ABS is a plant extract and medicinal product used for hemostatic purposes in traditional Turkish medicine. This experimental in vivo study was designed with the hypothesis that some properties of locally applied ABS could help heal bone defects. ABS consists of a mixture of various plants, including V. vinifera, G. glabra, T. vulgaris, A. officinarum, and U. dioica. These plant extracts have various positive effects on hematological parameters, neovascularization with cytokine-induction, vascular functions, cellular proliferation, and antitumor, antiplatelet, antioxidant, anti-inflammatory, anti-thrombin and anti-atherosclerotic activities. Each component that makes up this mixture has its own characteristics
9, 17-26.
Goker et al. 17 histopathologically examined the effects of ABS on healing in bone defects in diabetic animals and reported that ABS forms an encapsulated protein network that creates binding sites that allow red blood cell collection. Bulut et al. reported that ABS in both diabetic and nondiabetic rats increased bone tissue healing. In addition, Bulut et al. 18 reported that ABS, which is used locally in bone defects, does not cause an inflammatory reaction but instead reduces inflammation and necrosis in early bone healing and increases new bone formation. Based on these results, the researchers emphasized that ABS could be used safely in oral and maxillofacial surgical procedures in patients with wound-healing disorders. According to the histological data obtained in the current study, locally used ABS did not cause any foreign body reaction in the ABS and control groups.
In an in vivo study on rat tibias, Isler et al. reported that ABS decreased inflammation, cell death, and fibrous tissue formation and increased new bone formation in the early bone healing period and that no foreign body reaction was observed against ABS 9. In addition to these studies, Ezirganlı et al. 27 reported that the local application of ABS had a positive effect on bone healing in an ovariectomized rat model in an experimental in vivo study. In addition, the researchers stated that further experimental animal and clinical studies focusing on ABS may be needed to determine the therapeutic dose of ABS. Turgut et al. 28 reported in an experimental animal study that ABS provided positive effects on bone healing, while bone wax impaired bone regeneration. Based on scintigraphic, histochemical, and immunohistochemical analyses, researchers reported that local application of ABS has positive effects on bone regeneration and can stop bleeding quickly. In a study on rats, Tanik et al. evaluated the healing of 7 mm defects created in the calvarium by applying a graft and local ABS 29. According to histological and bone mineral density data, the researchers determined that both graft + ABS and ABS alone had positive effects on wound healing and bone formation in nondiabetic rats 29. Healthy rats were used in the current study, and no diabetic or osteoporotic rats were used. The fact that the bone healing and fibrosis values obtained in this study for the experimental groups are not statistically different from the controls does not support the mentioned studies. In a clinical study of individuals with chronic periodontitis, Pamuk et al. 30 reported that local ABS application with autogenous cortical bone grafts could stimulate angiogenesis and vascular endothelial cell function, thus increasing the soft tissue healing of periodontal defects, preventing gingival recession, and increasing clinical attachment gain. In the histological and immunohistochemical results obtained from a study comparing the effectiveness of ABS and enamel matrix derivatives in the treatment of fenestration defects in rats, Guler et al. 31 reported that ABS can contribute to bone healing in periodontal defects. As indicators of bone healing in periodontal defects, increases in clinical attachment levels and soft tissue healing have been reported in patients receiving local ABS. However, the data obtained in this study do not support the studies of Pamuk et al. 30 and Guler et al. 31 because, although bone healing was higher in subjects treated with ABS compared to controls at a numerical level, the data were not statistically significant. In addition, fibrosis, which can be used as another indicator of defect healing, was not found to be statistically significant.
Some studies in the literature have investigated bone healing and regeneration of bone grafts with ABS use 29,31. However, in the current study, we thought that the regenerative properties of ABS applied to defects created in the bone could be determined more accurately and objectively, as the most common use of ABS in oral and maxillofacial surgery is local application to stop bleeding. Additionally, we thought that the risk of infection in the area where the graft was applied and the difficulty of applying the graft would compromise the objectivity of the study.
The current study has some limitations. First, the relationship between ABS and bone metabolism could not be revealed at the molecular level; only histopathological methods was used, immunohistochemistry and ELISA were not used. Second, in vivo studies can be used to estimate the physiological and pathological conditions of the subject in humans. Third, bone healing was not evaluated in the long term in this study. Fourth, long bones such as tibia and femur have different osteogenic properties compared to other bones of the body and therefore, other bones of the body such as mandible and maxilla may respond differently to ABS application 32.
In conclusion, based on the limited results of this study, the local application of ABS to bone defects cannot be confirmed to contribute to the healing of bone tissue. Further studies will help elucidate the mechanism of ABS and bone tissue healing.
Availability of Data and Materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Conflict Of Interest: The authors declare that there is no conflict of interest.
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