Abstract

The healing of oral lesions that are associated with diabetes mellitus is a matter of great concern. Bioactive glass is a highly recommended bioceramic scaffold for bone and soft tissue regeneration. In this study, we aimed to assess the efficacy of a novel formula of bioactive glass nanofibers in enhancing oral mucosal wound regeneration in diabetes mellitus. Bioactive glass nanofibres (BGnf) of composition (1–2) mol% of B2O3, (68–69) mol% of SiO2, and (29–30) mol% of CaO were synthesized via the low-temperature sol-gel technique followed by mixing with polymer solution, then electrospinning of the glass sol to produce nanofibers, which were then subjected to heat treatment. X-Ray Diffraction analysis of the prepared nanofibers confirmed its amorphous nature. Microstructure of BGnf simulated that of the fibrin clot with cross-linked nanofibers having a varying range of diameter (500–900 nm). The in-vitro degradation profile of BGnf confirmed its high dissolution rate, which proved the glass bioactivity. Following fibers preparation and characterization, 12 healthy New Zealand male rabbits were successfully subjected to type I diabetic induction using a single dose of intravenous injection of alloxan monohydrate. Two weeks after diabetes confirmation, the rabbits were randomly divided into two groups (control and experimental groups). Bilateral elliptical oral mucosal defects of 10 × 3.5 mm were created in the maxillary mucobuccal fold of both groups. The defects of the experimental group were grafted with BGnf, while the other group of defects considered as a control group. Clinical, histological, and immune-histochemical assessment of both groups of wounds were performed after one, two and three weeks’ time interval. The results of the clinical evaluation of BGnf treated defects showed complete wound closure with the absence of inflammation signs starting from one week postoperative. Control defects, on the other hand, showed an open wound with suppurative exudate. On histological and immunohistochemical level, the BGnf treated defects revealed increasing in cell activity and vascularization with the absence of inflammation signs starting from one week time interval, while the control defects showed signs of suppurative inflammation at one week time interval with diminished vascularization. The results advocated the suitability of BGnf as bioscaffold to be used in a wet environment as the oral cavity that is full of microorganisms and also for an immune-compromised condition as diabetes mellitus.

Highlights

  • Diabetes mellitus is a metabolic disorder that is characterized by a deficiency in insulin secretion or action resulting in hyperglycemia [1]

  • Analysis of the bioactive glass nanofibers (BGnf) pattern showed a broad peak around 20◦ to 23◦ corresponding to the Si-O-Si network indicating the amorphous structure of the glass nanofibers [29,49] (Figure 3)

  • We suggested that it is highly related to the BGnf remnants that accumulated in the deep submucosal layer circumscribed by the multinucleated giant cells

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Summary

Introduction

Diabetes mellitus is a metabolic disorder that is characterized by a deficiency in insulin secretion or action resulting in hyperglycemia [1]. The World Health Organization reported in 2016, that it is a potentially morbid condition affecting 422 million adults aged above 18 years worldwide and it is expected to affect 592 million in 2035. It is classified into two types: insulin-dependent diabetes mellitus (IDDM) or type 1, and non-insulin dependent diabetes mellitus (NIDDM) or type 2 [2]. Egypt is one of the top 10 countries in the world in the number of diabetic patients, according to the International. In 2013, the IDF reported that about 7.5 million have diabetes. They reported that 2.2 million Egyptians have undiagnosed pre-diabetes [3]

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