Physical properties of root cementum: Part 5. Volumetric analysis of root resorption craters after application of light and heavy orthodontic forces

Comparisons of orthodontic root resorption under heavy and jiggling reciprocating forces during experimental tooth movement in a rat model

OBJECTIVE

Root mobility due to reciprocating movement of the tooth (jiggling) may exacerbate orthodontic root resorption (ORR). "Jiggling" describes mesiodistal or buccolingual movement of the roots of the teeth during orthodontic treatment. In the present study, buccolingual movement is described as "jiggling." We aimed to investigate the relationship between ORR and jiggling and to test for positive cell expression in odontoclasts in resorbed roots during experimental tooth movement (jiggling) in vivo.

METHODS

Male Wistar rats were divided into control, heavy force (HF), optimal force (OF), and jiggling force (JF) groups. The expression levels of cathepsin K, matrix metalloproteinase (MMP)-9 protein, interleukin (IL)-6, cytokine-induced neutrophil chemoattractant 1 (CINC-1; an IL-8-related protein in rodents), receptor activator of nuclear factor κB ligand (RANKL), and osteoprotegerin protein in the dental root were determined using immunohistochemistry.

RESULTS

On day 21, a greater number of root resorption lacunae, which contained multinucleated odontoclasts, were observed in the palatal roots of rats in the JF group than in rats from other groups. Furthermore, there was a significant increase in the numbers of cathepsin K-positive and MMP-9-positive odontoclasts in the JF group on day 21. Immunoreactivities for IL-6, CINC-1, and RANKL were stronger in resorbed roots exposed to jiggling than in the other groups on day 21. Negative reactivity was observed in the controls.

CONCLUSIONS

These results suggest that jiggling may induce ORR via inflammatory cytokine production during orthodontic tooth movement, and that jiggling may be a risk factor for ORR.

Saturation of the biological response to orthodontic forces and its effect on the rate of tooth movement

OBJECTIVES

Investigate the expression and activity of inflammatory markers in response to different magnitudes of orthodontic forces and correlate this response with other molecular and cellular events during orthodontic tooth movement.

SETTING AND SAMPLE POPULATION

CTOR Laboratory; 245 Sprague Dawley male rats.

METHODS AND MATERIALS

Control, sham, and 5 different experimental groups received different magnitudes of force on the right maxillary first molar using a coil spring. In the sham group, the spring was not activated. Control group did not receive any appliance. At days 1, 3, 7, 14, and 28, the maxillae were collected for RNA and protein analysis, immunohistochemistry, and micro-CT.

RESULTS

There was a linear relation between the force and the level of cytokine expression at lower magnitudes of force. Higher magnitudes of force did not increase the expression of cytokines. Activity of CCL2, CCL5, IL-1, TNF-α, RANKL, and number of osteoclasts reached a saturation point in response to higher magnitudes of force, with unchanged rate of tooth movement.

CONCLUSION

After a certain magnitude of force, there is a saturation in the biological response, and higher forces do not increase inflammatory markers, osteoclasts, nor the amount of tooth movement. Therefore, higher forces to accelerate the rate of tooth movement are not justified.

Severe root resorption resulting from orthodontic treatment: prevalence and risk factors

OBJECTIVE:

To assess the prevalence of severe external root resorption and its potential risk factors resulting from orthodontic treatment.

METHODS:

A randomly selected sample was used. It comprised conventional periapical radiographs taken in the same radiology center for maxillary and mandibular incisors before and after active orthodontic treatment of 129 patients, males and females, treated by means of the Standard Edgewise technique. Two examiners measured and defined root resorption according to the index proposed by Levander et al. The degree of external apical root resorption was registered defining resorption in four degrees of severity. To assess intra and inter-rater reproducibility, kappa coefficient was used. Chi-square test was used to assess the relationship between the amount of root resorption and patient's sex, dental arch (maxillary or mandibular), treatment with or without extractions, treatment duration, root apex stage (open or closed), root shape, as well as overjet and overbite at treatment onset.

RESULTS:

Maxillary central incisors had the highest percentage of severe root resorption, followed by maxillary lateral incisors and mandibular lateral incisors. Out of 959 teeth, 28 (2.9%) presented severe root resorption. The following risk factors were observed: anterior maxillary teeth, overjet greater than or equal to 5 mm at treatment onset, treatment with extractions, prolonged therapy, and degree of apex formation at treatment onset.

CONCLUSION:

This study showed that care must be taken in orthodontic treatment involving extractions, great retraction of maxillary incisors, prolonged therapy, and/or completely formed apex at orthodontic treatment onset.

The effect of corticision on root resorption with heavy and light forces

OBJECTIVE

To investigate the association between corticision and different force magnitudes with the amount of root resorption.

METHODS

Forty-four male Wistar rats (7 week old) were evaluated after an orthodontic spring delivering either 10 or 100 g was placed on the left maxillary first molars to move molars mesially. Experimental rats were divided into four groups, with 11 animals in each group: (1) LF, no corticision and 10 g of orthodontic force; (2) LFC, corticision and 10 g of force; (3) HF, no corticision and 100 g of force; and (4) HFC, corticision and 100 g of force. Contralateral sides were used as unloaded controls. The total duration of the experimental period was 14 days. Two-dimensional (histomorphometric) and three-dimensional (volumetric, micro-focus X-ray computed tomography [microCT]) analysis of root craters were performed on maxillary first molars.

RESULTS

Histomorphometric and microCT analysis revealed a significant amount of resorptive areas in the experimental groups when compared to unloaded controls. However, no significant difference was detected in the amount of resorption among the four experimental groups.

CONCLUSIONS

At day 14, neither the amount of force nor the cortical incision caused significant effect on root resorption that was registered by histomorphometric or microCT analysis.

Finite Element Analysis of Bone Stress around Micro-Implants of Different Diameters and Lengths with Application of a Single or Composite Torque Force

Background

Stress on the bone surrounding dental micro-implants affects implant success.

Purpose

To compare the stress on the bone surrounding a micro-implant after application of a single force (SF) of 200 g or a composite force (CF) of 200 g and 6 N.mm torque.

Materials and Methods

Finite element models were developed for micro-implant diameters of 1.2, 1.6, and 2.0 mm, and lengths of 6, 8, 10, and 12 mm and either a SF or CF was applied. The maximum equivalent stress (Max EQS) of the bone surrounding the micro-implant was determined, and the relationships among type of force, diameter, and length were evaluated.

Results

The Max EQS of the CF exceeded that of the SF (P< 0.05). The effect of force on stress was related to implant diameter, but not to implant length. The larger CF led to greater instability of the micro-implant and the effect was most pronounced at an implant diameter of 1.2 mm. The use of implant diameters of 1.6 mm and 2.0 mm produced no significant difference in implant stability when either a CF or SF was applied.

Conclusion

When considering the use of an implant to perform three-dimensional control on the teeth, the implant diameter chosen should be > 1.2 mm.

Novel universal system for 3-dimensional orthodontic force-moment measurements and its clinical use

INTRODUCTION

Orthodontic treatment is an important part of dental health care in Europe: the percentages of the population undergoing therapy vary from 10% to 55%. Therefore, quantifying effective orthodontic loads is a challenging topic with regard to the predictability of tooth movements and the reduction of traumatic side effects.

METHODS

A customized measuring platform was developed and used for detecting orthodontic forces in a range between 0.1 and 2 N. The system consists of 6 load cells, each equipped with 6 strain gauges. The tests were conducted on a 3-dimensional printed malocclused mouth model and on a plaster cast. Four types of superelastic ligation and 2 types of invisible aligners were tested to analyze, respectively, a malocclusion with a high maxillary canine, and the effects on the axial rotation of a maxillary central incisor with and without a divot in the invisible aligners.

RESULTS

Optimal treatment forces are exerted by low-friction wires, especially if they are partially engaged. Moreover, by reducing the treatment force, there is less necessity of anchoring to surrounding teeth, thus decreasing the side effects. The efficacy of using invisible aligners with a divot was validated.

CONCLUSIONS

This platform allowed measurement, at the radicular level, of the resultant forces of orthodontic treatments performed with different orthodontic appliances. In addition to customizing and calibrating the therapy for each patient, this platform could be used to develop new specific instruments able to exert lower treatment forces, thus preventing irreversible damages.

Association of orthodontic force system and root resorption: A systematic review

INTRODUCTION

In this systematic review, we assessed the literature to determine which evidence level supports the association of orthodontic force system and root resorption.

METHODS

PubMed, Cochrane, and Embase databases were searched with no restrictions on year, publication status, or language. Selection criteria included human studies conducted with fixed orthodontic appliances or aligners, with at least 10 patients and the force system well described.

RESULTS

A total of 259 articles were retrieved in the initial search. After the review process, 21 full-text articles met the inclusion criteria. Sample sizes ranged from 10 to 73 patients. Most articles were classified as having high evidence levels and low risks of bias.

CONCLUSIONS

Although a meta-analysis was not performed, from the available literature, it seems that positive correlations exist between increased force levels and increased root resorption, as well as between increased treatment time and increased root resorption. Moreover, a pause in tooth movement seems to be beneficial in reducing root resorption because it allows the resorbed cementum to heal. The absence of a control group, selection criteria of patients, and adequate examinations before and after treatment are the most common methodology flaws.

Decreased alveolar bone turnover is related to the occurrence of root resorption during experimental tooth movement in dogs

OBJECTIVE

To investigate the relationship between root resorption (RR) and bone turnover in two different types of tooth movement in dogs.

MATERIALS AND METHODS

A total of 16 dogs in two different groups were used. Tooth movement of dog premolars resulted from approximately 200 g of force. Histomorphometric analysis of premolar roots was assessed after 4 and 12 weeks of tooth movement by comparing nonresorptive to resorptive surfaces.

RESULTS

Histomorphometric analysis indicated a significant decrease in the bone formation rate in the root resorptive areas, which resulted in decreased bone volume after 12 weeks. The threshold to detect RR in periapical radiographs was about 1.0 mm(2).

CONCLUSIONS

A sustained mechanical load, due to the prolonged stress and strain of continuous mechanics, induces elevated bone metabolic activity, such as the bone turnover (remodeling) and change in bone volume (modeling). Therefore, our data support the hypothesis that increased RR is related to decreased bone formation (turnover) in high stress areas exposed to prolonged orthodontic tooth movement.

The effect of orthodontic therapy on periodontal health: a review of the literature

Objectives. This review aims to evaluate the effect of orthodontic therapy on periodontal health. Data. Original articles that reported on the effect of orthodontic therapy on periodontal health were included. The reference lists of potentially relevant review articles were also sought. Sources. A literature search was conducted using the databases, Medline, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus databases for relevant studies. The search was carried out by using a combined text and the MeSH search strategies: using the key words in different combinations: “periodontal disease,” “orthodontics” and “root resorption.” This was supplemented by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed. Articles published only in English language were included. Letters to the Editor, historical reviews and unpublished articles were not sought. Conclusions. Within the limitations of the present literature review, it was observed that there is a very close inter-relationship between the periodontal health and the outcome of orthodontic therapy.

Effect of cytokines on osteoclast formation and bone resorption during mechanical force loading of the periodontal membrane

Mechanical force loading exerts important effects on the skeleton by controlling bone mass and strength. Several in vivo experimental models evaluating the effects of mechanical loading on bone metabolism have been reported. Orthodontic tooth movement is a useful model for understanding the mechanism of bone remodeling induced by mechanical loading. In a mouse model of orthodontic tooth movement, TNF-α was expressed and osteoclasts appeared on the compressed side of the periodontal ligament. In TNF-receptor-deficient mice, there was less tooth movement and osteoclast numbers were lower than in wild-type mice. These results suggest that osteoclast formation and bone resorption caused by loading forces on the periodontal ligament depend on TNF-α. Several cytokines are expressed in the periodontal ligament during orthodontic tooth movement. Studies have found that inflammatory cytokines such as IL-12 and IFN-γ strongly inhibit osteoclast formation and tooth movement. Blocking macrophage colony-stimulating factor by using anti-c-Fms antibody also inhibited osteoclast formation and tooth movement. In this review we describe and discuss the effect of cytokines in the periodontal ligament on osteoclast formation and bone resorption during mechanical force loading.

Interleukin-17/T-helper 17 cells in an atopic dermatitis mouse model aggravate orthodontic root resorption in dental pulp

Interleukin (IL)-17 is an important mediator of orthodontically induced inflammatory root resorption (OIIRR). However, its role in the dental pulp (DP) has not been studied. The aim of this study was to investigate, using an atopic dermatitis (AD) model, how IL-17 contributes to OIIRR in DP. Atopic dermatitis is the most common IL-17-associated allergic disease. Atopic dermatitis model mice (AD group) and wild-type mice (control group) were subjected to an excessive orthodontic force. The localization of T-helper (Th)17 cells, IL-17, IL-6, and keratinocyte chemoattractant (KC; an IL-8-related protein in rodents) were determined in DP. In addition, CD4+ T cells, including IL-17 production cells, were obtained from patients with AD and from healthy donors, and the effects of IL-17 on the production of IL-6 and IL-8 were investigated using a co-culture of CD4+ T cells with human dental pulp (hDP) cells stimulated with substance P (SP). Immunoreactivity for Th17 cells, IL-17, IL-6, and KC was increased in DP tissue subjected to orthodontic force in the AD group compared with DP tissue subjected to orthodontic force in the control group. The cells obtained from the AD patients displayed increased IL-6 and IL-8 production. These results suggest that IL-17 may aggravate OIIRR in DP.

Th17-cells in atopic dermatitis stimulate orthodontic root resorption

OBJECTIVE

The aim of this study was to investigate how atopic dermatitis (AD) contributes to root resorption during orthodontic tooth movement.

MATERIALS AND METHODS

Atopic dermatitis model mice and wild-type mice were subjected to an excessive orthodontic force (OF) to induce movement of the upper first molars. The expression levels of the tartrate-resistant acid phosphatase (TRAP), IL-17, IL-6, and RANKL proteins were determined in the periodontal ligament (PDL) by an immunohistochemical analysis. Furthermore, the effects of the compression force on co-cultures of CD4(+) cells from AD patients or healthy individuals and human PDL cells were investigated with regard to the levels of secretion and mRNA expression of IL-17, IL-6, RANKL, and osteoprotegerin.

RESULTS

The immunoreactivities for TRAP, IL-17, IL-6, and RANKL in the AD group were found to be significantly increased. The double immunofluorescence analysis for IL-17/CD4 detected immunoreaction. The secretion of IL-17, IL-6, and RANKL, and the mRNA levels of IL-6 and RANKL in the AD patients were increased compared with those in healthy individuals.

CONCLUSION

Th17 cells may therefore be associated with the deterioration of root resorption of AD mice, and may explain why AD patients are more susceptible to root resorption than healthy individuals when an excessive OF is applied.

Association analysis of clinical aspects and vitamin D receptor gene polymorphism with external apical root resorption in orthodontic patients

INTRODUCTION

Vitamin D is responsible for the regulation of certain genes at the transcription level, via interaction with the vitamin D receptor, and influences host immune responses and aspects of bone development, growth, and homeostasis. Our aim was to investigate the association of TaqI vitamin D receptor gene polymorphism with external apical root resorption during orthodontic treatment.

METHODS

Our subjects were 377 patients with Class II Division 1 malocclusion, divided into 3 groups: (1) 160 with external apical root resorption ≤1.43 mm, (2) 179 with external apical root resorption >1.43 mm), and (3) 38 untreated subjects. External apical root resorption of the maxillary incisors was evaluated on periapical radiographs taken before and after 6 months of treatment. After DNA collection and purification, vitamin D receptor TaqI polymorphism analysis was performed by polymerase chain reaction-restriction fragment length polymorphism. Univariate and multivariate analyses were performed to verify the association of clinical and genetic variables with external apical root resorption (P <0.05).

RESULTS

There was a higher proportion of external apical root resorption in orthodontically treated patients compared with the untreated subjects. In patients orthodontically treated, age higher than 14 years old, initial size of the maxillary incisor root superior to 30 mm, and premolar extraction were associated with increased external apical root resorption. Genotypes containing the C allele were weakly associated with protection against external apical root resorption (CC + CT × TT [odds ratio, 0.29; 95% confidence interval, 0.07-1.23; P = 0.091]) when treated orthodontic patients were compared to untreated individuals.

CONCLUSIONS

Clinical factors and vitamin D receptor TaqI polymorphism were associated with external apical root resorption in orthodontic patients.

An ex vivo culture model for orthodontically induced root resorption

OBJECTIVES

Root resorption is a ubiquitous although undesirable sequela to orthodontic treatment. Current methods to investigate the pathophysiology have certain limitations. In pursuit to understand and develop treatment modalities for orthodontically induced root resorption, the ability to manipulate cells within their natural extracellular matrix in a three dimensional organotypic model is invaluable. The study aimed to develop a laboratory-based organotypic model to investigate the effect of orthodontic forces on the periodontium.

METHODS

Mandibular slices of male Wistar rats were maintained in Trowel-typed cultures at 37°C in 5% carbon dioxide in air for 7 days with test specimens subjected to compressive forces at 50 g and 100g by stainless steel springs. Tissue architecture and cell viability were maintained under culture conditions.

RESULTS

Osteoclast numbers increased significantly in both test groups whilst odontoclasts increased in the 50 g group. Immunohistochemistry demonstrated increased dentine sialoprotein expression in both test groups, suggesting changes in mineralization-related activity due to mechanical strain.

CONCLUSION

The study showed initial cellular and molecular changes of key markers that relate to root resorption in response to mechanical loading.

CLINICAL SIGNIFICANCE

Severe root resorption may occur when forces applied are heavy or transmitted over an extended period and could lead to mobility and tooth loss. This ex vivo model can be used to investigate cellular and molecular processes during orthodontic tooth movement which may advance the clinical management of root resorption.

Physical properties of root cementum: Part 19. Comparison of the amounts of root resorption between the right and left first premolars after application of buccally directed heavy orthodontic tipping forces

INTRODUCTION

Previous studies have used the right and left sides of the same jaw to compare different force levels, types of movement, and durations of forces. However, the amounts of root resorption have not been compared between the right and left sides after applying the same amount of force. The aims of the study were to quantitatively compare the volumes of the root resorption lacunae between the right and left first premolars to determine whether 1 side can serve as a control to the other and to compare the volumes of root resorption lacunae of the first premolars between the maxilla and the mandible.

METHODS

Forty-four first premolars, orthodontically indicated for extraction from 11 patients (left and right maxillary and mandibular first premolars from each) were moved buccally by using beta-titanium-molybdenum alloy 0.017 × 0.025-in cantilever springs with continuous heavy (225 g) force. After the experimental period, the teeth were extracted under a strict protocol to prevent root cementum damage and then analyzed by using a microcomputed tomography scan x-ray system (1172; SkyScan, Aartselaar, Belgium) and specially designed software (Convex Hull 2D, University of Sydney, Sydney, Australia) for direct volumetric measurements.

RESULTS

There were no statistically significant differences in the mean cube root volumes of root resorption craters between the right and left sides (P = 0.18) or between the maxillary and mandibular jaws (P = 0.10). There was also no statistical significance for the interception (P = 0.41), which indicated that the jaw and the side had independent effects.

CONCLUSIONS

The amount of root resorption on the left and right sides of the jaw were similar in both the maxilla and the mandible. Therefore, for future root resorption studies, it is justifiable to use the split-mouth technique so that teeth from 1 side of the jaw can serve as the controls.

Physical properties of root cementum: Part 17. Root resorption after the application of 2.5° and 15° of buccal root torque for 4 weeks: a microcomputed tomography study

INTRODUCTION

Root resorption is an undesirable consequence of orthodontic tooth movement. The severity is unpredictable, and, despite extensive research, the etiology remains unknown. Torque has been acknowledged as a risk factor for root resorption. The aims of the study were to evaluate and quantify the extent of root resorption after the application of 2.5° and 15° of buccal root torque for 4 weeks.

METHODS

Fifteen patients requiring bilateral extraction of their maxillary first premolars for orthodontic treatment were recruited to the study. By using a standardized experimental protocol, the right and left premolars were randomly subjected to either 2.5° or 15° of buccal root torque. At the end of the 4-week experimental period, the premolars were extracted. A volumetric analysis of root resorption was performed by using microcomputed tomography and measured with specially designed software.

RESULTS

Overall, the amounts of root resorption were comparable after the application of 2.5° or 15° of buccal root torque (P = 0.59). There was a significant difference between the 2 force levels only at the apical region (P = 0.034). More root resorption occurred in areas of compression than in areas of tension. The variables of age and sex were not statistically significant.

CONCLUSIONS

Root resorption was evident after 4 weeks of buccal root torque application. More root resorption was seen at the apical region than at the middle and cervical regions. Higher magnitudes of torque might cause more root resorption, particularly in the apical region. As shown in previous studies, the etiology of root resorption is multi-factorial and cannot be explained by mechanical factors alone.

Scanning electron microscopy stereoimaging for three-dimensional visualization and analysis of cells in tissue-engineered constructs: technical note

In tissue engineering research, various three-dimensional (3D) techniques are available to study cell morphology, biomaterials, and their relations. To overcome disadvantages of frequently used imaging techniques, in the current study stereoimaging scanning electron microscopy (SEM) is proposed. First, the 3D SEM application was validated using a series of standardized microspheres. Thereafter, MC-3T3 cell morphology was visualized and cell parameters as cell height were quantified on titanium and calcium-phosphate materials using 3D reconstruction software. Besides 3D visualization of the cells, quantitative assessment showed significant substrate dependency of cell spreading in time. Such quantification of cell spreading kinetics can be used for optimization of tissue engineering scaffold surface properties. However, further standardization of SEM image acquisition and 3D SEM software settings are still essential for 3D cell analysis.

A influência de imagens tridimensionais no plano de tratamento ortodôntico

INTRODUÇÃO: a tomografia computadorizada de feixe cônico (TCFC) foi introduzida no final da década de 90 e estudos têm aprimorado o seu emprego na Odontologia. OBJETIVO: o objetivo desse artigo foi verificar a influência de imagens tridimensionais (3D) no plano de tratamento ortodôntico. MÉTODOS: duas situações clínicas (reabsorção cervical e deiscência óssea) foram descritas por meio de imagens 3D. RESULTADOS: a conduta ortodôntica foi redirecionada para a simplificação da mecânica e o controle das lesões durante o tratamento ortodôntico. CONCLUSÃO: imagens 3D são capazes de aumentar a acurácia do diagnóstico e redirecionar o plano de tratamento ortodôntico.

IL-8 and MCP-1 induced by excessive orthodontic force mediates odontoclastogenesis in periodontal tissues

OBJECTIVE

The aim of this study was to investigate how interleukin (IL)-8 (cytokine-induced neutrophil chemoattractant; CINC-1) and monocyte chemotactic protein (MCP)-1/CCL2 contribute to root resorption during orthodontic tooth movement.

MATERIALS AND METHODS

Forty 6-week-old male Wistar rats were subjected to orthodontic force of 10 or 50 g to induce a mesially tipping movement of the upper first molars for 7 days. We determined the expressions of CINC-1, CXCR2, and MCP-1 proteins in root resorption area using immunohistochemistry. Furthermore, we investigated the effects of compression forces (CF) on IL-8 and MCP-1 production by human periodontal ligament (hPDL) cells. We observed an effect of chemokine treatment on rat odonto/osteoclasts in dentin slices that recapitulated root resorption.

RESULTS

The immunoreactivity for CINC-1/CXCR2 and MCP-1 was detected in odontoclasts and PDL fibroblasts by the orthodontic force of 50 g on day 7. CF increased the secretion and the expression of mRNA of IL-8 and MCP-1 from PDL cells in a magnitude-dependent manner. Moreover, CINC-1 and MCP-1 stimulated osteoclastogenesis from rat osteoclast precursor cells.

CONCLUSION

IL-8 (CINC-1) and MCP-1 may therefore facilitate the process of root resorption because of excessive orthodontic force.

Expressions of RANKL/RANK and M-CSF/c-fms in root resorption lacunae in rat molar by heavy orthodontic force

The differentiation and functions of osteoclasts are regulated by receptor activator of nuclear factor-κB (RANK)/receptor activator of nuclear factor-κB ligand (RANKL) system that stimulates osteoclasts formation. Macrophage colony-stimulating factor (M-CSF) is also essential for osteoclastogenesis. A recent immunocytochemical study reported that RANKL/RANK and M-CSF/c-fms were localized in the periodontal ligament of rat molars during experimental orthodontic tooth movement. The present study focused on the expressions of RANKL/RANK and M-CSF/c-fms in root resorption area during experimental tooth movement in rats. Forty 6-week-old male Wistar rats were subjected to an orthodontic force of 10 or 50 g with a closed coil spring (wire size: 0.005 inch, diameter: 1/12 inch) ligated to the maxillary first molar cleat by a 0.008 inch stainless steel ligature wire to induce a mesial tipping movement of the upper first molars. Experimental tooth movement was undertaken for 10 days. Each sample was sliced into 6 μm continuous sections in a horizontal direction and prepared for haematoxylin and eosin (H and E) and immunohistochemistry staining for tartrate-resistant acid phosphatase (TRAP), RANK, RANKL M-CSF, and c-fms in root resorption area. Statistical analysis was carried out using a Mann-Whitney U-test with a significance level of P<0.01. On days 7 and 10, immunoreactivity for RANKL/RANK and M-CSF/c-fms was detected in odontoclasts with an orthodontic force of 50 g, but not 10 g. Therefore, RANKL/RANK and M-CSF/c-fms systems may be involved in the process of root resorption by heavy orthodontic force.

Repair of root resorption 2 to 16 weeks after the application of continuous forces on maxillary first molars in rats: a 2- and 3-dimensional quantitative evaluation

INTRODUCTION

Root resorption is a side effect of orthodontic treatment that occurs with the removal of hyalinized tissue. Studies have shown that a reparative process in the periodontium begins when the applied orthodontic force is discontinued or reduced below a certain level. However, quantitative 3-dimensional evaluation of root resorption repair has not been done. The aim of this study was to quantitatively assess the 2- and 3-dimensional changes of root resorption craters after 2 weeks of continuous mesially applied orthodontic forces of 50 g on rat molars and 2- to 16-week retention periods.

METHODS

We used 60 male Wistar rats (10 weeks old). Nickel-titanium closed-coil springs were used to apply 50-g mesial forces for 2 weeks to move the maxillary left first molars. The rats were randomly allocated to 6 groups. Those in the zero-week retention group were killed after force application. In the remaining 5 groups, the interdental spaces between the maxillary first and second molars were filled with resin to retain the molars. The molars were extracted after periods of retention from 2 and 16 weeks. The maxillary right molars were used as the controls. Mesial and distal roots (distobuccal and distopalatal) were examined by using scanning electron and 3-dimensional scanning laser microscopes. The surface area, depth, volume, and roughness of the root resorption craters were measured.

RESULTS

The area, depth, and volume of the craters decreased gradually and showed similar trends over the retention time, approaching a plateau at the 12th week. After 16 weeks of retention, the volumes of the resorption craters of the distobuccal and distopalatal roots reached recovery peaks of 69.5% and 66.7%, respectively. Small pits on the mesial roots showed recovery of 62.5% at the 12th week. The healing patterns in distal roots with severe resorption and mesial roots with shallow resorption had no significant differences.

CONCLUSIONS

The resorption and repair processes during the early stages of retention are balanced, and most of the reparative process occurs after 4 weeks of passive retention after the application of orthodontic force. Frequent orthodontic reactivations should be avoided to allow recovery and repair of root surface damage.

Root resorption after experimental tooth movement using superelastic forces in the rat

The purpose of this study was to assess the rate of root resorption in relation to different magnitudes of continuous force during experimental tooth movement using nickel-titanium (NiTi) alloy wire. Four force magnitudes of 0.8, 1.6, 4, and 8 g were applied to the upper first molars of 75 male Wistar rats (300-320 g, 10-week-old) for 1, 7, 14, 21, and 28 days and compared with a control group without an orthodontic appliance. Light microscopic images of the compressed periodontal ligament (PDL) were processed by computer, and the ratio of the root resorption lacuna length to root surface length without the lacuna was analysed and statistically compared using Tukey-Kramer multiple comparison honestly significant difference test. The experimental groups with 4 and 8 g force showed undermining bone resorption with degenerating tissue and marked root resorption, the 1.6 g group showed only root resorption, while the 0.8 g group was similar to the control. Comparison of the ratios showed that the 0.8 g group was similar to the control with no significant difference. The ratio on day 28 in the 1.6 g group was larger than that in the 0.8 g and control groups, while on days 14, 21, and 28, the ratios in the 4 and 8 g groups were larger than those in the control (P < 0.01); these two experimental groups showed the same significant differences. It is suggested that significant root resorption occurs when the force magnitude exceeds 1.6 g in the rat upper first molar during tipping tooth movement by continuous force, and the amount of root resorption increases with serial force magnitudes from 0.8 to 4 g.

An M-CSF receptor c-Fms antibody inhibits mechanical stress-induced root resorption during orthodontic tooth movement in mice

OBJECTIVE

To examine the effect of anti-c-Fms antibody on odontoclastogenesis and root resorption in an orthodontic tooth movement mouse model.

MATERIALS AND METHODS

We used orthodontic tooth movement in which an Ni-Ti coil spring was inserted between the upper incisors and the upper first molar. Root resorption occurred in this model. Anti-c-Fms antibody was injected daily into a local site for 12 days during mechanical loading. Odontoclastogenesis and root resorption were assessed by histology and scanning electron microscopy.

RESULTS

The anti-c-Fms antibody significantly inhibited odontoclastogenesis and root resorption during orthodontic tooth movement.

CONCLUSION

M-CSF and/or its receptor is a potential therapeutic target in mechanical stress- induced odontoclastogenesis, and injection of an anti-c-Fms antibody might be useful for inhibition of mechanical stress-induced root resorption during orthodontic tooth movement.

Comparison of corticotomy-facilitated vs standard tooth-movement techniques in dogs with miniscrews as anchor units

INTRODUCTION

One method used to accelerate orthodontic tooth movement is the corticotomy-facilitated (CF) technique. The purposes of this study were to (1) identify the effect of the CF technique on orthodontic tooth movement compared with the standard technique, and (2) explore the histologic basis of the difference between the 2 techniques.

METHODS

Six dogs, aged 6 to 9 months, were used in this study. Extraction of the maxillary second premolar and miniscrew placement were done bilaterally in the maxilla. On the right side, the corticotomy was performed. The first premolars were distalized against the miniscrews with nickel-titanium coil springs on both sides. One dog was killed each week after orthodontic force application.

RESULTS

The first premolar on the CF side moved significantly more rapidly (P <0.05). Histologic findings showed more active and extensive bone remodeling on both the compressive and tension sides in the CF group.

CONCLUSIONS

The CF technique doubled the rate of orthodontic tooth movement. Histologically, the more active and extensive bone remodeling in the CF group suggested that the acceleration of tooth movement associated with corticotomy is due to increased bone turnover and based on a regional acceleratory phenomenon.

Physical properties of root cementum: Part 13. Repair of root resorption 4 and 8 weeks after the application of continuous light and heavy forces for 4 weeks: a microcomputed-tomography study

INTRODUCTION

The reparative process of root absorption begins in the periodontium when orthodontic force is discontinued or reduced below a certain level. Our aim was to evaluate cementum repair at 4 and 8 weeks of retention after 4 weeks of continuous light and heavy orthodontic forces. The effects of age, tooth movement, and fluoride exposure were also investigated.

METHODS

Forty patients were recruited and divided into 4 groups of 10. The maxillary first premolars were loaded with either light (25 g) or heavy (225 g) orthodontic force. After 4 weeks of loading, the maxillary left first premolars were extracted as the positive control group, and the maxillary right first premolars were placed in retention for 4 or 8 more weeks before extraction; these were the experimental groups. The extracted teeth were studied with microcomputed tomography. To assess cementum repair, volumetric changes of the resorption craters were measured with specially designed computer software. Tooth movement was also measured on study casts taken before and after the extractions.

RESULTS

Root resorption continued for 4 weeks after orthodontic force ceased. The resorptive activity was more pronounced from heavy forces. Passive retention after 4 weeks of light force had the least root resorption crater volume (cube root scale). The total amount of the cementum repaired did not depend on magnitude of orthodontic force or retention time within our parameters (P >0.05). This might indicate concurrence of resorption and repair during passive retention. Most repair seemed to occur after 4 weeks of passive retention following the 4 weeks of heavy forces. The volume of root resorption craters positively depended on tooth movement (P = 0.02) and negatively correlated with chronologic age (P <0.01).

CONCLUSIONS

Although there was no significant difference in the amounts of repair between groups, root resorption continued for 4 weeks after orthodontic force stopped. Resorptive activity was more pronounced after the heavy forces. The reparative processes were different between the light and heavy forces, with marked individual variations. Repair seemed to become steady after 4 weeks of passive retention following 4 weeks of light force application, whereas most repair occurred after 4 weeks of passive retention following 4 weeks of heavy force application. Root resorption crater volume positively depended on tooth movement and negatively correlated with chronologic age.

Physical properties of root cementum: part 12. The incidence of physiologic root resorption on unerupted third molars and its comparison with orthodontically treated premolars: a microcomputed-tomography study

INTRODUCTION Root resorption can occur as a physiologic or a pathologic process, and it is an unwanted side effect of orthodontic treatment. No baseline studies have assessed this phenomenon in the absence of force variables such as mastication, parafunction, and soft-tissue pressure. In this study, we investigated the incidence and quantitative value of root resorption on unerupted third molars with normal development using microcomputed tomography.

METHODS

Nine unerupted, nonimpacted maxillary third molars were collected from 6 patients (ages, 19.47 plus /minus 1.89 years). The teeth were examined with microcomputed tomography and compared with teeth from other studies. (The other teeth had been treated with buccally directed light [25 g] or heavy [225 g] forces applied for 28 days, or light [25 g] or heavy [225 g] intrusion forces for 28 days.)

RESULTS

Imaging and volumetric analyses showed resorption craters in many locations and with various magnitudes. Analysis of variance was completed by position (P = 0.04), surface (P = 0.07), height (P = 0.045), left or right side of the mouth (P = 0.85), and subject (P = 0.70). The midroot region on the mesial surfaces of the third molars, near the root structure of adjacent erupted second molars, had the greatest statistical significance. When compared with crater volumes of fully erupted first premolars, we found that the unerupted third molar sample had a slightly greater cube root volume per tooth than the erupted first premolars not subjected to orthodontic force and a similar cube root volume per tooth as did first premolars subjected to light (25 g) buccal and intrusive orthodontic forces.

CONCLUSIONS

Root resorption as a consequence of orthodontic treatment might be added to a baseline level of root resorption. The elevated results suggest that resorption might occur as part of hard-tissue remodeling and turnover, eruption, or transmission of masticatory forces through the dentition to the alveolar bone.

Analysis of orthodontically induced root resorption using micro-computed tomography (Micro-CT)

OBJECTIVE

To establish a protocol for assessing orthodontically induced tooth root resorption (OITRR) in human premolars using micro-computed tomography.

MATERIALS AND METHODS

Ten extracted maxillary first premolars were obtained from eight healthy adolescent patients; five of these premolars were extracted before any orthodontic movement was applied to them, and the other five premolars were involved in nonextraction orthodontic treatment for 1 year before treatment plan modification lead to extraction treatment. Using reconstructed scanned images, we measured several key resorption lacunae parameters, including the number, volume, and depth on each surface, as well as its extension coronoapically.

RESULTS

Orthodontic treatment resulted in a significantly greater tooth root resorption lacunae volume, number, maximum depth, and coronoapical extension as well as in areas of dentin demineralization subjacent to the resorption lacunae than in normal premolars.

CONCLUSIONS

We have established a protocol to evaluate OITRR quantitatively and have provided a method to predict further resorption based on dentine demineralization.

Role of basic biological sciences in clinical orthodontics: a case series

INTRODUCTION

Orthodontic therapy is based on interaction between mechanics and biology. Basic biologic research aims at developing a better understanding of the mechanism of transformation of mechanical energy into biologic reactions, and exposing the reasons for iatrogenic tissue damage in orthodontics. Previous research has shown that inflammation is a major part of the biologic response to orthodontic forces. In inflammation, signal molecules that originate in remote diseased organs can reach strained paradental tissues and exacerbate the inflammatory process, leading to tissue damage.

METHODS

Our case series includes 3 patients, each having had systemic diseases and malocclusion. One had diabetes mellitus, Hashimoto's thyroiditis, and depression. Concern about the possible effect of these conditions on the well-being of the teeth and their surrounding tissues compelled the orthodontist to choose not to treat this patient. The other 2 patients had allergies, and 1 also had bronchial asthma and bruises.

RESULTS

Although these conditions are thought to be risk factors for root resorption, these patients received orthodontic treatment for 2 and 3.5 years, respectively. At the end of treatment, both had excessive root resorption of many teeth. In 1 patient, this damage led to the loss of most maxillary teeth.

CONCLUSIONS

Basic research should continue to address questions related to the biologic mechanisms of tooth movement on tissue, cellular, and molecular levels. Moreover, this research should continue to identify risk factors that might jeopardize the longevity of treated teeth. Such basic research should promote the development of new tissue-friendly and patient-friendly therapeutic methods.