Force-induced changes in the vascularity of the periodontal ligament

An immunofluorescence study on VEGF and extracellular matrix proteins in human periodontal ligament during tooth movement

The periodontal ligament (PDL) is a highly vascularized connective tissue surrounding the root of a tooth. In particular, the PDL is continuously exposed to mechanical stresses during the phases of mastication, and it provides physical, sensory, and trophic functions. It is known that the application of orthodontic force creates a change in periodontal structures. In fact, these forces generate a pressure on the ligament that closes the vessels. The aim of this study is to observe the modifications of vascular endothelial growth factor (VEGF) in the PDL and extracellular matrix proteins after application of a pre-calibrated and constant orthodontic force at different phases of treatment. We used a 50-g NiTi coiled spring and in vivo samples of PDL of maxillary and mandibular premolars of patients subjected to orthodontic treatment. These teeth were extracted at 1, 7, 14, 21, and 30 days, respectively, by application of force. The extraction of the PDL was effectuated by scarifying the radicular surface on the pressure and tension sides. The mechanical stress induced by the application of force caused an increase in the reactive type of metabolism of extracellular matrix proteins and modulation of neoangiogenesis until restoration.

The osteoimmunology of alveolar bone loss

The mineralized structure of bone undergoes constant remodeling by the balanced actions of bone-producing osteoblasts and bone-resorbing osteoclasts (OCLs). Physiologic bone remodeling occurs in response to the body's need to respond to changes in electrolyte levels, or mechanical forces on bone. There are many pathological conditions, however, that cause an imbalance between bone production and resorption due to excessive OCL action that results in net bone loss. Situations involving chronic or acute inflammation are often associated with net bone loss, and research into understanding the mechanisms regulating this bone loss has led to the development of the field of osteoimmunology. It is now evident that the skeletal and immune systems are functionally linked and share common cells and signaling molecules. This review discusses the signaling system of immune cells and cytokines regulating aberrant OCL differentiation and activity. The role of these cells and cytokines in the bone loss occurring in periodontal disease (PD) (chronic inflammation) and orthodontic tooth movement (OTM) (acute inflammation) is then described. The review finishes with an exploration of the emerging role of Notch signaling in the development of the immune cells and OCLs that are involved in osteoimmunological bone loss and the research into Notch signaling in OTM and PD.

Understanding the advances in biology of orthodontic tooth movement for improved ortho-perio interdisciplinary approach

This article provides an insight on detailed current advances in molecular understandings of periodontal ligament cells and the influence of orthodontic force on them in the light of recent advances in molecular and genetic sciences. It sequentially unfolds the cellular events beginning from the mechanical force initiated events of cellular responses to bone remodeling. It also highlights the risks and limitations of orthodontic treatment in certain periodontal conditions, the important areas of team work, orthodontic expectations from periodontal treatment and the possibility of much more future combined research to improve the best possible periodontal health and esthetic outcome of the patient.

Effects of hypoxia on osteogenic differentiation of rat bone marrow mesenchymal stem cells

Bone reconstruction is essential in orthodontic treatment that caters to the correction of malocclusion by bone reconstruction. Mesenchymal stem cells (MSCs) have been demonstrated a great potency of osteogenesis. The aim of this study was to investigate the effect of hypoxia on the rat bone marrow MSCs (rBMSCs) in vitro during osteogenesis. In this study, we found that temporary exposure of rBMSCs after osteogenic induction for 7 days to hypoxia (2% oxygen) led to a marked decrease in ALPase activity and the expression of osteocalcin and Runt related transcription factor 2/core binding factor a1 (Runx2/Cbfa1). Meanwhile, we found that exposure to hypoxia led to an early and transient increase in the level of phosphorylated ERK1/2 but had no obvious effects on mitogen-activated protein kinase (p38 MAPK) level. Based on these results, we concluded that hypoxia could inhibit osteogenic differentiation of rBMSCs possibly through MEK-ERK 1/2, while p38 MAPK may not participate in this regulation. Further exploration into the mechanisms of hypoxia on osteogenesis would surely provide reliable evidence for clinical practice.

Morphological changes in the rat periodontal ligament and its vascularity after experimental tooth movement using superelastic forces

The aim of this study was to statistically assess the morphological changes of the rat periodontal ligament (PDL) and its vascularity in relation to varied magnitudes of superelastic force in experimental tooth movement using nickel-titanium (NiTi) alloy wire. Forces of 0.8, 1.6, 4, 8, and 18 g were applied to the upper first molars of five groups of 10-week-old male Wistar rats (300-320 g) for 1, 7, 14, 21, and 28 days. A control group with no orthodontic appliance application was assessed in accordance with the five experimental periods. The specimens were observed under light microscopy, processed by computer imaging, and analysed statistically with Tukey's HSD non-parametric test. One day after the start of the experiment, a few blood vessels could be seen in the compressed PDL with forces of 0.8 and 1.6 g. The cross-sectional areas of blood vessels (CAV) and periodontal ligament (CAPL) in the experimental groups where a force of over 4 g was applied were significantly smaller than those where 0.8 and 1.6 g forces were used, and in the control group. On day 7, large CAV were seen in the 1.6, 4, and 8 g groups. On day 28, the 8 and 18 g groups showed significantly larger CAPL than the 0.8, 4 g, or control groups. The findings suggest that a light continuous force, under 1.6 g, maintains the vascular structure during experimental tooth movement. In contrast, a heavy continuous force over 4 g causes the vascular structure to be absent in the early stages of tooth movement, but a dynamic regeneration of the PDL with vascularity and expansion follows.

A new idea and method of tooth movement using a ratchet bracket

Since ideally effective tooth movement in orthodontics should occur without causing damage to the periodontal ligament (PDL), a new bracket with a ratchet-locking system, the 'Ratchet Bracket', was designed to produce tooth movement while maintaining blood circulation. To define the mechanism of the appliance, a histological study was carried out on four Beagle dogs (9 months old) and a clinical study on five female patients (11 years to 38 years 10 months of age). Five upper canines in the dogs were moved 1.82 mm per month. On light microscopic observations, vascular forms showed a round-oval shape, without undermining bone resorption. No root resorption was observed in the compressed PDL at days 1, 14, and 35 of the experimental period. On fluorescent images at day 46, distinctive bone formation was apparent at the tension side. In the clinical investigation, nine upper canines in the five female patients were moved 1.92 mm per month. A wide and long alveolar hard line was seen only on the tension side of the canines on dental radiographs, indicating bodily tooth movement, without obvious signs of root resorption in all subjects. Neither spontaneous pain nor pain during biting were reported. The findings indicate that use of the ratchet bracket could result in rapid and pain-free tooth movement with vascular clarity to maintain blood circulation in the PDL.

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.

Cellular, molecular, and tissue-level reactions to orthodontic force

Remodeling changes in paradental tissues are considered essential in effecting orthodontic tooth movement. The force-induced tissue strain produces local alterations in vascularity, as well as cellular and extracellular matrix reorganization, leading to the synthesis and release of various neurotransmitters, cytokines, growth factors, colony-stimulating factors, and metabolites of arachidonic acid. Recent research in the biological basis of tooth movement has provided detailed insight into molecular, cellular, and tissue-level reactions to orthodontic forces. Although many studies have been reported in the orthodontic and related scientific literature, a concise convergence of all data is still lacking. Such an amalgamation of the rapidly accumulating scientific information should help orthodontic clinicians and educators understand the biological processes that underlie the phenomenon of tooth movement with mechanics (removable, fixed, or functional appliances). This review aims to achieve this goal and is organized to include all major findings from the beginning of research in the biology of tooth movement. It highlights recent developments in cellular, molecular, tissue, and genetic reactions in response to orthodontic force application. It reviews briefly the processes of bone, periodontal ligament, and gingival remodeling in response to orthodontic force. This review also provides insight into the biological background of various deleterious effects of orthodontic forces.

Nonlinear stress-strain behavior of periodontal ligament under orthodontic loading

Previous studies of the periodontal ligament (PDL) have applied high forces to the dental units to examine the stress-strain behavior of this soft tissue. In this study, cadaveric specimens of mandibular premolars from 2 young adult and 2 elderly adult donors were tested to determine the biomechanical behavior of the PDL over an orthodontic force range. Transverse specimens were prepared from 9 premolars and subjected to loading in intrusion and extrusion. Stress-strain curves for both loading directions had distinct toe and linear regions, demonstrating nonlinear behavior of the PDL. The average linear shear modulus was higher for intrusion than for extrusion. The toe extrusive modulus was higher for the young group, and extrusive toe size was larger for the elderly group. In extrusion, the average modulus was higher for the cervical margin and the apex regions than for the midroot regions. The size of the toe region was smaller for intrusion than extrusion. The results indicate age-dependent, location-dependent, and load-direction-dependent nonlinear properties of the human PDL and suggest that analytical computer simulations of orthodontic tooth movements might benefit from incorporating the nonlinear material properties of the PDL.

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.

Human tooth movement in response to continuous stress of low magnitude

Conventional orthodontic therapy often uses force magnitudes in excess of 100 g to retract canine teeth. Typically, this results in a lag phase of approximately 21 days before tooth movement occurs. The current project was undertaken to demonstrate that by using lower force magnitudes, tooth translation can start without a lag phase and can occur at velocities that are clinically significant. Seven subjects participated in the 84-day study. A continuous retraction force averaging 18 g was applied to 1 of the maxillary canines, whereas a continuous retraction force averaging 60 g was applied to the other. The magnitude was adjusted for each canine to produce equivalent compressive stresses between subjects. Estimated average compressive stress on the distal aspect of the canine teeth was 4 kPa or 13 kPa. The moment-to-force ratios were between 9 and 13 mm. Tooth movement in 3 linear and 3 rotational dimensions was measured with a 3-axis measuring microscope and a series of dental casts made at 1- to 14-day intervals. The results showed a statistical difference in the velocity of distal movement of the canines produced by the 2 stresses (P =.02). The lag phase was eliminated and average velocities were 0.87 and 1.27 mm/month for 18 and 60 g of average retraction force. Interindividual velocities varied as much as 3 to 1 for equivalent stress conditions. It was concluded that effective tooth movement can be produced with lower forces and that because loading conditions were controlled, cell biology must account for the variability in tooth velocities measured in these subjects.

Distributional changes of osteoclasts and pre-osteoclastic cells in periodontal tissues during experimental tooth movement as revealed by quantitative immunohistochemistry of H(+)-ATPase

To investigate the mechanism of alveolar bone remodeling in response to orthodontic force application, we examined the distribution of osteoclasts and pre-osteoclastic cells using quantitative immunohistochemistry of vacuolar type H(+)-ATPase. For orthodontic force to be produced by the Waldo method, an orthodontic elastic band was inserted between the upper first and second molars of rats. The observed areas of periodontal tissues around second molars were the distal surfaces of mesial roots, as the pressure side, and the mesial surfaces of distal roots, as the tension side. Specific expression of vacuolar-type H(+)-ATPase at the ultrastructural level was detected in mononuclear and multinucleated pre-osteoclastic cells, as well as osteoclasts with ruffled borders on bone surfaces. At 6 hrs after orthodontic force application, many osteoclasts and pre-osteoclastic cells with H(+)-ATPase expression were first observed in vascular canals of the alveolar bone crest near the pressure side of the periodontal ligament, but the number of osteoclasts was not increased in the periodontal ligament. On day 1 after tooth movement, osteoclasts were increased in number in the periodontal ligament and in adjacent alveolar bones on the pressure side, but were seldom observed in corresponding areas on the tension side. The number of osteoclasts increased until day 7, but had decreased by day 14. These results suggest that, in bone remodeling during experimental tooth movement, (1) osteoclasts and pre-osteoclastic cells can be identified by H(+)-ATPase immunohistochemistry, (2) osteoclasts and pre-osteoclastic cells are rapidly induced after force application, (3) osteoclast induction first occurs in vascular canals of the alveolar bone crest on the pressure side, and then, (4) the number of osteoclasts increases in the periodontal ligament on the pressure side.

Vascular changes in the periodontal ligament after removal of orthodontic forces

Vascular changes in the periodontal ligament after release of orthodontic force and their possible contribution to relapse of relocated teeth are poorly understood. This study documented the periodontal vascular changes after 2 weeks of tooth movement and during a 3-week period after release of orthodontic force. This study is the first comprehensive quantitative description of these events. Changes in blood vessel number and density were correlated with the direction of tooth movement (initially mesial in response to force but later distal because of relapse). Application and removal of orthodontic force produced significant changes in blood vessel number and density, which were not related to changes in tissue volume. The vascular changes were dependent on the site of evaluation and the size of the blood vessel. The periodontal vascular distribution and density can be summarized as follows: (1) increased after application of orthodontic force, (2) transient decrease subsequent to removal of force, (3) transient increase during reactivated distal drift, and (4) normalization. Normalization was achieved during an interval equivalent to the duration of orthodontic force, suggesting that the vasculature could modulate interstitial tissue pressures, resulting in relapse of relocated teeth. The role of the periodontal vasculature in alveolar remodeling and in modifying interstitial tissue fluid pressures coincident to human tooth movement requires further study.

The effect of mechanical deformation on the distribution of ions in fibroblasts

The extracellular and intracellular sodium, potassium and chloride concentrations were determined in fibroblast cells located in the rat calvarium. The ionic values were determined by fluorescence microscopy after incubation with the fluorescent probes, sodium-binding benzofuran isophthalate (SBFI), potassium-binding benzofuran isophthalate (PBFI) and 6-methoxy-N-(3-sulfopropyl) quinolinium (SPQ) (Dyes were supplied by CALBIOCHEM, Nottingham, England). After determination of the resting membrane potential, the calvaria were placed under tension by retraction of a micromanipulator. The fluorescence was measured again. A statistically significant difference was found in the calculated potassium ion concentration (Mann-Whitney; p < 0.05). This affected the resting cell membrane potential by an average of 5.2 mV. This effect was blocked by the addition of a potassium channel blocker, tetraethylammonium (TEA).

[The long-term observation of alveolar bone blood flow during tooth movement with the aid of skeletal scintigraphy in an animal model]

We observed in eleven dogs the blood flow in the alveolar bone during the tooth movement with the bone scintigraphy for one year. Additional we used for histological evaluation polychrome sequence marking and for improving of therapy electrostimulation. There is a correlation between tooth movement and blood flow. Four to six weeks after beginning tooth movement and blood circulation are reduced although the applied force was continuous all the time. This is an advice for stress interruption during treatment. Electrostimulation improves the conditions for tissue regeneration because the lifetime of osteoblasts is prolonged.

Material parameters and stress profiles within the periodontal ligament

Levels and profiles of initial stress in the periodontal ligament after application of various force systems were studied. Two finite-element models, based on sections of human autopsy material, were developed to simulate one full and one partial mandible. The validity of the finite-element model was improved by identification of material parameters; the mechanical properties of the tissue were described by means of strain-gauge measurements of initial tooth movements in human autopsy material. The multiple modeling technique, in which data from a coarse global model are transferred to a more detailed one, was used to identify bone structure and boundary conditions. Parameters known to influence the results were varied to establish the validity of the finite-element model. Iterative calculation methods were used to gain stable results. However, optimizing features of the bone structure and boundary conditions did not influence the results significantly. The elastic stiffness of the periodontal ligament was determined to 0.07 MPa and tau = 0.49 (tau being the Poisson's ratio). Stress profiles were obtained for various force systems--as in tipping, translation, and root movement. As we expected, there was a marked variation in the stress distribution from cervix to apex when tipping forces were applied. Bodily movement of the tooth produced an almost uniform stress distribution; root movement produced stress patterns opposite to those observed during tipping; and masticatory forces alone produced stress patterns almost identical to those achieved by masticatory force in combination with orthodontic forces.

A device for the application of known simulated orthodontic forces to human cells in vitro

Connective tissues are responsive to mechanical forces. In orthodontic tooth movement it appears that the periodontal ligament (PDL) is the source of a pleuropotential cell population and extracellular matrix structure which translates mechanical perturbation information into a host of cellular events. These include proliferation, repair, differentiation, and shape change. We have designed, built, and tested a simple, adaptable machine which enables us to examine molecular changes or events in the cell nucleus, cell membrane, and the cytoskeleton of any eukasytic cell that will adhere to a membrane. These responses to clinically simulated forces applied to an in vitro system can be measured.

[Reactive changes in the periodontal microcirculation under orthodontic forces]

The influence of intrusive forces on the periodontal microcirculation exerted as conventional through brackets on the teeth is demonstrated with laser Doppler flowmetry. This noninvasive method shows that forces of 0.1 N on the human upper incisor cause a decrease of the periodontal perfusion of 20% which shall regain its initial level after 50-80 seconds. With an intrusive force of 0.5 N the perfusion decreases 42% within two to three seconds, which however shall not even regain its original level after ten minutes. Immobilisation of the teeth and infiltrative anaesthesia with vasoconstrictor were carried out in order to specify these measurements.

Tooth extrusion effects on microvessel volumes, endothelial areas, and fenestrae in molar apical periodontal ligament

Extrusive tooth loads, simulating short-term orthodontic movements, have not previously been used for transmission electron microscopic quantification of their effects on the periodontal ligament vessels. In this study, a continuous extrusive load of 1.0 N, applied to the rat maxillary first molar for 30 minutes, produced statistically significant changes in the microvascular bed of the tensioned apical periodontal ligament. The mean vascular volume, as a percentage of apical periodontal ligament volume, increased (p less than 0.01) in postcapillary-sized venules, venous capillaries, arterial capillaries, and terminal arterioles from 16.6% to 22.3%, 2.0% to 2.7%, 0.4% to 1.0%, and 1.0% to 2.5%, respectively. Mean endothelial surface area per cubic millimeter of apical periodontal ligament tissue increased (p less than 0.01) in postcapillary-sized venules from 16.8 to 25.7 x 10(6) microns 2/mm3, in venous capillaries from 3.0 to 4.8 x 10(6) microns 2/mm3, and in arterial capillaries from 0.7 to 1.5 x 10(6) microns 2/mm3. The number of fenestrae per square micron of endothelium in postcapillary-sized venules, venous capillaries, and arterial capillaries showed a mean increase from 0.02 to 0.07, 0.11 to 0.31, and 0.02 to 0.21 fenestrae/microns 2, respectively (p less than 0.01). Fenestrae per cubic millimeter of periodontal ligament tissue also demonstrated a statistically significant increase with extrusion (p less than 0.01) in postcapillary-sized venules from 0.37 to 1.55 x 10(6) fenestrae/mm3, in venous capillaries from 0.27 to 1.34 x 10(6) fenestrae/mm3, and in arterial capillaries from 0.02 to 0.22 x 10(6) fenestrae/mm3. Fenestrae in control vessels had a mean diameter of 54.2 +/- 0.56 nm (SE) compared with 61.1 +/- 0.7 nm in tensioned vessels (p less than 0.01). This investigation demonstrates multiple ultrastructural changes in the periodontal ligament microvascular bed after tooth extrusion.

Activation of the vascular system: a main mediator of periodontal fiber remodeling in orthodontic tooth movement

The behavior and role of blood vessels and blood-borne cells in the process of the remodeling of the periodontal ligament (PDL) incident to experimental tooth movement was studied in rats. Particular interest was focused on areas of tension and of pressure with frontal bone resorption but without overt hyalinization. An increase of vascular activity occurred in the above mentioned situations. Extensive breakdown of collagen was observed in pressure areas with frontal resorption and in areas of tension concomitant with vascular invasion. Two patterns of fiber and bone remodeling were seen in areas of tension: intense vascular activity within the periodontal membrane and intense vascular activity inside the alveolar bone. Macrophages occurred consistently near blood vessels both in areas of tension and in areas of resorption. These are multipotent cells that obviously influence the remodeling process.