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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 15-18  

An overview of chitosan and its role in periodontics


1 Department of Periodontics, JKK Nattraja Dental College, Komarapalayam, India
2 Professor, Prudent Dental Clinic, Dindigul, Tamil Nadu, India
3 Department of Preventive Dental Sciences, College of Dentistry, Gulf Medical University, Ajman, UAE
4 Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Faisal University, Al-Ahsa, Saudi Arabia
5 Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
6 Department of Periodontics, RMDCH, Chidambaram, Tamil Nadu, India

Date of Submission23-Oct-2020
Date of Decision27-Oct-2020
Date of Acceptance29-Oct-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Arthiie Thangavelu
Department of Periodontics, JKK Nattraja Dental College, Komarapalayam, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_701_20

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   Abstract 


Chitosan is a biopolymer with numerous biological properties such as antibacterial, anti-inflammatory, and wound healing. Chitosan also stimulates cell proliferation and osteogenesis and thus used as a scaffold material in tissue engineering. The physical proprieties of chitosan such as biocompatibility and biodegradability give promising results in periodontal therapies. This review gives an updated explanation of the applications of chitosan in dentistry and periodontics. Furthermore, the review demonstrates the actions of chitosan in detail and its role in the regeneration of periodontal structures.

Keywords: Chitin, chitosan, local drug delivery, periodontal diseases


How to cite this article:
Thangavelu A, Stelin K S, Vannala V, Mahabob N, Hayyan FM, Sundaram R. An overview of chitosan and its role in periodontics. J Pharm Bioall Sci 2021;13, Suppl S1:15-8

How to cite this URL:
Thangavelu A, Stelin K S, Vannala V, Mahabob N, Hayyan FM, Sundaram R. An overview of chitosan and its role in periodontics. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Oct 26];13, Suppl S1:15-8. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/15/317635




   Introduction Top


The oral cavity harbors heterogeneous microbial communities. Several methods such as DNA plasmids, vaccines, and antibiotics are used to reduce or eliminate the colonization of bacteria.[1] Antibiotics such as penicillin, cephalosporins, macrolides, and tetracyclines play a vital role in eliminating and reducing the spread of pathogenic microorganisms in the oral cavity. The emergence of antibiotic resistance along with the new pathogenic strains has led to infections still remain in the targeted site. The plasmid-mediated spread of antibiotic resistance is the most common cause.[2] Biofilms present on the tooth surface also increase the resistance to antimicrobials. Thus, the world of technology and nature must go hand in hand to fulfill the necessities of humans. This led to the search for materials which are eco friendly and economical. Natural compounds have some advantages over synthetic ones such as faster healing with less incompatibility in human beings. They also reduce operation time and improve patient recovery.

Biomaterials are nonliving materials which are used in various fields such as medical, biomedical, and dental. The growing interest in the use of antimicrobial polymers made them as an alternative therapy for oral diseases. As the biomaterials do not exhibit disease transmission risks and immune rejection they can be used for the replacement of tissues at low cost.[3] Chitosan, a novel natural polymer, has shown promising potential in various fields.


   Chitosan Top


Chitin is the second-most common naturally available biopolymer and an amino polysaccharide, which forms the core material that gives strength to the exoskeletons of crustaceans. The interaction between hydroxyl and acetamide groups gives chitin a rigid crystal structure. Chitosan is produced upon 70% deacetylation of chitin. Chitosan is obtained from the skeletal material of arthropods, and is also found in the cell walls of fungi.[4]

Chitosan exhibits excellent biocompatibility, nontoxicity to humans, and biodegradability. Chitosan also exerts selective permeability, polyelectrolyte action, antimicrobial activity, and hemostatic activity. Its ability to form gel, film, and sponge with its absorptive capacity and anti-inflammatory and wound-healing properties make it suitable for periodontal regeneration.[5] Chitosan is modified to increase its activity and to improve aqueous solubility.


   History Top


Braconnot in 1811 discovered chitin from fungi and named fongine which was then named chitin by Odier. The main derivative of chitin, chitosan, was discovered by Rouget in 1859 when chitin was added to hot potassium hydroxide solution. The presence of glucosamine in chitin was confirmed by Gilson in 1894, and it was named chitosan by Hoppe-Seyler in 1894.[5]


   Structure Top


Chitosan is a cationic polysaccharide that occurs naturally or can be obtained by deacetylation of chitin. Its linear structure consists of Beta-1, 4-O-glycosylamine. The active regions of chitosan include amino and amide groups in C-2 location and hydroxyl groups in C-3 and C-6. The deacetylation results in enzymatic hydrolysis which transforms chitosan into a water-soluble and low-molecular-weight oligosaccharide. Chitosan is soluble in dilute acid medium and forms a cationic polymer.[6] The chemically modified chitosan in the amino group or in the hydroxyl groups produces derivatives containing cationic moieties. The biocompatibility of this material with high viscosity and high water-binding capacity makes it suitable for use in different forms such as gels, chips, and membranes.


   Applications of Chitosan in Dentistry Top


Chitosan, a hydrophilic polysaccharide, has a wide range of bio-dental applications with its antimicrobial, immunostimulatory, hemostatic, and wound-healing properties. In pediatric dentistry, chitosan is used to prevent the mucoadhesion of cariogenic bacteria.[7] It is used along with chewing gum and mouthwash owing to its antibacterial and antiplaque effects. In endodontics, chitosan is used along with glass ionomer cement regenerative endodontics and dental bonding systems and provides hemostasis for pulpotomy.[8] In oral surgery, chitosan is used in guided bone regeneration, hemostasis of surgical wounds, and coating of dental implants, in oral reconstruction, repairing temporomandibular joint disc guided periodontal tissue regeneration. In prosthetic dentistry, it is used for modification of glass ionomer restoratives and antibacterial activity of dental adhesive and modification of lithium disilicate glass ceramic cementation procedures. In orthodontics, chitosan is used for preventing demineralization around orthodontic brackets and promoting remineralization after orthodontic treatment.[9]


   Applications of Chitosan in Periodontics Top


Chitosan exhibits antibacterial effect and promotes guided tissue regeneration. Chitosan also exhibits antioxidant and antimicrobial properties. It promotes epithelial attachment re-growth and acts as an advanced scaffold in periodontal tissue engineering. Chitosan gels can also be used in nonsurgical periodontal therapy in the treatment of periodontitis.[10]

Anti-microbial action

The antimicrobial activity of chitosan would prevent any possible infections. The functional groups present in chitosan derivatives are quaternary ammoniumyl, guanidinyl, carboxyalkyl, hydroxyalkyl, thiol-containing groups, and hydrophobic groups such as long alkyl chains and substituted phenyl and benzyl rings.[11] It is believed that amino groups of chitosan in contact with physiological fluids are protonated. Chitosan binds with anionic groups of microorganisms and causes agglutination of microbial cells and inhibition of their growth. According to Zheng and Zhu,[12] the antimicrobial activity of chitosan is directly related with the absorption of polysaccharide to the bacterium and this causes alterations in the cell wall structure and increases the permeability of the cell membrane, causing cell death. Chitosan also interferes with bacterial coaggregation.

Chitosan in its gel form and hydrogel base used along with toothpastes, mouthwashes, and chewing gums exhibits antimicrobial property in reducing microorganisms in the oral cavity. According to Subbiah et al.,[13] the antiplasmid effect of chitosan nanoparticle inhibits Cyperus rotundus and Anacyclus pyrethrum. Costa et al.[14] reported that chitosan inhibits violacein production in Chromobacterium violaceum. Abedian et al.[7] showed that chitosan has a significant antibacterial effect on common oral bacteria such as Streptococcus mutans and Streptococcus sobrinus and further inhibits biofilm formation. Chitosan also exhibits antiplaque activity against several oral pathogens such as Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans.

Anti-inflammatory

Chitosan exerts anti-inflammatory activity by inhibiting the inflammatory cytokine interleukin (IL)-6 production in human keratinocytes and IL-12 production in human monocytes and prostaglandin E2 levels. The tumor necrosis factor-alpha expression and IL-6 at the mRNA levels are downregulated. The signal pathways c-Jun NH terminal kinase and p38 mitogen-activated protein kinase, activated by lipopolysaccharide, are attenuated by chitosan. Studies have concluded that the anti-inflammatory effect of chitosan particles in periodontal and gingival fibroblasts reduces inflammation in periodontal diseases.[8]

Periodontal regeneration

Chitosan-containing formulations remain for a prolonged time on the application site; its tissue regeneration ability and hemostatic properties eliminate any additional material necessity, such as barrier membranes and bone grafts in regenerative therapies. Chitosan also shows osteoconductivity and induction of neovascularization, which leads to accelerated bone growth. In a study by Park et al.,[15] chitosan incorporated with platelet-derived growth factor-BB and hydroxyapatite in the treatment of intrabony defects resulted in increased bone formation. Mukherjee et al.[16] evaluated a paste of chitosan glutamate and hydroxyl apatite (HA) as a synthetic bone graft material in rats and concluded that the paste exhibited osteoinductive factors such as bone morphogenetic protein-2. Chitosan gel can be effectively used in combination with demineralized bone grafts.

Bone repair

The biodegradability and biocompatibility properties of chitosan make it suitable for application as a biomaterial and scaffold for hard tissue regeneration. Chitosan with its chemical H-bond chains, cross-linkings, and NH2+ with negative tissues in the human body thus provides good stability to start new bone cell formation at an early stage of bone healing. Klokkevold's[17] study proved that spongy chitosan supports the proliferation of osteoblasts, can increase osteogenesis, and helps in guided bone regeneration. It has been demonstrated that chitosan-filled socket bone results in increased bone density than untreated dental sockets.

Wound healing and hemostasis

Chitosan affects specific cells involved in the process of wound healing and stimulates macrophages to release IL-1 that stimulates fibroblast proliferation. Chitosan also releases acetylglucosaminidase N and increases biosynthesis of hyaluronic acid and extracellular components related with scar formation and wound healing. The wounds treated with exhibited increased number of collagen, more active fibroblasts, and osteopontin with a heavy infiltration of polymorphonuclear leukocytes.[18]

Local drug delivery

Chitosan nanoparticles deliver antibiotics such as metronidazole, chlorhexidine, and nystatin to periodontal tissues. When chitosan gel incorporated with or without 15% metronidazole was applied as an adjunctive to scaling and root planing in chronic periodontal patients, it exhibited significant improvements in bleeding indices, probing depth, and clinical attachment level.[19] A study conducted by Popa et al.[20] revealed that a chitosan concentration of 3% w/w could offer a base for an optimum modulation in drug dose, and make them efficient to use as a local drug delivery agent. According to Jothi et al.,[21] the local drug delivery system using chlorhexidine with chitosan base polymer reported reduction in probing depths and gain in clinical attachment levels and concluded that chitosan-loaded drugs can be an alternative treatment modality for patients with chronic periodontitis in recall intervals.


   Conclusion Top


New materials recommended for bone repair should be analyzed due to the increase in the number of invasive surgical treatments in periodontics. These materials should shorten the duration of treatments, eliminate pain, and ascertain faster recovery of the patient, biocompatible, and affordable. One such promising material in dentistry is chitosan. Increased usage of chitosan in periodontics will be more beneficial in periodontal nonsurgical treatments. With a thorough understanding of its properties and mechanism of action, the effective use of chitosan should be evaluated in different treatment modalities in larger sample.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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13.
Subbiah U, Elayaperumal G, Elango S, Ramanathan A, Gita B, Subramani K. Effect of chitosan, chitosan nanoparticle, anacyclus pyrethrum and cyperus rotundus in combating plasmid mediated resistance in periodontitis. Antiinfect Agents 2020;18:1.  Back to cited text no. 13
    
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Costa EM, Silva S, Pina C, Tavaria FK, Pintado M. Antimicrobial effect of chitosan against periodontal pathogens biofilms. SOJ Microbiol Infect Dis 2014;2:1-6.  Back to cited text no. 14
    
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Mukherjee DP. An animal evaluation of a paste of chitosan glutamate and hydroxyapatite as a synthetic bone graft material. J Biomed Mater Res Part B Appl Biomater 2003;67B: 603-9.  Back to cited text no. 16
    
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Kim NR, Lee DH, Chung PH, Yang HC. Distinct differentiation properties of human dental pulp cells on collagen, gelatin, and chitosan scaffolds. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:e94-100.  Back to cited text no. 18
    
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Popa L, Ghica MV, Dinu-Pirvu C. Periodontal chitosan-gels designed for improved local intra-pocket drug delivery. Farmacia 2013;61:240-9.  Back to cited text no. 20
    
21.
Jothi MV, Bhat KM, Pratibha PK, and Bhat GS. The evaluation of a biodegradable dental chip containing chlorhexidine in chitosan base as a targeted drug delivery in the management of chronic periodontitis in patients. Drug Dev Res 2009;70:395-401.  Back to cited text no. 21
    




 

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    Abstract
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   History
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