Induction of cytokines, MMP9, TIMPs, RANKL and OPG during orthodontic tooth movement

Inhibition of Orthodontic Relapse by Local Application of Simvastatin-Loaded Gelatin Hydrogel in a Rabbit Model

OBJECTIVES

This study aims to determine the effect of gelatin-simvastatin hydrogel application on bone remodelling during relapse.

MATERIALS AND METHODS

Twenty-four rabbits (Oryctolagus cuniculus) were divided into a control group (n = 12) and a treatment group (n = 12). The lower incisors were subjected to orthodontic force and moved distally by an open coil spring. The force (50 cN) was extended for 1 week and retained in a new position for 2 weeks (stabilisation period). The treatment group received a local gelatin-simvastatin hydrogel administration during stabilisation, and the control group received only gelatin hydrogel. The springs were debonded after the stabilisation phase from both groups to facilitate a relapse. The percentage of relapse was measured in a model study using digital callipers. Levels of OPG and RANKL were analysed using ELISA.

RESULTS

The local application of gelatin-simvastatin hydrogel in the treatment group significantly decreases the relapse percentage and RANKL level. Additionally, the gelatin-simvastatin hydrogel significantly increases the level of OPG and ratio of OPG/RANKL.

CONCLUSIONS

Applying gelatin-simvastatin hydrogel in the retention period can induce bone formation, inhibit orthodontic relapse and increase tooth stability (in vivo).

Integrated bioinformatic analysis of protein landscape in gingival crevicular fluid unveils sequential bioprocess in orthodontic tooth movement

BACKGROUND

The biological mechanisms driving orthodontic tooth movement (OTM) remain incompletely understood. Gingival crevicular fluid (GCF) is an important indicator of the periodontal bioprocess, providing valuable cues for probing the molecular mechanisms of OTM.

METHODS

A rigorous review of the clinical studies over the past decade was conducted after registering the protocol with PROSPERO and adhering to inclusion criteria comprising human subjects, specified force magnitudes and force application modes. The thorough screening investigated differentially expressed proteins (DEPs) in GCF associated with OTM. Protein-protein interaction (PPI) analysis was carried out using the STRING database, followed by further refinement through Cytoscape to isolate top hub proteins.

RESULTS

A comprehensive summarization of the OTM-related GCF studies was conducted, followed by an in-depth exploration of biomarkers within the GCF. We identified 13 DEPs, including ALP, IL-1β, IL-6, Leptin, MMP-1, MMP-3, MMP-8, MMP-9, PGE2, TGF-β1, TNF-α, OPG, RANKL. Bioinformatic analysis spotlighted the top 10 hub proteins and their interactions involved in OTM. Based on these findings, we have proposed a hypothetic diagram for the time-course bioprocess in OTM, which involves three phases containing sequential cellular and molecular components and their interplay network.

CONCLUSIONS

This work has further improved our understanding to the bioprocess of OTM, suggesting biomarkers as potential modulating targets to enhance OTM, mitigate adverse effects and support real-time monitoring and personalized orthodontic cycles.

The age-related effects on orthodontic tooth movement and the surrounding periodontal environment

Orthodontic treatment in adults is often related to longer treatment time as well as higher periodontal risks compared to adolescents. The aim of this review is to explore the influence of age-related chages on orthodontic tooth movement (OTM) from macro and micro perspectives. Adults tend to show slower tooth movement speed compared to adolescence, especially during the early phase. Under orthodontic forces, the biological responses of the periodontal ligament (PDL) and alveolar bone is different between adult and adolescents. The adult PDL shows extended disorganization time, increased cell senescence, less cell signaling and a more inflammatory microenvironment than the adolescent PDL. In addition, the blood vessel surface area is reduced during the late movement phase, and fiber elasticity decreases. At the same time, adult alveolar bone shows a higher density, as well as a reduced osteoblast and osteoclast activation, under orthodontic forces. The local cytokine expression also differs between adults and adolescents. Side-effects, such as excessive root resorption, greater orthodontic pain, and reduced pulpal blood flow, also occur more frequently in adults than in adolescents.

Biological alterations associated with the orthodontic treatment with conventional appliances and aligners: A systematic review of clinical and preclinical evidence

Background&objectives

Mechanical forces applied during an orthodontic tooth movement (OTM) propel several biochemical and molecular responses in the periodontal ligament and alveolar bone. Here, we compile the existing clinical and preclinical evidence on these biological changes, aiming to provide a comprehensive discussion on the influence of the mechanical parameters of the OTM in the biological profile of the periodontium.

Material and methods

This systematic integrative review was conducted according to PICOS strategy and PRISMA guidelines. A bibliographic search was performed in three electronic databases (PubMed, Scopus, and Web of Science) to find research articles published until 2023 and written in English. This search resulted in a total of 2279 publications, which were independently assessed by two evaluators using appropriate tools.

Results

Forty-six studies were selected for this review. These revealed that compression, and stretching of the periodontal ligament fibers and cells are observed in the initial phase of the OTM. Specifically, on the tension side, high levels of IL-1β, OPG, and TIMPs are identified. On the compression side, an increase of RANKL, RANK, and MMPs levels predominate.

Conclusion

This paper describes the release profile of common biomarkers according to the orthodontic protocol, suggesting the most appropriate parameters to keep the teeth and their supporting structures healthy. Overall, this manuscript provides a better understanding of the OTM-associated biological phenomena, also highlighting the importance of early evaluation of oral health, and thus it contributes as a fundamental basis for the development of more effective and safe orthodontic treatments with conventional appliances and aligners.

Impact of occlusal contact pattern on dental stability and oromandibular system after orthodontic tooth movement in rats

How to ensure dental stability in new positions and reduce the likelihood of relapse is a major clinical concern in the orthodontic field. Occlusal contacts between arches may affect the transmission of masticatory forces, thereby influencing the biological response of the periodontal and the oromandibular system. Occlusion factors that may influence the stability after orthodontic tooth movement (OTM) remain largely unknown. Hence, this research was conducted in order to investigate the influence of different occlusal contact patterns on tooth stability and oromandibular system including the masseter muscle and the temporomandibular joint following OTM. By modifying the occlusal surfaces, in vivo animal study models with distinct occlusal patterns corresponding to clinical circumstances were established. The relapse distance of teeth and the level of inflammatory factors in the gingival cervical fluid were analyzed. We also closely observed the histological remodeling of periodontal tissue, masseter tissue, and joint tissue after one week of relapse. Moreover, genes expression in the alveolar bone was analyzed to illustrate the potential biological mechanisms of relapse under the influence of different occlusal contact patterns following OTM. Different occlusal contact patterns after OTM in rats were established. The intercuspation contact between cusp and fossa group exhibited the lowest level of relapse movement, inflammatory factors and osteoclast activity (P < 0.05). On the other hand, groups with interferences or inadequate contacts exhibited more relapse movement, and tend to promote inflammation of periodontal tissue and activate bone resorption (P < 0.05). Adequate occlusal contacts without interference may enhance tooth stability and reduce the likelihood of relapse. After active orthodontic treatment, necessary occlusal adjustment should be made to achieve the desired intercuspation contact relationship and ensure adequate contact between the arches. The elimination of occlusal interferences is crucial to achieving optimal stability and promoting overall healthy condition of the oromandibular system.

Role of noncoding RNAs in orthodontic tooth movement: new insights into periodontium remodeling

Orthodontic tooth movement (OTM) is biologically based on the spatiotemporal remodeling process in periodontium, the mechanisms of which remain obscure. Noncoding RNAs (ncRNAs), especially microRNAs and long noncoding RNAs, play a pivotal role in maintaining periodontal homeostasis at the transcriptional, post-transcriptional, and epigenetic levels. Under force stimuli, mechanosensitive ncRNAs with altered expression levels transduce mechanical load to modulate intracellular genes. These ncRNAs regulate the biomechanical responses of periodontium in the catabolic, anabolic, and coupling phases throughout OTM. To achieve this, down or upregulated ncRNAs actively participate in cell proliferation, differentiation, autophagy, inflammatory, immune, and neurovascular responses. This review highlights the regulatory mechanism of fine-tuning ncRNAs in periodontium remodeling during OTM, laying the foundation for safe, precise, and personalized orthodontic treatment.

Human Interleukin-1β Profile and Self-Reported Pain Monitoring Using Clear Aligners with or without Acceleration Techniques: A Case Report and Investigational Study

INTRODUCTION

There is a growing demand for more aesthetic, comfortable, and faster orthodontic treatments, and clear aligners emerged as a solution to fulfill this need. However, the effectiveness of clear aligners to treat complex malocclusions is yet contentious. The use of acceleration methods could improve the efficacy of clear aligners by stimulating cells' mechanobiology through numerous pathways, but this hypothesis is still poorly explored.

OBJECTIVE

We aimed to monitor the release profile of an inflammatory marker-the interleukin-1β-and to evaluate its relationship with self-reported pain scores with and without the use of acceleration techniques during an orthodontic treatment requiring difficult tooth movements with clear aligners. Case Report. Here, we report a case of a 46-year-old female patient who presented functional and aesthetic complaints. Intraoral examination revealed a diminished overjet and overbite, rotation of teeth 45 and 24, absence of teeth 25, 35, and 36, buccolingual dislocation of tooth 21, a tendency to a Class III malocclusion, and a 2 mm left deviation of the lower midline. This study is divided into three stimulation phases: no stimulation, mechanical vibration stimulation, and photobiomodulation. Interleukin-1β levels in gingival crevicular fluid samples from the pressure side of six selected teeth were evaluated at four time points after the orthodontic treatment onset. Pain monitoring in those teeth was performed using a visual analogue scale at the same time points.

RESULTS

Interleukin-1β protein production peaked 24 h after treatment onset. Complex movements were associated with increased self-reported pain.

CONCLUSION

Clear aligners show limitations in solving complex tooth movements, even when combined with acceleration. The development of customized and programmable stimulation microdevices integrated into "smart aligners," which could be designed to specifically stimulate the direction of movement and stimulation parameters and could constitute a solution to optimize the orthodontic tooth movement with clear aligners.

Semaphorin 3A regulates alveolar bone remodeling on orthodontic tooth movement

Semaphorin 3A (Sema3A) promotes osteoblast differentiation and inhibits osteoclast differentiation. In the present study, we observed the regulation of alveolar bone remodeling by Sema3A during orthodontic tooth movement (OTM). Four inflammatory cytokines (IL-1β, IL-6, TNFα, and INF-γ) involved in OTM were applied to osteoblasts in vitro, and Sema3A expression was determined by reverse-transcription quantitative polymerase chain reaction (RT-qPCR). In vivo, springs were attached to the maxillary first molars of C56BL/6J mice (OTM model) and the localization of Sema3A was confirmed by immunofluorescent. Recombinant Sema3A (rSema3A) was locally injected into the OTM model. Inflammatory cytokine localization in the OTM model was confirmed by immunohistochemistry. In vivo, more Sema3A was observed on the tension side in the OTM group. Injection of rSema3A into the OTM model increased mineralization on the tension side and decreased the number of osteoclasts on the compression side. In vitro, IL-1β significantly increased Sema3A mRNA levels. Immunohistochemistry for IL-1β in vivo showed more concentrated staining in the periodontal ligament on the tension side than on the compression side. In summary, our findings revealed the distribution of Sema3A in the periodontal ligament and demonstrated that rSema3A administration promotes bone formation and inhibits bone resorption during OTM.

Evaluation of periodontal parameters and gingival crevicular fluid cytokines in children with anterior open bite receiving passive orthodontic treatment with a spur

Objective

To evaluate clinical parameters and gingival crevicular fluid (GCF) cytokines in children with anterior open bite receiving passive orthodontic treatment with spurs.

Methods

Twenty children with indications for interceptive orthodontic treatment, an anterior open bite, and good oral hygiene and periodontal health were included in this study. GCF samples were collected from the mandibular and maxillary central incisors before (baseline) and 24 hours and 7 days after spur bonding. Clinical and periodontal examinations and cytokine analyses were performed.

Results

At 7 days after spur attachment, gingival bleeding in the mandibular group was increased relative to that in the maxillary group. Visible plaque was correlated with gingival bleeding at 7 days and the GCF volume at 24 hours after spur attachment. Compared with those at baseline, interleukin (IL)-8 levels in the maxillary group and IL-1β levels in both tooth groups increased at both 24 hours and 7 days and at 7 days, respectively. At 24 hours, IL-8, IL-1β, and IL-6 levels were higher in the maxillary group than in the mandibular group. Cytokine production was positively correlated with increased GCF volume, but not with gingival bleeding, visible plaque, or probing depth.

Conclusions

Although orthodontic treatment with spurs in children resulted in increased gingival bleeding around the mandibular incisors, IL levels were higher around the maxillary incisors and not correlated with periodontal parameters. Increased cytokine levels in GCF may be associated with the initial tooth movement during open bite correction with a passive orthodontic appliance in children.

Open bite

The Role of Matrix Metalloproteinases (MMP-8, MMP-9, MMP-13) in Periodontal and Peri-Implant Pathological Processes

Severe periodontitis, a destructive inflammatory disease of the supporting tissues of the teeth, ranks sixth in terms of global spread, affecting about 11% of the population. Metalloproteinases (MMPs) are extracellular matrix (ECM) macromolecules that are important in cellular development and morphogenesis, and they are capable of activating growth factors in their proximity, cell surface receptors, and adhesion molecules. MMPs are part of a major family of zinc-dependent endopeptidases, and their activity is modulated and regulated by certain inhibitors known as tissue metalloproteinase inhibitors (TIMPs). Because type I collagen is the major component of the periodontal extracellular matrix, special attention has been paid to the role of collagenases, especially MMP-8 and MMP-13 and gelatinases, MMP-2 and MMP-9, in periodontal diseases. In fact, MMP-8 (or collagenase 2) is currently one of the most promising biomarkers for periodontitis in oral fluids. Among them, salivary MMP-9 has been shown to be a more sensitive marker for periodontal inflammation during orthodontic treatment, which opens new perspectives in reducing periodontal hazards during such treatments. Both MMP-8 and MMP-9 are extremely valuable diagnostic tools in treating periodontitis, and future studies and healthcare policies should focus on implementing more accessible methods of chairside testing in order to reduce the prevalence of this disease.

Mechanosensitive Piezo1 in Periodontal Ligament Cells Promotes Alveolar Bone Remodeling During Orthodontic Tooth Movement

Orthodontic tooth movement (OTM) is a process depending on the remodeling of periodontal tissues surrounding the roots. Orthodontic forces trigger the conversion of mechanical stimuli into intercellular chemical signals within periodontal ligament (PDL) cells, activating alveolar bone remodeling, and thereby, initiating OTM. Recently, the mechanosensitive ion channel Piezo1 has been found to play pivotal roles in the different types of human cells by transforming external physical stimuli into intercellular chemical signals. However, the function of Piezo1 during the mechanotransduction process of PDL cells has rarely been reported. Herein, we established a rat OTM model to study the potential role of Piezo1 during the mechanotransduction process of PDL cells and investigate its effects on the tension side of alveolar bone remodeling. A total of 60 male Sprague-Dawley rats were randomly assigned into three groups: the OTM + inhibitor (INH) group, the OTM group, and the control (CON) group. Nickel-titanium orthodontic springs were applied to trigger tooth movement. Mice were sacrificed on days 0, 3, 7, and 14 after orthodontic movement for the radiographic, histological, immunohistochemical, and molecular biological analyses. Our results revealed that the Piezo1 channel was activated by orthodontic force and mainly expressed in the PDL cells during the whole tooth movement period. The activation of the Piezo1 channel was essential for maintaining the rate of orthodontic tooth movement and facilitation of new alveolar bone formation on the tension side. Reduced osteogenesis-associated transcription factors such as Runt-related transcription factor 2 (RUNX2), Osterix (OSX), and receptor activator of nuclear factor-kappa B ligand (RANKL)/osteoprotegerin (OPG) ratio were examined when the function of Piezo1 was inhibited. In summary, Piezo1 plays a critical role in mediating both the osteogenesis and osteoclastic activities on the tension side during OTM.

Production of a Soluble Recombinant Antibody Fragment against MMP9 Using Escherichia coli

Matrix metalloproteinase 9 (MMP9) is involved in several aspects of the pathology of cancer, including invasion, metastasis, and angiogenesis. In this study, we expressed a recombinant scFv-type anti-MMP9 antibody in soluble form using Escherichia coli, purified it, and confirmed its antigen-binding ability. The convenient, rapid, inexpressive system used in this study for producing recombinant antibody fragments needs only five days, and thus can be used for the efficient production of scFv against MMP9, which can be used in a range of applications and industrial fields, including diagnosis and treatment of inflammatory and cancer-related diseases.

Calreticulin silencing inhibits extracellular matrix synthesis of human gingival fibroblasts cultured on three-dimensional poly(lactic-co-glycolic acid) scaffolds by inhibiting the calcineurin/nuclear factor of activated T cells 3 signalling pathway

BACKGROUND

The retraction and compression of gingival tissue have a significant impact on the efficiency and stability of orthodontic treatment, but the underlying molecular mechanism has not been fully elucidated. The aim of the current study was to investigate the effects of mechanical forces on the expression level of calreticulin (CRT), the activity of the calcineurin (CaN)/nuclear factor of activated T cells (NFAT) 3 signalling pathway, and extracellular matrix (ECM) synthesis in human gingival fibroblasts (HGFs) cultured on three-dimensional (3D) poly(lactic-co-glycolic acid) (PLGA) scaffolds and to further explore the mechanical transduction pathways that may be involved.

MATERIALS AND METHODS

A mechanical force of 25 g/cm² was applied to HGFs for 0, 6, 24, 48, or 72 h. The expression of CRT, CaN, NFAT3, phosphorylated NFAT3 (p-NFAT3) and type I collagen (COL-I) were detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blotting. Subsequently, small interfering RNA (siRNA) was used to knock down the expression of CRT in HGFs, and the impacts of the applied force on the expression levels of CaN, NFAT3, p-NFAT3, and COL-I were also evaluated by RT-qPCR and western blotting.

RESULTS

The application of mechanical force on HGFs cultured on 3D PLGA scaffolds led to a significant increases in CRT, CaN, and COL-I expression as well as a decrease in p-NFAT3 expression. However, the effects of mechanical force on CaN, p-NFAT3, and COL-I expression were reversed following downregulation of CRT and displayed a significant decrease in CaN/NFAT3 activity and COL-I synthesis.

CONCLUSION

This study showed that the CaN/NFAT3 signalling pathway and CRT appear to be involved in the mechanotransduction of HGFs, and downregulation of CRT inhibits COL-I synthesis potentially via the CaN/NFAT3 signalling pathway. Taken together, these findings ultimately provide novel insight into the mechanisms underlying mechanical force-induced ECM synthesis, which may be conducive to the development of targeted therapeutics to treat fibrotic diseases, including gingival fibrosis caused by orthodontic treatment.

MMPs and TIMPs Expression Levels in the Periodontal Ligament during Orthodontic Tooth Movement: A Systematic Review of In Vitro and In Vivo Studies

Background: During orthodontic tooth movement (OTM), applied orthodontic forces cause an extensive remodeling of the extracellular matrix (ECM) in the periodontal ligament (PDL). This is mainly orchestrated by different types of matrix metalloproteinases (MMPs) and their tissue inhibitors of matrix metalloproteinases (TIMPs), which are both secreted by periodontal ligament (PDL) fibroblasts. Multiple in vitro and in vivo studies already investigated the influence of applied orthodontic forces on the expression of MMPs and TIMPs. The aim of this systematic review was to explore the expression levels of MMPs and TIMPs during OTM and the influence of specific orthodontic force-related parameters. Methods: Electronic article search was performed on PubMed and Web of Science until 31 January 2021. Screenings of titles, abstracts and full texts were performed according to PRISMA, whereas eligibility criteria were defined for in vitro and in vivo studies, respectively, according to the PICO schema. Risk of bias assessment for in vitro studies was verified by specific methodological and reporting criteria. For in vivo studies, risk of bias assessment was adapted from the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross-sectional study. Results: Electronic article search identified 3266 records, from which 28 in vitro and 12 in vivo studies were included. The studies showed that orthodontic forces mainly caused increased MMPs and TIMPs expression levels, whereas the exact effect may depend on various intervention and sample parameters and subject characteristics. Conclusion: This systematic review revealed that orthodontic forces induce a significant effect on MMPs and TIMPs in the PDL. This connection may contribute to the controlled depletion and formation of the PDLs' ECM at the compression and tension site, respectively, and finally to the highly regulated OTM.

Clinical research: low-level laser therapy in accelerating orthodontic tooth movement

Background

The present study aimed to investigate the effects of low-level laser therapy (LLLT) on orthodontic tooth movement and its correlation with the levels of interleukin-1β (IL-1β), receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) in gingival crevicular fluid (GCF).

Methods

This split-mouth design study included 12 patients scheduled for the extraction of both upper first premolars. Patients were randomly selected for experimental group that received left- or right-side radiation with a diode laser (810 nm wavelength, 100 mW power output, 6.29 J/cm² energy density). Laser treatment was applied on days 0, 7, 14, and 21, after loading the canine retraction forces. GCF concentrations of IL-1β, RANKL, and OPG were analyzed. The upper arch of each patient was scanned with an intraoral scanner to assess tooth movement.

Results

The cumulative tooth movement over 28 days was significantly higher in the laser group than in the control group. We observed significant reductions in OPG levels and increases in IL-1β and RANKL levels in GCF samples on the experimental sides.

Conclusion

With the parameter settings used in this study, LLLT could, to some extent, lead to changes in bone metabolism, which could accelerate orthodontic tooth movement.

Trial registration: Chinese Clinical Trial Registry, ChiCTR2000039594. Registered 2 November 2020—Retrospectively registered, www.chictr.org.cn/edit.aspx?pid=62465&htm=4.

Impact of Vibration on the Levels of Biomarkers: A Systematic Review

Introduction:

The objective of this systematic review is to assess the effect of vibrational force on biomarkers for orthodontic tooth movement.

Methods:

An electronic search was conducted for relevant studies (up to December 31, 2020) on the following databases: Pubmed, Google scholar, Web of Science, Cochrane Library, Wiley Library, and ProQuest Dissertation Abstracts and Thesis database. Hand searching of selected orthodontic journals was also undertaken. The selected studies were assessed for the risk of bias in Cochrane collaboration risk of bias tool. The “traffic plot” and “weighted plot” risk of bias distribution are designed in the RoB 2 tool. The 2 authors extracted the data and analyzed it.

Results:

Six studies fulfilled the inclusion criteria. The risks of biases were high for 4, low and some concern for other 2 studies. The biomarkers, medium, device, frequency and duration of device, as well as other data were extracted. The outcomes of the studies were found to be heterogenous.

Conclusion:

One study showed highly statistically significant levels of IL-1 beta with <.001. Rate of tooth movement was correlated with levels of released biomarkers under the influence of vibrational force in 3 studies, but it was found to be significant only in 1 study. It was further observed that vibration does not have any significant reduction in pain and discomfort.

Immune Changes Induced by Orthodontic Forces: A Critical Review

Orthodontic tooth movement (OTM) is generated by a mechanical force that induces an aseptic inflammatory response in the periodontal tissues and a subsequent coordinated process of bone resorption and apposition. In this review, we critically summarize the current knowledge on the immune processes involved in OTM inflammation and provide a novel insight into the relationship between classical inflammation and clinical OTM phases. We found that most studies focused on the acute inflammatory process, which ignites the initial alveolar bone resorption. However, the exact mechanisms and the immune reactions involved in the following OTM phases remain obscure. Recent studies highlight the existence of a typical innate response of resident and extravasated immune cells, including granulocytes and natural killer (NK), dendritic, and γδT cells. Based on few available studies, we shed light on an active, albeit incomplete, process of resolution in the lag phase, supported by continuously elevated ratios of M1/M2 macrophage and receptor activator of nuclear factor κB ligand/osteoprotegerin ratio. This partial resolution enables tissue formation and creates the appropriate environment for a transition between the innate and adaptive arms of the immune system, essential for the tissue's return to homeostasis. Nevertheless, as the mechanical trigger persists, the resolution turns into a low-grade chronic inflammation, which underlies the next, acceleration/linear OTM phase. In this stage, the acute inflammation dampens, and a simultaneous process of bone resorption and formation occurs, driven by B and T cells of the adaptive immune arm. Excessive orthodontic forces or tooth movement in periodontally affected inflamed tissues may hamper resolution, leading to "maladaptive homeostasis" and tissue loss due to uncoupled bone resorption and formation. The review ends with a brief description of the translational studies on OTM immunomodulation. Future studies are necessary for further uncovering cellular and molecular immune targets and developing novel strategies for controlling OTM by local and sustained tuning of the inflammatory process.

Evaluation of heat shock protein 70 and toll-like receptor 4 expression in gingival crevicular fluid in response to orthodontic forces

OBJECTIVES

The aim of this study was to assess the concentrations of heat shock protein 70 (HSP70) and toll-like receptor 4 (TLR4) during orthodontic tooth movement and to compare their levels with interleukin-1β (IL-1β), a well-known proinflammatory biomarker.

MATERIALS AND METHODS

This study consisted of 20 patients (8 males, 12 females; mean age 14.75 ± 2.34 years) who needed maxillary premolar extraction and segmental canine distalization. Concentrations of HSP70, TLR4, and IL-1β were examined before extraction (T1), at the 1st (T2), 4th (T3), 7th (T4), 14th (T5), and 30th (T6) days of canine retraction by enzyme-linked immunosorbent assay analysis of gingival crevicular fluid samples. Statistical analyses were performed with repeated measure ANOVA and Spearman's rank correlation coefficient analysis (p < 0.05).

RESULTS

HSP70 increased gradually from T1 to T6 and showed significant differences between T1-T6 and T2-T6 (T1:3.28 ± 0.92 ng/ml; T2:3.72 ± 0.66 ng/ml; T6:9.35 ± 2.45 ng/ml). The lowest TLR4 concentration was at T1, peaked at T3 and remained constant afterwards with significant differences between T1-T3, T1-T4, and T1-T6 (T1:0.71 ± 0.02 pg/ml; T3:1.04 ± 0.11 pg/ml; T4:0.95 ± 0.06 pg/ml; T6:1.00 ± 0.07 pg/ml). IL-1β increased from T1 to T6 with significant differences between T1-T4, T1-T5, and T1-T6 (T1:55.71 ± 5.48 pg/ml; T4:100.11 ± 16.92 pg/ml; T5:103.71 ± 23.19 pg/ml; T6:125.12 ± 22.04 pg/ml). The increase in HSP70 and TLR4 from T2-T3 showed a significant correlation (r = 0.598; p = 0.005).

CONCLUSIONS

The increased levels of HSP70, TLR4, and IL-1β show the contribution of these mediators to the inflammatory response from the early stages of orthodontic tooth movement.

CLINICAL RELEVANCE

The regulation of HSP70, TLR4, and/or IL-1β secretion during orthodontic force application could provide alterations for desired optimal tooth movement.

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.

Interleukin-1β Induced Matrix Metalloproteinase Expression in Human Periodontal Ligament-Derived Mesenchymal Stromal Cells under In Vitro Simulated Static Orthodontic Forces

The periodontal ligament (PDL) responds to applied orthodontic forces by extracellular matrix (ECM) remodeling, in which human periodontal ligament-derived mesenchymal stromal cells (hPDL-MSCs) are largely involved by producing matrix metalloproteinases (MMPs) and their local inhibitors (TIMPs). Apart from orthodontic forces, the synthesis of MMPs and TIMPs is influenced by the aseptic inflammation occurring during orthodontic treatment. Interleukin (IL)-1β is one of the most abundant inflammatory mediators in this process and crucially affects the expression of MMPs and TIMPs in the presence of cyclic low-magnitude orthodontic tensile forces. In this study we aimed to investigate, for the first time, how IL-1β induced expression of MMPs, TIMPs and how IL-1β in hPDL-MSCs was changed after applying in vitro low-magnitude orthodontic tensile strains in a static application mode. Hence, primary hPDL-MSCs were stimulated with IL-1β in combination with static tensile strains (STS) with 6% elongation. After 6- and 24 h, MMP-1, MMP-2, TIMP-1 and IL-1β expression levels were measured. STS alone had no influence on the basal expression of investigated target genes, whereas IL-1β caused increased expression of these genes. In combination, they increased the gene and protein expression of MMP-1 and the gene expression of MMP-2 after 24 h. After 6 h, STS reduced IL-1β-induced MMP-1 synthesis and MMP-2 gene expression. IL-1β-induced TIMP-1 gene expression was decreased by STS after 6- and 24-h. At both time points, the IL-1β-induced gene expression of IL-1β was increased. Additionally, this study showed that fetal bovine serum (FBS) caused an overall suppression of IL-1β-induced expression of MMP-1, MMP-2 and TIMP-1. Further, it caused lower or opposite effects of STS on IL-1β-induced expression. These observations suggest that low-magnitude orthodontic tensile strains may favor a more inflammatory and destructive response of hPDL-MSCs when using a static application form and that this response is highly influenced by the presence of FBS in vitro.

Using Salivary MMP-9 to Successfully Quantify Periodontal Inflammation during Orthodontic Treatment

Periodontitis is one of the most common immune-mediated inflammatory conditions resulting in progressive destruction of periodontium. Metalloproteinase-9 (MMP-9), an enzyme that is involved in the degradation of gelatin and collagen and present in the gingival crevicular fluid, is markedly increased in periodontitis. The aim of the study is to evaluate the effects of periodontal treatment either alone or in combination with orthodontic treatment on MMP-9 levels. In this study, 60 individuals were subjected to periodontal treatment (PD) or periodontal treatment combined with orthodontic treatment (POD). Both periodontal and periodontal plus orthodontic treatments significantly improved clinical parameters and lowered MMP-9 levels compared to control group. However, the combination of periodontal with orthodontic treatment further improved clinical parameters and enhanced the lowering effect on MMP-9 levels compared to periodontal or control groups alone. Finally, the degree of malocclusion significantly affected the effect of the treatment on MPP-9 levels with PD treatment having the most pronounced effect. We concluded that salivary MMP-9 can serve to accurately predict the level of inflammation in affected periodontal tissues during orthodontic treatment that is also associated with the type of malocclusion, making it a viable diagnosis tool in monitoring the progression of the periodontium during orthodontic treatment.

Sympathetic nervous system contributes to orthodontic tooth movement by central neural regulation from hypothalamus

Orthodontic tooth movement (OTM) is a specific treatment of malocclusion, whose regulation mechanism is still not clear. This study aimed to reveal the relationship between the sympathetic nervous system (SNS) and OTM through the construction of an OTM rat model through the utilization of orthodontic nickeltitanium coiled springs. The results indicated that the stimulation of SNS by dopamine significantly promote the OTM process represented by the much larger distance between the first and second molar compared with mere exertion of orthodontic force. Superior cervical ganglionectomy (SCGx) can alleviate this promotion effect, further proving the role of SNS in the process of OTM. Subsequently, the ability of orthodontic force to stimulate the center of the SNS was visualized by the tyrosin hydroxylase (TH) staining of neurons in ventromedial hypothalamic nucleus (VMH) and arcuate nucleus (ARC) of the hypothalamus, as well as the up-regulated expression of norepinephrine in local alveolar bone. Moreover, we also elucidated that the stimulation of SNS can promote osteoclast differentiation in periodontal ligament cells (PDLCs) and bone marrow-derived cells (BMCs) through regulation of receptor activator of nuclear factor-κB ligand (RANKL)/osteoprotegerin (OPG) system, thus promoting the OTM process. In conclusion, this study provided the first evidence for the involvement of the hypothalamus in the promotion effect of SNS on OTM. This work could provide a novel theoretical and experimental basis for further understanding of the molecular mechanism of OTM.

Transcriptomic profiling of feline teeth highlights the role of matrix metalloproteinase 9 (MMP9) in tooth resorption

Tooth resorption (TR) in domestic cats is a common and painful disease characterised by the loss of mineralised tissues from the tooth. Due to its progressive nature and unclear aetiology the only treatment currently available is to extract affected teeth. To gain insight into TR pathogenesis, we characterised the transcriptomic changes involved in feline TR by sequencing RNA extracted from 14 teeth (7 with and 7 without signs of resorption) collected from 11 cats. A paired comparison of teeth from the same cat with and without signs of resorption identified 1,732 differentially expressed genes, many of which were characteristic of osteoclast activity and differentiation, in particular matrix metalloproteinase 9 (MMP9). MMP9 expression was confirmed by qPCR and immunocytochemistry of odontoclasts located in TR lesions. A hydroxamate-based MMP9 inhibitor reduced both osteoclast formation and resorption activity while siRNA targeting MMP9 also inhibited osteoclast differentiation although had little effect on resorption activity. Overall, these results suggest that increased MMP9 expression is involved in the progress of TR pathogenesis and that MMP9 may be a potential therapeutic target in feline TR.

Biomarkers of orthodontic tooth movement with fixed appliances and vibration appliance therapy: a pilot study

INTRODUCTION

The aim of this study was to investigate the effect of supplemental vibratory force on biomarkers of bone remodelling during orthodontic tooth movement, the rate of mandibular anterior alignment (RMAA), and compliance with a vibration device.

DESIGN, SETTINGS, AND PARTICIPANTS

Forty patients between the ages 15-35 undergoing fixed appliance treatment that presented to a university orthodontic clinic were randomly allocated to supplemental use of an intraoral vibrational device (n = 20, AcceleDent®) or fixed appliance only (n = 20). Salivary multiplex assay was completed to analyse the concentration of selected biomarkers of bone remodelling before treatment (T0) and at three following time points (T1, T2, T3), 4-6 weeks apart. Irregularity of the mandibular anterior teeth and compliance was assessed at the same trial time points. Data were analysed blindly on an intention-to-treat basis with descriptive statistics, Mann-Whitney U-test, Wilcoxon signed-rank test, and linear mixed effects regression modelling.

RESULTS

No difference in the changes in salivary biomarkers of bone remodelling and RMAA between groups at any time point over the trial duration was observed. No correlation was found between changes in irregularity and biomarker level from baseline to another time point. Lastly, there was no association between RMAA and compliance with the AcceleDent® device.

CONCLUSIONS

Supplemental vibratory force during orthodontic treatment with fixed appliances does not affect biomarkers of bone remodelling or the RMAA.

LIMITATIONS

The main limitation of the study was the small sample size and the large variability in the salivary biomarkers.

HARMS

No harms were observed during the duration of the trial.

PROTOCOL

The protocol was not published prior to trial commencement.

REGISTRATION

The study was registered in Clinical Trials.gov (NCT02119455) first posted on April 2014.

Label-free quantitative proteomic analysis of gingival crevicular fluid to identify potential early markers for root resorption

Background

Orthodontically-induced root resorption is an iatrogenic effect and it cannot be examined regularly due to the harmful effects of sequential doses of radiation with more frequent radiography. This study aims to compare protein abundance (PA) of pre-treatment and during orthodontic treatment for root resorption and to determine potential early markers for root resorption.

Methods

Ten subjects (n = 10) who had upper and lower fixed appliances (MBT, 3 M Unitek, 0.022″ × 0.028″) were recruited for this study. Human gingival crevicular fluid (GCF) was obtained using periopaper strips at pre-treatment (T0), 1 month (T1), 3 months (T3), and 6 months (T6) of orthodontic treatment. Periapical radiographs of the upper permanent central incisors were taken at T0 and T6 to measure the amount of root resorption. Identification of changes in PA was performed using liquid chromatography-tandem mass spectrometry. Student’s t-test was then performed to determine the significance of the differences in protein abundance before and after orthodontic treatment.

Results

Our findings showed that all ten subjects had mild root resorption, with an average resorption length of 0.56 ± 0.30 mm. A total of 186 proteins were found to be commonly present at T0, T1, T3, and T6. There were significant changes in the abundance of 16 proteins (student’s t-test, p ≤ 0.05). The increased PA of S100A9, immunoglobulin J chain, heat shock protein 1A, immunoglobulin heavy variable 4–34 and vitronectin at T1 suggested a response to stress that involved inflammation during the early phase of orthodontic treatment. On the other hand, the increased PA of thymidine phosphorylase at T3 suggested growth promotion and, angiogenic and chemotactic activities.

Conclusions

The identified proteins can be potential early markers for root resorption based on the increase in their respective PA and predicted roles during the early phase of orthodontic treatment. Non-invasive detection of root resorption using protein markers as early as possible is extremely important as it can aid orthodontists in successful orthodontic treatment.

Comparative assessment of mouse models for experimental orthodontic tooth movement

Animal experiments are essential for the elucidation of biological-cellular mechanisms in the context of orthodontic tooth movement (OTM). So far, however, no studies comparatively assess available mouse models regarding their suitability. OTM of first upper molars was induced in C57BL/6 mice either via an elastic band or a NiTi coil spring for three, seven or 12 days. We assessed appliance survival rate, OTM and periodontal bone loss (µCT), root resorptions, osteoclastogenesis (TRAP⁺ area) and local expression of OTM-related genes (RT-qPCR). Seven days after the elastic bands were inserted, 87% were still in situ, but only 27% after 12 days. Survival rate for the NiTi coil springs was 100% throughout, but 8.9% of the animals did not survive. Both methods induced significant OTM, which was highest after 12 (NiTi spring) and 7 days (band), with a corresponding increase in local gene expression of OTM-related genes and osteoclastogenesis. Periodontal bone loss and root resorptions were not induced at a relevant extent by neither of the two procedures within the experimental periods. To induce reliable OTM in mice beyond 7 days, a NiTi coil spring is the method of choice. The elastic band method is recommended only for short-term yes/no-questions regarding OTM.

Effects of diabetes on oxidative stress, periodontal ligament fiber orientation, and matrix metalloproteinase 8 and 9 expressions during orthodontic tooth movement

OBJECTIVES

To evaluate the influence of diabetes on oxidative stress, periodontal ligament (PDL) orientation, and matrix metalloproteinase (MMP) 8 and 9 expressions during orthodontic tooth movement in a rat model.

MATERIALS AND METHODS

An orthodontic appliance was placed in 60 Sprague-Dawley rats divided into three groups: normoglycemics (n = 20) and two streptozotocin-induced diabetic groups, one untreated (n = 20) and one insulin-treated (n = 20). At 24, 48, and 72 h and 1 week, rats were sacrificed. At each time point, myeloperoxidase (MPO) and malondialdehyde (MDA) were quantified by spectrophotometry, tooth movement was evaluated by micro-CT analysis, and hematoxylin and eosin staining was used to evaluate PDL fiber orientation and immunohistochemistry staining with semi-quantitative H-score analysis of MMP-8 and MMP-9 was performed..

RESULTS

At 24 h, MPO activity was significantly higher in untreated-diabetics than normoglycemics. At 24 and 48 h, the MDA level in untreated-diabetic rats was significantly higher than in normoglycemics and insulin-treated animals. At 72 h and 1 week, PDL fibers were oriented significantly more irregularly in untreated-diabetics than in normoglycemics. At all time points, MMP-8 and MMP-9 expressions were significantly higher in both diabetic groups than in the normoglycemic group. After the second day, tooth movement was significantly greater in untreated-diabetics than in the insulin-treated and normoglycemic groups.

CONCLUSIONS

Mechanical stress in untreated-diabetic rats produces more inflammatory response, oxidative stress, tooth movement, PDL disorganization, and MMP-8 and MMP-9 expressions than among normoglycemics. Insulin reverses these effects, favoring the reorganization of periodontal ligament.

CLINICAL RELEVANCE

Our results suggest that the application of orthodontic force in diabetic patients would increase inflammation and delay periodontal restructuring. Insulin would partly reverse this situation although glycemic decompensation episodes may occur. For these reasons, the periods between fixed orthodontic appliance activations should be of sufficient duration to allow adequate tissue recovery.

Cytokine levels in gingival crevicular fluid samples of patients wearing clear aligners

Objective

The aim of this study was to assess & compare the changes in cytokine levels in GCF samples of patients wearing clear aligners.

Methods

GCF samples of 10 patients undergoing orthodontic treatment, for correction of lower anterior crowding with clear aligners, were collected on day 0, 1, 3, 7 and 21 using periopaper strips. The upper arch was taken as the control site. The samples collected were further analyzed using commercially available ELISA based kits.

Results

The mean levels of IL-1β at day 0, 1, 3, 7 and 21 were compared between experimental and control sites using unpaired t-test and it was found that the levels of IL-1β were significantly elevated on experimental site in comparison to control site.

Conclusion

It was concluded from the study that elevation in levels of IL-1β as a biomarker of orthodontic tooth movement reaches its peak after 24 h of force application. The clear aligners, as an alternative to conventional fixed orthodontic treatment, were found to be efficient in correcting mild to moderate lower arch crowding.

DR3 and its ligands take roles in periodontium remodeling during orthodontic tooth movement

Background/purpose

Based on ‘pressure-tension theory’, the application of orthodontic force to the tooth site affects the remodeling of periodontal tissue, specifically, mechanical stress induces the release of cytokines. The purpose of this research paper is to examine death receptor 3/TNF-like protein 1A/progranulin (DR3/TL1A/PGRN) expression levels in periodontium tissue during orthodontic tooth movement in rats.

Materials and methods

Thirty-six ten-week-old male SD rats were used in this study. A total of 20 cN of orthodontic force was exerted by coil springs onto the upper right first molars in order for mesialization purposes. All rat members of their corresponding groups were euthanized based on the following time intervals: 0 day for the control group, 1 day (group two), 3 days (group three), 5 days (group four), 7 days (group five), and lastly 14 days for group six. The effects of DR3/TL1A/PGRN were observed through the use of immunohistochemical staining techniques. One-way analysis of variance followed by a LSD t-test was performed by SPSS 20 to compare the differences of the level of DR3/TL1A/PGRN amongst each specified time interval.

Results

The expression levels of DR3/PGRN increased significantly on day 14 compared to that of the control group, thus indicating a wide range of statistical differences. The expression levels of TL1A soared upwards on day 1, then plunged to an all-time low on day 7 before finally bouncing back to its initial value on day14.

Conclusion

DR3 and its two ligands—PGRN and TL1A play indispensable roles in regulating periodontal ligament remodeling during orthodontic tooth movement.

Effect of orthodontic forces on levels of enzymes in gingival crevicular fluid (GCF): A systematic review

Objective:

Orthodontic force application releases multiple enzymes in gingival crevicular fluid (GCF) for activation, resorption, reversal, deposition of osseous elements and extracellular matrix degradation. The current systematic review critically evaluated all existing evidence on enzymes in orthodontic tooth movement.

Methods:

Literature was searched with predetermined search strategy on electronic databases (PubMed, Scopus, Embase), along with hand search.

Results:

Initial search identified 652 studies, shortlisted to 52 studies based on PRISMA. Quality assessment further led to final inclusion of 48 studies (13 moderately and 35 highly sensitive studies). Primary outcomes are significant upregulation in GCF levels of enzymes-aspartate aminotransferase (AST), alkaline phosphatase (ALP), matrix metalloproteinases (MMPs), lactate dehydrogenase (LDH), β-glucuronidase (βG), tartrate resistant acid phosphatase (TRAP), acid phosphatase (ACP) and down regulation in cathepsin B (Cb). Site specificity is shown by ALP, TRAP, AST, LDH, MMP9 with levels at compression site increasing earlier and in higher quantities compared with tension site. ALP levels are higher at tension site only in retention. A positive correlation of LDH, ALP and AST is also observed with increasing orthodontic force magnitude.

Conclusions:

A strong evidence of variation in enzymes (ALP, AST, ACP TRAP, LDH, MMPs, Cb) in GCF is found in association with different magnitude, stages and sites of orthodontic force application.

Variation of the Cytokine Profiles in Gingival Crevicular Fluid Between Different Groups of Periodontally Healthy Teeth

Profiling of biomarkers of physiological process represents an integrative part in optimisation of diagnostic markers in order to adjust the diagnostic ranges to the potential effects of the local factors such occlusal forces in case of periodontal tissues. The objective of this study was estimation of IL-1β, IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-12, IL-13, IL-17, IL-22, TNFα and IFNγ concentrations in gingival crevicular fluid samples (GCF) between different groups of teeth. Two hundred fifty-nine systemically healthy non-smokers having at least one vital tooth without restorations, with healthy periodontal tissues, were clinically examined and the GCF sample was retrieved. The cytokine levels were estimated using flow cytometry and compared between central incisors (CI), lateral incisors, canines, first premolars, second premolars, first molars and second molars. Cytokine profiles varied between different groups of teeth with tendency of increase in proinflammatory cytokines from anterior teeth toward molars. Molars might be considered teeth with natural predisposition for faster bone resorption while the adjustment of diagnostic range of periodontal biomarkers for anterior or posterior teeth should be considered within diagnostic context. Cytokine profiles varied between different groups of teeth with tendency of increase in proinflammatory cytokines from anterior teeth toward molars. Molars might be considered teeth with natural predisposition for faster bone resorption while the adjustment of diagnostic range of periodontal biomarkers for anterior or posterior teeth should be considered within diagnostic context.

Salivary protein biomarkers associated with orthodontic tooth movement: A systematic review

OBJECTIVE

Saliva can provide a non-invasive approach to indicate changes in the oral and systemic conditions. Salivary proteomics allows the discovery of new protein biomarkers associated with certain conditions. The effectiveness and physiological effects of orthodontic tooth movement in theory can be measured using salivary protein biomarkers.

SETTING AND SAMPLE POPULATION

This study applied a systematic review to analyse current literature to define and summarize salivary biomarkers associated with orthodontic tooth movement identified by mass spectrometry proteomics and other protein detection techniques.

MATERIALS AND METHODS

Peer-reviewed articles published through the 15th of November 2018 via the PubMed, EMBASE, Web of Science and Dentistry & Oral Sciences databases were reviewed. Only studies analysing protein biomarkers in saliva samples collected from human subjects associated with orthodontic treatments were included.

RESULTS

Out of 482 articles, 7 studies were selected. Sample size ranged from 3 to 72 subjects. Minor variations of unstimulated whole saliva sample collection protocol were noted. Mass spectrometry proteomics and ELISA represented the majority of biomarker discovery and targeting, respectively. Twenty biomarkers were identified or chosen as target biomarkers.

CONCLUSION

Salivary proteins may be used to indicate effectiveness of orthodontic treatment and orthognathic treatment as well as adverse treatment consequence, such as root resorption.

Effect of static compressive force on in vitro cultured PDL fibroblasts: monitoring of viability and gene expression over 6 days

OBJECTIVES

The aim was to investigate the impact of static compressive force (CF) application on human PDL-derived fibroblasts (HPDF) in vitro for up to 6 days on the expression of specific genes and to monitor cell growth and cell viability.

MATERIALS AND METHODS

CF of 2 g/cm² was applied on HPDFs for 1-6 days. On each day, gene expression (cFOS, HB-GAM, COX2, IL6, TNFα, RUNX2, and P2RX2) and secretion (TNFα, PGE₂) were determined by RT-qPCR and ELISA, respectively. Cell growth and cell viability were monitored daily.

RESULTS

In comparison with controls, significant upregulation of cFOS in compressed HPDFs was observed. HB-GAM showed no changes in expression, except on day 5 (P < 0.001). IL6 expression was significantly upregulated from day 2-5, reaching the maximum on day 3 (P < 0.001). TNFα expression was upregulated on all but day 2. COX2 showed upregulation, reaching the plateau from day 3 (P < 0.001) until day 4 (P < 0.001), and returning to the initial state till day 6. P2RX7 was downregulated on days 2 and 4 to 6 (P < 0.001). RUNX2 was downregulated on days 2 and 5 (both P < 0.001). Cells in both groups were proliferating, and no negative effect on cell viability was observed.

CONCLUSION

Results suggest high molecular activity up to 6 days, therefore introducing further need for in vitro studies with a longer duration that would explain other genes and metabolites involved in orthodontic tooth movement (OTM).

CLINICAL RELEVANCE

Extension of an established in vitro force application system for prolonged force application (6 days) simulating the initial phase of OTM.

Gelatinolytic activity in gingival crevicular fluid and saliva of growing patients with Marfan syndrome: a case-control study

Background

Aim of the study was to evaluate the gelatinolytic activity in the saliva and gingival crevicular fluid from a sample group of subjects with Marfan syndrome.

Methods

Two groups were analyzed in this case-control study. A group of 28 subjects with Marfan syndrome (MG) was recruited from the Centre for Rare Disease, Marfan Clinic of Tor Vergata University Hospital. The second sample, 23 subjects, with the same characteristics and without any syndrome, was the control group (CG). Saliva and gingival crevicular fluid were collected and transferred to a sterile test tube and stored frozen at − 20 °C until analysis at the Medical Chemistry Laboratory. Gelatin substrate zymography was used for the evaluation and characterization of saliva and crevicular fluid proteinases. Correlation test and Student’s t-test have been used to analyze data.

Results

In all samples different gelatin-degrading activities were observed. Two bands, which are related to the molecular weights of pro-MMP-9 and active MMP-9, respectively, were detectable in 100% of Marfan and control samples. MMP-2 activity was higher in Marfan group. Additional bands (55/48 kDa), corresponding to the activated forms of collagenase (MMP-13), were observed in saliva samples of both groups.

Conclusions

The association of an enhanced activity by MMP-13 with an increased amount of active MMP-9 might be an important biomarker for the diagnosis of Marfan syndrome.

Evaluation of leptin concentration in Gingival Crevicular Fluid (GCF) during orthodontic tooth movement and its correlation to the rate of tooth movement

OBJECTIVES:

Leptin, a polypeptide which is related to body fat regulation, is also found to have a role in the inflammatory reaction. The aim of this study is to assess the concentration of leptin in Gingival Crevicular Fluid (GCF) during orthodontic force application and to correlate its concentration to rate of tooth movement.

METHODS:

Twenty orthodontic patients (10 males and 10 females) were selected for the study. Leptin concentration was measured at T0, before force application; T1, one hour after force application; T2, one day after force application; T3, one week after force application; T4, one month after force application. GCF was collected using filter paper strips from the distal aspect of gingival sulcus of the right maxillary canine distalized by an active lace-backs of tooth movement was measured on dental casts, before and one month after force application. One-way ANOVA with Bonferroni correction and Pearson's correlation test were used to analyze the data.

RESULTS:

The mean GCF leptin concentration increased from T0 to T1, rose to a peak at T2, then declined to a minimum value at T3 and then increased to a value at T4, closer to the base line value (T0), and it was statistically significant (P < 0.05). There was positive correlation of the overall mean leptin concentration to rate of tooth movement (correlation coefficient = 0.634).

CONCLUSION:

There was a biphasic change in GCF leptin concentration during one cycle of orthodontic force application. There was a positive correlation between the GCF leptin concentration and rate of tooth movement.

Effectiveness of electric toothbrush as vibration method on orthodontic tooth movement: a split-mouth study

Objective:

To investigate the effects of application of vibratory stimuli, using an electric toothbrush, on the rate of orthodontic tooth movement during maxillary canine retraction.

Methods:

A split-mouth study was conducted in 28 subjects (mean age = 20.8 years; ranging from 18 to 24 years) whose bilateral maxillary first premolars were extracted with subsequent canine retraction. On the Vibration side, light force (100 g) was applied to the canine for 90 days, in combination with vibratory stimuli provided by an electric toothbrush; only orthodontic force was applied to the canine on the non-vibration side. Amount of canine movement was measured monthly. Related to electronic toothbrush usage, a diary was provided to each patient for recording discomfort during experimental period, having 100-mm visual analogue scale (VAS). The paired t-test was used to assess the differences in amount of tooth movement between canines of the vibration and non-vibration sides.

Results:

The amount of tooth movement was similar for canines on the vibration side and on the non-vibration side (mean 0.81 ± 0.10 mm and 0.82 ± 0.11 mm, respectively, p> 0.05). Plaque accumulation was minimal in any subject throughout the study. No subject reported discomfort as a result of using the electric toothbrush.

Conclusions:

This study demonstrates that application of vibratory stimuli using an electric toothbrush, in combination with light orthodontic force, do not accelerate orthodontic tooth movement.

A cross-sectional cohort study of gingival crevicular fluid biomarkers in normal-weight and obese subjects during orthodontic treatment with fixed appliances

OBJECTIVES

To investigate the effects of obesity on biomarker levels within lower incisor gingival crevicular fluid (GCF) in subjects undergoing routine fixed appliance orthodontic treatment.

MATERIALS AND METHODS

This was a cross-sectional clinical cohort study. GCF was collected from normal-weight and obese subjects at completion of alignment at least 1 month after placement of 0.019 × 0.025-inch stainless-steel archwires. The primary outcome was the difference in GCF biomarker levels between groups. Secondary outcomes included differences in clinical parameters of plaque and gingival indices, unstimulated whole-mouth saliva, and GCF flow rates.

RESULTS

Thirty-eight subjects (18 male, 20 female) with a mean age of 25.6 (SD, 6.3) years and mean body mass index (BMI) of 22.6 (1.6) in normal-weight and 32.4 (2.2) kg/m² in obese groups were investigated. Apart from BMI (P < .0001), there were no statistically significant differences in essential demographics between groups. Significantly increased levels of the adipokine leptin (P < .009) and the tissue-remodeling biomarker matrix metalloproteinase-9 (MMP9; P < .020) were identified in the obese cohort. For the remainder of the biomarkers, including the RANKL bone-remodeling marker and several inflammatory markers, there were no significant differences between groups. No correlation was observed between plaque index or gingival index for any GCF biomarker for either group (P = .07-1.00).

CONCLUSIONS

This study investigated the GCF biochemical profile of obese and normal-weight subjects undergoing fixed-appliance orthodontic treatment. Significantly increased levels of the adipokine leptin and the tissue-remodeling biomarker MMP9 were identified in the obese group. These data provide evidence of differences in GCF biochemistry between obese and normal-weight subjects undergoing fixed appliance orthodontic treatment.

Expression of cytokines in gingival crevicular fluid associated with tooth movement induced by aligners: a pilot study

Introduction:

The search for more aesthetic and comfortable orthodontic devices has led to an increase in the use of clear aligners.

Objective:

To increase knowledge on biological mechanisms of orthodontic tooth movement using Invisalign aligners.

Methods:

This study included 11 patients with a mean age of 23.6 ± 4.8 years. Cases planning included alignment and leveling of lower incisors using Invisalign aligners. Gingival crevicular fluid samples were collected from the lower incisors on the day of delivery of aligner number 1 (T0) and after 1 (T24h), 7 (T7d), and 21 (T21d) days. During the observation period of the study, the patients used only the aligner number 1. Levels of nine cytokines were quantified using Luminex’s multi-analysis technology. Non-parametric tests were used for comparisons between cytokine expression levels over time.

Results:

Cytokine expression levels remained constant after 21 days of orthodontic activation, except those of MIP-1β, which presented a statistical difference between T24h and T21d with a decrease in the concentration levels. IL-8, GM-CSF, IL-1β, MIP-1β, and TNF-α showed the highest concentrations over time.

Conclusions:

The different behavior in the levels of the investigated cytokines indicates a role of these biomarkers in the tissue remodeling induced by Invisalign.

The effect of orthodontic separator and short-term fixed orthodontic appliance on inflammatory mediators and somatosensory function

BACKGROUND

Although inflammation can alter cytokines release and nerve function, it is not yet fully established if orthodontic-induced inflammation can cause significant extraoral trigeminal somatosensory alterations and release of inflammatory chemical mediators.

OBJECTIVE

The primary aim of this study was to investigate the impact of orthodontic separator and short-term fixed orthodontic appliance on the extraoral trigeminal somatosensory function and concentrations of cytokines in the gingival crevicular fluid (GCF).

METHODS

Twenty-two female patients were evaluated as follow: baseline, 24 hour-after elastomeric separator (-aES), 24 hour- and 1 month-after bonding brackets (-aBB) at both arches. The outcome variables were as follows: self-reported pain (Visual Analog Scale), QSTs (current perception threshold-CPT, cold detection threshold-CDT, warm detection threshold-WDT, mechanical detection threshold-MDT, mechanical suprathreshold-MST and wind-up ratio-WUR. All QSTs were performed at infra-orbital and mental nerve entry zone at patient`s dominant side. In addition, GCF samples in order to assess cytokines profile (IL-1β,IL-8,IL-6 and TNF-α) were collected. ANOVA and Tukey's post hoc analyses were performed (a = 5%).

RESULTS

Patients reported higher pain intensity 24 hour-aBB compared to baseline and 24 hour-aES (P < 0.050). Patients were less sensitive to pin-prick pain (MST) at 24 hour-aBB and 1 month-aBB compared to baseline (P < 0.006). Significant increases in IL-6 levels were observed 24 hour-aBB (P < 0.001). Multiple comparison analysis showed significant increase in IL-1β levels (P < 0.001) and TNF-α (P < 0.001) 1 month-aBB compared to baseline.

CONCLUSION

Elastomeric separators only induced mild pain and were not able to significantly increase proinflammatory cytokines level in the GCF. In addition, orthodontic fixed appliance may induce only minor somatosensory changes at extraoral trigeminal locations.

Sclerostin Modulation Holds Promise for Dental Indications

Sclerostin modulation is a novel therapeutic bone regulation strategy. The anti-sclerostin drugs, proposed in medicine for skeletal bone loss may be developed for jaw bone indications in dentistry. Alveolar bone responsible for housing dentition share common bone remodeling mechanisms with skeletal bone. Manipulating alveolar bone turnover can be used as a strategy to treat diseases such as periodontitis, where large bone defects from disease are a surgical treatment challenge and to control tooth position in orthodontic treatment, where moving teeth through bone in the treatment goal. Developing such therapeutics for dentistry is a future line for research and therapy. Furthermore, it underscores the interprofessional relationship that is the future of healthcare.

Assessment of tumor necrosis factor alpha (TNFα) and interleukin 6 level in gingival crevicular fluid during orthodontic tooth movement: a randomized split-mouth clinical trial

Background

Orthodontic tooth movement (OTM) is based on induction of periodontal tissue remodeling. Mechanical tooth stimulation results in the release of pro-inflammatory mediators. These mediators cause bone resorption and deposition at the pressure and tension sites and play a role in OTM. Thus, assessment of chemical biomarkers can help determine the exact amount of load and its duration of application required for each tooth and select the most efficient treatment plan with minimal complications.

Objective

This study aimed to determine the level of tumor necrosis factor alpha (TNFα) and interleukin 6 (IL-6) in gingival crevicular fluid (GCF) during OTM.

Methods

This randomized split-mouth clinical trial (parallel) was performed on 10 patients who were presenting to the Orthodontic Department of Qazvin University of Medical Sciences from November 2015 to June 2016. A canine tooth was randomly selected as the study group and subjected to distalization force while the contralateral canine tooth served as control. Using paper strip, GCF was collected from the study and control teeth prior to orthodontic force application (T0), one hour after (T1) and 28 days after force application (T2), then the level of TNFα and IL-6 was measured using ELISA. Data were analyzed using SPSS version 20 via Friedman and Wilcoxon test, and considering the significance level at p<0.05.

Results

The level of TNFα (p=0.0799) and IL-6 (p=0.678) at both sides of study teeth was higher than both side of control teeth at T1. Also, the level of IL-6 (p=0.515) and TNFα (p=0.508) were higher at the tension side compared to the pressure side; but the difference was not statistically significant.

Conclusion

Due to the free circulation of GCF in gingival sulcus, the level of mediators in the GCF collected from the mesial and distal areas alone cannot serve as a suitable index for assessment of activity at the tension and pressure sites.

Trial registration

The trial was registered at the Iranian Registry of Clinical Trials with the IRCT ID: IRCT2017030632903N2.

Funding

The present study was supported by a grant from the Research Council, Qazvin University of Medical Sciences, Qazvin, Iran (thesis no.: 40).

Secretory microRNA-29 expression in gingival crevicular fluid during orthodontic tooth movement

Secretory microRNAs (miRNAs) have been used increasingly as biomarkers for cancers, autoimmune diseases and inflammatory diseases. They are reported as being freely circulated or encapsulated in microvesicles such as exosomes. This study was performed to elucidate the presence of miRNAs with exosomes in human gingival crevicular fluid (GCF), and the expression profile of miRNA-29 during orthodontic tooth movement. Four healthy volunteer and fifteen orthodontic patients were enrolled in the study. Secretory miRNA in GCF was collected and analyzed using a bioanalyzer, realtime PCR and Western blot analysis. The expression profile of secretory miR-29 family in GCF was analyzed during the course of canine retraction for 6 weeks. The results demonstrated the presence of miRNAs in the GCF. After series of ultracentrifugation and RT-PCR array, exosome-depleted fractions and pellets were isolated and we found that secretory miRNAs were detected in both the exosome-associated fraction and the exosome-depleted supernatant fraction; however, the concentration of miRNAs was higher in the exosome-associated fraction than in the exosome-depleted fraction suggesting a close association between the secretory miRNAs and exosomes in GCF. We also demonstrated the increased expression profiles of miR-29 family during six weeks of orthodontic tooth movement in humans. Secretory miRNAs are present in GCF and secretory miRNA-29 family expression profiles increase during the tooth movement in humans. Secretory miRNA-29 in GCF could serve as potential biomarkers for periodontal remodeling.