Home | About us | Editorial board | Ahead of print | Current issue | Archives | Search | Submit article | Instructions | Subscribe | Advertise | Contact us |  Login 
National Journal of Maxillofacial Surgery
Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 782

Table of Contents
Year : 2011  |  Volume : 2  |  Issue : 2  |  Page : 132-136  

Clinical evaluation of cissus quadrangularis and moringa oleifera and osteoseal as osteogenic agents in mandibular fracture

1 Department of Oral and Maxillofacial Surgery, CSM Medical University, Lucknow, India
2 International Institute of Herbal Medicine, Gomti Nagar, Lucknow, India
3 Department of Anaesthesiology, CSM Medical University, Lucknow, India

Date of Web Publication31-Mar-2012

Correspondence Address:
Vibha Singh
A-43, Krishna Nagar, Lucknow
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-5950.94466

Rights and Permissions

Background: Ayurveda the ancient science of medicine describes various herb preparations that achieve the hastening of bone healing. Harjor showed clinical efficacy in the treatment of fractures. Objectives: The comparative evaluation of herbal agents as osteogenic agents in mandibular fractures. Study design: The patients were divided into four groups. Group 1: Osteoseal; Group 3: Harjor (Cissus quadrangularis); Group 2: Moringa (Moringa Oleifera); Group 4: Placebo. Result and Conclusion: Pain, Swelling, Tenderness, Mobility reduction is maximum in Osteoseal group and minimum in Placebo. There was an increase in the serum calcium and phosphorus level at different follow-ups in each groups but there was a decrease in the placebo group. Ca, Ca+, Phosphrous increase was maximum in the group 1.

Keywords: Osteogenic, prana, Asthisanghara

How to cite this article:
Singh V, Singh N, Pal U S, Dhasmana S, Mohammad S, Singh N. Clinical evaluation of cissus quadrangularis and moringa oleifera and osteoseal as osteogenic agents in mandibular fracture. Natl J Maxillofac Surg 2011;2:132-6

How to cite this URL:
Singh V, Singh N, Pal U S, Dhasmana S, Mohammad S, Singh N. Clinical evaluation of cissus quadrangularis and moringa oleifera and osteoseal as osteogenic agents in mandibular fracture. Natl J Maxillofac Surg [serial online] 2011 [cited 2022 Dec 10];2:132-6. Available from: https://www.njms.in/text.asp?2011/2/2/132/94466

   Introduction Top

Fractures of the jaw bones render not only physical trauma but al so makes the person miss out on work productivity and other social obligations for a period ranging from four to eight weeks on an average.

Fractures of the jaw bones, like other bones of the body take a reasonably long time to heal. Attempts have been made through the centuries to be able to reduce this period of six to eight weeks, either by means of improved surgical technology or by interfering with the physiological mechanism of bone healing.

Ayurveda the ancient science of medicine describes various herb preparations that achieve the hastening of bone healing.

In Ayurveda most of the names of the plants have been given according to their medicinal values.

The plant is known as Harshankar in Hindi and Asthisanghara in Sanskrit. Harjor means that which joins the bones (har is bone, jor the one which joins).

   Materials and Methods Top

Patients with jaw fracture were selected randomly from the outpatient department of the Oral and Maxillofacial Surgery and Trauma center. Patients with mandible fracture and associated undisplaced maxilla, zygomatic complex fracture were also included. Patients on steroid therapy or immunosuppressants and suffering from any other chronic debilitating diseases were not included in this study. The drugs were provided by the International Institute of Herbal Medicine in capsule form. The dose was two capsules twice/day with meals.

A total of 44 patients were included in this study and divided into four groups [Table 1], [Table 2], [Table 3] and [Table 4].
Table 1: Osteoseal (Group 1) analysis of clinical variables at different time intervals

Click here to view
Table 2: Moringa olifera (Group 2) analysis of clinical variables at different follow-ups

Click here to view
Table 3: Harjor (Group 3)

Click here to view
Table 4: Placebo (Group 4) comparison of clinical variables at different follow-up

Click here to view

Group 1: Osteoseal

Group 3: Harjor (Cissus quadrangularis)

Group 2: Moringa (Moringa Oleifera) [1]

Group 4: Placebo

The capsules were provided by the International Institute of Herbal Medicine and they were certified organic, they were free from any pesticides and chemicals and heavy metals. These were freshly powdered whole herb part dried to low moisture content of 6-7% and then grinded with slow grinders at low temperature. This specific limit of moisture prevents the degradation of the phyto chemicals and also the chemical reaction between different in poly-herbal formulations. This is the only way which can provide at least 90% of the prana of the whole herb intact. In this method most of the active constituents are maintained for a long period and are highly bio-available to the human system through the gastrointestinal tract.

The consent of the patients was obtained after the explaining the nature of the study. Proforma was filled, brief history and clinical examinations were recorded.

Pre- and post-treatment serum calcium, total and ionic, and phosphorus were also investigated. Radiographs were taken pre- and post-treatment.

Patients were called at the first, fourth, and sixth week for examination-pain, swelling, tenderness, and mobility of the fractured segment were recorded.

Radiograhic interpretation was done which showed there was significant radiographic evidence of the early healing of the fracture in the cases treated with Osteoseal, Harjor followed by Moringa and at last Placebo [Table 1], [Table 2], [Table 3], [Table 4] and [Table 5].
Table 5: Comparison of change in severity in clinical variables among the groups

Click here to view

   Observation and Results Top

1. Result

Osteoseal is Best group and Placebo is worst.

Pain, swelling, tenderness, mobility reduction in maximum in osteoseal group and minimum in placebo at different follow-ups Ca, Ca + , P increase is maximum.

2. Result

The most common cause of trauma was found to be RTA, followed by fall from height as described in [Table 1].

The most common site of fracture was parasymphysis (45.4%) followed by body fracture (34.9%), and the least common site was ramus fracture [Table 2].

The increased number of automobiles on the road and lack of traffic sense, coupled with high speed are the main causes of RTAs.

3. Result

Osteoseal is best group and Placebo is worst.

Pain, swelling, tenderness, mobility reduction is maximum in osteoseal group and minimum in Placebo. There was an increase in the serum calcium and phosphorus level at different follow-ups in each groups but there was a decrease in the placebo group. Ca, Ca + , phosphrous increase was maximum in the osteoseal group.

Suitable, antibiotic, analgesic, and anti-inflammatory drugs were given for five days [Table 6] and [Table 7].
Table 6: Etiology

Click here to view
Table 7: Site of fractures

Click here to view

   Discussion Top

Cissus quandrangularis contains vitamins and steroid which are found to have a specific effect on bone fracture healing. The anabolic steroidal principle from Cissus quandrangularis shows a marked influence on the rate of fracture healing by influencing early regeneration of all connective tissues involved in the healing and quicker mineralization of callus. There was shortening of about two weeks in the duration of bone healing. [2]

The hastening in the fracture healing was attributed to the stimulation of all cells of mesenchymal origin, namely, the fibroblasts, chondroblasts and osteoblasts, by Cissus quandrangularis.

Thus Cissus quandrangularis builds up the chemical composition of the fractured bone namely mucopolysachrides, collagen calcium phosphorus and others as well as its functional efficiency. [2]

In our study intermaxillary fixation was removed at the third or fourth week in cases which were treated by Harjor and Osteoseal, there was no mobility no tenderness. At the sixth week there was a significance rise in serum calcium both ionic and total, and serum phosphorus also. In another study there was no significance alternation in the serum calcium level at the third week. [3] Radioactive Ca64 bone uptake decreased in the first week, followed by a gradual increase in subsequent weeks, and came to normal in six to eight weeks. It seems that Harjor increases the efficacy of the fracture healing mechanism which functions under the rule of maximum economy deposition of calcium is just enough safe joining of the broken parts of bone and entire remodeling process comes to end faster. [4],[5],[6]

In another study the early radiographic evidence of periosteal reactin and bony dissolution in the Harjor-treated group indicates a faster healing process. [2] Active constituents of Cissus quandrangularis may stimulate the proliferation and differentiation of mesenchymal cells (MSCs) and promote new bone formation through the WntLRP5-B-Creatnin signaling pathway of pre-osteoblast formation. It can be used to treat various bone disorders and can also be used as a preventive measure for disorders that lead to decreased bone mineral density. [7]

The role of nutrition in bone healing is the most important factor which influences bone healing, Calcium is effective but cannot be utilized just by increasing the uptake-the ability of absorption of the calcium also has to be increased. Lysine is an amino acid that helps in the absorption of calcium, Vitamin C is essential nutritionally to make the collagen that helps the body form healthy bones. It also promotes bone healing. Asprin and anti-inflammatory drugs can retard bone healing. The damaged cells in the fractured area release a large amount of prostaglandin these are important in first stage of tissue repair, and as so causes pain, and if blocked by pain killers for longer duration can affect n bone healing. The antioxidant and antimicrobial activities are also reported by Murthy et al. [8],[9]

The plant extract serves as a rich source of calcium ion, when reacted with CO2 lead to formation of calcite crystals of highly irregular morphology indicating that bioorganic molecules present in extract modulate the crystals morphology. [10]

The leaves and stems of Moringa olifera are known to have a large amount of their calcium bound in calcium oxalate crystals more vitamin than carrot, more calcium than milk more iron than spinach more vitamin c than orange and more potassium than in Banana. [9]

One tablespoon of (8 g) of leaf powder will satisfy about 14% of protein, 40% of calcium, 23% of iron, and all the vitamin A needs of a child aged one to three years. Six teaspoons full of powder will satisfy nearly all the women, daily need of iron and calcium needs during pregnancy and breast feeding. [4]

It also has potent antibacterial, antifungal, antiviral, and anti-inflammatory activity analgesic antipyretic and muscle relaxant actions. [11],[12]

Osteoseal is a formula with the highest natural bio-available calcium, phosphorus, vitamins and amino acids. It helps prevent bone density loss, supplies natural, herbal calcium and minerals for strong bones and teeth, speeds healing of fractured bones, promotes healthy bone growth and increases bone mineral density in osteoporosis. It is a combination of Harjor, Shajan and Neem. [4]

Osteoseal should be avoided during the first three months of pregnancy and should not be recommended in higher doses for the rest of the pregnancy due to its neem content which has some anti-fertility and abortive properties.

Neem is to prevent infection in the fractured bone joint and surrounding tissues as well as to support the analgesic anti-inflammatory action of these two herbs.

Harjor showed clinical efficacy in the treatment of fractures, [5] our study also showed reduction in intermaxillary fixation time from six weeks to three to four weeks with Ostoeseal, followed by Harjor, followed by Moringa, and in cases of placebo there was no reduction in time of intermaxillary fixation [Figure 1]. Serum Ca level, both ionic and total, and serum phosphorus level were significantly increased in the other three groups but decreased in the placebo group [Figure 2].
Figure 1: Comparative clinical evaluation

Click here to view
Figure 2: Comparative biochemical evaluation

Click here to view

   References Top

1.Moringa oleifera. wikipedia. Available from: http://en.wikipediaorg/wiki/moringa-oleifera. [cited in 2010].  Back to cited text no. 1
2.Srivastava MG, Sourabh, Nagori BP. Pharmacological and therpeutic activity of cissus quadrangularis: An overview. Int J Pharm Tech Res CODE (USA) ;2010:1298-310.  Back to cited text no. 2
3.Deka DK, Lohan LC, Saikia J, Mukti A. Effect of Cissus quadrangularis in accelerating healing process of experimentally fractured radius ulna of dog: A preliminary study. Indian J Pharmacol 1994;26:44-5.  Back to cited text no. 3
  Medknow Journal  
4.Singh N. Gilca Marilena Herbal Medicine Science embraces Tradion A new site in to ancient Ayurveda. LAMERT Acedemic Publishing AGandCo KG Dudweiler Landstr 99,66123 Saarbrucken Germany: ISBN 978-3-8383-2145-5.  Back to cited text no. 4
5.Udupa KN, Prasad GC. Cissus quadrangularis in healing of fracture: A clinical study. J Med Assoc 1962;38:590-3.  Back to cited text no. 5
6.Udupa KN Prasad GC. Biochemical and calcium -54 study on the effect of Cissus quadrangularis in fracture repair. Indian J Med Res 1964;52:50480-7.  Back to cited text no. 6
7.Bhagat PK, Bhat Kumar MR, Rao SM, Nampurath KG, Chamallamudi RM, Nayak RS, et al. Petrolium ether extract of cissus quadrangularis enhance bone marrow mesenchymal stem cell proliferation and facilitates osteoblastogenesis. J Clin Sao Paulo 2009;64:10.  Back to cited text no. 7
8.Chidambara Murthy KN, Vanitha A, Mahadeva Swamy M, Ravishankar GA. Antioxidant and Antimicrobial activity of Cissus quadrangularis L. J Med Food 2003;6:99-105.  Back to cited text no. 8
9.Healing fractures. Available from: http://lesann.tripod.com/healing/20fractures.htm. [cited in 2010].  Back to cited text no. 9
10.Sanayal A, Ahmed A, Sastry M. Calcite growth in Cissus Quadrangularis plant extract a traditional Indian Bone Healing aid. Curr Sci 2005;89:25.  Back to cited text no. 10
11.Eilert U, Wolters B, Nahrstedt A. The antibiotic principle of seeds of Moringa oleifera and Moringa Stenopetala. J Med Plant Res 1981;42:55-61.  Back to cited text no. 11
12.Jed FW. Moringa oleifera: A review of medical evidence for its nutritional, therapeutic and prophylactic properties trees for life journal. Available from: http://www.TFLJournal.org. [cited in 2010].  Back to cited text no. 12


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]

This article has been cited by
1 Comparison of Teriparatide and Combination of Cissus Quadrangularis and Dalbergia Sissoo on Bone Healing Against the Control Group in Maxillofacial Fractures: A Randomized Open-label Control Trial
Gigi PG, Ankita Chugh, Kirti Chaudhry, Amanjot Kaur, Pravin Kumar, Shubham Gaur, Shailendra Kumar, Surjit Singh
Craniomaxillofacial Trauma & Reconstruction. 2022; : 1943387521
[Pubmed] | [DOI]
2 Moringa oleifera leaf extract induces osteogenic-like differentiation of human osteosarcoma SaOS2 cells
Mohammad Idreesh Khan, Sahabjada Siddiqui, Md. Abul Barkat, Fahad Saad Alhodieb, Fauzia Ashfaq, Harshita Abul Barkat, Abdulkareem A. Alanezi, Md Arshad
Journal of Traditional and Complementary Medicine. 2022;
[Pubmed] | [DOI]
3 Effect of Cissus quadrangularis Hydrogel on Enhancing Osseointegration of Titanium Implant to Bone: An In Vivo Study
Ramesh Chowdhary, Srinidhi Bhat
The Journal of Contemporary Dental Practice. 2022; 23(6): 582
[Pubmed] | [DOI]
4 Quantitative determination and characterization of polyphenols from Cissus quadrangularis L. and dietary supplements using UHPLC-PDA-MS, LC-QToF and HPTLC
Bharathi Avula,Ji-Yeong Bae,Jianping Zhao,Yan-Hong Wang,Mei Wang,Zhihao Zhang,Zulfiqar Ali,Amar G. Chittiboyina,Ikhlas A. Khan
Journal of Pharmaceutical and Biomedical Analysis. 2021; 199: 114036
[Pubmed] | [DOI]
5 Evaluation of osteogenic potential of Cissus quadrangularis on mandibular alveolar ridge distraction
Alaa Abdelqader Altaweel,Abdel Aziz Baiomy Abdullah Baiomy,Hazem Shawky Shoshan,Hisham Abbas,Ahmed Abdel-Shakour Abdel-Hafiz,Abd El-Hamid Gaber,Amr Abdelfatah Zewail,Marwa A. M. Elshiekh
BMC Oral Health. 2021; 21(1)
[Pubmed] | [DOI]
6 Evaluation of bone healing activity of Cissus quadrangularis (Linn), Cryptolepis buchanani, and Sardinella longiceps in Wistar rats
Somasundaram Ramachandran,Laith Fadhil,Chandravadivelu Gopi,Masa Amala,Magharla Dasaratha Dhanaraju
Beni-Suef University Journal of Basic and Applied Sciences. 2021; 10(1)
[Pubmed] | [DOI]
7 A review on efficacy of Cissus quadrangularis in pharmacological mechanisms
Zaki Sadiya,Malathi R,Latha V,Sibi G
International Journal of Clinical Microbiology and Biochemical Technology. 2020; 3(1): 049
[Pubmed] | [DOI]
8 Fabrication and characterization of Spinacia oleracea extract incorporated alginate/carboxymethyl cellulose microporous scaffold for bone tissue engineering
Govindasamy Sharmila,Chandrasekaran Muthukumaran,Shanmugam Kirthika,Sundarapandian Keerthana,Narasimhan Manoj Kumar,Jeyadharmarajan Jeyanthi
International Journal of Biological Macromolecules. 2020; 156: 430
[Pubmed] | [DOI]
9 An Assessment of the Osteogenic Potential of Cissus quadrangularis in Mandibular Fractures: A Pilot Study
Tulasi Nayak,Keerthi R
Journal of Maxillofacial and Oral Surgery. 2019;
[Pubmed] | [DOI]
10 Ethyl acetate and n-butanol fraction of Cissus quadrangularis promotes the mineralization potential of murine pre-osteoblast cell line MC3T3-E1 (sub-clone 4)
Rabail Hassan Toor,Raazia Tasadduq,Achyut Adhikari,Muhammad Iqbal Chaudhary,Jane B. Lian,Janet L. Stein,Gary S. Stein,Abdul Rauf Shakoori
Journal of Cellular Physiology. 2018;
[Pubmed] | [DOI]
11 Evaluation of Clinical Efficacy of Cissus quadrangularis in Pain Management and Bone Healing after Implant Placement: A Pilot Study
Disha Naveen Shah,Jigar Chandrakantbhai Patel,Nagaraj Yallappa Puttanikar,Dishan Sunilkumar Shah,Sunita Anil Managutti
International Journal of Oral Implantology & Clinical Research. 2015; 6(2): 35
[Pubmed] | [DOI]
12 Cissus quadrangularisLinn exerts dose-dependent biphasic effects: osteogenic and anti-proliferative, through modulating ROS, cell cycle andRunx2gene expression in primary rat osteoblasts
S. Siddiqui,E. Ahmad,M. Gupta,V. Rawat,N. Shivnath,M. Banerjee,M. S. Khan,M. Arshad
Cell Proliferation. 2015; 48(4): 443
[Pubmed] | [DOI]
13 A Review and Evaluation of the Efficacy and Safety ofCissus quadrangularisExtracts
Sidney J. Stohs,Sidhartha D. Ray
Phytotherapy Research. 2013; 27(8): 1107
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
    Materials and Me...
    Observation and ...
    Article Figures
    Article Tables

 Article Access Statistics
    PDF Downloaded1019    
    Comments [Add]    
    Cited by others 13    

Recommend this journal