Biochemical aspects of orthodontic tooth movement. I. Cyclic nucleotide and prostaglandin concentrations in tissues surrounding orthodontically treated teeth in vivo

Pain profile during orthodontic levelling and alignment with fixed appliances reported in randomized trials: a systematic review with meta-analyses

OBJECTIVE

To assess the pain profile of patients in the levelling/alignment phase of orthodontic treatment, as reported from randomized clinical trials.

MATERIALS AND METHODS

Five databases were searched in September 2022 for randomized clinical trials assessing pain during levelling/alignment with a visual analogue scale (VAS). After duplicate study selection, data extraction, and risk-of-bias assessment, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression, and certainty analyses.

RESULTS

A total of 37 randomized trials including 2277 patients (40.3% male; mean age 17.5 years) were identified. Data indicated quick pain initiation after insertion of orthodontic appliances (n = 6; average = 12.4 mm VAS), a quick increase to a peak at day 1 (n = 29; average = 42.4 mm), and gradually daily decrease the first week until its end (n = 23; average = 9.0 mm). Every second patient reported analgesic use at least once this week (n = 8; 54.5%), with peak analgesic use at 6 h post-insertion (n = 2; 62.3%). Patients reported reduced pain in the evening compared to morning (n = 3; MD =  - 3.0 mm; 95%CI =  - 5.3, - 0.6; P = 0.01) and increased pain during chewing (n = 2; MD = 19.2 mm; 95% CI = 7.9, 30.4; P < 0.001) or occlusion of the back teeth (n = 2; MD = 12.4 mm; 95% CI = 1.4, 23.4; P = 0.3), while non-consistent effects were seen for patient age, sex, irregularity, or analgesic use. Subgroup analyses indicated increased pain among extraction cases and during treatment of the lower (rather than the upper) arch, while certainty around estimates was moderate to high.

CONCLUSIONS

Evidence indicated a specific pain profile during orthodontic levelling/alignment, without signs of consistent patient-related influencing factors.

Current perspectives of residual ridge resorption: Pathological activation of oral barrier osteoclasts

PURPOSE

Tooth extraction is a last resort treatment for resolving pathological complications of dentition induced by infection and injury. Although the extraction wound generally heals uneventfully, resulting in the formation of an edentulous residual ridge, some patients experience long-term and severe residual ridge reduction. The objective of this review was to provide a contemporary understanding of the molecular and cellular mechanisms that may potentially cause edentulous jawbone resorption.

STUDY SELECTION

Clinical, in vivo, and in vitro studies related to the characterization of and cellular and molecular mechanisms leading to residual ridge resorption.

RESULTS

The alveolar processes of the maxillary and mandibular bones uniquely juxtapose the gingival tissue. The gingival oral mucosa is an active barrier tissue that maintains homeostasis of the internal organs through its unique barrier immunity. Tooth extraction not only generates a bony socket but also injures oral barrier tissue. In response to wounding, the alveolar bone socket initiates regeneration and remodeling through coupled bone formation and osteoclastic resorption. Osteoclasts are also found on the external surface of the alveolar bone, interfacing the oral barrier tissue. Osteoclasts in the oral barrier region are not coupled with osteoblastic bone formation and often remain active long after the completion of wound healing, leading to a net decrease in the alveolar bone structure.

CONCLUSIONS

The novel concept of oral barrier osteoclasts may provide important clues for future clinical strategies to maintain residual ridges for successful prosthodontic and restorative therapies.

The use of omega-3 fatty acids in the treatment of oral diseases

Omega-3 polyunsaturated fatty acids (ω-3 PUFAs) have been reported to exert important roles in the inflammatory response. There are many inflammatory diseases in dentistry which support the administration of ω-3 PUFAs as an adjunct therapy during the treatment of these diseases. The aim of this review was to evaluate the use of ω-3 PUFAs as an adjuvant therapy during the treatment of buccal diseases. The review showed that supplementation with ω-3 PUFAs was used for treatment of gingivitis, periodontal diseases, apical periodontitis, stomatitis, and orthodontic tooth movement. The results indicate that ω-3 PUFAs decreased the number of pro-inflammatory mediators in the gingival tissues of individuals with gingivitis and periodontitis. In apical periodontitis, the supplementation suppressed bone resorption and promoted bone formation in the periapical area of rats. During orthodontic movement, the supplementation showed a decrease of bone resorption in rats. It also showed that painful symptoms of recurrent aphthous stomatitis were alleviated in supplemented patients. In conclusion, the ω-3 PUFAs may be used as an adjuvant therapy in the treatment of inflammatory diseases that affect the oral cavity. However, more studies are required to elucidate the role of ω-3 PUFAs in decreasing oral cavity inflammatory processes.

The role of endothelin B receptor in bone modelling during orthodontic tooth movement: a study on ETB knockout rats

The endothelin system has an important role in bone modelling during orthodontic tooth movement (OTM); however, little is known about the involvement of endothelin B receptors (ET_B) in this process. The aim of this study was to evaluate the role of ET_B in bone modelling during OTM using ET_B knockout rats (ET_B-KO). Thirty-two male rats were divided into 4 groups (n = 8 per group): the ET_B-KO appliance group, ET_B-KO control group, wild type (ET_B-WT) appliance group, and ET_B-WT control group. The appliance consisted of a super-elastic closed-coil spring placed between the first and second left maxillary molar and the incisors. Tooth movement was measured on days 0 and 35, and maxillary alveolar bone volume, osteoblast, and osteoclast volume were determined histomorphometrically on day 35 of OTM. Next, we determined the serum endothelin 1 (ET-1) level and gene expression levels of the osteoclast activity marker cathepsin K and osteoblast activity markers osteocalcin and dentin matrix acidic phosphoprotein 1 (DMP1) on day 35. The ET_B-KO appliance group showed significantly lower osteoblast activity, diminished alveolar bone volume and less OTM than the ET_B-WT appliance group. Our results showed that ET_B is involved in bone modelling in the late stage of OTM.

The effect of naproxen patches on relieving orthodontic pain by evaluation of VAS and IL-1β inflammatory factor: a split-mouth study

Introduction:

Pain related to orthodontic tooth movement is common and cause dissatisfaction and discomfort. Objective: The present study aimed to compare the efficacy of naproxen patches in pain control during orthodontic tooth separation, by means of visual analogue scale (VAS) and interleukin 1β (IL-1β) levels in gingival crevicular fluid (GCF).

Methods:

In this split-mouth triple-blind clinical trial, with 40 patients following separation, 5% naproxen or placebo patches were randomly placed on the upper right or left first molars every 8 hours. Pain intensity scores were determined after 2 and 6 hours, sleep time, 24 hours, days 2, 3 and 7 by the patients using a 100-mm VAS ruler. IL-1β levels in GCF were evaluated by ELISA at baseline, 1 and 24 hours and 7 days. Paired samples t-tests and two-way repeated measures ANOVA analysis of variance with a significance level of 0.05 were applied.

Results:

A total number of 30 patients (13 males and 17 females) finished the trial. Significant differences were found in pain scores (p< 0.0001) and IL-1β levels (p= 0.047) between naproxen and placebo groups. Lower pain scores were reported for the patients using naproxen patches at all time points, except 1 hour after separation. IL-1β levels were lower for the patients using naproxen patches only 1 hour after separation (p= 0.047). The peak of pain scores and IL-1β levels were calculated at 24 hours.

Conclusion:

In the light of VAS scores and IL-1β levels, naproxen patches reduced the pain caused by separator placement.

Effect of statins on orthodontic tooth movement: A systematic review of animal and clinical studies

OBJECTIVE

The objective was to systematically-review the effect of statin drugs on orthodontic-tooth-movement (OTM).

DESIGN

The focused-question was "Does statin therapy affect OTM?" PubMed, Ovid Medline, Cochrane Library, Scopus, EMBASE and Web of Science databases were searched without time and language restrictions using different key words. Studies assessing the effect of adjunctive statin administration on OTM compared with orthodontic treatment alone were included. The search was performed up to and including December 2018. Data regarding the study design/grouping, subjects, age/gender, duration of follow-up, outcome variables and parameters related to OTM and statins administration were evaluated.

RESULTS

Nine studies (1 clinical and 8 studies performed in animal-models) were included. Six studies used Simvastatin, whereas three studies used Atorvastatin. Six experimental studies and one clinical study reported reduction in OTM upon statin administration. Two experimental studies reported no effect of statin administration on OTM. In 90 % of the studies, the risk-of-bias was high.

CONCLUSION

Based upon the high risk-of-bias and methodological inconsistencies among the included studies, the influence of statin delivery on OTM remains debatable.

Insight into orthodontic appliance induced pain: Mechanism, duration and management

Most of the orthodontic patients experience pain during treatment and this significantly influences their attitudes and the approach towards treatment. A number of factors that influence pain response include age, gender, personal pain threshold, mood and stress level of the person, cultural differences and types of orthodontic treatment. Pain is a often overlooked subject by orthodontists, it is nevertheless important to understand the source and mechanism of the pain that occurs during treatment, as well as the methods for managing and controlling this pain. This review attempts to overview the mechanism, duration and current management strategies of orthodontic treatment.

Critical roles of periostin in the process of orthodontic tooth movement

AIM

The process of orthodontic tooth movement (OTM) involves multiple mechanisms of action including bone and extracellular matrix remodelling, although the role of periodontal ligament (PDL) in this process is largely unknown. Periostin, which is highly expressed in the PDL, is known to be responsible for mechanical stimulation in maintaining the integrity of periodontal tissues. We hypothesize that this protein plays an important role during OTM.

MATERIAL AND METHODS

By using spring in 4-week-old wild-type (WT) and periostin null mice, the rate of tooth movement and mineralization were evaluated. For the evaluation, double labelling, expression of sclerostin (SOST), number of TRAP-positive cells, and quality of collagen fibrils by Sirius red were analysed and compared between these two groups.

RESULTS

Our findings showed that the distance of the tooth movement and mineral deposition rates were significantly reduced in periostin null mice (P < 0.05), with a lack of expression changes in SOST as observed in the WT group. The arrangement, digestion, and integrity of collagen fibrils were impaired in periostin null mice. The number of osteoclasts reflected by expressions of TRAP (tartrate-resistant acid phosphatase) in the null mice was also significantly lower than the WT control (P < 0.05).

CONCLUSION

Periostin plays a stimulatory role in both SOST and TRAP responses to OTM in the compassion site, although it is not clear if this role is direct or indirect during orthodontic loading.

The effectiveness of low-level diode laser therapy on orthodontic pain management: a systematic review and meta-analysis

To assess the effectiveness of diode low-level laser therapy (LLLT) for orthodontic pain control, a systematic and extensive electronic search for randomised controlled trials (RCTs) investigating the effects of diode LLLT on orthodontic pain prior to November 2014 was performed using the Cochrane Library (Issue 9, 2014), PubMed (1997), EMBASE (1947) and Web of Science (1956). The Cochrane tool for risk of bias evaluation was used to assess the bias risk in the chosen data. A meta-analysis was conducted using RevMan 5.3. Of the 186 results, 14 RCTs, with a total of 659 participants from 11 countries, were included. Except for three studies assessed as having a ‘moderate risk of bias’, the RCTs were rated as having a ‘high risk of bias’. The methodological weaknesses were mainly due to ‘blinding’ and ‘allocation concealment’. The meta-analysis showed that diode LLLT significantly reduced orthodontic pain by 39 % in comparison with placebo groups (P = 0.02). Diode LLLT was shown to significantly reduce the maximum pain intensity among parallel-design studies (P = 0.003 versus placebo groups; P = 0.000 versus control groups). However, no significant effects were shown for split-mouth-design studies (P = 0.38 versus placebo groups). It was concluded that the use of diode LLLT for orthodontic pain appears promising. However, due to methodological weaknesses, there was insufficient evidence to support or refute LLLT’s effectiveness. RCTs with better designs and appropriate sample power are required to provide stronger evidence for diode LLLT’s clinical applications.

The efficacy of different pre- and post-operative analgesics in the management of pain after orthodontic separator placement: A randomized clinical trial

Introduction:

Pain-free treatment to the patients is considered as an important treatment objective for orthodontic health care providers. However, many orthodontists underestimate the degree of pain experienced by the patients. Hence, this study was conducted as a randomized, double-blinded clinical trial with the following objectives.

Objective:

To study the pain characteristics after separator placement; to compare the efficacy of various commonly used analgesics in pain management and to determine the efficacy of pre- and post-operative analgesics in pain management.

Subjects and Methods:

Data were collected from 154 patients (77 males and 77 females, age group of 14-21 years, with mean age of 18.8 years) who reported to Department of Orthodontics. Patients were randomly divided in to four groups. Group 1: Paracetamol 650 mg, Group 2: Ibuprofen 400 mg, Group 3: Aspirin 300 mg, Group 4: Placebo and the study were conducted as a randomized, double-blinded clinical trial. The patients were instructed to take two tablets, one tablet 1 h before separator placement, and the other one after 6 h. The pain evaluations were made by the patients, when teeth not touching (TNT), biting back teeth together, chewing food (CF) using a 100-mm visual analogue scale for 7 days after separator placement. Patients were advised to record the severity of pain.

Results:

Group 3 (Aspirin 300 mg) showed lowest pain values, followed by Group 2 (ibuprofen 400 mg), and Group 1 (paracetamol 650 mg). All NSAID's achieved good pain control compared to Group 4 (placebo), where the intensity pain was maximum.

Conclusion:

Pre- and post-operative analgesics were found to be more effective in controlling orthodontic pain, after separator placement at all-time intervals.

Low-level laser therapy for treatment of pain associated with orthodontic elastomeric separator placement: a placebo-controlled randomized double-blind clinical trial

OBJECTIVE

The objective of this study was to evaluate the effectiveness of the use of irradiation with a low-level laser therapy (LLLT), wavelength 830 nm, for treating pain inherent to tooth movement caused by orthodontic devices, simulated by positioning interdental elastomeric separators.

METHODS

Sixty orthodontic patients were randomly assigned to two groups: GA (ages 12-25 years; mean 17.1 years) was the control, and GB (ages 12-26 years; mean 17.9 years) the intervention group. All patients received elastomeric separators on the mesial and distal surfaces of one of the lower first molars, and immediately after insertion of the separators received irradiation as randomly indicated. The intervention group (GB) received irradiation with LLLT (aluminum gallium arsenide diode), by a single spot in the region of the radicular apex at a dose of 2 J/cm(2) and application along the radicular axis of the buccal surface with three spots of 1 J/cm(2) (wavelength 830 nm; infrared). Control group (GA) received irradiation with a placebo light in the same way. This was a double-blind study. All the patients received a questionnaire to be filled out at home describing their levels of pain 2, 6, and 24 h and 3 and 5 days after orthodontic separator placement, in situations of relaxed and occluded mouth.

RESULTS

The patients in the intervention group (LLLT) had lower mean pain scores in all the measures. The incidence of complete absence of pain (score=0) was significantly higher the intervention group.

CONCLUSIONS

Based on this study, authors concluded that single irradiation with LLLT of wavelength 830 nm efficiently controlled the pain originating from positioning interdental elastomeric separators, to reproduce the painful sensation experienced by patients when fixed orthodontic devices are used.

Self-reported pain associated with the use of intermaxillary elastics compared to pain experienced after initial archwire placement

OBJECTIVE

To evaluate the pain during the use of intermaxillary elastics and to compare it with that of initial archwire placement.

MATERIALS AND METHODS

Sixteen orthodontic patients who underwent initial bonding (7 girls, 13 boys; mean age 16.75 ± 2.61 years) and 19 patients who would be using intermaxillary elastics for the first time (13 girls, 7 boys; mean age 16.21 ± 3.01 years) were enrolled in this prospective study. A visual analog scale form was given to each patient to measure the pain levels, and these were measured by the same investigator using a digital caliper. Data were evaluated using Mann Whitney U-test.

RESULTS

The pain started to increase 2 hours after the application of elastics. The highest levels were achieved at the sixth hour and the same night. The pain levels started to decrease at day 2. Although the pain levels of the elastic group started to decrease after the second day, the pain levels of the initial bonding group were still significantly high.

CONCLUSIONS

Intermaxillary elastics cause similar amounts of pain compared with initial archwire placement, but the pain of the elastics did not last as long as the pain felt after initial bonding.

Effect of surgical denervation on orthodontic tooth movement in rats

INTRODUCTION

Tooth movement through bone depends on local inflammatory reactions of the dentoalveolar tissues. Mechanical signals cause sensory afferent nerves to liberate inflammatory peptides around the teeth, creating local inflammation. Relationships between neurogenic inflammation and tooth movement are poorly understood. The objective of this study was to measure the differences in orthodontic tooth movement between rats treated with and without surgical transection of the maxillary nerve.

METHODS

Forty-two Sprague-Dawley rats were divided into 3 groups: (1) those with surgical transection of the maxillary nerve, (2) those with sham surgeries, and (3) those without surgery. After a 2-week healing period, a closed-coil spring appliance was activated to produce a 50 g mesial tipping force on the maxillary first molar. Diastema sizes distal to the first molar were measured in triplicate by using vinyl polysiloxane impression material and stone model pour-ups at 14 and 28 days of tooth movement. Images were captured and measured with a charge coupled device (CCD) microscope camera (Leeds Precision, Minneapolis, Minn) and Optimas measurement software (Media Cybernetics, Newburyport, Mass), respectively. Two-way repeated-measures ANOVA was used for statistical analysis.

RESULTS

Both weight and diastema size increased for all animals throughout the study. Although there were no significant differences between groups at any time point (log diastema, P = .43), the maxillary nerve transection surgery group had a significantly smaller increase in log diastema from 14 to 28 days than either the sham surgery or the nonsurgery group (P = .045).

CONCLUSIONS

This study suggests that surgical denervation causes little net effect on orthodontic tooth movement at these force levels.

Focal hyalinization during experimental tooth movement in beagle dogs

The aim was to study morphological differences between the periodontal structures of beagle dogs showing different rates of tooth movement under identical experimental conditions. An orthodontic appliance was placed on the mandibular second premolar and the first molar to exert a continuous and constant reciprocal force of 25 cN. Tooth movement was recorded weekly. The dogs were killed after 1, 4, 20, 40, and 80 days for histological evaluation. Haematoxylin and eosin staining was used for tissue survey, alkaline phosphatase staining was used as a marker for active osteoblasts, and tartrate resistant acid phosphatase staining was used for osteoclasts. After 24 hours, osteoclastic and osteoblastic activity had already increased at the pressure and tension sides, respectively, and, in some samples, hyalinization was found. In case of fast-moving teeth, areas of direct bone resorption at the pressure side and deposition of trabecular bone at the tension side were found throughout the experimental period. In the periodontal ligaments of teeth showing little movement, small patches of hyalinization were found at the pressure side, mostly located buccally or lingually of the mesiodistal plane. These phenomena were found in both molars and premolars and at all time points. It is concluded that small focal hyalinizations might be a factor that could explain individual differences in the rate of tooth movement.

Involvement of nitric oxide in orthodontic tooth movement in rats

Nitric oxide (NO) is an important regulatory molecule in bone formation and resorption. The purpose of this study was to examine the role of NO in orthodontic tooth movement in rats. We used specific inhibitors of NO synthases (NOS). Upper first molars of 9-week-old male Wistar rats were moved buccally for 21 days. The local administration of N(G)-nitro-L-arginine methyl ester. HCl (L-NAME), a general inhibitor of NOS activity, significantly reduced tooth movement. On the other hand, N(6)-(1-iminoethyl)-L-lysine. 2HCl (L-NIL), a selective inhibitor of the inducible isoform of NOS, had no effect. These results suggest that NO is an important biochemical mediator in the response of periodontal tissue to orthodontic force and is produced primarily through the activity of constitutive NOS.

Nonsteroidal anti-inflammatory drugs in orthodontic tooth movement: metalloproteinase activity and collagen synthesis by endothelial cells

Orthodontic treatment is based on the biologic principle that prolonged pressure on teeth results in remodeling of periodontal structures, allowing for tooth movement. Periodontal remodeling is a complex process regulated in part by prostaglandins and adversely affected by the use of nonsteroidal anti-inflammatory drugs. We investigated the effects of indomethacin on collagenase activity and procollagen synthesis in rat endothelial cell cultures. Cyclooxygenase inhibition resulted in exacerbation of IL-1 beta-mediated collagenase B (MMP-9) production and activity, as well as attenuation of type IV procollagen synthesis levels by endothelial cells in vitro. Hence, the use of over-the-counter nonsteroidal anti-inflammatory drugs during tooth movement may result in aberrant remodeling of periodontal vasculature and other structures, ultimately affecting orthodontic treatment efficacy. Further studies are needed to establish novel pain relievers that do not interfere with orthodontic processes.

Histomorphometric and biochemical study of osteoclasts at orthodontic compression sites in the rat during indomethacin inhibition

Prostaglandins affect the number of osteoclasts at compression sites in orthodontic tooth movement. They may also have a role in tooth movement and influence the extent of root resorption. The purpose was to examine the effect of indomethacin on the activity of resident osteoclasts, recruitment of new osteoclasts and root resorption at orthodontic compression sites. Two separate populations of osteoclasts were studied: those resident at the sites after initial appliance activation and those recruited by a subsequent activation. Orthodontic appliances were activated to provide mesially directed forces of 40 g on the maxillary molars of rats. The appliances were activated with the same force after 4 days. The rats were killed at 1, 3, 6 and 10 days after initial activation. Half of the rats were injected with indomethacin. Tooth movement was measured cephalometrically; osteoclast numbers, sizes, numbers of nuclei per osteoclast and root resorption were assessed histomorphometrically; tartrate-resistant acid phosphatase (TRAP) in alveolar bone was measured biochemically. Indomethacin inhibited both initial tooth displacement and that following the delay. It also reduced the increase in osteoclast numbers, total osteoclast surface and alveolar bone TRAP at day 10. It had no effect on the surface area of each individual osteoclast or number of nuclei in each osteoclast. Root resorption increased in both groups but it was enhanced at day 10 in the indomethacin group. These data suggest that orthodontic tooth movement after appliance activation requires the recruitment of osteoclasts to sites of compression and that this is indomethacin-sensitive. Furthermore, indomethacin enhances root resorption at compression sites 10 days after appliance reactivation.

The effects of exogenous prostaglandin E2 on root resorption in rats

This study evaluated the amount and depth of root resorption associated with varying concentrations and frequencies of injectable, exogenous prostaglandin E2 (PGE2) in conjunction with orthodontic tooth movement in rats. The sample consisted of 155 maxillary right and left first molars from 88, 8-week old, male Sprague-Dawley rats. The animals were divided into three control groups and two experimental groups. The control animals were divided into one nonappliance and two appliance groups. The experimental animals were divided into 2- and 4-week experimental time periods that were further subdivided based on single and weekly injection intervals of PGE2 and four different injectable concentration levels, i.e., 0.1, 1.0, 5.0, and 10.0 micrograms. A fixed orthodontic appliance was ligated between the maxillary incisors and maxillary first molars with closed-coil nickel-titanium springs. The appliance had an initial activating force of 60 gm. Serial histologic sections of the mesial root of the maxillary first molar were made, and a quantitative histomorphometric analysis of root resorption on the mesial and distal surfaces was performed. This study demonstrated increased root surface resorption when using exogenous PGE2 injections to enhance orthodontic tooth movement over a 2-week period with increasing root resorption on the mesial surface as compared with the distal surface in PGE2 treated teeth. No differences in root resorption were found with either multiple injections or increasing concentration in the 4-week experimental group. Local injection of PGE2 appeared to have no effect on the number or depth of resorption lacunae in either the 2- or 4-week groups.

Influence of indomethacin on bone turnover related to orthodontic tooth movement in miniature pigs

The purpose was to evaluate the influence of a prostaglandin inhibitor, indomethacin, on the tissue reaction related to orthodontic tooth movement. Sixteen miniature pigs were chosen for the study, eight of which received indomethacin perorally every day of the 39-day observation period. Sentalloy expansion springs (GAC, Central Islip, N.Y.) delivering 100 cN were inserted on a segmented arch between the central lower incisors. Intravital labeling with tetracycline was used for the evaluation of the rate of bone formation. After the pigs were killed, the bone turnover was evaluated on undecalcified methacrylate embedded sections and on microradiographs. The histomorphometric analysis of bone turnover revealed that the relative extent of resorption surfaces was decreased significantly in the indomethacin treated animals. Formation surfaces were also decreased although not significantly. The bone turnover, but not the mineralization rate, was influenced. The results corroborate the recommendation that prostaglandin inhibitors should be avoided during orthodontic treatments.

Dietary lipids, prostaglandin E2 levels, and tooth movement in alveolar bone of rats

A previous study showed that certain dietary lipids can alter arachidonic acid concentrations in alveolar bone. Because arachidonic acid is a precursor of prostaglandin (PG) E2, which is known to play an important role in orthodontic tooth movement, the purpose of the present study was to determine the effect of dietary lipids on PGE2 levels and tooth movement. Two groups of male Sprague-Dawley rats (20/group) were fed nutritionally adequate purified diets containing 10% corn oil (group I, rich in n-6 fatty acids) or 9% ethyl ester concentrate of n-3 fatty acids + 1% corn oil (group II rich in n-3 fatty acids). After 5 weeks of feeding the diets, orthodontic force of 56 g was applied to the maxillary incisors to tip them distally. Prior to killing the rats at day 4 and 8 of orthodontic force application, tooth movement was measured by computerized image analysis. Premaxillae were dissected out free of soft tissue and incisors. The alveolar bone was frozen in liquid nitrogen, pulverized, and lipids were extracted. The concentrations of arachidonic acid and fatty acid composition of total phospholipids were measured by gas chromatography. PGE2 levels were measured by enzyme immunoassay. Arachidonic acid and PGE2 concentration were significantly lower (P < 0.001) in alveolar bone of rats in group II than in group I. The tooth movement was also significantly lower (P < 0.02) in group II than in group I at both 4 and 8 days. The results suggest that PGE2 levels in alveolar bone and orthodontic tooth movement can be affected by the type of dietary fat.

The effect of acetylsalicylic acid on orthodontic tooth movement in the guinea pig

This study examined the influence of acetylsalicylic acid an inhibitor of prostaglandin synthesis, on orthodontic tooth movement induced with light spring forces in the guinea pig. The animal model was shown to permit reliable and accurate recording of tooth movement up to 28 days. Tooth movement was found to be highly correlated with spring forces, indicating that the model provided a sensitive test of the effect of aspirin on tooth movement. Aspirin was administered orally at the rate of 65 mg/kg per day in three divided doses and was found to effectively inhibit prostaglandin synthesis at the level of the bronchioles. However, aspirin did not appear to significantly affect tooth movement. Thus prostaglandins may not be the only mediators of the bone resorption associated with tooth movement induced by light orthodontic forces under these experimental conditions.

Substance P immunoreactivity in periodontal tissues during orthodontic tooth movement

Neurotransmitters, such as substance P (SP), may mediate the biological response to mechanical stress applied to teeth during orthodontic treatment. This hypothesis was investigated immunohistochemically on maxillae of cats which had one maxillary canine tipped distally for a period of time ranging from 1 h to 14 days. Horizontal histological sections 5 microns thick, collected on adhesive tape while still frozen, then freeze-dried, were stained by an immunoglobulin-enzyme bridge method using rabbit anti-SP polyclonal antibodies. The specificity of the staining was evaluated either by using the serum of non-immunized rabbits in lieu of anti-SP serum, or by pre-incubating the anti-SP serum with the antigen. Only sparse SP-like immunoreactivity was detected in the dental pulp, near or in the walls of blood vessels, or in the periodontal ligament (PDL) of unstressed canines. However, the density of neuronal elements exhibiting positive staining for SP appeared to increase markedly after application of an orthodontic force. This phenomenon occurred rapidly (3 h) in the dental pulp, but later in the PDL (24 h to 14 days), mainly at compression sites. These results demonstrate that the stimulation of periodontal nerve terminals by means of orthodontic forces may induce the peripheral release of the neurotransmitter SP, suggesting that it may be an initial trigger for a biochemical cascade which comprises the activation of various types of PDL cells.

Interactive effects between cytokines on PGE production by human periodontal ligament fibroblasts in vitro

Mononuclear cell production of cytokines that stimulate fibroblast production of prostaglandin E (PGE) is an important mechanism by which mononuclear cells regulate fibroblast function. The objective of this investigation was to determine the effects of the cytokines interleukin 1 beta (IL-1 beta), interleukin 1 alpha (IL-1 alpha), tumor necrosis factor alpha (TNF-alpha), and interferon gamma (IFN-gamma), alone or in paired combinations, on PGE production by near-confluent human periodontal ligament (PDL) fibroblasts in vitro. Premolars extracted in the course of orthodontic treatment were used for this study. Fibroblast cultures, free of epithelial cells, were obtained after the fourth subculture by the use of accurately-timed trypsin treatment. Cells in the fourth to sixth passage, incubated in DMEM supplemented with 10% equine serum, were used for these experiments. Cells (1 x 10(5)) were seeded in 12- x -75-mm tissue culture tubes and incubated with various doses of IL-1 beta, IL-1 alpha, TNF-alpha, and IFN-gamma, alone or in specific combinations, for 15 min, two, 12, 24, and 72 h. PGE concentrations in the media were measured by radio-immunoassay. The results showed that human PDL fibroblasts responded to the administration of cytokines by an elevation in the synthesis of PGE in a dose- and time-related fashion. The increase in PGE production was inhibited by the addition of indomethacin. The interactions between these cytokines varied in degree, depending on the particular combinations of cytokines. In addition, the administration of cytokine combinations was found to be additive, synergistic, subtractive, or suppressive on the production of PGE by PDL fibroblasts, depending on the duration of incubation. These experiments demonstrate the importance of the consideration of the interplay between cytokines produced by mononuclear cells on the mechanisms that regulate the functions of PDL fibroblasts.

Nonsurgical management of ectopic teeth

Four cases have been presented involving malpositioned premolars and molars that were brought into the arch. From the cases presented, it appears that aggressive surgical intervention to redirect ectopic premolars creates significant secondary problems. Interference with the bone surrounding the ectopic tooth may compromise the adjacent teeth and bone level. Pressure against the root of the impacted tooth may cause resorption. If the buccal or labial plate is removed, orthodontic movement will be impeded. Specific biochemical changes in bone are induced by the application of orthodontic forces. In these cases, creating space with coiled spring appliances resulted in remarkable reorientation and proper eruption of ectopic, impacted teeth. When surgical intervention is required in cases involving ectopic teeth, close collaboration between orthodontist and oral and maxillofacial surgeon is imperative to achieve successful results without negative sequelae.

Growth, development, and aging of orofacial tissues: neural aspects

Neural factors influence post-natal growth, development, and aging throughout the body. This influence may be mediated through sensory or motor effects interacting with endocrine and immunological factors. Growth effects may be expressed directly by sensory or motor nerves on the tissue or indirectly by motor function. Direct neutrotrophic effects have been well-documented in the development of striated muscle, the taste bud, and the amphibian limb. Evidence for a trigeminal neurotrophic effect on tooth development and facial development is lacking. Growth disturbances of the jaws consequent to lesioning of the trigeminal nerve are due most likely to functional disturbances rather than neutrotrophism. Examples of function impact on orofacial growth are abundant. Oral and facial target tissues, like those elsewhere in the body, determine the nature of the target tissue innervation and its central organization. Central effects consequent to tooth loss or dental pulp entirpation are well-documented. Inflammation and pain may exert growth effects through release of "wound hormones" or secondarily to somatic and autonomic effects. There is evidence that vasoactive intestinal peptide (VIP) and calcitonin gene-related peptide (CGRP) elaborated from sympathetic and parasympathetic neurons may have a modulatory role in growth. While the effects of longstanding motor pathologies on skeletal growth are well-known, concomitant sensory deficits and soft tissue disturbances have not been examined. However, the pathological models beg the question of normal regulation. While muscle develops in the absence of innervation, neurotrophic effects are clearly identified. Little is known about the interaction of simple and complex motor behavior on growth. Regulation of growth is frequently visualized within a form-function paradigm. For example, anterior open bites have been seen as the consequence of tongue thrusting or tongue thrusting as a consequence of open bites. Low tonic forces in posture are thought to be more important in the development of both the face and the dental alveolar complex than the higher intermittent forces in mastication and swallowing. The need for an active (reflex) contribution to growth at the TMJ is in dispute.(ABSTRACT TRUNCATED AT 400 WORDS)

Leukotrienes in orthodontic tooth movement

Prostaglandins (PGs) and leukotrienes (LTs) are products of arachidonic acid conversion. PGs have an established role in mediating orthodontic tooth movement. The role of LTs in modulating or mediating orthodontic tooth movement was investigated in this study. One hundred thirty-two Sprague-Dawley rats were used; the animals weighed 300 to 400 gm with equal numbers of male and female rats. They were divided into five main groups of 24 animals each and a sham group of 12 animals. An orthodontic appliance was placed and activated on all the animals except the sham group; in this group the appliances were not active. Each main group was given one of the following treatments daily: distilled water, 5% gum arabic solution, PG synthesis inhibitor indomethacin, LT synthesis inhibitor AA861, and a combination of both drugs. Each group was divided into six subgroups of four animals; the animals were killed at either 1, 3, 5, 7, 10, or 14 days, and tooth movement measured. The three sham subgroups received distilled water and were killed at 1, 7, or 10 days. The first maxillary molar (the moved tooth) and surrounding tissues were removed from all animals in the sham group and the subgroups killed at 1, 7, and 10 days in the gum arabic solution group and the LT synthesis inhibitor group. Prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) were extracted, measured with radioimmunoassay (RIA), and standardized per milligram of protein in the sample. A significant inhibition of tooth movement occurred beginning on day 7 in the indomethacin, AA861, and combination groups; there was no significant difference among these groups.(ABSTRACT TRUNCATED AT 250 WORDS)