Combination of anthocyanin ternatin and hydroxyapatite/β-tricalcium phosphate coralline as a socket preservation biomaterial in dental implant: A narrative review

Background: Tooth extraction is surgical treatment with clinical manifestation is alveolar bone resorption of 11-63% which potentially fails dental implant treatment. Socket preservation is bone regeneration treatment to minimize bone morphological changes in post-extraction using bone graft. Anti-inflammatory biomaterial is needed to modulate inflammatory cascade in the lesion. Anthocyanin ternatin is a flavonoid derived from butterfly pea (Clitoria ternatea) as an anti-inflammatory and antioxidants agent. Hydroxyapatite/β-Tricalcium Phosphate coralline (HA/β-TCP coralline) is a combination of bioceramic material from calcium carbonate heating of Porites spp. coral which has potential to induce osteogenesis, osteoinduction, and osteoconduction. Combination of Anthocyanin ternatin and HA/β-TCP coralline applied to the defect area in dried powder form to induce hard tissue regeneration. Purpose: To describe the potential of combination of Anthocyanin ternatin and HA/β-TCP coralline as a socket preservation biomaterial in dental implant. Review: Combination of Anthocyanin ternatin and dried powder HA/β-TCP coraline is applied in dental socket. Anthocyanin ternatin suppresses ROS and iNOS then inhibit NF-kB signaling pathway. Downregulation of the pathway decreases TNF-α and IL-1β/6 expression so the expression of RANKL is inhibited. Lowering of ROS followed by upregulated Ca2+ level from HA/β-TCP coralline causes the increase in DKK1 and PTEN expression so Akt and Wnt expression is induced. Upregulation of the proteins induces the BMP2/TGF-β/Smad1/5/8 signaling pathway activation manifest in the increase of Runx2, OCN, and Osx then the preosteoblast differentiation to osteoblast is increased. Conclusion: Combination of Anthocyanin ternatin and HA/β-TCP coralline is potential as socket preservation biomaterial in dental implant.