded in place with dental cement. A removable partial denture consists of replacement teeth that are attached to a natural-looking pink base. The natural teeth also act to stabilize and hold the removable plastic base in its position place. This pink base is designed in a way that matches the color of the gums and the color of the normal teeth [7].
