**4.11 Combinations**

Hyaluronidase is one of the proteolytic enzymes that are providing a physiologic limiting factor for intercellular cement substance, hyaluronic acid. It was used in the treatment of submucous fibrosis by promoting the lysis of accumulated fibrous tissues and relieving the stiffness of tissues by intralesional injection. It provides a rapid short-term improvement [29, 78]. In addition, corticosteroids could be combined with bisphosphonates in the treatment of central giant cell lesions with neither recurrence nor clinical side effects being detected [27]*.*

Steroids are well-known immunosuppressive agents which offer a control of the inflammation. Up till now, different types of cortisone were used to undergo the needed outcome as triamcinolone and dexamethasone. Despite its potency, it was preferred because of its cost-effectiveness. Single-dose injection per week was needed till improvement is detected, which may extend to 4 months. Progression could be detected after two injections [29, 77].

**79**

*Oral Mesotherapy: Might Be Considered as An Adjunctive Technique for the Different Surgical…*

The usage of hyaluronidase and cortisone injection combination provides long-term improvement of the signs and symptoms associated with such diseases,

According to literature, up till now there is no definite protocol for dermal mesotherapy. In the oral cavity, it was more difficult to add specific rules due to the presence of multiple geometry, types, and dimensions of tissues as gingiva, buccal mucosa, palate, tongue, etc.; we have tried to establish guidelines for general

• Oral mesotherapy technique needs longer time for practice in order to achieve

• Only minute quantities of injectable agent ranging between 0.05 and 0.1 ml/point are permissible according to the range of the injected tissue

• In 1965, *Woodard* recommended that the pH of any injected material should range between 4.5 and 8.0. Local injections show lower rate of buffering capacity than intravenous and intramuscular route. During oral mesotherapy

bringing sensation, ulceration, and pain [29, 77].

**5. Oral mesotherapy injection protocol**

injection, higher pH is preferred.

practitioners and beginners.

*Bone morphogenic protein injection [75].*

better results.

**Figure 10.**

expansion.

*DOI: http://dx.doi.org/10.5772/intechopen.88355*

**Figure 9.** *Simvastatin injection [75].*

*Oral Mesotherapy: Might Be Considered as An Adjunctive Technique for the Different Surgical… DOI: http://dx.doi.org/10.5772/intechopen.88355*

**Figure 10.** *Bone morphogenic protein injection [75].*

*Periodontal Disease - Diagnostic and Adjunctive Non-surgical Considerations*

chitosan hydrogel in sequential injections [75, 76] (**Figure 10**).

neither recurrence nor clinical side effects being detected [27]*.*

could be detected after two injections [29, 77].

**4.10 Bone morphogenic proteins (BMPs)**

**4.11 Combinations**

of bone growth factors (e.g., BMP-2). On local injection, it was found that simvastatin could efficiently treat the infrabony defects and furcation defects and be used for guided bone regeneration. The injection visits could range from one to three times with 0.5–2 ml per visit. It is considered a successful nonsurgical treatment approach [75] (**Figure9**).

In orthopedics, recombinant BMPs were commonly used during distraction of long bones in order to accelerate osteogenic potentials, increase bone volume (both width and height), improve bone density, and reduce relapse possibilities. BMP-2 was commonly used with or without delivery systems as collagen sponge and

Hyaluronidase is one of the proteolytic enzymes that are providing a physiologic limiting factor for intercellular cement substance, hyaluronic acid. It was used in the treatment of submucous fibrosis by promoting the lysis of accumulated fibrous tissues and relieving the stiffness of tissues by intralesional injection. It provides a rapid short-term improvement [29, 78]. In addition, corticosteroids could be combined with bisphosphonates in the treatment of central giant cell lesions with

Steroids are well-known immunosuppressive agents which offer a control of the inflammation. Up till now, different types of cortisone were used to undergo the needed outcome as triamcinolone and dexamethasone. Despite its potency, it was preferred because of its cost-effectiveness. Single-dose injection per week was needed till improvement is detected, which may extend to 4 months. Progression

**78**

**Figure 9.**

*Simvastatin injection [75].*

The usage of hyaluronidase and cortisone injection combination provides long-term improvement of the signs and symptoms associated with such diseases, bringing sensation, ulceration, and pain [29, 77].
