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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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