Influence of infliximab therapy on bone healing post-dental extraction in rats

Objective: TNF-alpha, which acts directly on osteoclastogenesis, may modify bone turnover. Thus, the objective of this study was to evaluate the influence of infliximab on extraction socket healing. Material and methods: Eighty-four Wistar rats were randomized into two groups (infliximab EV 5 mg / kg or saline EV 1 ml / kg) and submitted to lower first molar extraction protocol. The animals were sacrificed 1, 3, 7, 14, 21 and 28 days after surgery. The jaws were subjected to radiographic, histomorphometric, histochemical (picrosirius red) and immunohistochemical (TNF-alpha, RANKL and OPG) analysis. Results: No differences were observed between the groups in surgical difficulty parameters: mass of teeth, number of root fractures and surgical time. Lower area filling with bone as well as increased amounts of remaining cicatricial tissue were observed in the infliximab group at 14 days (p < 0.001). Lower scores for polymorphonuclear neutrophils were seen at 3 (p < 0.01) and 7 days (p < 0.001), lower mononuclear counts at 7 days (p < 0.01) and lower osteoclast counts at 7 and 14 days (p < 0.01 and p < 0.001, respectively). Additionally, reduced TNF-alpha, RANKL and OPG immunoreactivity were observed, especially at 7 days (p < 0.05). Conclusion: TNF-alpha inhibitor may alter the bone repair capacity after tooth extraction, especially in the initial repair periods, by lower expression of TNF-alpha, RANKL and OPG. Thus, additional caution may be needed in patients who use this class of medication after dental extraction.