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Cry Op Reserved Amniotic Membrane

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    Dr. Sangeeta Sehrawat

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    Innermost lining of fetal membrane that is in contact with thedeveloping fetus.

    Histologically: loosely connected to chorion, consists of a simple

    cuboidal epithelium, basement membrane, and an avascular

    stroma.

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    Adapted from Parry and Strauss (1998)

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    1. Reduce inflammation

    2. Diminish the occurrence of adhesions and scarring,

    3. Modulate angiogenesis,

    4.

    Promote wound healing,5. Promote epithelialization, maintains a normal epithelial

    phenotype

    6. Antimicrobial properties. (Solomon A et al)

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    A cryopreservation methodology was developed by Tseng to

    preserve the biologic properties that this tissue exhibits in

    utero.

    Factors contributing to its biologic actions of regulated

    through IL-1, -4, -6, epidermal growth factors, basic FGF,

    (TGF)-b, TGF-a, keratinocyte growth factor, neural growth

    factor, endostatins, anti-angiogenic factors, &collagen I, II,

    III, IV.

    Natural barrier to protect the fetus from infections &

    trauma because of the lack of a fetal immune system.

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    Applications:

    1. Ocular surface reconstruction: graft to replace damaged tissue,biologic dressing, or a combination of both.

    2. Helps in ocular surface wound healing & may be used for treatment of

    conjunctival & corneal lesions.

    3. Reduce acute inflammatory response in scalpel, laser surgery & burns.

    4. Management of Stevens-J

    ohnson syndrome.5. Decreases chronic inflammation & necrosis in HSV & VZV infected

    tissues: reduces recruitment of several populations of inflammatory

    cells including PMNs, CD3+ cells, CD4+ T cells, and CD11b+ cells.

    6. Facilitation of lipid peroxidation & apoptosis of keratinocytes

    (programmed cell death).

    7. Effective in covering and repairing extensive ocular defects afterexcision of masses >2.0 cm.

    Typically, the wounds heal without inflammation

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    Stromal side of graft attached to a white nitrocellulose filter paper

    This side is sticky compared with epithelial (shiny & non-sticky).

    CAM must be placed on the lesional surface with the stromal side incontact with the wound.

    Fibrin glue sticks to stromal side adherence of membrane, with or

    without suturing.

    Tissue damage is deep: multiple layers

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    Obtained from healthy maternal donors during an elective

    Caesarian section who are negative for hepatitis B, surfaceantigen and core antibody, hepatitis C, syphilis, HIV 1 & 2, and

    H T-lymphotropic virus 1 and 2 antibodies.

    Maternal tests are repeated on the donors 6 months after

    delivery and before clinical use is allowed.

    Donors are also screened for other infectious diseases;

    malignant, autoimmune, and neurologic conditions; and social

    habits and other exposures.

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    Epithelial healing occurs underneath layer of CAM. CAM does not fuse with host epithelium or prevent

    epithelialization.

    Completely dissolves after providing its therapeutic actions.

    Bari et al: in superficial burns, CAM adheres, remains until

    epithelialization is complete.

    Incorporated into host tissue when used as a substrate

    replacement or permanent graft.

    Excellent membrane for reconstructive surgery: easily

    accessible, ethically acceptable, easy to use, & easily stored

    without alteration to its therapeutic properties.

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    Would be effective in the prevention of unfavorable functional

    & cosmetic results related to periodontal surgical wound

    healing. Contains laminin , mitogenic growth factors, and anti-

    inflammatory proteins: ideal for supporting growth of

    epithelial cells, thus facilitating migration, reinforcing

    adhesion, and promoting differentiation.

    Anti-inflammatory effect by the facilitation of the apoptosis ofmacrophages.

    CAM suppresses tumor growth factor b1 and, therefore, the

    deposition of collagen.

    Fibronectin reduces myofibroblastic differentiation & collagen

    contraction: anti-scarring effect.

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    To assess the value of CAM in helping the

    cicatrization and wound healing afterplacement of dental implants.

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    15 pts (9 M + 6 F)

    Inclusion criteria: at least 2 bilateral dental implants with

    placement occurring during a single clinical session, be male or

    female patients >18 years.

    Exclusion criteria: pregnancy; a history of collagen diseases

    such as Sjogren syndrome, lupus erythematosus, scleroderma,

    dermatomyositis, or rheumatoid arthritis; immunodeficiency;

    infectious disease; infection at either surgical site or a history

    of radiation therapy to the head and neck. Moderate to severegingivitis and/or periodontal disease.

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    LA, crestal incisions over edentulous alveolar sites & full-thickness

    flaps. Osteotomies for implant placement, performed bilaterally.

    Before wound closure of experimental site, CAM was placed over thesurgical wound with stroma in contact tissues.

    Postop: 0.12% chlorhexidine gluconate rinses twice a day for 2 weeks.Amoxicillin (500 mg, 3/ day) for 1 week. Clindamycin if allergy to

    penicillin. Ibuprofen (800 mg, 3/day)

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    1) Self-reported pain (Likert scale), 0 = not present to10= worstpain imaginable.

    2) Wound size (mm) using UNC #15 probe. Lesion was measured

    across its greatest dimension.

    3) Degree of epithelialization: UNC #15. measured until complete

    healing. Measurements until complete healing occurred(complete epithelialization). Recorded as:

    0 = no epithelialization;

    + = initial epithelialization with connective tissue exposed;

    ++ =complete epithelialization.

    4) Clinically apparent scarring was recorded as 0 = not present; += present.

    5) Infection: 0 = not present; + = present.

    6) Any post-surgical adverse

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    Outcome measures obtained 7 times: at baseline

    (immediately after surgical procedure), 72 hours, 144

    hours, 2 weeks after surgery, and 1, 1.5, and 3 months

    after surgery.

    Code was broken, and the membrane and control sides for

    each patient were identified after all patients had been

    scored.

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    Non-parametricWilcoxon matched-pair rank-sum test was used

    for inferential testing because the sample size was relatively

    small, most measurements were ordinal in nature, and most

    distributions were non-normal, except for wound size, which

    showed a normal distribution at baseline (but not thereafteras healing progressed).

    Chi 2 analysis was used for yes/no categoric comparisons.

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    For 6 days

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    Scarring

    Inflammation: not significant

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    Limitations of the Study

    Small sample size: findings are preliminary.

    Type of lesion. No difference in the final outcome of the

    dental implant surgery was found. However, statistically

    significant differences regarding the cicatrization of thewound were noted.

    Not cost effective.

    However, the results are promising for other types of

    wounds.

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    Regarding dental implants, the placement of

    CAM was not cost effective.

    However, the results were promising for

    other types of wounds and new studies withlarger samples that evaluate other ulcerative

    oral conditions are encouraged.

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    Solomon A, Wajngarten M, Alviano F, et al. Suppression ofinflammatory and fibrotic responses in allergicinflammation by the amniotic membrane stromal matrix.Clin Exp Allergy 2005;35:941-948.

    Hong-Jeng Chen, Renato T F Pires, Scheffer C G Tseng.Amniotic membrane transplantation for severe

    neurotrophic corneal ulcers. Br J Ophthalmol 2000;84:826833

    Jin A Choi, Jun-Sub Choi, Choun-Ki Joo. Effects of amnioticmembrane suspension in the rat alkali burn model.Molecular Vision 2011; 17:404-412.

    Annamma John, John Oommen. Use of amniotic membranein dermatology. Indian J Dermatol Venereol Leprol2010;76:196-7.

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    Richard M. Jay, DPM, FACFAS. Initial Clinical Experience

    with the Use of Human Amniotic Membrane Tissue During

    Repair of Posterior Tibial and Achilles Tendons. Professor

    of Foot and Ankle Orthopedics, Temple University School

    ofPodiatric Medicine Div. of Orthopedics, Regional

    Medical Center, South Jersey Healthcare Vineland, New

    Jersey

    Ardeshir Lafzi. Amniotic membrane: A potential candidate

    for periodontal guided tissu regeneration? Medical

    Hypotheses (2007) 69, 454473

    Rinastiti M, Harijadi, Santoso ALS, Sosroseno W.

    Histological evaluation of rabbit gingival wound healing

    transplanted with human amniotic membrane. Int J Oral

    Maxillofac Surg 2006;35(3):24751.

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    Thank youThank you

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