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Clinical Efficacy of Piper betle L. Nanoemulgel as an Adjunct to Scaling and Root Planing in Chronic Periodontitis: A Randomized, Double-Blind, Placebo-Controlled Trial Muhammad Ashraf; Eduardo Michael Perez
Eureka Herba Indonesia Vol. 6 No. 1 (2025): Eureka Herba Indonesia
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ehi.v6i1.136

This study evaluated the clinical efficacy of a Piper betle L. (betel leaf) nanoemulgel as an adjunct to scaling and root planing (SRP) in chronic periodontitis through a randomized, double-blind, placebo-controlled trial. Sixty-four patients with Stage III Grade B periodontitis were randomized to P. betle nanoemulgel (5% w/w ethanolic extract standardized to ≥30 mg/g hydroxychavicol; n = 32) or placebo gel (n = 32), applied subgingivally at baseline, week 2, and week 4 as adjuncts to SRP, at a private hospital in Palembang, Indonesia. The nanoemulgel had a mean droplet size of 78.4 ± 12.6 nm, polydispersity index 0.218, zeta potential −32.6 mV, and encapsulation efficiency 87.3%. Primary outcomes were probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and gingival index (GI) at 12 weeks. The intervention group showed significantly greater PPD reduction (−2.58 ± 0.68 vs −1.56 ± 0.74 mm; p < 0.001; Cohen d = 1.43), CAL gain (d = 1.23), BOP reduction (d = 1.12), and GI improvement (d = 1.25). Gingival crevicular fluid TNF-α decreased to 18.4 ± 8.2 versus 28.6 ± 10.4 pg/mL (p < 0.001; d = 1.09). Adverse events were limited to mild transient burning in 12.5% of patients. Piper betle nanoemulgel provided significant adjunctive clinical benefit in chronic periodontitis through anti-inflammatory and antimicrobial mechanisms, supporting its integration into evidence-based herbal periodontal therapy.

Early Childhood Feeding Practices and the Development of Severe Early Childhood Caries (S-ECC): A Prospective Cohort Study in Medan, Indonesia Andhika Kurnianta Kusuma; Muhammad Ashraf; Yi-Fen Huang; Aprilia Sari; Firman Hadi; Sohyuk Kim
Scientific Journal of Pediatrics Vol. 3 No. 1 (2025): Scientific Journal of Pediatrics
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjped.v2i2.175

Introduction: Severe early childhood caries (S-ECC) is a significant public health problem, particularly in developing countries like Indonesia. Early childhood feeding practices are recognized as major risk factors, but prospective data from specific regions like Medan, Indonesia, are limited. This study aimed to investigate the association between various feeding practices and the development of S-ECC in a cohort of children in Medan. Methods: A prospective cohort study was conducted involving 450 mother-child dyads recruited from Posyandu (integrated health posts) in Medan, Indonesia. Baseline data on maternal demographics, socioeconomic status, oral health knowledge, and infant feeding practices were collected via questionnaires and interviews. Children were followed up at 6-month intervals for 36 months. Dental examinations were performed by calibrated dentists using the dmft index (decayed, missing, filled teeth) to diagnose S-ECC. Cox proportional hazards regression was used to analyze the association between feeding practices and S-ECC development, adjusting for potential confounders. Results: The incidence of S-ECC at 36 months was 38.2% (n=172). Prolonged bottle feeding (beyond 12 months) (Hazard Ratio [HR] = 2.15; 95% Confidence Interval [CI]: 1.55-2.98; p<0.001), nocturnal bottle feeding with sweetened liquids (HR = 2.85; 95% CI: 2.01-4.03; p<0.001), and frequent consumption of sugary snacks/drinks (≥3 times/day) (HR = 1.92; 95% CI: 1.38-2.67; p<0.001) were significantly associated with an increased risk of S-ECC. Exclusive breastfeeding for the first 6 months showed a protective effect (HR = 0.62; 95% CI: 0.45-0.86; p=0.004), even after adjusting for socioeconomic status and maternal oral health knowledge. Conclusion: This study confirms the significant impact of early childhood feeding practices on S-ECC development in Medan, Indonesia. Prolonged and nocturnal bottle feeding, particularly with sweetened liquids, and frequent consumption of sugary snacks/drinks were key risk factors. Promoting exclusive breastfeeding for the first six months and educating mothers about appropriate feeding practices are crucial for S-ECC prevention in this population.

Personalized Periodontal Regeneration: Integrating 3D Bioprinting with Autologous Activated Growth Factor (AGF) for Enhanced Alveolar Bone Defect Healing Zelka Dapala; Rachmat Hidayat; Muhammad Ashraf
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1605

Background: The complete structural restoration of alveolar bone defects remains a critical challenge in reconstructive periodontology. Conventional grafting methods often fail to replicate the complex microarchitecture of periodontal tissues. This study integrated three-dimensional bioprinting technology with Autologous Activated Growth Factor to construct personalized scaffolds for treating severe infrabony periodontal defects. Methods: A randomized controlled clinical study was conducted at a private hospital in Palembang, South Sumatera, involving patients with Stage III periodontitis exhibiting vertical alveolar bone defects. Cone-beam computed tomography data guided the precise three-dimensional bioprinting of polycaprolactone and beta-tricalcium phosphate scaffolds. These constructs were functionalized operatively with Autologous Activated Growth Factor prepared from peripheral blood. The control group received conventional deproteinized bovine bone mineral with a collagen membrane. Clinical attachment level, probing depth, and radiographic bone fill were evaluated over six months. Results: The three-dimensional bioprinted scaffolds functionalized with Autologous Activated Growth Factor demonstrated superior clinical outcomes. At six months, the experimental group showed a mean probing depth reduction of 4.82 mm and a clinical attachment level gain of 4.15 mm. Radiographic analysis revealed a mean bone fill of 82.4% in the experimental group compared to 64.1% in the control. Inflammatory biomarkers were significantly modulated, indicating a highly favorable regenerative microenvironment. Conclusion: The synergistic integration of personalized three-dimensional bioprinted scaffolds with the potent osteoinductive and angiogenic properties of Autologous Activated Growth Factor significantly enhanced alveolar bone defect healing, providing a highly predictable alternative for complex periodontal regeneration.

Personalized Periodontal Regeneration: Integrating 3D Bioprinting with Autologous Activated Growth Factor (AGF) for Enhanced Alveolar Bone Defect Healing Zelka Dapala; Rachmat Hidayat; Muhammad Ashraf
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1605

Background: The complete structural restoration of alveolar bone defects remains a critical challenge in reconstructive periodontology. Conventional grafting methods often fail to replicate the complex microarchitecture of periodontal tissues. This study integrated three-dimensional bioprinting technology with Autologous Activated Growth Factor to construct personalized scaffolds for treating severe infrabony periodontal defects. Methods: A randomized controlled clinical study was conducted at a private hospital in Palembang, South Sumatera, involving patients with Stage III periodontitis exhibiting vertical alveolar bone defects. Cone-beam computed tomography data guided the precise three-dimensional bioprinting of polycaprolactone and beta-tricalcium phosphate scaffolds. These constructs were functionalized operatively with Autologous Activated Growth Factor prepared from peripheral blood. The control group received conventional deproteinized bovine bone mineral with a collagen membrane. Clinical attachment level, probing depth, and radiographic bone fill were evaluated over six months. Results: The three-dimensional bioprinted scaffolds functionalized with Autologous Activated Growth Factor demonstrated superior clinical outcomes. At six months, the experimental group showed a mean probing depth reduction of 4.82 mm and a clinical attachment level gain of 4.15 mm. Radiographic analysis revealed a mean bone fill of 82.4% in the experimental group compared to 64.1% in the control. Inflammatory biomarkers were significantly modulated, indicating a highly favorable regenerative microenvironment. Conclusion: The synergistic integration of personalized three-dimensional bioprinted scaffolds with the potent osteoinductive and angiogenic properties of Autologous Activated Growth Factor significantly enhanced alveolar bone defect healing, providing a highly predictable alternative for complex periodontal regeneration.

The Pentahelix Approach to Oral-Systemic Health Integration: A Policy Framework for Academic-Primary Care Partnerships in Transitional Health Systems Zelka Dapala; Rachmat Hidayat; Muhammad Ashraf
Community Medicine and Education Journal Vol. 6 No. 2 (2025): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v6i2.877

The historical bifurcation of dental and medical care pathways imposes a severe epidemiological burden, particularly within transitional health systems confronting a high prevalence of both non-communicable diseases and chronic periodontitis. Bridging this gap requires robust policy frameworks that extend beyond clinical interventions to involve cross-sectoral collaboration. To evaluate the structural efficacy, clinical outcomes, and policy implications of integrating oral-systemic healthcare using a Pentahelix collaborative model between primary healthcare centers and academic dentistry institutions in South Sumatra, Indonesia. A mixed-methods implementation study was conducted over eighteen months across twelve primary care centers in South Sumatra. The intervention utilized the Pentahelix model, integrating government authorities, academic dentistry faculties, health technology industries, community leaders, and local media. Quantitative data included inter-departmental referral completion rates, changes in patient glycemic control (HbA1c), and systemic inflammatory markers (C-Reactive Protein). Qualitative data assessed stakeholder engagement and interprofessional competencies. Implementation of the Pentahelix framework significantly improved medical-dental cross-referral completion rates from a baseline of twelve percent to seventy-six percent. Clinically, patients with comorbid type 2 diabetes and severe periodontitis receiving integrated care demonstrated a mean HbA1c reduction of 0.9% and a significant decrease in serum C-Reactive Protein levels following combined medical and non-surgical periodontal therapy. Furthermore, interprofessional competency scores among participating academic students and primary care staff increased significantly. In conclusion, the Pentahelix model provides a viable, highly effective policy framework for dismantling clinical silos in transitional health systems. By anchoring interprofessional clinical practice within a multi-stakeholder governance structure, health systems can achieve measurable improvements in both population health metrics and health workforce readiness.

Glycated Hemoglobin (HbA1c) as a Predictor of Periodontal Disease Progression in Patients with Type 2 Diabetes: A Longitudinal Study in Surabaya, Indonesia Alexander Mulya; Muhammad Ashraf; Muhammad Yoshandi; Ayesh Mahmood; Daphne Marshall
Sriwijaya Journal of Internal Medicine Vol. 3 No. 1 (2025): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v2i2.178

Introduction: Periodontal disease is a prevalent complication of type 2 diabetes mellitus (T2DM), and poor glycemic control is a known risk factor. This longitudinal study aimed to investigate the predictive value of glycated hemoglobin (HbA1c) for periodontal disease progression in a cohort of T2DM patients in Surabaya, Indonesia. Methods: A prospective cohort study was conducted at private hospital, Surabaya, Indonesia, from January 2021 to January 2023. 180 patients with T2DM and pre-existing chronic periodontitis were enrolled. Periodontal parameters, including probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and plaque index (PI), were assessed at baseline, 12 months, and 24 months. HbA1c was measured at each visit. Multivariate linear regression and mixed-effects models were used to analyze the association between HbA1c and changes in periodontal parameters over time, adjusting for potential confounders. Results: The mean age of participants was 58.5 ± 8.2 years, and 55% were female. Baseline mean HbA1c was 8.2 ± 1.5%. After adjusting for age, gender, smoking status, diabetes duration, and baseline periodontal parameters, higher baseline HbA1c was significantly associated with greater increases in PPD (β = 0.15 mm per 1% HbA1c increase, 95% CI: 0.08-0.22, p < 0.001) and CAL (β = 0.18 mm per 1% HbA1c increase, 95% CI: 0.10-0.26, p < 0.001) over 24 months. Furthermore, sustained elevation of HbA1c (average HbA1c over 24 months) was a stronger predictor of periodontal disease progression than baseline HbA1c alone. A significant interaction between HbA1c and time was observed (p < 0.001), indicating that the effect of HbA1c on periodontal parameters increased over time. Conclusion: HbA1c is a significant independent predictor of periodontal disease progression in patients with T2DM. Sustained glycemic control is crucial for preventing and managing periodontal complications in this population. These findings highlight the importance of interdisciplinary collaboration between internists and dentists in the comprehensive care of T2DM patients.

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