Chondroitin sulphate (WF6 epitope) levels in peri-miniscrew implant crevicular fluid during orthodontic loading

Quantitative Evaluation of Pentraxin-3 in Peri-Miniscrew Implant Crevicular Fluid in Patients Undergoing Orthodontic Treatment: A Prospective Study

OBJECTIVE

To assess the levels of Pentraxin-3 (PTX3) in peri-miniscrew implant crevicular fluid (PMICF) before and after orthodontic force application Material and Methods: This study included 40 miniscrew implants (MSI) sites in 11 orthodontic patients with high arch discrepancy requiring first premolar extraction using maximum anchorage mechanics for the retraction of anterior teeth. After alignment, the en-masse anterior retraction was carried out using the MSI-supported direct anchorage method. PMICF was collected from the crevice of MSI using Periopaper strips 1.2µl (Oraflow Inc. USA) after one hour, 24 hours, and three weeks of MSI insertion and after one hour, 24 hours, seven days, three weeks, and six weeks of the force application. Samples were quantitatively analyzed for PTX3 levels through enzyme-linked immunosorbent assay (ELISA).

RESULTS

The trend in the change of PTX3 levels was evaluated using the Wilcoxon signed-rank test. The mean concentration of PTX3 immediately after MSI insertion was 1.19 ng/ml, significantly higher than after 3 weeks after MSI insertion (0.72 ng/ml), which may correspond to the baseline. After loading, the mean PTX3 concentration increased significantly with the peak at 24 hrs (1.28 ng/ml), followed by a gradual decline till the completion of the study (0.5 ng/ml).

CONCLUSION

After MSI insertion, a rise in PTX3 levels in PMICF suggests an underlying inflammatory process. The slow decline in PTX3 level and return to the baseline after loading suggests an adaptive bone response to the stimulus.

Expression of circulating cell-free nucleic acids around miniscrew implant during orthodontic tooth movement-a prospective study

OBJECTIVES

Literature shows that the expression of various biomarkers in peri-miniscrew crevicular fluid (PMICF) is related to the stability of miniscrew implants (MSIs). The present study investigated the role and alterations in levels of circulating cell-free nucleic acids (cfNAs) in PMICF before and after orthodontic loading.

MATERIAL AND METHODS

This prospective study consisted of forty-six MSIs placed between the second premolar and first molar in the maxillary and mandibular arches. Direct loading was done after 3 weeks of MSI insertion with nickel-titanium closed coil spring exerting a force of 200 g. The PMICF sample was collected at various time intervals, and the level of cfNA was determined. Clinical parameters, including implant mobility and gingival health, were also assessed. Pre-loading and post-loading parameters were assessed using Wilcoxon's rank-sum test.

RESULTS

Among 46 MSIs, 36 were stable during the study and 10 MSIs showed peri-implant inflammation and increased mobility. There was a significant rise in the cfNA concentration 24 h after implant insertion (0.4 ± 0.86 ng/μl). The level of cfNAs significantly decreased over 3 weeks and reached the baseline level (0.2 ± 0.31 ng/μl). There was also a significant rise in the levels of cfNA (0.8 ± 0.70 ng/μl) at 24 h after loading MSIs, which gradually decreased to 0.2 ± 0.24 ng/μl after 63 days. The expression of cfNAs was on the average 0.32 units more in the cases with failed implants (P = 0.05).

CONCLUSIONS

cfNA levels in PMICF showed an upward trend 24 h after MSI insertion and 24 h after orthodontic loading. The expression of cfNA was more in cases with failed MSIs. Hence, the cfNAs can be considered as a prognostic biomarker of MSI stability.

Effect of Low-Level Laser Therapy on Peri-Miniscrew Fluid Prostaglandin E2 and Substance P Levels: A Controlled Clinical Trial

Objective

This study aims to evaluate the effect of low-level laser therapy on peri-miniscrew fluid prostaglandin E2 (PGE2) and substance P (SP) levels during orthodontic treatment.

Methods

A total of 15 individuals were included in this study. Miniscrews were inserted to the inter-radicular region of the maxillary right and left second premolar and the first molar teeth, and diode lasers were randomly applied to the right or left side. Irradiation was performed at 940 nm wavelength using a gallium-aluminum-arsenide diode laser with 100 mW power output, 0.125 cm2 spectral area, 8 J/cm2 energy density, and 10 seconds of exposure time. Peri-miniscrew fluid samples were collected on the 1st, 3rd, and 7th days, and PGE2 and SP levels were assessed. For statistical comparison, two-way (factors) analysis of variance with repeated measurements on one-factor levels was used at statistical significance (p) of <0.05.

Results

PGE2 levels on the 1st, 3rd, and 7th days were 160.64±10.05, 135.17±37.18, and 98.57±22.94, respectively, in the control group and 150.75±9.08, 87.17±40.67, and 78.10±16.50, respectively, in the laser group. SP levels on the 1st, 3rd, and 7th days were 79.90±12.05, 64.61±10.05, and 70.05±9.10, respectively, in the control group and 76.32±11.39, 60.25±9.08, and 65.71±5.59, respectively, in the laser group. The differences in PGE2 and SP levels between the laser and control groups were not statistically significant at all time intervals.

Conclusion

Low-level laser therapy cannot be recommended as a clinical adjunct therapy to reduce inflammation and pain around the miniscrews.

Levels of TGF-β1 in peri-miniscrew implant crevicular fluid

The peri-miniscrew implant crevicular fluid is analogous to gingival crevicular fluid, and its contents reflect the state of inflammation and health during the life of the miniscrews in the mouth. The stability of MSI is fundamental to its role as an anchorage. This study aimed to evaluate transforming growth factor-beta one (TGF-β1) of the peri-miniscrew implant crevicular fluid (PMICF), on implant insertion, pre- and post-loading of MSIs to find a clue to their role in the stability of MSI. Fifty-two MSIs sites were placed in the mouths of 13 patients aged 12-26 years undergoing orthodontic treatment. PMICF was collected using micro-pipettes at T1 (day 0, 1 h after MSI implantation), T2 (day 1), T3/baseline (day 21, preloading of MSI), T4 (day 21, 1 h post loading), T5 (day 22, 1 day post loading), T6 (day 43, 3 weeks post loading). The levels of TGF-β1 were estimated by enzyme-linked immunosorbent assay (ELISA). The data were subjected to statistical analysis. Of the 52 MSIs, 20 MSIs failed at T3. In the case of successful MSIs, the TGF-β1 levels were found to monotonously decrease from T1 (~1400 pg/mL) until T3 (~700 pg/mL) and saturate thereafter. In the case of failed MSIs, the levels of TGF-β1 at various time periods were approximately constant and of much lower value than corresponding time periods of successful MSIs. This study highlights the role of TGF- β1 in bone metabolism around miniscrew reflecting the state of inflammation from 1 h post-implantation.

Influence of orthodontic loading on biomarkers levels around miniscrews

OBJECTIVE

The aim of this study was to evaluate the levels of Interleukin-1α (IL-1α), Interleukin-1β (IL-1β), Interleukin-1 receptor antagonist (IL-1Ra), Interleukin-10 (IL-10), Interleukin-13 (IL-13), Vascular endothelial growth factor (VEGF), Granulocyte-colony stimulating factor (G-CSF), and Growth related oncogene (GRO) in the peri-miniscrew implant crevicular fluid (MICF) under orthodontic loading.

DESIGN

The study sample comprised 14 miniscrews immediately loaded and 17 unloaded ones. A load of 200gF was immediately applied to the miniscrews in the loaded group after the placement surgery. Peri-miniscrew implant crevicular fluid was collected at baseline, at day 7, and at day 21. The levels of the biomarkers were measured using a multiplexed bead immunoassay. Intergroup comparisons were made using Mann-Whitney test. Friedman and Dunn's multiple comparison tests were used to evaluate intragroup differences over time.

RESULTS

Although no statistical differences were observed between the groups at any time point for any of the 8 biomarkers evaluated, there was a statistically significant increase (p < 0.02) in the levels of all the biomarkers over time on both groups.

CONCLUSIONS

An immediate loading of 200gF does not alter the balance in the inflammatory response in peri-miniscrew tissues.

Comparison of BALP, CTX-I, and IL-4 levels around miniscrew implants during orthodontic tooth movement between two different amounts of force

OBJECTIVES

To evaluate the Interleukin-4 (IL-4), bone-specific alkaline phosphatase (BALP), and C-telopeptide of type I collagen (CTX-I) levels in peri-miniscrew crevicular fluid (PMCF) during orthodontic tooth movement between 75 and 150 g of distalization force.

MATERIALS AND METHODS

Thirty miniscrews were placed bilaterally between the maxillary second premolars and first molars. The right and the left maxillary canines were moved distally using either 75 or 150 g of force. PMCF samples were collected before loading (T0); at 2 hours (T1) and 24 hours (T2) later; and on days 7 (T3), 14 (T4), 21 (T5), 30 (T6), and 90 (T7) after force application. Enzyme-linked immunosorbent assay kits were used to determine BALP, CTX-I, and IL-4 levels.

RESULTS

There was no significant difference between the force groups at all time points with respect to BALP, CTX-I, and IL-4 levels (P > .05). There was no significant difference among time points for the two force groups in terms of BALP and IL-4 levels (P > .05). The CTX-I level at T3 was significantly higher than at T0 for both force groups (P < .05).

CONCLUSIONS

Both 75 g and 150 g of orthodontic force are within optimal force limits, and there is no difference in biochemical markers of bone turnover.

A review of biomarkers in peri-miniscrew implant crevicular fluid (PMICF)

Background

The temporary anchorage devices (TADs) which include miniscrew implants (MSIs) have evolved as useful armamentarium in the management of severe malocclusions and assist in complex tooth movements. Although a multitude of factors is responsible for the primary and secondary stability of miniscrew implants, contemporary research highlights the importance of biological interface of MSI with bone and soft tissue in augmenting the success of implants.

The inflammation and remodeling associated with MSI insertion or loading are reflected through biomarkers in peri-miniscrew implant crevicular fluid (PMICF) which is analogous to the gingival crevicular fluid. Analysis of biomarkers in PMICF provides indicators of inflammation at the implant site, osteoclast differentiation and activation, bone resorption activity and bone turnover. The PMICF for assessment of these biomarkers can be collected non-invasively via paper strips, periopaper or micro capillary pipettes and analysed by enzyme-linked immunosorbent assay (ELISA) or immunoassays. The markers and mediators of inflammation have been previously studied in relation to orthodontic tooth movement include interleukins (IL-1β, IL-2, IL-6 and IL-8), growth factors and other proteins like tumour necrosis factor (TNF-α), receptor activator of nuclear factor kappa-B ligand (RANKL), chondroitin sulphate (CS) and osteoprotegerin (OPG).

Studies have indicated that successful and failed MSIs have different concentrations of biomarkers in PMICF. However, there is a lack of comprehensive information on this aspect of MSIs. Therefore, a detailed review was conducted on the subject.

Results

A literature search revealed six relevant studies: two on IL-1β; one on IL-2, IL-6 and IL-8; one on TNF-α; one on CS; and one on RANKL/OPG ratio. One study showed an increase in IL-1β levels upon MSI loading, peak in 24 hours (h), followed by a decrease in 21 days to reach baseline in 300 days. A 6.87% decrease in IL-2 levels was seen before loading and a 5.97% increase post-loading. IL-8 showed a 6.31% increase after loading and IL-6 increased by 3.08% before MSI loading and 15.06% after loading. RANKL/OPG ratio increased in loaded compared to unloaded MSIs.

Conclusions

Cytokines (mainly ILs and TNF-α) and RANKL/OPG ratio showed alteration in PMICF levels upon loading of MSIs as direct or indirect anchorage.

Biochemical and Clinical Assessments of Segmental Maxillary Posterior Tooth Intrusion

Objective. To compare chondroitin sulphate (CS) levels around maxillary second premolars, first molars, and second molars between the unloaded and the loaded periods and to measure the rates of intrusion of maxillary posterior teeth during segmental posterior tooth intrusion. Materials and Methods. In this prospective clinical study, 105 teeth (from 15 patients exhibiting anterior open bite and requiring maxillary posterior tooth intrusion) were studied. Competitive ELISA was used to detect CS levels. Dental casts (during the unloaded and loaded periods) were scanned, and posterior tooth intrusion distances were measured. Results. During the unloaded period, the median CS levels around maxillary second premolars, first molars, second molars (experimental teeth), and mandibular first molars (negative control) were 0.006, 0.055, 0.056, and 0.012 and during the loaded period were 2.592, 5.738, 4.727, and 0.163 ng/μg of total protein, respectively. The median CS levels around experimental teeth were significantly elevated during the loaded period. The mean rates of maxillary second premolar and first and second molar intrusion were 0.72, 0.58, and 0.40 mm/12 weeks, respectively. Conclusions. Biochemical and clinical assessments suggested that the segmental posterior tooth intrusion treatment modality with 50 g of vertical force per side was sufficient. Trial Registration. The study is registered as TCTR20170206006.

Comparisons between two biochemical markers in evaluating periodontal disease severity: a cross-sectional study

Background

The purpose of this study was to compare two biochemical markers, which have been previously used to determine the degrees of alveolar bone destruction, in evaluating periodontal disease severity.

Methods

The WF6 epitope of chondroitin sulfate (CS) and the alkaline phosphatase (ALP) levels were determined in gingival crevicular fluid (GCF) samples collected from patients with various degrees of disease severity, including ten patients with gingivitis (50 gingivitis sites) and 33 patients with chronic periodontitis (including gingivitis, slight, moderate, and severe periodontitis sites; n = 50 each), as well as from ten healthy volunteers (50 healthy sites) by Periopaper strips. The levels of CS and ALP were measured by an ELISA and a fluorometric assay, respectively.

Results

The results demonstrated low levels of CS and ALP in non-destructive and slightly destructive periodontitis sites, whereas significantly high levels of these two biomolecules were shown in moderately and severely destructive sites (p < 0.05). Although a significant difference in CS levels was found between moderate and severe periodontitis sites, no difference in ALP levels was found. Stronger correlations were found between CS levels and periodontal parameters, including probing depth, loss of clinical attachment levels, gingival index and plaque index, than between ALP levels and these parameters.

Conclusions

It is suggested that the CS level is a better diagnostic marker than the ALP level for evaluating distinct severity of chronic periodontitis.

A study of interleukin 1β levels in peri-miniscrew crevicular fluid (PMCF)

Background

This study provides a vital insight in assessing the clinical and biochemical changes in interleukin (IL)-1β levels in peri-miniscrew crevicular fluid (PMCF) during the course of orthodontic tooth movement.

Methods

The study comprised the analysis of IL-1β in peri-miniscrew crevicular fluid obtained from crevices around the miniscrews inserted in 11 patients (eight females and three males, mean age 17.3 ± 4.64 years) with all first premolar extraction and maximum anchorage requirement using miniscrew-supported anchorage. Miniscrews were loaded at 3 weeks after placement by 200-g nitinol closed coil springs of 9-mm length for en masse retraction. Peri-miniscrew crevicular fluid was collected at miniscrew placement (T1), at 3 weeks (T2/baseline) and on loading at 0 (T3) and 1 day (T4), 21 (T5), 72 (T6), 120 (T7), 180 (T8) and 300 (T9) days. IL-1β levels were estimated by enzyme-linked immunosorbent assay (ELISA). Peri-miniscrew tissue was examined for signs of inflammation, and also, miniscrew mobility was assessed with Periotest and handles of two mouth mirrors.

Results

IL-1β levels in all miniscrews were significantly higher at T1 and peaked again at T4 showing a bimodal peak. However, there was a gradual and statistically significant decrease in IL-1β till T5, while further changes till the end of the study were statistically not significant.

Conclusions

The changing levels of IL-1β levels in PMCF over a duration of 300 days are suggestive of the underlying inflammatory process. IL-1β levels in PMCF show a significant rise during miniscrew insertion and on immediate loading. The trend of gradually reducing IL-1β levels around the miniscrew over the period after loading towards baseline is suggestive of adaptive bone response to stimulus.

Comparisons of the chondroitin sulphate levels in orthodontically moved canines and the clinical outcomes between two different force magnitudes

The aims of this study were to compare the chondroitin sulphate (CS) levels in gingival crevicular fluid (GCF) of moved canines using either 70 or 120 g of orthodontic force, and to compare the rate of tooth movement and the amount of pain between these two force magnitudes. Sixteen patients (6 males and 10 females; aged 16.91 ± 2.99 years), with class I malocclusion, who required orthodontic treatment with first premolar extractions, were recruited. The force magnitudes used to move the maxillary canines distally were controlled at 70 and 120 g on the right and the left sides, respectively. GCF samples were collected with Periopaper(®) strips before and during orthodontic tooth movement. Competitive ELISA with monoclonal antibody was used to measure the CS levels. The distance of tooth movement and the amount of pain assessed by visual analog scale (VAS) scores were evaluated. The medians of CS levels during the loaded period were significantly greater than those during the unloaded period (P < 0.05). The differences between the medians of CS levels of 70 g and 120 g retraction force during each 1 week period were not significant. There was no significant difference in the rates of canine movement between these two force magnitudes. However, using 120 g, the medians of VAS scores were significantly greater than those with 70 g (P < 0.05). Collectively, 70 g retraction force appears to be sufficient and more suitable than 120 g force as it causes no difference in biochemically-assessed bone remodelling activity, the same rate of tooth movement, reduced pain and better comfort.