Screening for salivary levels of deoxypyridinoline and bone-specific alkaline phosphatase during orthodontic tooth movement: a pilot study

Reliability of salivary biomarkers as skeletal maturity indicators: A systematic review

OBJECTIVE

To assess the reliability of different salivary biomarkers as skeletal maturity indicators when compared with other methods of skeletal maturity assessment.

METHODS

A comprehensive search was conducted on three electronic databases: PUBMED, Google scholar and Cochrane library for the articles published from 2000 to July 2021. Assessment of skeletal age on the basis of levels of different salivary biomarkers at different pubertal stages was considered as the primary outcome. Electronic search, data collection and risk of bias assessment were performed by two authors with conflict resolution by the third author.

RESULTS

Total 158 articles were retrieved after screening of titles, abstracts and full texts of all articles, of which 15 articles were selected for qualitative synthesis. All these studies were cross-sectional in design. These studies compared the levels of different salivary biomarkers as Alkaline Phosphatase (ALP), Insulin-like Growth Factor - I (IGF-I), Insulin-like Growth Factor Binding Protein-3 (IGFBP-3), Cortisol, Indian Hedgehog (IHH) protein and Dehydroepiandrosterone sulphate (DHEAS) with other methods of skeletal age estimation. Out of these six biomarkers salivary IGF-1 is a reliable indicator for skeletal maturity assessment.

CONCLUSION

The current evidence suggests that salivary biomarkers can be used as an adjunct for growth prediction during orthodontic treatment planning along with other methods of skeletal maturation assessment. Still there is need for further research with longitudinal studies in this field.

Longitudinal assessment of salivary vitamin D binding protein during orthodontic tooth movement

Background

Vitamin D is critical for bone physiology. In this study, we quantified Vitamin D Binding Protein (VitDBP) levels in saliva as a measure of Vitamin D during orthodontic tooth movement.

Methods

In this longitudinal study, saliva samples were collected from 73 orthodontic patients for 4 timepoints for the first six months of orthodontic treatment, along with dental casts at the beginning and the end of the study period. The saliva was measured for VitDBP as a biological marker for bone apposition and clinical tooth movement. We used the absolute change in Little's Irregularity Index as a quantitative measure for alignment. In addition, we measured the levels of alkaline phosphatase (ALP) in saliva as a marker of bone turnover.

Results

Both low (< 2.75 ng/ml) and high (> 6.48 ng/ml) VitDBP levels were associated with reduced tooth movement. Significant (p < 0.05) seasonal changes in VitDBP using a two-season year model were found with lower levels observed in the summer (Apr–Sept) than in the winter (Oct–Mar).

Conclusions

Clinically significant orthodontic tooth movement is associated with an optimal range of VitDBP in saliva. Normal levels of VitDBP correlated with more orthodontic tooth movement, suggesting a "normal" range of salivary content of VitDBP. Given the strong trend that is independent of the confounding factors (ex. age, race or gender), the predictive value or salivary VitDBP for tooth movement should be studied in larger cohorts in future studies.

Evaluation of Salivary Alkaline Phosphatase and Albumin in HIV Infected Patients: A Historical Cohort Study

BACKGROUND

Saliva is a very important complex biological oral fluid .Antioxidants are present in all body fluids. Uric acid, albumin and vitamins are some of the non- enzymatic molecular antioxidants. Alkaline phosphatase is related to cell injury and death.

OBJECTIVES

The aim of this study was the evaluation of salivary alkaline phosphatase and albumin level in HIV positive patients in comparison to healthy control group.

METHODS

Case groups were 49 HIV positive subjects, compared with 49 healthy control group. Oral clinical examination was carried out. Five ml unstimulated whole saliva was collected during 5 min with the Navazesh method. Alkaline phosphatase was determined by spectrophotometric assay. Albumin was assessed by the nephelometric method.

RESULTS

The results of this study showed significantly lower salivary albumin in the case group in comparison to healthy control group (p= 0.001). HIV positive group had greater alkaline phosphatase than the healthy control group. However, this difference was not statistically significant (p=0.458).

CONCLUSION

Salivary albumin level was significantly decreased and salivary alkaline phosphatase level slightly increased in HIV positive patients in comparison to healthy control group. All of the HIV infected patients were in early phase of HIV infection with normal immune status. More research is needed to estimate these enzymes changes in late phase of HIV infection and AIDS step.

Effectiveness of Low-Level Laser Therapy during Tooth Movement: A Randomized Clinical Trial

The present study evaluated the effects of low-level laser therapy (LLLT) by means of a diode laser in accelerating orthodontic tooth movement (OTM). After extraction of the first upper premolars for orthodontic purpose, 82 maxillary canines which needed distalization were analyzed in 41 enrolled patients (21 males, 20 females, mean age 13.4 ± 2.1 years). On all experimental sites, an orthodontic force of 50/N was applied by a nickel-titanium (NiTi) closed coil spring (G&H, Franklin, IN, USA) in order to obtain the space closure. Using a split mouth randomized design, the test side was treated using a diode laser (Wiser Laser Doctor Smile, Brendola, Italy) operating at 810 nm wavelength in continuous wave mode at both the buccal and palatal side on three points/side (distal, medial and mesial) (1 W output power, continuous wave of 66.7 J/cm², energy density of 8 J) at baseline and at 3, 7, and 14 days and every 15 days until the space closed. On the control side, the opposite selected canine was treated only using orthodontic traction. The primary outcome chosen was the overall time needed to complete the levelling and closing space, measured on a study cast. The secondary outcome chosen was the evaluation of pain levels related to tooth traction, using a Visual Analogue Scale (VAS), recorded at 3, 7, and 14 days after treatments. The mean space closures of the maxillary canines were comparable between groups [Test, 4.56 mm (95% CI 3.9-4.8); Control, 4.49 mm (95% CI 3.8-4.7), p = 0.456]. The laser group yielded less mean time [84.35 ± 12.34 days (95% CI 79.3-86)] to accomplish space closure compared to the control group [97.49 ± 11.44 days (91.7-102.3)] (p < 0.001). The test side showed a significant reduction in the average range of dental pain at 3 [Test, 5.41 (95% CI 5.1-5.6); Control, 7.23 (95% CI 6.9-7.6), p < 0.001], 7 [Test, 4.12 (95% CI 3.8-4.7); Control, 5.79 (95% CI 5.4-5.8), p < 0.001], and at 14 days [Test, 2.31 (95% CI 1.8-2.3); Control, 3.84 (95% CI 3.3-4.2), p < 0.001] after treatment (p < 0.001). This study demonstrates that the use of LLLT therapy was effective in accelerating tooth movement and reducing pain levels related to OTM.

Identification of bone-specific alkaline phosphatase in saliva and its correlation with skeletal age

Context

Bone-specific alkaline phosphatase (B-ALP), a product of osteoblasts, is a bone formation marker whose serum levels fluctuate with puberty and adolescence.

Aims

This study aims to assess B-ALP levels in saliva and correlate it with different skeletal maturity stages of hand-wrist radiographs using Hagg and Taranger method.

Settings and Design

Observational study and cross-sectional design.

Subjects and Methods

Total sample comprised of 90 individuals, right hand-wrist radiographs, and 2 ml unstimulated whole saliva samples taken from each patient on the same day. The hand-wrist radiographs were traced and staged into 5 subgroups (18 individuals each) according to Hagg and Taranger method.

Statistical Analysis Used

One-way analysis of variance (ANOVA) and Tukey's multiple post hoc test.

Results

The comparison of salivary B-ALP values between the different skeletal subgroups using one-way ANOVA depicted statistically significant results (P = 0.0003). Pairwise comparison using Tukey's multiple post hoc procedures showed that salivary B-ALP levels were comparatively higher in subgroup 3 and that the difference between subgroups 1 and 3 (P = 0.0109) and subgroups 3 and 5 (P = 0.0014) was statistically significant.

Conclusion

B-ALP could be successfully identified and quantitatively estimated in saliva and showed significant correlation with different skeletal age subgroups as determined by Hagg and Taranger method.

Low-level laser therapy increases interleukin-1β in gingival crevicular fluid and enhances the rate of orthodontic tooth movement

INTRODUCTION

The aim of this investigation was to evaluate the effects of low-level laser therapy on interleukin-1β (IL-1β) levels in gingival crevicular fluid and its correlation with orthodontic tooth movement.

METHODS

A split-mouth design was used in 10 subjects (6 female, 4 male) aged 14 to 25 years, whose maxillary first premolars were extracted. A gallium-aluminum-arsenide semiconductor diode laser (wavelength, 940 nm; energy density, 8 J/cm2; power output, 100 mW) delivered low-level laser therapy to the experimental canine undergoing distalization at 10 points. The control canine was distalized without low-level laser therapy. The experimental and control canines were distalized using a force of 150 g provided by nickel-titanium closed-coil springs. Gingival crevicular fluid was collected at 5 time points from the control and experimental sides, and the levels of IL-1β were analyzed by enzyme-linked immuno-sorbent assay (ELISA). The distal movements of the maxillary canines were measured and compared.

RESULTS

Increased levels of IL-1β were observed in the experimental canines compared with the control canines (P <0.001). Cumulative tooth movements over an 8-week experimental period were greater for the experimental canines (occlusogram and software, 4.450 and 4.4903 mm, respectively) compared with the control canines (occlusogram and software, 2.025 and 2.0501 mm, respectively). A positive correlation existed between the IL-1β levels and the amounts of tooth movement across all time intervals.

CONCLUSIONS

In combination with light orthodontic force, application of low-level laser therapy increased the levels of IL-1β in gingival crevicular fluid and accelerated orthodontic tooth movement.

Comparison of Salivary pH, Buffering Capacity and Alkaline Phosphatase in Smokers and Healthy Non-Smokers: Retrospective cohort study

OBJECTIVES

Saliva contains alkaline phosphatase (ALP)-a key intracellular enzyme related to destructive processes and cellular damage-and has buffering capacity (BC) against acids due to the presence of bicarbonate and phosphate ions. Smoking may have deleterious effects on the oral environment due to pH changes which can affect ALP activity. This study aimed to evaluate the salivary pH, BC and ALP activity of male smokers and healthy non-smokers.

METHODS

This retrospective cohort study took place between August 2012 and December 2013. A total of 251 healthy male non-smokers and 259 male smokers from Hamadan, Iran, were selected. Unstimulated whole saliva was collected from each participant and pH and BC were determined using a pH meter. Salivary enzymes were measured by spectrophotometric assay.

RESULTS

Mean salivary pH (7.42 ± 0.48 and 7.52 ± 0.43, respectively; P = 0.018) and BC (3.41 ± 0.54 and 4.17 ± 0.71; P = 0.001) was significantly lower in smokers compared to non-smokers. Mean ALP levels were 49.58 ± 23.33 IU/L among smokers and 55.11 ± 27.85 IU/L among non-smokers (P = 0.015).

CONCLUSION

Significantly lower pH, BC and ALP levels were observed among smokers in comparison to a healthy control group. These salivary alterations could potentially be utilised as biochemical markers for the evaluation of oral tissue function and side-effects among smokers. Further longitudinal studies are recommended to evaluate the effects of smoking on salivary components.

Bonebiomarkers in periodontal disease: a review article

Periodontitis, is an inflammatory state of the tooth supporting structures and if left untreated, the disease continues to progressive bone destruction and subsequent tooth loss. The increasing prevelance of periodontal disease paved way to the development of new diagnostic tests that could detect the presence of active disease,the course of the disease and its response to treatment. Bone is a metabolically active tissue and undergo continuous remodelling, a process that largely relies on the activity of osteoclasts to remove bone and of osteoblasts to form bone. In health ,bone resorption and formation are coupled to each other and its long term maintenance of skeletal balance is brought about by the systemic hormones and local mediators.In contrasts,during disease there is a pronounced in balance in bone turnover. Bone biomarkers which are produced either in health or in disease state are tell tale markers which would be used to monitor the health status. This review highlights, the recent advances in the use of biomarkers of bone remodelling,that could facilitate the screening, diagnosis and management of periodontal diseases.

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.