Gingival response to orthodontic force

Hyperbaric Oxygen Therapy to Minimize Orthodontic Relapse in Rabbits

OBJECTIVES

 The purpose of the present study was to discover how hyperbaric oxygen therapy (HBOT) could reduce orthodontic relapse by altering the expressions of hypoxia-inducible factor (HIF)-1 messenger ribonucleic acid (mRNA), type I collagen (Col I), and matrix metalloproteinase-1 (MMP-1) in the gingival supracrestal fibers in rabbits.

MATERIALS AND METHODS

 This study involved 44 male rabbits (Oryctolagus cuniculus) randomly divided into the normal group (K0), the orthodontic group without HBOT (K1), and the orthodontic group with HBOT (K2). Following orthodontic separation of the two upper central incisors, a retention phase and relapse assessment were performed. The HBOT was performed for a period of 2, 4, 6, 8, and 10 days after retention. HIF-1α transcription was assessed employing real-time polymerase chain reaction, whereas Col I and MMP-1 proteins were examined using immunohistochemistry. The orthodontic relapse was measured clinically using a digital caliper.

STATISTICAL ANALYSIS

 We used the one-way analysis of variance followed by Tukey's post hoc for multiple comparisons to measure differences between pairs of means; a p-value of 0.05 was considered statistically significant.

RESULTS

 HBOT significantly increased the HIF-1α mRNA expression (p = 0.0140), increased Col I (p = 0.0043) and MMP-1 (p = 0.0068) on the tensioned and pressured side of the gingival supracrestal fibers, respectively, and clinically decreased the relapse (p = 3.75 × 10-40).

CONCLUSION

 HBOT minimizes orthodontic relapse by influencing HIF-1α expression, collagen synthesis (Col I), and degradation (MMP-1). This result suggests that HBOT has the potential to be used as an adjunctive method in the orthodontic retention phase.

Orthodontic retention: Rationale and periodontal implications

Post-treatment change in the form of true relapse and physiological and maturational effects is common following orthodontics. The unpredictable nature of these manifestations dictates a conservative, near-universal approach to retention. Both fixed and removable forms of retention are popular with the latter constrained by variable levels of adherence particularly in the medium- to long-term. Fixed retention may offer a more predictable means of preservation of orthodontic outcomes; however, this advantage is offset by the requirement for prolonged supervision and the potential for adverse changes including periodontal breakdown. Nevertheless, while examples of severe complications are common, a clear causal relationship between intact, passive retainers and periodontal issues does not appear to exist. Nevertheless, the importance of diligent maintenance and careful supervision during fixed retention, in particular, cannot be disregarded.

Potential Use of Hyperbaric Oxygen Therapy in Orthodontic Treatment: A Systematic Review of Animal Studies

Understanding the fundamental principles of tooth movement could reduce the duration of treatment and achieve a stable outcome, resulting in patient satisfaction. Hyperbaric oxygen therapy was a modality in which a patient inhaled 100% O₂ while subjected to high atmospheric pressure. Hyperbaric oxygen therapy facilitated the supply of oxygen to the human body's organs and tissues and served a variety of applications, including patient care and wound treatment. This review article aimed to describe animal studies of the potential effects of hyperbaric oxygen therapy in orthodontic therapy. It was conducted using a systematic literature review method, including searching PubMed and Google Scholar for publications relevant to the research topics. The search was filtered to include only research on orthodontic treatment and hyperbaric oxygen therapy and was published in any year. Articles that did not specify biological components of orthodontic tooth movement (OTM) were excluded. The Preferred Reporting Items identified the papers for the Systematic Reviews and Meta-Analyses (PRISMA) strategy, which resulted in the selection of 11 publications. Hyperbaric oxygen therapy affected parameters of biomarkers representing the clinical, molecular, and cellular biology of bone formation and resorption in periodontal tissues in responding to orthodontic physical forces, including alkaline phosphatase, collagen synthesis, osteoblast, osteoclast, osteocyte, type I collagen, vascular endothelial growth factor, osteocalcin, fibroblast, matrix metalloproteinase-8, transforming growth factor-β, partial pressure of oxygen, partial pressure of carbon dioxide, trabecular bone density, and tooth mobility. Hyperbaric oxygen therapy induced an inflammatory response to follow OTM events during active orthodontic therapy. Hyperbaric oxygen therapy might play a role in the tissue healing process during passive treatment. Nonetheless, additional research should be conducted to establish the efficacy of hyperbaric oxygen therapy in orthodontics.

Orthodontists' preferences regarding the difference of bracket bonding height between the maxillary incisors

Introduction:

The vertical position of orthodontic brackets in maxillary incisors may influence the incisal step between the anterior teeth and thereby interfere with the smile esthetics. Even so, esthetic standards have been modified over time and consistently required technical adjustments.

Objective:

This study analyzed orthodontists’ preferences regarding the difference of bracket bonding height between the maxillary central incisors (MCI) and maxillary lateral incisors (MLI), and further determined whether the orthodontist sex, age and time of specialization have association to their choices.

Methods:

This study collected data through an electronic form. Study participants analyzed a clinical case in which they indicated their preference for bracket bonding height. The placement height options ranged from 3.0 mm to 5.5 mm from the incisal edge, with 0.5-mm intervals, or at the clinical crown center (CCC). The difference in the bonding height between the MCI and MLI was analyzed, considering the formation of incisal steps between these teeth.

Results:

Participants indicated that the difference in bracket bonding height between the MCI and MLI should be as follows: 0 mm (3.9%); 0.5 mm (78.3%); 1 mm (7.6%); 1.5 mm (0.2%); and CCC (9.9%). There was no statistically significant correlation between the choice for bracket bonding height and sex, age and time since specialization.

Conclusion:

Most participating orthodontists choose the 0.5-mm difference in bracket placement height between the MCI and MLI. The variables sex, age and time since specialization did not influence this choice.

Effect of Orthodontic Treatment on Anterior Tooth Displacement in Patients with Periodontal Disease: A Meta-Analysis

OBJECTIVE

To systematically evaluate the effect of orthodontic treatment (ODT) on anterior tooth displacement (ATD) in patients with periodontal disease.

METHODS

PubMed, Web of Science, Embase, China National Knowledge Infrastructure, and Wanfang databases were electronically searched for relevant literature studies on ODT and basic treatment for ATD in patients with periodontal disease, and then the related journals and reference lists of the included studies were manually searched. The search time was set from January 2010 to May 2021. Stata 16.0 software was used for meta-analysis.

RESULTS

Totally, 783 articles were retrieved, and finally, 14 studies were included. The effective rate of basic treatment combined with OTD was significantly higher than that of basic treatment alone (OR = 7.27, 95% CI: 3.76, 14.04). Specifically, the combined treatment led to lower values of periodontal pocket depth (SMD = -2.30, 95% CI: -2.94, -1.66), anterior overjet (SMD = -2.75, 95% CI: -3.72, -1.78), anterior overbite (SMD = -2.13, 95% CI: -3.16, -1.10), and periodontal bleeding index (SMD = -4.25, 95% CI: -5.48, -3.03) compared with those of basic treatment alone.

CONCLUSION

Compared with basic treatment, ODT combined with basic treatment is more effective for patients with periodontal disease-caused ATD and can also improve the clinical symptoms of patients.

Gingival proliferative growth - stress and cytoarchitecture related with fixed and mobile orthodontic therapy

The fixed orthodontic measures taken induce significant stress to the gingival growth process during arch wire maneuvers of aligning and leveling. We observed, for a period of one to four years, fixed orthodontic devices in 80 human subjects. From these, we selected 44 subjects (22 women and 22 men) where the inflammatory process exhibited following the orthodontic fixed treatment, and with vacuum-formed orthodontic retainers (VFR) succeeding to fixed treatment. Samples were collected from each patient and histological and immunohistochemical (IHC) methodology was made to analyze the cytoarchitecture. Statistics were made after one-way analysis of variance (ANOVA), with the Bonferroni’s correction. The IHC examination performed in the early stage revealed the presence in the inflammatory infiltrate of CD8-type T-lymphocytes, and of dendritic cells in large numbers. The examination performed in the late stage revealed the presence in the inflammatory infiltrate of CD20-type B-lymphocytes, which are mature cells capable of immunoglobulin synthesis, their activation being an important step in the maturation of the antibody response. The stress generated by arch wires in both genders was significantly higher than in the case of VFR. This observation was pointed out also by the cytohistological investigation outcome but was also based on an original scale conceived by our research team, following gingival hyperplasia evaluation. Also, with statistical significance, the comparative obtained values for men (p=0.01) and for women (p=0.001) illustrate clinical observations, allowing to affirm that, in our case, men were more stressed in bearing arch wire devices (AWD) and VFR, in comparison with women.

The rationale for orthodontic retention: piecing together the jigsaw

Retaining teeth in their corrected positions following orthodontic treatment is one of the most challenging aspects of orthodontic practice. Despite much research, the rationale for retention is not entirely clear. Teeth tend to revert to their pre-treatment positions due to periodontal and gingival, soft tissue, occlusal and growth factors. Changes may also follow normal dentofacial ageing and are unpredictable with great variability. In this overview, each of these factors are discussed with their implications for retention, along with adjunctive procedures to minimise relapse. The state of current knowledge, methods used to assess relapse, factors regarded as predictive of or associated with stability as well as overcorrection are outlined. Potential areas requiring further investigation are suggested. The way in which the clinician may manage current retention practice, with a need for individualised retention plans and selective retainer wear, is also considered.

Effects of Smad4 on the expression of caspase‑3 and Bcl‑2 in human gingival fibroblasts cultured on 3D PLGA scaffolds induced by compressive force

Human gingival fibroblasts (HGFs) are the main cells that comprise gingival tissue, where they transfer mechanical signals under physiological and pathological conditions. The exact mechanism underlying gingival tissue reconstruction under compressive forces remains unclear. The present study aimed to explore the effects of Smad4, caspase-3 and Bcl-2 on the proliferation of HGFs induced by compressive force. HGFs were cultured on poly(lactide-co-glycolide) (PLGA) scaffolds under an optimal compressive force of 25 g/cm². Cell viability was determined via Cell Counting Kit-8 assays at 0, 12, 24, 48 and 72 h. The expression levels of Smad4, caspase-3 and Bcl-2 were measured via reverse transcription-quantitative PCR and western blotting. The application of compressive force on HGFs for 24 h resulted in a significant increase in cell proliferation and Bcl-2 expression, but a significant decrease in the expression of Smad4 and caspase-3; however, inverse trends were observed by 72 h. Subsequently, a lentivirus was used to overexpress Smad4 in HGFs, which attenuated the effects of compressive force on HGF proliferation and Bcl-2 expression, but enhanced caspase-3 expression, suggesting that Smad4 may regulate compressive force-induced apoptosis in HGFs. In conclusion, these findings increased understanding regarding the mechanisms of compressive force-induced HGF proliferation and apoptosis, which may provide further insight for improving the efficacy and stability of orthodontic treatment.

Potential Role of Integrin α₅β₁/Focal Adhesion Kinase (FAK) and Actin Cytoskeleton in the Mechanotransduction and Response of Human Gingival Fibroblasts Cultured on a 3-Dimension Lactide-Co-Glycolide (3D PLGA) Scaffold

BACKGROUND The stability of orthodontic treatment is thought to be significantly affected by the compression and retraction of gingival tissues, but the underlying molecular mechanism is not fully elucidated. The objectives of our study were to explore the effects of mechanical force on the ECM-integrin-cytoskeleton linkage response in human gingival fibroblasts (HGFs) cultured on 3-dimension (3D) lactide-co-glycolide (PLGA) biological scaffold and to further study the mechanotransduction pathways that could be involved. MATERIAL AND METHODS A compressive force of 25 g/m² was applied to the HGFs-PLGA 3D co-cultured model. Rhodamine-phalloidin staining was used to evaluate the filamentous actin (F-actin) cytoskeleton. The expression level of type I collagen (COL-1) and the activation of the integrin alpha₅ß₁/focal adhesion kinase (FAK) signaling pathway were determined by using real-time PCR and Western blotting analysis. The impacts of the applied force on the expression levels of FAK, phosphorylated focal adhesion kinase (p-FAK), and COL-1 were also measured in cells treated with integrin alpha₅ß₁ inhibitor (Ac-PHSCN-NH 2, ATN-161). RESULTS Mechanical force increased the expression of integrin alpha₅ß₁, FAK (p-FAK), and COL-1 in HGFs, and induced the formation of stress fibers. Blocking integrin alpha₅ß₁ reduced the expression of FAK (p-FAK), while the expression of COL-1 was not fully inhibited. CONCLUSIONS The integrin alpha₅ß₁/FAK signaling pathway and actin cytoskeleton appear to be involved in the mechanotransduction of HGFs. There could be other mechanisms involved in the promotion effect of mechanical force on collagen synthesis in addition to the integrin alpha₅ß₁ pathway.

Expression of proteins of elastic fibers and collagen type I in orthodontically rotated teeth in rats

INTRODUCTION

The aims of this study were to investigate the expression of proteins of elastic fibers and collagen type I in the supra-alveolar structure of orthodontically rotated teeth in rats and to elucidate whether circumferential supracrestal fiberotomy diminishes relapse.

METHODS

The rats' maxillary left first molars were rotated by couple of force. Specimens were divided into groups according to different orthodontic procedures. A1-3 and B1-3 were blank control groups and operation control groups. Group C underwent rotation only, and group D was treated with rotation and retention. Groups E and F were treated with rotation, retention, and release of retention; additionally, circumferential supracrestal fiberotomy was performed in group F before the release of retention. The animals were killed, and the jaws were processed for histologic evaluation using the immunohistochemical method to evaluate the protein expressions of elastin, fibrillin-1, fibrillin-2, and collagen type I in supra-alveolar structures (around and below the gingival sulcus) between the maxillary left first and second molars. The degree and percentage of relapse were measured by a series of impressions.

RESULTS

The degree and percentage of relapse in group F were much lower than those in group E (P <0.05). Collagen type I was increased in group C (P <0.05) and at normal levels in groups D, E, and F. Elastin below the gingival sulcus and fibrillin-1 showed the same patterns of expression and were consistently elevated in groups C, D, E, and F (P <0.05). No positive staining for elastin was found around the gingival sulcus in any specimen. The difference in the expression of fibrillin-2 between the experimental groups (C, D, E, and F) and their matching control groups was not statistically significant (P >0.05).

CONCLUSIONS

Circumferential supracrestal fiberotomy can alleviate the relapse of rotated teeth. Collagen fibers of supra-alveolar structures might contribute to relapse in a short time, whereas elastic fibers may be the reason that rotated teeth relapse to their original positions after retention.

Effect of local administration of simvastatin on postorthodontic relapse in a rabbit model

INTRODUCTION

Posttreatment relapse is a major challenging clinical issue. The objective of this study was to evaluate the effect of local administration of simvastatin on posttreatment relapse.

METHODS

Orthodontic tooth movement was induced in 10 white New Zealand rabbits. After 21 days of active tooth movement, the orthodontic appliances were removed, and the experimental teeth were allowed to relapse for 21 days. During the relapse phase, 1 mandibular quadrant received local simvastatin administration, and the other received the control vehicle solution on a weekly basis. Three-dimensional models of the experimental teeth were created to allow the measurement of experimental tooth movement and posttreatment relapse. The animals were killed at the end of the relapse phase for histomorphometric analysis of alveolar bone remodeling.

RESULTS

The mean relapse percentages were 75.83% in the quadrant receiving the control vehicle solution and 62.01% in the quadrant receiving simvastatin. Neither the relapse magnitude nor the relapse percentage showed a significant difference between the 2 quadrants. Histomorphometric analyses showed that local simvastatin administration yielded a significant reduction in the area of active bone-resorptive lacunae and a significant increase in newly formed bone area.

CONCLUSIONS

Although local administration of simvastatin aids in bone remodeling associated with posttreatment relapse by reducing the area of active bone resorption and upregulating bone formation, it did not significantly minimize posttreatment relapse.

Odontogenic Ameloblast-associated Protein (ODAM) Mediates Junctional Epithelium Attachment to Teeth via Integrin-ODAM-Rho Guanine Nucleotide Exchange Factor 5 (ARHGEF5)-RhoA Signaling

Adhesion of the junctional epithelium (JE) to the tooth surface is crucial for maintaining periodontal health. Although odontogenic ameloblast-associated protein (ODAM) is expressed in the JE, its molecular functions remain unknown. We investigated ODAM function during JE development and regeneration and its functional significance in the initiation and progression of periodontitis and peri-implantitis. ODAM was expressed in the normal JE of healthy teeth but absent in the pathologic pocket epithelium of diseased periodontium. In periodontitis and peri-implantitis, ODAM was extruded from the JE following onset with JE attachment loss and detected in gingival crevicular fluid. ODAM induced RhoA activity and the expression of downstream factors, including ROCK (Rho-associated kinase), by interacting with Rho guanine nucleotide exchange factor 5 (ARHGEF5). ODAM-mediated RhoA signaling resulted in actin filament rearrangement. Reduced ODAM and RhoA expression in integrin β₃- and β₆-knockout mice revealed that cytoskeleton reorganization in the JE occurred via integrin-ODAM-ARHGEF5-RhoA signaling. Fibronectin and laminin activated RhoA signaling via the integrin-ODAM pathway. Finally, ODAM was re-expressed with RhoA in regenerating JE after gingivectomy in vivo. These results suggest that ODAM expression in the JE reflects a healthy periodontium and that JE adhesion to the tooth surface is regulated via fibronectin/laminin-integrin-ODAM-ARHGEF5-RhoA signaling. We also propose that ODAM could be used as a biomarker of periodontitis and peri-implantitis.

The influence of low-level laser on orthodontic relapse in rats

SUMMARY OBJECTIVES

This study evaluated the effect of low-level laser therapy (LLLT) on the tendency of rat molars to relapse following orthodontic tooth movement (OTM).

MATERIAL AND METHODS

Maxillary rat molars were moved mesially for 10 days. Animals were randomly assigned to group I (non-irradiated) or II (irradiation with LLLT). Appliances were removed, and the molars allowed to relapse for 1, 3, 5, 7, 14, or 21 days; rats in group II received LLLT according to a protocol. Bone density of periapical alveolar bone was measured using radiographs and Digora software. Dental supporting structures were examined histologically with haematoxylin and eosin and tartrate-resistant acid phosphatase.

RESULTS

In both groups, first molar relapse was rapid 1 day after the end of active treatment; by 21 days percentage relapse was measured as 86.11 per cent in group I, and 72.22 per cent in group II. Osteoclast number was highest at the end of active OTM, and thereafter successively decreased during the relapse phase in both groups. Decrease in number, and redistribution of osteoclasts occurred more rapidly in the non-irradiated than the LLLT group. Whilst molar relapse was generally less and osteoclast numbers generally higher in group II compared to group I, the differences were not significant. There was no significant difference in bone density between the two groups.

CONCLUSIONS

These results indicate that LLLT may reduce the relapse tendency, possibly due in part to bone formation in previous tension areas, and to redistribution of osteoclasts following removal of orthodontic force. The role of LLLT in the prevention of orthodontic relapse requires further study.

Leptin levels in gingival crevicular fluid during orthodontic tooth movement

OBJECTIVES

To test if leptin can be detected in the gingival crevicular fluid (GCF) around moving teeth, and to determine whether any changes occur during orthodontic tooth movement.

MATERIALS AND METHODS

An upper canine requiring distal movement served as the test tooth; the contralateral canine was used as a control tooth. The control tooth was included in the orthodontic appliance, but was not subjected to the orthodontic force. GCF sampling from the distal sites of the test and control teeth was done at baseline, 1 hour, 24 hours, and 168 hours.

RESULTS

Leptin concentrations of the test teeth decreased in a time-dependent manner. When compared with the baseline measurement, the decrease was significant at 168 hours (P < .05).

CONCLUSIONS

The concentration of leptin in GCF is decreased by orthodontic tooth movement; the results of the present study also suggest that leptin may have been one of the mediators responsible for orthodontic tooth movement.

Gingival response to mandibular incisor intrusion

INTRODUCTION

The aims of the study were to evaluate the rate of accompanying gingival movement and the changes in attached and keratinized gingivae after orthodontic intrusion of mandibular incisors.

METHODS

The study was carried out with 16 subjects whose mandibular incisors were orthodontically intruded for the correction of overbite. The orthodontic intrusion was performed with the segmented utility arch technique. Periodontal indexes and the widths of attached and keratinized gingivae were recorded before and after treatment. The gingival movement in relation to orthodontic intrusion was determined by means of radioopacity with a specially designed metal device indicating the position of the gingival margin and the mucogingival junction on the cephalograms taken before treatment and after intrusion.

RESULTS

There were no statistically significant changes in the width of attached and keratinized gingivae after treatment (P >.05). The gingival margin and the mucogingival junction moved in the same direction as the teeth by 79% and 62%, respectively. A statistically significant decrease of the clinical crown length was also observed (P <.05).

CONCLUSIONS

These results suggest that orthodontic intrusion does not lead to significant changes in the width of attached and keratinized gingivae when adequate plaque control is maintained. The gingiva moves in the same direction with the tooth, yet considerably less. This might indicate the need for follow-up or gingival correction after intrusion therapy.

Interleukins 2, 6, and 8 levels in human gingival sulcus during orthodontic treatment

INTRODUCTION

The aims of this study were to determine levels of interleukins 2, 6, and 8 during tooth movement, and test whether they differ from each other with leveling and distalization forces used in various treatment stages of standard orthodontic therapy.

METHODS

Fifteen patients (9 female, 6 male; ages, 15-19 years; mean age, 16.7 +/- 2.3 years) participated in this study. Each underwent a session of professional oral hygiene and received oral hygiene instructions. Two months later, a fixed orthodontic appliance was placed. The patients were seen at baseline, at days 7 and 21, and as the teeth were leveled. Records of the baseline scores for the distalization forces were taken at the sixth month. Scores of days 7 and 21 after 6 months of the distalization treatment were also recorded.

RESULTS

Increases were seen in the volume of gingival crevicular fluid and the concentrations of interleukins 2, 6, and 8.

CONCLUSIONS

Leveling and distalization of the teeth evoke increases in interleukins 2, 6, and 8 levels in the periodontal tissues that can be detected in gingival crevicular fluid.

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.

Use of Relaxin in Orthodontics

BAS Medical is investigating the use of relaxin to improve ortho-dontic treatments. Relaxin is well known for its effects on remodeling soft tissue, and we believe relaxin will be clinically useful in speeding tooth movement and preventing relapse. We investigated the use of relaxin in preventing relapse in a dog model. Dog maxillary second incisors were orthodontically rotated an average of 42 degrees, and then relaxin was administered by gingival injection to relieve the rotational memory in the connective tissues. Teeth were retained for 30 days to allow fibers to reform. Teeth then were released and relapse was measured by a series of impressions. Animals receiving relaxin gingival injections (n = 8) were compared with placebo-treated animals (n = 8) (exhibiting high relapse) and gingival fiberotomies (n = 8) (low relapse). Gingival fiberotomy is a surgical procedure to cut the gingival connective tissues away from the tooth and has been shown to be effective in preventing relapse clinically and in animal models. There was a significant difference in relapse between the fiberotomy and the placebo control groups, and the relaxin-treated group had an intermediate response between the two groups (nonsignificant). Dose and treatment optimization may improve the response in future studies. To study the underlying mechanisms, we have localized relaxin receptors on gingival and periodontal ligament fibroblasts in tissue slices and cell cultures. Relaxin was found to stimulate collagenase production by relaxin in human gingival fibroblast cultures. Taken together, the data support a role for relaxin therapy to speed tooth movement and prevent relapse in orthodontic practice.

Extracellular matrix synthesis, proliferation and death in mechanically stimulated human gingival fibroblasts in vitro

Gingival tissues are constantly exposed to the effect of physical forces. Mechanical stimuli are regulators of connective tissue homeostasis and sustained mechanical stimulation may lead to modifications in cell activity and extracellular matrix (ECM) composition. This study examined in vitro ECM synthesis, proliferation, and death in mechanically stimulated human gingival fibroblastlike cells. Four primary human cell strains were established and subjected to intermittent stretching in FX-3000 Flexercell Strain Unit for 10 days, 45 min/day, at 1 Hz, 10% strain, and cell proliferation, cell death, and synthesis of collagens types I, III, and V, matrix metalloproteinase 1, elastin, and tenascin were assessed. In some of the cell strains mechanical stimulation led to changes in synthesis of the ECM molecules, proliferative activity, and death of stimulated cells as shown by statistically significant differences between the experimental and unstimulated control cultures. Although not seen in every culture investigated, these findings suggest that prolonged mechanical stimulation might lead to conspicuous modifications in the metabolic activity of gingival fibroblasts and cause changes in the ECM composition of the gingival connective tissue. The results indicate a pronounced interindividual variation in reactions of gingival fibroblasts to mechanical stimulation.

Lactate dehydrogenase activity in gingival crevicular fluid during orthodontic treatment

During orthodontic treatment, the early response of periodontal tissues to mechanical stress involves several metabolic changes that allow tooth movement. Many studies have evaluated such modifications by analysis of various host metabolites released into the gingival crevicular fluid (GCF). This study used a cross-sectional design to examine the lactate dehydrogenase (LDH) activity in GCF to assess whether GCF LDH can be proposed as a sensitive marker for periodontal tissue modifications during orthodontic tooth movement. Thirty-seven subjects, 16 males and 21 females (mean age 18.7 years, range 14.0 to 26.7 years), participated in this study. Each subject underwent a session of professional oral hygiene and received oral hygiene instructions; 2 weeks later, a fixed orthodontic appliance was placed on the maxillary arch. A randomly selected maxillary canine was considered as the test tooth, and its antagonist, which had no appliance, was used as the control tooth. From 2 to 12 weeks after orthodontic appliance placement, GCF was harvested from both experimental teeth at the mesiobuccal angle, for GCF volume and LDH activity determinations. Clinical monitoring consisted of recording supragingival plaque presence, bleeding on probing, and probing depth at the same collection sites. The results showed that no differences in clinical conditions and GCF volume occurred between the experimental teeth. On the contrary, GCF LDH activity in the test teeth was significantly greater than that of the control teeth (P <.01). Moreover, no differences were found in the enzymatic activity between the sexes by experimental tooth, and no significant correlation was present between GCF LDH activity and patients' ages within experimental teeth. Our enzymatic results initially indicated a possible role of GCF LDH during the early phases of orthodontic treatment and therefore warrant further study as a possible diagnostic tool for tissue response during orthodontic treatment.

Strain relaxation of fibroblasts in the marginal periodontium is the common trigger for alveolar bone resorption: a novel hypothesis

In summary, the present commentary proposes a hypothesis that alveolar bone remodeling and bone loss in periodontitis, periodontal surgery, and in orthodontic tooth movement is triggered by a common "strain relaxation" signaling pathway of gingival and periodontal fibroblasts. The abrupt splitting, degradation, or relaxation of collagen fibers in the marginal periodontium produces a "strain relaxation" signal in the local fibroblasts which reside on these fibers, activating an ECM-integrin-cytoskeleton pathway. A cascade of cellular reactions which lead to osteoclastic bone resorption starting on the inner aspect (periodontal) of the alveolar bone then persists. A novel therapeutic approach is suggested here by using locally delivered drugs intervening in the cell contractile apparatus.

Phagocytosis of fibronectin and collagens type I, III, and V by human gingival and periodontal ligament fibroblasts in vitro

BACKGROUND

Electron microscopic studies have suggested that the volume density of collagen-containing vacuoles in fibroblasts is higher in the periodontal ligament (PDL) than in the gingiva. Whether this difference reflects intrinsic differences in phagocytic capacity among the cells in these tissues is not known.

METHODS

PDL and gingival fibroblasts were isolated from subjects and cultured under identical conditions in the presence of fluorescent beads coated with collagen type I, III, or V or fibronectin. Control beads were coated with bovine serum albumin or an enamel matrix protein mixture that does not constitute part of the extracellular matrix of PDL and gingiva. After various time intervals (1 to 24 hours), the percentage of cells that had internalized beads was assessed by flow cytometry. Since alkaline phosphatase activity has been suggested to play a role in collagen phagocytosis, the activity of this enzyme was determined for all cell populations.

RESULTS

The results demonstrated the following order in the percentage of cells internalizing protein-coated beads: fibronectin > collagen type I > III > V. Internalization of collagen type I-coated beads exceeded that of beads coated with bovine serum albumin or enamel matrix proteins by 6 and 3 times, respectively. No differences were observed in collagen phagocytic activity between PDL and gingival fibroblasts, and no relationship could be demonstrated between collagen phagocytosis and alkaline phosphatase activity.

CONCLUSIONS

We conclude that differences in collagen phagocytosis between PDL and gingiva, as observed in vivo, are not likely to be explained in terms of intrinsic phagocytic capacities of these cells.

Effects of mechanical force on primary human fibroblasts derived from the gingiva and the periodontal ligament

Previous experiments have shown that mechanical stress may alter the interactions between cells and extracellular matrix (ECM). The purpose of our study was to investigate the effects of mechanical load on metabolism and ECM expression of primary human periodontal cells. The influence of gravitational force on proliferation, lactate dehydrogenase (LDH) release, and tenascin expression of gingival (HGF) and periodontal ligament fibroblasts (HPDL), as well as their adhesion to various extracellular matrix (ECM) components, was determined. Cells were centrifuged in microplates or flat tubes for 16 hrs at 217 g. Neither an enhanced release of LDH nor an alteration of cell proliferation could be detected after centrifugation. However, the attachment of loaded gingival and periodontal ligament fibroblasts to all tested ECM components significantly decreased in comparison with controls (Wilcoxon-Mann-Whitney test; HGF, p < 0.05; HPDL, p < 0.01). Tenascin expression of mechanically stressed fibroblasts significantly increased in comparison with controls (p < 0.01).

Expression of mRNAs encoding for alpha and beta integrin subunits, MMPs, and TIMPs in stretched human periodontal ligament and gingival fibroblasts

The biological mechanisms of tooth movement result from the cellular responses of connective tissues to exogenous mechanical forces. Among these responses, the degradation of the extracellular matrix takes place, but the identification of the molecular basis as well as the components implicated in this degradation are poorly understood. To contribute to this identification, we subjected human fibroblasts obtained from the periodontal ligament (PDLs) and from the gingiva (HGFs) to a continuous stretch to quantify the mRNAs encoding for various metalloproteinases (MMPs), their tissue inhibitors (TIMPs), and alpha and beta integrin subunits. Both cell lines reacted by inducing the expression of the mRNAs encoding for MMP-1, MMP-2, TIMP-1, and TIMP-2, while other mRNAs did not vary (MT1-MMP, TIMP-3) or were not expressed (MMP-9). PDLs expressed selectively the mRNAs encoding for alpha4 and alphav, with no difference measurable under stretching, while the mRNAs encoding for alpha6 and beta1 were increased and the one encoding for alpha5 was decreased. HGFs increased the mRNAs encoding for alpha2, alpha6, beta1, and beta3 and decreased the one encoding for alpha3. Analysis of our data indicated that stretched HGFs and PDLs induced the same pattern of mRNAs encoding for MMPs and TIMPs but differed for those encoding various integrin subunits, known to act as protein receptors in mechanotransduction.