Volume 6, Issue 8, August – 2021 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Placenta Extract & Castor Oil

(Next Generation Wound Healer)
Innovations in Wound Healing by Mother’s & Nature’s Touch
Another Era of Healing in Periodontal Surgery

1st Author’s name - Dr. Vineeta Gupta 2nd Author: Dr. Jithendra K.D.
Designation: Senior Lecturer , Designation: Professor and Former Head of Department,
Dept of Periodontics &; Oral Implantology, Dept of Periodontics &; Oral Implantology
KD Dental College &; Hospital, Mathura KD Dental College &; Hospital , Mathura

3rd Author: Dr. Umesh Chandra Prasad 4th Author : Dr. Shailendra s. Chauhan
Designation: Professor and Head of Department, Designation: Professor and Head of Department,
Dept of Oral Pathology &; Microbiology Dept of Periodontics &; Oral Implantology
KD Dental College &; Hospital , Mathura KD Dental College &; Hospital Mathura

5th Author : Dr. Satendra Sharma 6th Author : Dr Shailesh Singh

Reader , Dept of Periodontics &; Oral Implantology Senior Consultant
KD Dental College &; Hospital, Mathura MAA Saraswati Hospital Campus , Mathura

Abstract:- Result
Marked improvement was reported in wound
Background healing considering time and treatment effect in all
Herbs and animals are used either whole or in part groups, faster wound healing observed in Coe pack &
have proved to be effective therapeutic remedies. It has Placentrix group compared to Castor oil group ,however
been claimed, Placental extract plays a beneficial role as in intergroup comparisonin 1st week there is faster
a topical agent in the management of chronic non- healing in Coepack is reported but P value is not
healing wounds & castor oil is anti-inflammatory when significant , P value is significant with castor oil in 1 st
externally applied to injuries. Where as periodontal week , in 2nd week healing is faster reported in Placentrix
dressing reduces the risk of wound infection, bleeding group then other two group but P value is not significant
and granulation tissue formation and improves tissue . In 3rd & 4th week no significant value is reported
healing. This study evaluated efficacy of these extracts between three groups . Post‑operative evaluation of the
on wound healing. NIPC PAIN SCALE score revealed that the discomfort
and pain level associated with Placentrix & castor oil
Aim was significantly lower than conventional Coe pack
Assess the role of placenta extract & castor oil dressing postoperatively ,on comparison of all three
along with periodontal dressing in surgical wound groups P value found to be significant. While in cases of
healing process . plaque index at 1st week of depigmentation procedure
plaque value found to be significant & more plaque
Material & Methods accumulation is found in that case of Coepack dressing
A randomized controlled clinical trial including alone ,while there is no significant difference found in
thirty (30) patients. Patients were divided into 3ngroups. between Placentrix & castor oil grouping.
Patients were selected on the basis of inclusion and
exclusion criteria. Surgical procedure will be performed Conclusion
. Primary efficacy outcome assessed by Landry index It may be concluded that Placentrix & castor oil
and Pain Assessment Scales. The secondary efficacy are a safe and low cost medicament and may feasibly
outcome were changes in Plaque index ( Sillness & Loe apply to promote wound healing & topical analgesic for
1964 ) followed by histological evaluation at 7th day of intra oral surgeries, especially in whom underlying
surgery. The patients will be followed 1 week systemic and local diseases that further disturb healing
postoperative followed by 2nd week , 3rd week, and 1 processes.
month.
Keywords:- Placentrix &, Castor Oil.

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I. INTRODUCTION application on surgical site followed by periodontal pack
mixing with castor oil in the ratio of 1:1 applied over the
Dr. A.W Ward in 1923 first introduced periodontal surgical site .
dressings , who has proposed the use of periodontal dressing
following periodontal surgery. Periodontal dressings are One surgeon performed surgeries for each patient &
oftenly used for accelerated wound healing following was performed with blade no. 15 under 2% lignocaine local
periodontal surgery by periodontist. anaesthesia in the anterior maxillary region from right
premolar area to the left premolar area. Once the procedure
The Placenta, is a fetomaternal organ serves as a was completed, The patients were instructed to, avoid eating
natural treasure of many biologically active components spicy food and brushing the operated sites till the next visit.
with significant healing properties . According to Wuet al.,
2003 the placenta extract is very much efficient in curing in III. CLINICAL PARAMETERS & EFFICACY
high degree burn injury & chronic non-healing wounds OUTCOME
including post-surgical dressings .
Gingival pigmentation:
At the first sign of illness, Many grandmothers and gingival pigmentation observation were made according to
parents would immediately turn to giving their baby castor Dummett‑Gupta Oral Pigmentation Index.
oil either topically or internally for increasing immunity & 0 ‑ No clinical pigmentation (pink gingiva)
speedy recovery of injury since decades. . Castor oil is the 1 ‑ Mild clinical pigmentation (mild light brown color)
“Arnica of Ayurveda.'” and treats bruising & damaged 2 ‑ Moderate clinical pigmentation (medium brown or
connective tissue and epithelium. mixed pink and brown color)
3 ‑ Heavy clinical pigmentation (deep brown or bluish
Collectively, based on superb mentioned properties we black color).
aimed to investigate Placentrix & Castor oil role in
accelerating wound healing after periodontal surgery with Clinical picture were taken preoperatively, during the
the help of Coepack also called as “Wondrpack” , with the surgical procedure,after the depigmentation surgical
aim of protecting the surgical site, , immobilization of the procedures and at 1st , 2nd , 3rd and 4th week post
surgical site, enhancing patient comfort after depigmentation operatively. they are asked to report any side effects result
esthetic procedure. of & during active or passive treatment.

II. MATERIALS AND METHODS Primary efficacy outcome was landry healing index
changes at 1st, 2nd, 3rd and 1 month follow-up, & NIPC
Gingival depigmentation is a periodontal esthetic assessment tool. The patients filled out a questionnaire about
procedure.. Through depigmentation procedure aims is pain and discomfort on basis of The National Initiative on
reducing this hyperpigmentation result in pink esthetics . Pain Control™ (NIPC™) including face rating scale ,
numeric pain scale &pt questionnaire the secondary
This study was approved by the Ethical Committees at outcomes were Plaque indices( Sillness & Loe 1964 ) was
kanti Devi Dental College & Hospital Mathura. Thirty recorded at baseline & all the two weeks of followed by
patients were selected from OPD of Dept of Periodontics & histological evaluation at 7th day of surgery with the help of
oral implantology age group 17-35 years in which 18 punch biopsy instrument,(5mm diameter) besides safety
female and 12 male who had concern regarding black gums. issues and disturbance in healing process. All surgeries and
They were classified on basis of the Dummett-Gupta Oral index recordings were done by an Periodontist in
Pigmentation Index (DOPI) . independent manner with a blinded manner in order to
exclude biases , no information was given to patients
The exclusion criteria were: periodontal dressing advantage & disadvantages in order to
1. In the past six months history of antibiotic treatment remove its psychological impact.
2.Pt is on or history of steroid therapy past 6 month
3.Pt is on hormonal therapy past 6 month Histological examination
4. History of Diabetes mellitus For all three dressing materials evaluation and tissue
5. History of any systemic disease response observation at the microscopic level, 5mm
6. History of smoking standred punch biopsy was taken at the end of 7th day of
depigmentation surgery from maxillary & madibular
After taking the patients consent , subjects assigned attached gingiva at the canine & 1st premolar region using a
into three groups of A and B & C., In group A, after disposable 5 mm diameter puch biopsy instrument. By
depigmentation procedure the first group A surgical site Hematoxyilin and Eosin (H and E) staining method
only Periodontal pack (COE-PAK TM G.C, America, Inc.) epithelium & connective tissue properties is observed in
was applied . For group B, periodontal dressing mixing with selected sites in each group. The interpretation was done at
commercially available preparation of placenta extract ×100 magnification by an independent examiner.
Placentrix topical application on the surgical site followed
by at the ratio of 1:1 at the mixing stage in coepack applied
over the surgical site , In group C, castor oil topical

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Volume 6, Issue 8, August – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
one way ANOVA is applied. , P<0.05 considered as the
level of significance in the present study .

IV. RESULTS

Marked improvement was reported in wound healing

considering time and treatment effect in all groups, however
faster wound healing observed in Coe pack & Placentrix
Punch biopsy 5 mm diameter at 7th day of surgery group compared to Castor oil group ,however in 1st week
there is faster healing in Coepack 3.40 then placentrix 3.30
Statistical analysis but P value is not significant however is significant with
Statistical Package for Social Sciences (SPSS Inc., castor oil 2.80 , in 2nd week healing is faster reported in
Chicago, IL, version 11.0 for windows) software helps in Placentrix group ,which is not significant . In 3rd & 4th week
Statistical analysis . For qualitative variables, mean and no significant value is reported between three groups as
standard deviation were calculated. Means were compared shown in Table 1
for three groups using chi square test. and for intergroup
comparisons, Kruskal wallis test applied.For Plaque indices

Table 1
landry healing GROUP A (coe GROUP GROUP C(castor
index Chi-
pack) B(placentrix) oil) P-value Inferences
Square
Mean S.D. Mean S.D. Mean S.D.
WEEK I 3.40 0.70 3.30 0.48 2.80 0.42 6.110 0.047 S
WEEK II 3.80 0.42 4.10 0.32 3.70 0.48 4.505 0.105 NS
WEEK III 4.20 0.63 4.20 0.42 4.10 0.57 0.223 0.894 NS
WEEK IV 4.90 0.32 4.90 0.32 4.80 0.42 0.558 0.757 NS

Post‑operative evaluation of the NIPC PAIN SCALE score revealed that the discomfort and pain level associated with
Placentrix was significantly lower than conventional Coe pack dressing postoperatively ,on comparison of all three groups P
value found to be significant ,as shown in table 2 and table 3.

Table 2
GROUP
GROUP A (coe pack) GROUP C(castor oil) Chi- P-
B(placentrix) Inferences
Square value
Mean S.D. Mean S.D. Mean S.D.
INTENSE SCALE 2.70 0.82 2.40 0.52 4.50 1.08 15.984 0.000 S
SHARP SCALE 3.70 0.95 2.10 0.74 3.80 1.14 13.166 0.001 S
HOT SCALE 3.70 0.95 2.20 0.63 2.70 0.67 11.856 0.003 S
COLD SCALE 4.40 0.97 2.70 0.95 5.30 0.95 17.405 0.000 S
SENSITIVE SCALE 4.70 0.95 2.00 0.47 5.00 0.94 20.386 0.000 S
TENDER SCALE 3.90 0.88 2.00 0.47 5.20 1.23 21.653 0.000 S
ITCHY SCALE 3.80 0.79 2.10 0.57 5.50 0.85 23.654 0.000 S
SHOOTING PAIN 3.70 0.67 1.80 0.63 4.20 0.63 20.869 0.000 S
NUMB SCALE 3.50 0.71 1.80 0.42 3.90 0.99 18.297 0.000 S
ELECTRICAL
3.70 0.67 1.90 0.74 3.50 0.97 15.909 0.000 S
SCALE
TINGLING SCALE 3.60 0.97 2.10 0.88 5.00 0.94 18.952 0.000 S
CRAMPING SCALE 4.00 0.67 1.80 0.42 3.60 1.07 18.318 0.000 S
RADIATING
2.90 0.88 2.30 0.67 3.60 0.52 11.284 0.004 S
SCALE
THROBBING
3.10 0.57 2.00 0.67 4.50 1.43 18.656 0.000 S
SCALE
ACHING SCALE 3.33 0.71 2.10 0.57 5.20 0.92 22.522 0.000 S

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Volume 6, Issue 8, August – 2021 International Journal of Innovative Science and Research Technology
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Table 3
Group A Group B Group C Chi-
P-value Inferences
Coe pack Placentrix Castor oil Square
Mean S.D. Mean S.D.
WONG BAKER FACES
2.60 0.70 1.70 0.48 3.30 0.67 16.692 0.000 S
PAIN RAITING SCALE
NUMERIC PAIN
3.30 0.67 2.00 0.47 2.90 0.57 15.088 0.001 S
RATING SCALE

While in cases of plaque index at 1st week of depigmentation procedure plaque value found to be significant & more plaque
accumulation is found in that case of Coepack dreesing alone ,while there is no significant difference found in between Placentrix
& castor oil grouping.

Table 4 Plaque index (ONE WAY ANOVA)

GROUP A (coe pack) GROUP B(placentrix) GROUP C(castor oil)
F P-value Inferences
Mean S.D. Mean S.D. Mean S.D.
Base Line 0.92 0.26 0.92 0.23 0.90 0.26 0.021 0.979 NS
I 1.68 0.44 1.30 0.32 1.28 0.38 3.471 0.046 S
II 0.89 0.21 0.86 0.19 0.85 0.17 0.12 0.888 NS

Figure 1 Group A

At day 7 th in histological examination, in the control group (Group A), lamina propia shows severe chronic inflammatory
cell infilteration below the epithelium followed by moderate tissue disruption & marked oedema also reported., (Figure 1 ), In the
group B, we observed poor signs of inflammatory response in the connective tissue ,dense accumulation of relatively well-aligned
new collagen fibers and relatively complete integrity between the epithelial cells . In the group C modeate chronic inflammatory
cell infilteration in the connective tissue with mild tissue disruption. Our result suggested that wounds treated with this novel
periodontal dressing (Placentrix ) has all the gold standard of complete healing one week postoperatively. A histological picture of
H&E stained sections of surgical wound one week post-operatively of Group C shows Mild persisting inflammatory response
with moderate repair parameters,new blood vessels observed ,showing better result than Group A but lesser healing than Group B

Group B

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Group C

V. DISCUSSION of the B1-receptor thereby exerting its anti-

inflammatory effect .
Wound Healing can be described as body reaction to  Extract also helps in activation of the clotting cascade
any injury or surgical procedure for restoration of normal by trauma which results in platelet activation, followed
function and structural integrity of tissue. Periodontal by aggregation
dressings is one of the factors that play an important role for  an extract of human placenta has also shown to
the healing to take place properly . A periodontal dressing stimulate collagen synthesis in vivo in rats.
may be used therapeutically with or without surgery.  By evidence it has been seen that placentrix promotes
However Coepak is the most commonly used noneugenol fibrogenesis, neoangiogenesis and epithelialisation.
dressing. Across the various researches it has been claimed  According to Chakraborty et al., 2009 Globally, the
that placenta has the rich regenerative power that it can extract is now recommended as an effective healer in
regenerate any part of any organ of the body. In 1912 burn injuries, chronic non-healing wounds, post surgical
Filatov started the principle of transplantation by using the dressing.
concept of grafting human corneas by using of preserved  Human and animal models show that placental extract
tissue. He reported that when tissue originated either from has an immune -stimulating action both at cellular and
human or animal are kept to the environmental factors that humoral levels.
hinder or stop their vital activity they accommodate  It activates IgG and IgM at the humoral level and total
biochemical changes resulting by doing this tissue develop lymphokines at the cellular level.
some substances that regulate their vital activity named as
Biogenic stimulator according to Filatov (1951). He Ricinus communis has a following magical effects on
implemented this principle to general medicine for other the wound healing process-
human tissues.  castor oil’s most important applications for supporting
the immune system.
Human placenta has the following actions in the body:
 Castor oil has properties of increasing type of special
 Accelerates cellular metabolism providing the energy white blood cells that act like antibodies ( the count of
for the inflammatory response to occur. T-11 cells) produced within the body’s lymphocytes
 According to Hong et al., 2010 it helps in management that help kill viruses, fungi, bacteria and cancer cells.
of bacterial load that are healthy for wound healing
 90 percent of its fatty acid content is a specific and rare
 It activates tissue regenerative capacity. compound called ricinoleic acid. Castor oil is
 Placenta extract also contain nucleotides like PDRNs considered unique because ricinoleic acid is not found
and NADPH that are known for their regeneration in many other substances, and it’s such a dense,
 It also activates growth factors and small peptides that concentrated source.
help in matrix formation and cell adhesion, thereby  Apart from its primary ingredient, ricinoleic acid,
promoting wound healing . castor oil also contains certain beneficial salts and esters
 Extracellular matrixes such as collagen, laminin, and that function primarily as skin-conditioning agents
fibronectin are also present which help in later phase of  It also improves blood flow & circulation of the body ,
healing process which helps the body better fight infections and heal
 .Placental extract plays a beneficial role as a topical wounds.
agent because it has anti-inflammatory and antiplatelet  Castor oil also works like a natural antibacterial,
aggregation activity, by inhibition/inactivation of antifungal and antimicrobrial agent
chemical mediators or by directly modulating  Lymph flow also improves with castor oil use, which
prostaglandin (PG) Kinins, can help speed up the removal of cellular-related toxins
 Through study it has been seen that in cotton pellet and therefore lowers levels of swelling, redness and
induced subacute inflammation model it act as inhibitor inflammation at the root of most diseases.

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Applying this concept first time castor oil & mixed in ratio of 1:1 during mixing increases the setting
Placentrex used with COE PACK to evaluate the healing time and improves adaptability of pack at surgical sites.
effect in depigmentation procedure . NIPC pain assessment diagnostics tool revealed that
WONG BAKER FACES PAIN rating scale is higher where
In this study, patients demonstrated more pain and castor oil used( graph 2) then Coe pack dressing alone ,but
discomfort in the Coepack alone treated sites than Coepack NUMERIC PAIN rating scale is lower than Coepack
with Placentrix treated sites during the first 7th day dessing using alone(graph 3 )
postoperatively. TheNIPC pain assessment scale ( which
includes WONG BAKER FACES PAIN RATING SCALE , While in cases of PAIN ASSESSMENT
NUMERIC PAIN RATING SCALE & PAIN QUESTIONARE which is a part of NIPC pain assessment
QUESTIONARE ) is an established method for assessing scale found to be lower in cases Coepack & Placentrix site
pain or discomfort responses of patients , Patient feel almost however Castor oil does not show any beneficiary effect
no pain and discomfort site treated with Placentrix added in over conventional Coepack dressing.altough patient uses
Coepack ratio of 1:1 during mixing procedure ( as seen in more pain after using at surgical site of castor oil used (
graph 1 & graph 2 , 3 ),although setting time is decreased graph 1 )
after mixing with Placentrix, while in cases of Castor oil

6.00
5.50
5.30 5.20 5.20
5.00 5.00
5.00 4.70
4.50 4.40 4.50
4.20
3.90 3.90 4.00
4.00 3.803.70
3.70 3.80 3.70 3.70 3.60
3.50 3.50 3.60 3.60
3.33
3.10
Mean

2.90
3.00 2.70 2.70 2.70
2.40 2.30
2.10 2.20 2.10 2.10 2.10
2.00 2.00 1.90 2.00
2.00 1.80 1.80 1.80

1.00

0.00

GRAPH 1
GROUP A (coe pack) GROUP B(placentrix) GROUP C(castor oil)

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4.00
3.30
2.60
3.00
Mean
1.70
2.00
1.00
0.00 GRAPH 2

WONG BAKER FACES PAIN RAITING SCALE

GROUP A (coe pack) GROUP B(placentrix) GROUP C(castor oil)

3.30
3.50
3.00 2.90
2.50 2.00
Mean

2.00
1.50
1.00
0.50
0.00 GRAPH 3

NUMERIC PAIN RATING SCALE

GROUP A (coe pack) GROUP B(placentrix) GROUP C(castor oil)

As shown in graph 4, group A & group B shows faster healing then group C ,while plaque accumulation is more in cases of
group A then Group B & Group C. (Graph 5)

5.00 4.904.904.80
4.10 4.204.204.10
4.00 3.403.30 3.80 3.70

3.00 2.80
Mean

2.00

1.00

0.00
GRAPH 4
WEEK I
WEEK II
WEEK III
GROUP A (coe pack) WEEK IV
GROUP B(placentrix)
GROUP C(castor oil)
LANDRY HEALING INDEX

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1.80 1.68
1.60
1.40 1.30 1.28
1.20
0.92 0.92 0.90
Mean

1.00
0.80 0.89 0.86
0.85
0.60
0.40
0.20
0.00

Base Line
I
II

PLAQUE INDEX GRAPH 5

GROUP A (coe pack) GROUP B(placentrix)

The histological picture of surgical site of the control group shows greater inflammatory cells and less collagen fibers
arrangement then (B, C ) Test group shows greater connective tissue formation with more mature collagen ,result in more firm
gingiva .However Placentrix shows mature healing then castor oil group.

VI. CONCLUSION

Now it may concluded that Placentrex is a topical wound healer , safe & cost effective, and may readily applied to promote
wound healing and has superadditive effect as topical analgesic for intra oral surgeries, especially in whom underlying systemic
and local diseases that further delayed healing . Putatively, this relative newly approached remedy with traditional background is
recommended. however further randomized control trial required for observing Magical touch of Mother’s fluid Placentrix &
Palm Christ castor oil.

VII. CLINICAL PICTURES

CASE 1 ( COE PACK )

Preoperative Postoperative

After de epithelization After Coepack placement

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after 7 day postoperatively After 2 week postoperatively

After 3 week postoperatively after 4th week postoperatively

CLINICAL CASE NO- 2

Preoperatively Postoperatively

After immediately deepithelization

After Coepack placement (mixed with Placentrix in the ratio of (1:1 )

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Healing after 7th day of depigmentation procedure

After 2 week postopertively After 3 week postopertively

After 4 week postopertively

CLINICAL CASENO .3

Castor oil placement

Preoperative Postoperative

After deepithelization

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After Coepack placement After 7 th day

After 2 week postoperatively After 3 week postoperatively

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