POSTER ID: LR25

The Utilization Of Milk Fish Chitosan For Bone And Soft Tissue
Regeneration After Tooth Extraction: A Literature Review
Arni Irawaty Djais1, Surijana Mappangara1, Asdar Gani1 , Shinta Rahma Mansyur2*,
Febrianty2, Nurfitra Abd Fatah2
of Periodontics Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia
1 Department
2 Periodontology Specialist Educational Program, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia

*Corresponding Author : shintarahmamansyur@gmail.com

Background &Objectives
Chitosan derived from milkfish scale chitin extraction is a polymer material that is biocompatible, biodegradable, and non-toxic.1 Chitosan has
been widely used as an antimicrobial, anti-inflammatory, bioactivity with dental materials, hemostasis and wound healing, and bone repair. 2
Wound healing after tooth extraction is a pathophysiological process that involves proliferation, cell migration, and tissue remodeling.3–5 The
ability of chitosan to regenerate tissue is expected to be used as a soft tissue regeneration material and scaffold for bone regeneration. This
literature review aims to discuss the ability of chitosan contained in milkfish scales to regenerate bone tissue and soft tissue after tooth extraction.

Source/Data Study Selection Milkf

ish C
h itosa
Data were n
collected t An initial search of Pubmed and
article sea hrough
rches on Cochrane found 392 articles.
and Cochr PubMed
ane publish Furthermore, 357 articles were
2016 to 20 ed from
22. Data se excluded because they did not meet
conducted arch was
using key the inclusion criteria desired by the
((Tooth Ex words;
traction) O author in the title and abstract, or
Regenerati R (Bone
on) ) OR there were duplications, so that 35
Tissue (Soft
Healing)) articles were obtained. Then from
(Chitosan). AND
these 35 articles, 24 articles were
excluded, and the final results were
11 articles that would be reviewed
and included in the synthesis table.

Literature Review
Discussion
1. Milkfish Scales Chitosan
Chitosan is a natural polysaccharide which is deacetylated The chitosan content of milkfish scales is
from chitin derived from the cell walls of fungi, crustaceans, obtained from chitin, and can reach 37.4% after
and insect exoskeletons. 7 Fish scales can be used as raw dehydration.7 Research shows that chitosan gel
material for chitin extraction and further modified into can stimulate macrophage cells to release the
chitosan. Fish scales with a content similar to bone contain cytokine TNF-α so that it has the effect of
potential antimicrobial materials that can be used as dental accelerating wound healing and early
materials.8 Chitosan from milkfish scales (chanos chanos) osteogenesis in the post-extraction socket.11,14
has antimicrobial activity against bacteria that cause However, chitosan itself has several
periodontitis.9 disadvantages, such as low water solubility at
2. Effect of Chitosan on Soft Tissue Regeneration neutral or high pH and low mechanical
properties.15 For this reason, several recent
Chitosan has been shown to promote tissue healing, studies have modified the surface of chitosan or
stimulate the production of platelet growth factors, and combined chitosan with other synthetic or
exhibit antibacterial activity that plays a role in reducing natural polymer materials, biomaterials, or
postoperative discomfort.10 Chitosan can increase tissue bioactive molecules to increase mechanical
granulation and angiogenesis, and accelerate wound resistance, protein absorption, and
healing.11 Chitosan is metabolized by certain enzymes so that biomineralization.13
it can be broken down and can act as a tissue engineering
scaffold.12 Conclusion
3. Effect of Chitosan on Hard Tissue Regeneration
Chitosan from milkfish scales has never been used for soft Milkfish scale chitosan has the potential as an anti-
inflammatory agent, stimulates the activity of fibroblasts,
tissue and bone regeneration. Chitosan has a positive effect
osteoblasts, and mesenchymal stem cell differentiation, as
on soft tissue and bone healing, both by stimulating anti- well as osteoconductive bone regeneration scaffold.
inflammatory cell and osteoblast activity, and by triggering However, the utilization will be better when combined with
the differentiation of mesenchymal stem cells into polymers/biomaterials, and/or other bioactive molecules to
osteoblasts. However, its use is limited, so it needs to be improve mechanical properties, protein absorption, and
combined with other materials to increase its utilization, both biomineralization of chitosan.
for its physical, chemical, and biological properties.13

References
1. Matica MA, Aachmann FL, Tøndervik A, Sletta H, Ostafe V. Chitosan as a wound dressing starting material: Antimicrobial properties and mode of action. Int J Mol Sci. 2019;20(23):1–34.
2. Kmiec M, Pighinelli L, Tedesco M, MM Silva, Reis V. Chitosan-Properties and Applications in Dentistry. Adv Tissue Eng Regen Med Open Access. 2017;2(4):205–11.
3. Mahdani FY, Nirwana I, Sunariani J. The decrease of fibroblasts and fibroblast growth factor-2 expressions as a result of X-ray irradiation on the tooth extraction socket in Rattus novergicus. Dent J (Majalah Kedokt Gigi). 2015;48(2):94.
4. Lunardhi LC, Kresnoadi U, Agustono B. The effect of a combination of propolis extract and bovine bone graft on the quantity of fibroblasts, osteoblasts and osteoclasts in tooth extraction sockets. Dent J (Majalah Kedokt Gigi). 2019;52(3):126.
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7. Cadano JR, Jose M, Lubi AG, Maling JN, Moraga JS, Shi QY, et al. A comparative study on the raw chitin and chitosan yields of common bio-waste from Philippine seafood. Environ Sci Pollut Res. 2020
8. Rumengan IFM, Suptijah P, Salindeho N, Wullur S LA. Nanochitosan From Fish Scales. 2018. 117 p.
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10. Pippi R, Santoro M, Cafolla A. The Use of a Chitosan-Derived Hemostatic Agent for Postextraction Bleeding Control in Patients on Antiplatelet Treatment. J Oral Maxillofac Surg. 2017;75(6):1118–23.
11. Gupta A, Rattan V, Rai S. Efficacy of Chitosan in promoting wound healing in extraction socket: A prospective study. J Oral Biol Craniofacial Res. 2019 Jan;9(1):91–5.
12. Ahmed S, Ikram S. Chitosan Based Scaffolds and Their Applications in Wound Healing. Achiev Life Sci. 2016;10(1):27–37.
13. Djais A, Mappangara S, Gani A, Achmad H, Endang S, Tjokro J, et al. The effectiveness of Milkfish (Chanos Chanos) scales Chitosan on soft and hard tissue regeneration intooth extraction socket: A literature review. Ann Rom Soc Cell Biol. 2021;25(3):8729–52.
14. Dash M, Chiellini F, Ottenbrite RM, Chiellini E. Chitosan - A versatile semi-synthetic polymer in biomedical applications. Prog Polym Sci. 2011;36(8):981–1014.
15. Keller L, Regiel-Futyra A, Gimeno M, Eap S, Mendoza G, Andreu V, et al. Chitosan-based nanocomposites for the repair of bone defects. Nanomedicine Nanotechnology, Biol Med. 2017;13(7):2231–40.

Presented at Poster Presentation at 1stJakarta Periodontic Seminar 2022, Jakarta, Indonesia.

29-30 October 2022.