Longitudinal monitoring of subgingival colonization by Actinobacillus actinomycetemcomitans, and crevicular alkaline phosphatase and aspartate aminotransferase activities around orthodontically treated teeth

Adverse effects of orthodontic forces on dental pulp. Appearance and character. A systematic review

OBJECTIVE

To comprehensively assess recent data on the effects of orthodontic forces on the dental pulp and to critically evaluate, whether any of the changes are permanent.

MATERIALS AND METHODS

Articles published between 2/2009 and 2/2022 were searched electronically on the PubMed, EMBASE and SCOPUS databases. The initial search retrieved 780 publications and, applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 33 relevant articles were identified. Twenty articles fulfilled the requirements for high (n = 1) or moderate (n = 19) methodological quality and were included. All assessments were made independently by three researchers.

RESULTS

Orthodontic forces appeared to cause a reduction in pulpal blood flow and a reduction in tooth sensibility, as indicated by increased response thresholds and increased amounts of negative responses to tooth sensibility tests. In addition, there were increases in the expression or activity levels of enzymes and neuropeptides associated with hypoxia and inflammation. Fibrotic tissue formation in the pulp was also reported.

CONCLUSIONS

Except for some histological and morphological alterations, the observed pulpal changes were in most cases only temporary, appearing within days of initiating the treatment and usually lasting for weeks. There were no clear signs of permanent damage.

Patient-Reported Outcome Measures on Oral Hygiene, Periodontal Health, and Treatment Satisfaction of Orthodontic Retention Patients up to Ten Years after Treatment-A Cross-Sectional Study

Background: This cross-sectional study evaluated patient-reported outcome measures (PROMs) on (1) oral hygiene, (2) periodontal health, (3) retainer failure, (4) orthodontic treatment satisfaction, and (5) outcome satisfaction in orthodontic retention patients. The purpose of the study was to evaluate whether orthodontic retention treatment is associated with patient-reported outcome measures on oral hygiene, periodontal health, and treatment satisfaction. Methods: A ten-item questionnaire on the five PROMs was conducted among 211 consecutive retention patients up to ten years following orthodontic treatment. Linear regression models were computed to detect possible associations between the PROMs and retention treatment or patient characteristics. Results: The presence of a fixed lingual retainer was not associated with the reduced ability to perform oral hygiene, self-perceived periodontal health, or orthodontic outcome satisfaction. Older patients were more content with the orthodontic treatment result (p < 0.05). Patients with fixed lingual retainers in the mandible were less satisfied with the course of orthodontic treatment (p < 0.05). Smokers more often reported gingival bleeding (p < 0.05). Females reported increased gingival recessions (p < 0.05) and perceived their teeth as longer than before treatment (p < 0.05). Longer orthodontic treatment duration corresponded to retainer failure (p < 0.05). Conclusions: In general, long-term orthodontic retention patients were satisfied with orthodontic treatment. These patients reported the satisfactory ability to perform adequate oral hygiene and periodontal health, and they communicated a high degree of treatment and outcome contentment. However, patients with a retainer in the mandible were less satisfied with orthodontic treatment.

THE EFFECT OF BISPHOSPHONATE RISEDRONATE HYDROGEL ON ALKALINE PHOSPHATASE AND OSTEOCLASTS DURING RELAPSE MOVEMENT

Objectives: To analyze the effect of risedronate hydrogel on enzyme alkaline phosphatase (ALP) and osteoclast/osteoblast ratio during tooth relapse movement Materials and methods: The research design is experimental with time series. The lower incisors of 75 guinea pigs are distally moved using open coil spring. The guinea pigs were divided into three groups: without risedronate (group A; n = 25); given 250 µmol/L of risedronate hydrogel (group B; n = 25), and given 500 µmol/L of risedronate hydrogel (group C; n = 25). Risedronate were applied intrasulcularly in the mesial part of the gingival sulcus every 3 days. After 14 days of stabilization, the open coil spring was removed (bisphosphonate administration was continued). The relapsed teeth and ALP levels on days 0, 3, 7, 14, and 21 were measured. The osteoclast/osteoblast ratio was measured by hematoxylin and eosin staining. ANOVA test was used to determine the difference in the three groups and their interactions with concentration and time. Results: There was a significant difference in osteoclast/osteoblast ratio on day 3 (p = 0.019, p

Fluctuation of bone turnover markers' levels in samples of gingival crevicular fluid after orthodontic stimulus: a systematic review

BACKGROUND

The aim of the present study was to provide an overview of gingival crevicular fluid (GCF) bone turnover markers (BTMs) concerning the physiology of orthodontic tooth movement (OTM) and assess their potential contributions to regulating bone remodeling, that could prove useful in designing future approaches to modulating orthodontic tooth movement.

METHODS

Multiple electronic databases (MEDLINE/PubMed, Ovid MEDLINE, Ovid Embase, LILACS, and Cochrane Library) were searched up to October 1st, 2020. Randomized controlled trials (RCTs), controlled clinical trials, observational studies of prospective and retrospective designs, and cross-sectional studies reporting on levels of BTMs in GCF were eligible for inclusion. The quality of the included RCTs was assessed per the revised Cochrane risk of bias tool for randomized trials (RoB 2.0), whereas the risk of bias of the included cohort studies was assessed using the Risk Of Bias In Non-randomized Studies of Interventions tool.

RESULTS

Five RCTs, 9 prospective cohort studies, and 1 cross-sectional study fulfilled the inclusion criteria. The risk of bias was deemed as high for the RCTs and 4 of the prospective studies and moderate for the rest of the studies. The following biomarkers for bone formation were assessed: bone alcaline phosphatase (BALP), alcaline phosphatase (ALP), and osteocalcin (OC). For bone resorption, the following BTMs were assessed: deoxypyridinoline (DPD) and pyridinoline (PYD), N-terminal telopeptide (NTX), osteopontin (OPN), and tartrate-resistant acid phosphatase (TRAP). The follow-up period ranged mainly from baseline to 45 days, although one study had an expanded follow-up period of up to 16 months. The results of the included studies comparing different BTMs were heterogeneous and qualitatively reported.

CONCLUSIONS

Current evidence continues to support the potential for BTMs to provide clinically useful information particularly for adjusting or standardizing the orthodontic stimulus. The present systematic review has retrieved studies of high, overall, risk of bias, and has unveiled a substantial clinical and methodological heterogeneity among included studies. Further data of the relationships between the clinical assays and the physiological or pre-analytical factors contributing to variability in BTMs' concentrations are required.

SYSTEMATIC REVIEW REGISTRATION

CRD42020212056 .

A randomized, 3-month, parallel-group clinical trial to compare the efficacy of electric 3-dimensional toothbrushes vs manual toothbrushes in maintaining oral health in patients with fixed orthodontic appliances

INTRODUCTION

The aim of this single-blinded, parallel-group, randomized clinical trial was to compare the efficacy of electric 3-dimensional (3D) toothbrushes and manual toothbrushes in removing plaque and reducing gingival inflammation in orthodontic patients.

METHODS

Eighty adolescents with fixed orthodontic appliances in both arches were randomized at a 1:1 ratio, with an equal number of both sexes, in this examiner blinded, parallel clinical trial. Eligibility criteria included subjects aged between 12 and 16 years, good general health, nonextraction orthodontic treatment, and plaque-induced gingivitis, excluding patients with active caries or periodontitis, tooth agenesis, syndromes, disabilities, and craniofacial deformities, ≥2 cervical and/or proximal fillings, dental prostheses or dental implants, and subjects smoking or using antibiotics or medication predisposing to gingival enlargement. Patients were assigned to use either an electric 3D orthodontic toothbrush (Oral-B Pro-1000 with Oral-B Ortho head; Procter & Gamble, Cincinnati, Ohio) or a manual toothbrush (Oral-B Orthodontic brush; Procter & Gamble) and instructed to brush twice daily for 2 minutes. The main outcomes were: (1) plaque removal, assessed with the Modified Silness and Löe plaque index and the Modified Full Mouth Plaque Score, and (2) gingival inflammation reduction, assessed with the Modified Silness and Löe Gingival Index and the Modified Simplified Gingival Index. Measurements were taken at baseline, 1, 2, and 3 months. Randomization was achieved with 2 random sequences, one for each brush, written and sealed in opaque numbered envelopes. Blinding was possible for outcome assessment only.

RESULTS

Considerable variability was observed among patients in the values of all dependent variables. There was no difference between interventions over time for any of the outcomes, and the main effects for treatment and time were also not statistically significant. For Modified Silness and Löe plaque index, the interaction was 0.001 (95% confidence interval, -0.011 to 0.013; P = 0.89).

CONCLUSIONS

No difference in plaque removal efficacy and gingival inflammation reduction was found between the electric 3D and manual toothbrushes in adolescents with fixed orthodontic appliances. Therefore, orthodontists should focus on enhancing their patients' dental awareness and oral hygiene, along with professional prophylaxis and other oral hygiene aids, independently of the brush used.

REGISTRATION

This trial was registered at ClinicalTrials.gov (Identifier: NCT02699931).

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

Electric and manual toothbrushes and toothpastes for all participants were provided by Procter & Gamble (Oral-B). Miscellaneous costs were covered by the participating departments.

An Evaluation of Microbial Flora, Alkaline Phosphatase and IL-8 Levels in GCF of Orthodontic Patients with Self-Ligating and Conventional Brackets

PURPOSE

To compare the microbial flora, alkaline phosphatase (ALP) and interleukin-8 (IL-8) levels during orthodontic treatment with self-ligating brackets versus conventional brackets.

PATIENTS AND METHODS

Forty patients were included in this study and distributed equally between two groups. One group received conventional edgewise brackets while the other group received DAMON self-ligating brackets. Periodontal parameters were recorded and biochemical and microbial analyses were conducted before bonding (baseline), and 14, 30, and 45 days after bonding. Paired t-test was performed to estimate the intergroup differences from the baseline at the various time points; unpaired t-test was used for intragroup comparisons.

RESULTS

A significantly higher prevalence of gram-negative as well as gram-positive microorganisms was found in the group with conventional brackets than that with self-ligating brackets. Alkaline phosphatase (ALP) activity and interleukin-8 (IL-8) levels were significantly higher in the gingival crevicular fluid of the group with conventional brackets than that with self-ligating brackets.

CONCLUSION

The conventional bracket-ligature technique exhibited an increase in IL-8 levels, ALP activity, and microbial colonization compared with that of the self-ligature technique. Accordingly, self-ligating brackets are recommended in orthodontic patients to improve periodontal health and minimize damage outcomes of periodontal tissue interventions.

Salivary Metalloproteinase-8 and Metalloproteinase-9 Evaluation in Patients Undergoing Fixed Orthodontic Treatment before and after Periodontal Therapy

(1) Background: Metalloproteinase-8 (MMP-8) and metalloproteinase-9 (MMP-9) are members of a family of proteases of major importance during orthodontic tooth movement. Their levels increase during orthodontic therapy and in periodontally affected tissues. Orthodontic fixed appliances retain dental plaque and can cause gingival inflammation. When gingival inflammation is present, the forces produced during orthodontic tooth movement can aggravate tissue reaction and cause the destruction of supportive periodontal tissue. This study aimed to identify biomarkers that facilitate the assessment of periodontal status during orthodontic treatment. (2) Methods: Our study was conducted on 111 patients who were about to receive fixed orthodontic treatment. We determined the salivary levels of MMP-8 and MMP-9 and bleeding on probing (BOP) before applying the orthodontic fixed appliance (T1), one week after appliance placement (T2), and during orthodontic treatment, one month after non-surgical periodontal treatment (T3). (3) Results: Patients undergoing orthodontic treatment show a significant increase in BOP, MMP-8, and MMP-9 levels one week after orthodontic appliance placement (T2) and a decrease in these parameters one month after periodontal treatment (T3). Statistically significant correlations were found between MMP-8 levels and BOP values at T1, T2, and T3. (4) Conclusion: In our study patients undergoing orthodontic treatment show a significant increase in BOP, MMP-8, and MMP-9 levels one week after orthodontic appliance placement and a decrease in these parameters one month after periodontal treatment. Strong positive statistically significant correlations were found between MMP-8 levels and BOP and medium positive statistically significant correlations between MMP-9 and BOP values before and after orthodontic treatment and periodontal treatment. MMP-8, MMP-9, and BOP could be used to assess the periodontal status of orthodontic patients.

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.

Evaluation of enzyme activity and rate of tooth movement in corticotomy-accelerated tooth movement - A randomized clinical trial

BACKGROUND:

This study was undertaken to evaluate the enzyme activity profiles in human saliva and gingival crevicular fluid (GCF) in accelerated tooth movement when compared with normal orthodontic tooth movement (OTM) in extraction cases.

MATERIALS AND METHODS:

Twenty patients who required premolar extractions were treated with MBT mechanotherapy. They were divided into two equal groups: conventional (Group I) and corticotomy (Group II) which was performed on both the jaw sides before initiating retraction. GCF was collected from mesial and distal aspects of canine before initiation of retraction and at 7^th, 14^th, 21^st, and 28^th days, and then at fifth and sixth weeks and third and sixth months after retraction. A total of 5 mL of unstimulated saliva was collected from the subjects after 90 min of nonoral activity (subjects were refrained from eating and drinking).

RESULTS:

The results showed that in Group I, the peak of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) enzyme activity occurred on the 14^th day of force application. In Group II, the enzyme activity progressively increased from day 0 to 6 weeks, peaking at the sixth week, and then a decline in enzyme activity was observed on third and sixth months. When ALP and AST activities in GCF and saliva were compared between Groups I and II, no statistically significant difference was observed on days 0, 7, and 14.

CONCLUSION:

Corticotomy-accelerated tooth movement is a promising technique that has many applications in orthodontic treatment of adults as it helps overcome many of the current limitations of this treatment. The enzymatic activity signifies osteoclastic and osteoblastic activities, so ALP and AST from the saliva and GCF may potentially be used as biomarkers for monitoring corticotomy-assisted OTM.

Orthodontic Treatment of a Periodontally - Affected Adult Patient (Case Report)

BACKGROUND:

The advanced periodontal disease is characterised by a strongly pronounced loss of attachment and reduction of the alveolar bone support, which leads to luxation, migration of the teeth, functional discomfort and poor facial aesthetics.

CASE PRESENTATION:

The aim of this paper is to present the case of a 26-year-old female patient, registered at the Clinic of Periodontology with highly expressed gingivitis, unsatisfactory periodontal status, presence of diastemas between the frontal teeth and attachment loss of 5-6 millimetres in different areas. We conducted a thorough classic periodontal treatment, as well as training for proper maintenance of oral hygiene, with frequent professional oral-prophylactic sessions, complemented with orthodontic treatment. Fixed orthodontic appliances were installed, and mild forces were applied for gradual levelling of the teeth, with constant control of the periodontal status. After 20 months of treatment, the patient was in retention.

CONCLUSION:

Orthodontic therapy of periodontally-affected teeth can begin only after exhaustive administration of a periodontal treatment. Orthodontic treatment as an addition to the periodontal restoration must be gradual with mild forces for an optimal dental response, thus helping to improve function, facial aesthetics and psychological confidence of adult patients.

Changes in oral microbiota due to orthodontic appliances: a systematic review

Background: Oral microbiota has been at the center of cultural attention in recent years. In daily clinical practice, orthodontic appliances may be associated with an increased cariogenic risk and a worsening of preexisting periodontal diseases. Objective: The purpose of this review is to investigate the available evidence regarding the association between orthodontic appliances and changes in the quality and quantity of the oral microbiota. Design: The research included every article published up to October 2017 featuring the keywords 'Orthodontic appliance* AND (microbiological colonization OR periodontal pathogen* OR Streptococcus mutans OR Lactobacillus spp. OR Candida OR Tannerella forsythia OR Treponema denticola OR Fusobacterium nucleatum OR Aggregatibacter actinomycetemcomitans OR Prevotella intermedia OR Prevotella nigrescens OR Porphyromonas gingivalis)' and was conducted in the major medical databases. The methodological quality of selected papers was scored using the 'Swedish Council on Technology Assessment in Health Care Criteria for Grading Assessed Studies' (SBU) method. Results: Orthodontic appliances influence the oral microbiota with an increase in the counts of S. mutans and Lactobacillus spp. and in the percentage of potentially pathogenic gram-negative bacteria. Conclusions: There is moderate/high evidence regarding the association between orthodontic appliances and changes in the oral microbiota. PROSPERO registration number CRD42018091589.

Enzymatic Analysis of the Gingival Crevicular Fluid in Hypoxia of High Altitude (Everest)

The aim of this study is to determine the qualitative and quantitative changes of alkaline phosphatase (ALP) that occur in the Gingival Crevicular Fluid (GCF) in hypobaric-hypoxic conditions (high altitude). Hypoxia affects systemic adaptation responses in different organs. We examined 17 Caucasians subjects, of whom 13 were mountain climbers (1 female and 12 males), and 4 Tibetans (2 females and 2 males) following exposure to the hypoxia environment of high altitude. The study was conducted at different altitudes (0 m control, 1000 m, 5200 m above sea level) on Mount Everest. The protocol consisted of withdrawing crevicular fluid through the use of cones made of endodontic paper size 30 sectioned to 15 mm from the apex, inserted for 30 seconds in the gingival sulcus (about 2 mm). The analyzed sites were the mesial and distal, buccal and palatal of tooth 1.1 and 2.1. Blood exams were performed on the subjects using I-Stat, furnishing analysis in real time (about 2 mins). In agreement with other results reported in literature, in all the subjects we found an increase in the hematocrit and hemoglobin with a large range of values between them, and with significant differences, as analysed with the Fisher, Scheffe and Bonferroni/Dunn statistical methods. The enzymatic analysis of the GFC showed an increase of the levels of ALP at each altitude studied. With this preliminary study we show that hypoxic environment determines not only the well known cardiovascular systemic responses, but also crevicular fluid adaptation.

Effect of scaling & root planing on the activity of ALP in GCF & serum of patients with gingivitis, chronic and aggressive periodontitis: A comparative study

INTRODUCTION

Host response and environmental factors are known to modify periodontal status adversely. Presently serum, saliva, and GCF are being investigated for its biochemical constituents. GCF contains array of biochemical factors, offering potential use as a diagnostic or prognostic biomarker of the biologic state of the periodontium in health and disease. Alkaline phosphatase is produced locally in the periodontium and shows positive correlation with disease activity and PD. Present study was designed to analyze the levels of ALP in GCF and serum of patients with gingivitis, chronic & aggressive periodontitis before and after SRP & to compare the difference within the study groups.

METHODS

OPD patients grouped into: Gingivitis, Aggressive periodontitis & chronic periodontitis patients. Clinical parameters recorded for each patient prior to therapy. Pooled GCF samples collected using micro capillary tubes from the deepest pocket sites for each patient and stored at -70° C. Serum samples also collected and stored at -20° C. Each patient was subjected to scaling and root planing with two weeks maintenance recall. After 6 to 8 weeks GCF and serum samples collected again and all clinical parameters rerecorded. GCF and serum samples analyzed for levels of ALP by using para nitro phenol assay for the three groups.

RESULTS

ALP levels in GCF increased significantly during active phase of disease followed by statistically significant reduction after phase I therapy. Baseline levels of ALP in GCF was CP > AP > G with maximum reduction in GCF ALP after SRP in G > CP > AP group.

The Gingival Crevicular Fluid as a Source of Biomarkers to Enhance Efficiency of Orthodontic and Functional Treatment of Growing Patients

Gingival crevicular fluid (GCF) is a biological exudate and quantification of its constituents is a current method to identify specific biomarkers with reasonable sensitivity for several biological events. Studies are being performed to evaluate whether the GCF biomarkers in growing subjects reflect both the stages of individual skeletal maturation and the local tissue remodeling triggered by orthodontic force. Present evidence is still little regarding whether and which GCF biomarkers are correlated with the growth phase (mainly pubertal growth spurt), while huge investigations have been reported on several GCF biomarkers (for inflammation, tissue damage, bone deposition and resorption, and other biological processes) in relation to the orthodontic tooth movement. In spite of these investigations, the clinical applicability of the method is still limited with further data needed to reach a full diagnostic utility of specific GCF biomarkers in orthodontics. Future studies are warranted to elucidate the role of main GCF biomarkers and how they can be used to enhance functional treatment, optimize orthodontic force intensity, or prevent major tissue damage consequent to orthodontic treatment.

Effect of orthodontic force on expression levels of ten cytokines in gingival crevicular fluid

Various types of inflammatory mediators are involved in the cascade of biological events behind tissue remodeling allowing orthodontic tooth movement. This split-mouth longitudinal study aimed to evaluate the gingival crevicular fluid (GCF) levels of ten cytokines, IL-6, IL-8, IL-10, IL-13, IL-17, IFN-γ, GM-CSF, MCP-1, MIP-1β and TNF-α, during initial orthodontic treatment. The sample comprised 15 healthy patients (9 males and 6 females, 13.9±2.5 years). The lower (test) incisors were moved using fixed appliance carrying a 0.014-inch nickel titanium wire, whereas the upper (control) incisors were bonded without any force. The GCF was collected from the test and control teeth before fixed appliance mounting (baseline) and after 1, 7 and 21days. In 6 sites per tooth, from canine to canine, periodontal conditions were defined as the percentage of sites with visible plaque and bleeding on probing. The total GCF cytokines levels were quantified using multianalysis Luminex technology. Throughout the experimental term, and for both test and control teeth, the mean percentage of sites with visible plaque and bleeding on probing were generally below 25% and 15%, respectively, although variability was also seen. In the test teeth, the GCF levels of all the cytokines remained constant throughout the experimental term. On the contrary, significant reductions were seen in the control teeth for each cytokine. Moreover, significantly greater levels of IL-6, GM-CSF, MCP-1 and TNFα were seen in the test teeth as compared to the control teeth at 7days. The reasons for the differential behavior in the levels of all the investigated cytokines between the test and control teeth may be related to the presence of orthodontic forces and/or subclinical tissue inflammation. Further investigation is needed to elucidate potential roles for these biomarkers in the tissue remodeling incident to orthodontic tooth movement.

Comparative metagenomics reveals taxonomically idiosyncratic yet functionally congruent communities in periodontitis

The phylogenetic characteristics of microbial communities associated with periodontitis have been well studied, however, little is known about the functional endowments of this ecosystem. The present study examined 73 microbial assemblages from 25 individuals with generalized chronic periodontitis and 25 periodontally healthy individuals using whole genome shotgun sequencing. Core metabolic networks were computed from taxa and genes identified in at least 80% of individuals in each group. 50% of genes and species identified in health formed part of the core microbiome, while the disease-associated core microbiome contained 33% of genes and only 1% of taxa. Clinically healthy sites in individuals with periodontitis were more aligned with sites with disease than with health. 68% of the health-associated metagenome was dedicated to energy utilization through oxidative pathways, while in disease; fermentation and methanogenesis were predominant energy transfer mechanisms. Expanded functionality was observed in periodontitis, with unique- or over-representation of genes encoding for fermentation, antibiotic resistance, detoxification stress, adhesion, invasion and intracellular resistance, proteolysis, quorum sensing, Type III/IV secretion systems, phages and toxins in the disease-associated core microbiome. However, different species or consortia contributed to these functions in each individual. Several genes, but not species, demonstrated robust discriminating power between health and disease.

Comparison of longitudinal changes in clinical periodontal parameters of canines and first molars treated with fixed orthodontic appliances

INTRODUCTION

Our objective was to learn the possible effects of fixed orthodontic therapy on the periodontium of the extraction sites adjacent to canines and first molars. This was a prospective cohort study.

METHODS

Sixty-two systemically healthy subjects were selected. The study was divided into the period of oral hygiene instructions and the period of active orthodontic treatment. Plaque index, gingival index, probing pocket depth, and clinical attachment loss were recorded for the canines and first molars at baseline, after 1 month of orthodontic therapy, and every 3 months until the completion of the orthodontic treatment.

RESULTS

There was a statistically significant increase in all clinical parameters (plaque index, gingival index, probing pocket depth, and attachment loss; P <0.05) on the first molars compared with the canines. Significant increases in attachment loss were noted in both the canines (baseline, 0.06 ± 0.01 mm; end of treatment, 0.17 ± 0.02 mm) and the molars (baseline, 0.07 ± 0.01 mm; end of treatment, 0.20 ± 0.02 mm).

CONCLUSIONS

Attachment loss cannot be explained solely by the effect of plaque or the banding of teeth. Other factors such as tooth extractions adjacent to the canines, tooth movement, and occlusal trauma may have contributing roles in the loss of periodontal support in adolescent patients.

Correlation of alkaline phosphatase activity to clinical parameters of inflammation in smokers suffering from chronic periodontitis

CONTEXT

Current clinical periodontal diagnostic techniques emphasize the assessment of clinical and radiographic signs of periodontal diseases which can provide a measure of history of disease. Hence, new methodologies for early identification and determination of periodontal disease activity need to be explored which will eventually result in expedited treatment.

AIM

To evaluate the correlation of alkaline phosphatase (ALP) activity in gingival crevicular fluid (GCF) to clinical parameters of periodontal inflammation in smokers with chronic periodontitis.

MATERIALS AND METHODS

Study population included 15 smoker male patients in the age group of 35-55 years suffering from moderate generalized chronic periodontitis with history of smoking present. Following parameters were evaluated at baseline, 1 month and 3 months after scaling and root planing: plaque index, bleeding index, probing pocket depth (PD), relative attachment level (RAL), and GCF ALP activity.

STATISTICAL ANALYSIS USED

Independent variables for measurements over time were analyzed by using Wilcoxon signed rank test.

RESULTS

A statistically significant reduction in all the clinical parameters and GCF ALP activity was observed from baseline to 1 month and 3 months. A correlation was observed between change in GCF ALP activity and PD reduction as well as gain in RAL at 3 months.

CONCLUSION

The present study emphasizes that total ALP activity could be used as a marker for periodontal disease activity in smokers. Estimation of changes in the levels of this enzyme has a potential to aid in the detection of progression of periodontal disease and monitoring the response to periodontal therapy.

Gingival crevicular fluid alkaline phosphate activity during the retention phase of maxillary expansion in prepubertal subjects: A split-mouth longitudinal study

INTRODUCTION

The aim of this study was to monitor the alveolar bone formation at the tension sites of teeth supporting the appliances for rapid maxillary expansion (RME) during the retention phase according to the local gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity.

METHODS

This split-mouth prospective study included 23 prepubertal subjects (15 girls, 8 boys; mean age, 9.0 ± 1.4 years) who had a constricted maxillary arch and were undergoing RME. Periodontal parameters, including probing depth, were recorded at 3 and 6 months after RME. Furthermore, the GCF ALP activity was measured at the tension sites of the supporting test teeth (TT) and at the antagonist control teeth (CT) sites.

RESULTS

Periodontal parameters were generally similar between the TT and CT sites during the study, with the exception that probing depth underwent a slight increase at the TT sites. At baseline, the GCF ALP activity was similar between the TT and CT sites; however, at both 3 and 6 months, significantly greater enzymatic activity was seen at the TT sites. The overall probing depth changes were not significantly correlated with the corresponding GCF ALP activity changes for either the TT or the CT sites.

CONCLUSIONS

Alveolar bone formation at the tension sites would last up to 6 months of retention after RME. These results warrant more comprehensive studies to assess whether the GCF ALP activity has potential as a diagnostic tool for bone formation during the retention phase of RME.

Biomarkers of Orthodontic Tooth Movement in Gingival Crevicular Fluid: A Systematic Review

BACKGROUND

The analysis of gingival crevicular fluid (GCF) may be an acceptable way to examine the ongoing biochemical processes associated with bone turnover during orthodontic tooth movement. If it is possible to biologically monitor and predict the outcome of orthodontic forces, then the management of appliances could be based on individual tissue responses, and the effectiveness of the treatment could be improved.

METHODOLOGY

A literature search was carried out in major databases, such as medline, EMBASE, cochrane library, web of science, google scholar and scopus for relevant studies. Publications in English between 2000 and 2014 which estimated GCF markers as indicators of orthodontic tooth movement were included.

RESULTS

The list of biomarkers available to date was compiled and presented in table format. Each biomarker is discussed separately based on the available evidence.

CONCLUSION

Several sensitive GCF markers are available to detect the biomechanical changes occurring during orthodontic tooth movement. Further focused research might help to analyze the sensitivity and reliability of these indicators, which in turn can lead to the development of chairside tests to assess the outcome of orthodontic therapy.

Comparison of the effects of ibuprofen and acetaminophen on PGE2 levels in the GCF during orthodontic tooth movement: a human study

Background

Pain is among the most cited negative effects of orthodontic treatment. Non-steroidal anti-inflammatory drugs seem to be an effective option for minimizing this but can have adverse effects on tooth movement owing to their ability to block prostaglandin synthesis. Acetaminophen has been suggested as the analgesic of choice during orthodontic treatment as it showed no effect on orthodontic tooth movement in previous animal studies. The purpose of this study was to compare the effects of ibuprofen and acetaminophen on the prostaglandin E₂ (PGE₂) levels of the gingival crevicular fluid (GCF) during orthodontic tooth movement in human subjects.

Methods

A total of 42 patients (mean age 18 ± 4.5 years) were randomly divided into three equal groups: ibuprofen, acetaminophen, and control groups. Maxillary canines were distalized with 150 g of force delivered by NiTi coil springs. GCF samples were obtained before (baseline) and after spring activation at 24, 48, and 168 h. The PGE₂ content of the GCF was determined using enzyme-linked immunosorbent assay.

Results

PGE₂ levels in all groups increased significantly by 24 and 48 h of force application and decreased to baseline levels by 168 h. No significant difference was found between the acetaminophen and control groups at any time point. There was a significant decrease in PGE₂ levels in the ibuprofen group at 24 and 48 h when compared to the other two groups.

Conclusions

Acetaminophen showed no significant effect on prostaglandin synthesis and may be the safe choice compared to ibuprofen for relieving pain associated with orthodontic tooth movement.

Crevicular Alkaline Phosphatase Activity and Rate of Tooth Movement of Female Orthodontic Subjects under Different Continuous Force Applications

Purpose. This study is aimed to compare the effects of two different orthodontic forces on crevicular alkaline phosphatase activity, rate of tooth movement, and root resorption. Materials and Methods. Twelve female subjects of class II division 1 malocclusion participated. Maxillary canines with bonded fixed appliances acted as the tested teeth, while their antagonists with no appliances acted as the controls. Canine retraction was performed using nickel titanium coil spring that delivered forces of 100 gm or 150 gm to either side. Crevicular fluid was analyzed for ALP activity, and study models were casted to measure tooth movements. Root resorption was assessed using periapical radiographs before and after the force application. Results. ALP activity at the mesial sites peaked at week 1 for 150 gm group with significant differences when compared with the 100 gm group. Cumulative canine movements were significantly greater in the 150 gm force (2.10 ± 0.50 mm) than in the 100 gm force (1.57 ± 0.44 mm). No root resorption was in the maxillary canines after retraction. Conclusions. A force of 150 gm produced faster tooth movements and higher ALP activity compared with the 100 gm group and had no detrimental effects such as root resorption.

Biomarkers of periodontal tissue remodeling during orthodontic tooth movement in mice and men: overview and clinical relevance

Biologically active substances are expressed by cells within the periodontium in response to mechanical stimuli from orthodontic appliances. Several possible biomarkers representing biological modifications during specific phenomena as simile-inflammatory process, bone resorption and formation, periodontal ligament changes, and vascular and neural responses are proposed. Citations to potentially published trials were conducted by searching PubMed, Cochrane databases, and scientific textbooks. Additionally, hand searching and contact with experts in the area were undertaken to identify potentially relevant published and unpublished studies. Selection criteria were as follows: animal models involving only mice and rats undergoing orthodontic treatment; collection of gingival crevicular fluid (GCF) as a noninvasively procedure for humans; no other simultaneous treatment that could affect experimental orthodontic movement. The data suggest that knowledge of the remodeling process occurring in periodontal tissues during orthodontic and orthopedic therapies may be a clinical usefulness procedure leading to proper choice of mechanical stress to improve and to shorten the period of treatment, avoiding adverse consequences. The relevance for clinicians of evaluating the rate of some substances as valid biomarkers of periodontal effects during orthodontic movement, by means of two models of study, mice and men, is underlined.

Biochemical markers of bone metabolism in gingival crevicular fluid during early orthodontic tooth movement

OBJECTIVE

To evaluate the expression of an activator of nuclear factor-kappa (RANK), osteoprotegerin (OPG), osteopontin (OPN), and transforming growth factor ß1 (TGF-ß1) in gingival crevicular fluid (GCF) of teeth subjected to orthodontic forces.

MATERIALS AND METHODS

A randomized, pilot clinical trial including 10 healthy volunteers was conducted using a split-mouth design. Orthodontic elastic separators were placed between the second premolar and first molar, with the contralateral quadrant serving as a control. The GCF samples were collected from the tension and compression sites at baseline, 24 hours, and 7 days after the placement of separators. The GCF sample volumes were measured using a Periotron 8000, and total protein concentrations were determined. Levels of RANK, OPG, OPN, and TGF-ß1 were also analyzed using a multiplex enzyme-linked immunosorbent assay.

RESULTS

The control sites remained unchanged throughout the study. In contrast, the concentration of OPG significantly decreased at the compression site by 24 hours, and the amount and concentration of RANK differed significantly between the control, compression, and tension sites after 7 days. A significant increase in absolute TGF-ß1 levels was also detected at the compression site versus the control and tension sites after 7 days.

CONCLUSION

Bone metabolism is affected by application of force to the teeth by elastic separators. Both increased expression of bone resorptive mediators (eg, RANK and TGF-ß1) and decreased expression of a bone-forming mediator (eg, OPG) on the compression side were detected.

Gingival crevicular fluid protein content and alkaline phosphatase activity in relation to pubertal growth phase

OBJECTIVE

To evaluate gingival crevicular fluid (GCF) protein content and alkaline phosphatase (ALP) activity in growing subjects in relation to stages of skeletal maturation, ie, the growth phase, as prepubertal, pubertal, and postpubertal.

SUBJECTS AND METHODS

Fifty healthy growing subjects (31 girls and 19 boys; age range, 7.8-17.7 years) were enrolled in this study that followed a double-blind, prospective, cross-sectional design. Collection of GCF was performed at the mesial and distal sites of both central incisors, for the maxilla and mandible. Growth phase was assessed through the cervical vertebral maturation method. GCF parameters were expressed as total protein content, total ALP activity, and normalized ALP activity.

RESULTS

The total GCF protein content was similar between the different growth phases. On the contrary, the total ALP activity showed a peak for the pubertal growth phase. The normalized GCF ALP activity was only poorly associated with growth phase. No differences were seen between the maxillary and mandibular sites, or between the sexes, for any GCF parameter.

CONCLUSIONS

The total GCF protein content is not sensitive to the growth phase. However, GCF ALP activity has potential as a diagnostic aid for identification of the pubertal growth phase in individual subjects when expressed as total, but not normalized, values.

Orthodontic-periodontics interdisciplinary approach

In this present era, when a significant number of patients seeking orthodontic treatment are adults, importance of multidisciplinary treatment approach cannot be overemphasized. Higher susceptibility of plaque accumulation in patients undergoing orthodontic treatment makes involvement of periodontist almost unavoidable. Also, orthodontic treatment frequently results in undesirable periodontal changes which require immediate attention. More recently, orthodontics has been used as an adjunct to periodontics to increase connective tissue support and alveolar bone height. The purpose of this article is to review the adverse effects of orthodontic treatment on the periodontal tissues and to discuss the mutually beneficial relationship shared between the two specialties.

Pentraxin-3 levels in gingival crevicular fluid during orthodontic tooth movement in young and adult patients

OBJECTIVES

To measure the levels of pentraxin-3 (PTX-3) in gingival crevicular fluid (GCF) in orthodontic young and adult patients in the first 2 weeks after the orthodontic appliance to determine whether those changes occur during orthodontic treatment and if those values could be the expression of an inflammatory state.

MATERIALS AND METHODS

GCF samples were collected with paper strips from 16 orthodontic young patients and 13 orthodontic adult patients from an upper canine requiring distalization as a test tooth. A contralateral canine was used as a control tooth. The absorbed volume was eluted in 100 µL phosphate-buffered saline (pH  =  7.2). PTX-3 levels in GCF were determined using a commercial enzyme-linked immunosorbent assay kit, and the results were expressed in ng/mL.

RESULTS

The results showed an increase of GCF levels of PTX-3 from 1 hour before the orthodontic appliance to a maximum at 24 hours, followed by a decrease in both groups of adult and young patients.

CONCLUSIONS

The results suggest PTX-3 involvement in periodontal orthodontic remodeling and the aseptic inflammation induced by the orthodontic forces.

Analysis of aspartate aminotransferase in gingival crevicular fluid: A study with initial therapy

Background and Objectives:

Conventional diagnostic indicators cannot distinguish between disease activity and inactivity but can detect the past tissue destruction. A proper and true periodontal diagnosis is essential in order to have a rational treatment and preventive strategy and to identify sites at risk. The present longitudinal study was designed with an aim to examine the relationship between gingival crevicular fluid (GCF) levels of aspartate aminotransferase (AST) and periodontal disease progression and to analyze the level of AST in GCF before and after the initial therapy in chronic periodontitis patients and determine the relationship between AST and conventional measures of periodontal status.

Materials and Methods:

A total of 20 patients with chronic periodontitis were randomly selected. Two diseased sites and one healthy site were selected in each patient. The periodontal status and GCF-AST levels were recorded at baseline and 3 months post-initial therapy and statistically analyzed.

Results:

There was a statistically significant difference in AST levels between diseased periodontal sites and healthy sites (P<0.05), and between baseline and post-initial therapy (P<0.05). Improvements in clinical status were noted following periodontal therapy and there was a corresponding decrease in AST levels.

Interpretation and Conclusion:

In conclusion, it is suggested that AST levels may be a useful adjunct in the clinical assessment of periodontal disease sites since AST level decreases when periodontal status improves.

Lactate dehydrogenase activity in gingival crevicular fluid as a marker in orthodontic tooth movement

Objectives:

This study aims at analyzing the changes in gingival crevicular fluid (GCF) lactate dehydrogenase (LDH) activity during orthodontic movement.

Methods:

Twenty patients all requiring first premolar extractions were selected and treated with conventional straight wire mechanotherapy. Canine retraction was done using 125 g Nitinol closed coil springs. The maxillary canine on one side served as the experimental site while the contralateral canine served as the control. GCF was collected from the canines before initiation of retraction, then 1 hour after initiating canine retraction, followed by 1 day, 7 days, 14 days and 21 days. GCF LDH levels were estimated and compared with the control site.

Results

The results revealed significantly higher LDH levels on the 7^th, 14^th and 21^st day at the sites where orthodontic force had been applied. The levels also showed a significant increase from 0 hour to the 21st day. Peak levels were seen on 14^th and 21^st day following initiation of retraction.

Conclusions:

The study showed that LDH could be successfully estimated in the GCF and its increased levels could indicate active tooth movement, which could aid the clinician in monitoring active orthodontic tooth movement.

The monitoring of gingival crevicular fluid volume during orthodontic treatment: a longitudinal randomized split-mouth study

This randomized split-mouth study was aimed at evaluating whether an orthodontic appliance per se or orthodontic tooth movement can induce detectable changes in gingival crevicular fluid (GCF) volume, and thus whether GCF volume is a predictable biomarker for tissue remodelling incident to orthodontic tooth movement.

MATERIALS AND METHODS

Sixteen healthy orthodontic patients (7 females and 9 males; mean age, 17.7 years; range, 13-27 years) with the need for extraction of the first upper premolars were enrolled. One randomly chosen maxillary canine was subjected to a distalizing force by a 0.017 × 0.025 inch titanium-molybdenum alloy archwire and considered as the test tooth (TT). The contralateral canine, which was not subjected to any force but was included in an orthodontic appliance, was used as a control (CT). GCF sampling was performed at both mesial and distal sites of the CTs and TTs at baseline, immediately before applying the orthodontic appliance, and after 1 hour, 24 hours, and 7, 14, and 21 days. A Periotron was used to measure the GCF volume. A modest but significant increase in the GCF volume over time was seen in both the CTs (mesial sites) and the TTs (both mesial and distal sites) with no differences between the experimental teeth. Subclinical tissue inflammation consequent to the placement of the orthodontic appliance might be responsible for these GCF volume changes. The GCF volume does not appear to be a reliable biomarker for tissue remodelling during orthodontic treatment.

In vitro tooth cleaning efficacy of electric toothbrushes around brackets

This in vitro study assessed the cleaning efficacy of different electric toothbrushes around upper incisor brackets. Standard and Mini Diamond brackets were fixed on black-stained teeth. The teeth were coated with white titanium oxide and brushed in a machine twice for 1 minute each. Twelve different brush heads with either a wiping or an oscillating-rotating action were tested. After brushing, the teeth were scanned, the black surfaces were assessed planimetrically and a modified plaque index for orthodontic patients (PIOP) was introduced. Tooth areas, which were black again after brushing indicated tooth surface contact of the filaments and were expressed as a percentage of total area. The remaining white areas around the brackets indicated 'plaque-retentive' niches. Analysis of variance was used for individual comparison of the brush types. Bonferroni/Dunn adjustment was applied for multiple testing. The Sonicare toothbrush handle with the brush head 'Compact ProResults' (81.7 per cent) and the brush head 'Standard ProResults' (80.8 per cent), as well as the sonic Waterpik toothbrush SR 800E with the standard brush head (78.2 per cent), showed statistically significantly better cleaning efficacy than all others. The poorest cleaning efficacy was observed for the oscillating-rotating Braun Oral-B Professional Care with the brush head 'Ortho' (less than 50 per cent). The planimetric findings were in correspondence with the results of the PIOP assessment. Cleaning efficacy of electric toothbrushes around brackets on upper incisors was different between the tested brushes. The PIOP was practicable, effective, and easy to use, although it has to be verified in a clinical study.

Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances

INTRODUCTION

Effective self-care is difficult for people with orthodontic appliances because of the inherent design of brackets and archwires. It is not uncommon to have increases in plaque and gingivitis after placement of fixed appliances. The purpose of this study was to evaluate the effect of using a dental water jet (DWJ) with a specialized tip (orthodontic) on plaque and bleeding in adolescent orthodontic patients with fixed appliances.

METHODS

One hundred six subjects were enrolled in this single blind, parallel clinical study. They were randomly assigned to 1 of 3 treatment groups: group 1, once daily irrigation with a DWJ and orthodontic jet tip plus a manual toothbrush; group 2, once daily flossing (FL) plus a manual toothbrush; group 3, manual toothbrush (MT) only. Plaque index (PI) and bleeding index (BI) scores were recorded at baseline, and at 2 and 4 weeks.

RESULTS

All groups showed statistically significant reductions in PI (whole mouth and interproximal) at 2 and 4 weeks (P <.001). In group 1, the DWJ was statistically more effective at reducing whole-mouth and interproximal plaque than the methods in the other groups (P >.001) at both 2 and 4 weeks, whereas the FL protocol in group 2 was significantly more effective than the MT protocol in group 3 at 4 weeks (P =.025) for whole-mouth plaque and at 2 and 4 weeks (P = .011 and P = .028, respectively) for interproximal plaque. All groups showed statistically significant reductions in BI (whole mouth and interproximal) at 2 and 4 weeks (P <.001). The DWJ in group 1 was statistically more effective at reducing whole-mouth bleeding than the protocols of the other groups at 2 and 4 weeks (P <.001), and the FL was statistically more effective than the MT at both times (P <.001). Both the DWJ and the FL were significantly more effective than the MT at 2 weeks (P <.001 and P <.016, respectively) for interproximal bleeding, but there were no differences between the groups at 4 weeks.

CONCLUSIONS

A DWJ with a specialized orthodontic jet tip is effective for adolescents in fixed orthodontic appliances; it demonstrated beneficial results for the reduction of plaque and bleeding.

Role of the friction free distalize appliance (2FDA)PAT in the molar distalization: photoelastic analysis and alkaline-phosphatase (ALP) activity on first molar and bicuspid

Maxillary molar distalization is an increasingly popular option for the resolution of Class II malocclusions. This study describes the effects of one particular molar distalizing appliance, the Friction Free Distalize Appliance (2FDA), in a sample of 20 consecutively treated and growing patients to verify the osteoblastic activity in the compression and traction sites of both the molars and the bicuspids when used as the anchorage teeth. The 2FDA appliances were constructed utilizing a Nickel Titanium open coil spring of 200 gr force in order to distalize the maxillary first molar. The reaction force was controlled utilizing the principle of low/free friction. The results show that the resin around the root of the bicuspid did not discolour at all, which indicates an absence of a force load. On the other hand, on the molar, the resin around the root of the molar became discoloured due to the fact that an orthodontic force was involved with the tooth. To better understand whether the quantity of force that reached the tooth was able to produce osteoblastic recruitment in the sites of tension of the molar and the bicuspid, we quantified an enzyme, the alkaline phosphatase (ALP), present. This measurement allowed us to verify a regular increase of the ALP on the site of molar traction. We also elaborated a mathematical model to evaluate the quantity of force of reaction that produces the device on the bicuspid. Such force results as being 8.34 grams which equals half the pressure of the capillaries of the parodontal ligament (18 grams). The 2FDA appliance compares favourably with other intra-oral distalization devices for the resolution of patients with Class II malocclusions, and is the only distalizing appliance that does not determine osteoclastic/osteoblastic recruitment on the anchorage tooth.

Periodontal conditions in subjects following orthodontic therapy. A preliminary study

The present study evaluated the periodontal conditions in dental students after appliance removal (mean period 7.16 +/- 3.5 years) compared with an untreated control group. Twenty-five subjects in the treated group (16 females and 9 males: 23.0 +/- 2.04 years) and 29 in a control group (15 females and 14 males: 23.99 +/- 2.46 years) underwent a periodontal examination: visible plaque index (VPI), gingival bleeding index (GBI), bleeding on probing (BOP), periodontal probing depth (PPD), and clinical attachment loss (CAL) of canines, premolars, and banded first molars and unbanded second molars. Statistical analysis was performed using a Mann-Whitney test, a Student's t-test, and Tukey's analysis of variance. The level of significance was set at 5 per cent. The median percentage of positive sites for the treated and control groups for VPI (1.25 +/- 2.37 and 1.25 +/- 5.45), GBI (0.95 +/- 1.81 and 1.23 +/- 2.14), and BOP (0.83 +/- 6.45 and 0.83 +/- 3.43) did not differ between groups. Mean PPD values were 1.33 +/- 0.19 and 1.34 +/- 0.14 for the treated and 1.40 +/- 0.24 and 1.39 +/- 0.25 for the control group. No intra- or intergroup differences were observed. For the control group, the smallest PPD was at the canines followed by premolars and molars. PPD was less for premolars than molars but similar to the canines in the treated group. No differences in CAL were observed between the examined teeth in the control group. For the treated group, the canines showed lower CAL values than the first molars. The results indicate that the use of orthodontic appliances is not necessarily related to a worsening of periodontal conditions.

Efficacy of Ultrasonic, Electric and Manual Toothbrushes in Patients with Fixed Orthodontic Appliances

OBJECTIVE

This crossover study compared the efficacy of an ultrasonic toothbrush for the reduction of plaque, gingival inflammation, and levels of Streptococcus mutans, in relation to an electric and a manual toothbrush.

MATERIALS AND METHODS

Twenty-one patients with orthodontic appliances were divided into three groups. All patients were evaluated by a periodontist and samples of saliva were collected for quantification of S mutans. The patients received their first brushes with appropriate instructions. For each crossover leg, patients used each toothbrush for a period of 30 days. At the end of each washout period, participants received a periodontal evaluation and new samples of saliva were collected. After 15 days of using their own toothbrushes, patients received the next toothbrushes in the experimental sequence.

RESULTS

The ultrasonic brush group presented significant improvement in the reduction of visible plaque on the buccal surfaces (-6.36%, P = .007). The counts of S mutans decreased in the electric (2.04 x 10(5) to 1.36 x 10(5) colony-forming units [CFU]/mL) and ultrasonic (2.98 x 10(5) to 1.84 x 10(5) CFU/mL) groups. There were no statistical differences among the three brushes for the clinical and microbiological parameters evaluated.

CONCLUSIONS

This study did not demonstrate that the ultrasonic toothbrush was better in reducing gingival inflammation in adolescent orthodontic patients, but plaque scores were lowered on buccal surfaces of teeth with orthodontic brackets. In addition, S mutans counts were markedly decreased in the electric and ultrasonic groups, which should be related to a reduced risk of oral disease.

Composition changes in gingival crevicular fluid during orthodontic tooth movement: comparisons between tension and compression sides

The aim of this study was to evaluate whether the application of tension or compression forces exerted on the periodontium during the early phase of orthodontic tooth movement is reflected by differences in the composition of the gingival crevicular fluid (GCF), at the level of interleukin-1beta (IL-1beta), substance P (SP), and prostaglandin E(2) (PGE(2)). Eighteen children (mean age 10.8 yr) starting orthodontic treatment were included in the study. Molar elastic separators were inserted mesially to two first upper or lower molars. One of the antagonist molars served as the control. GCF was collected from the mesial and distal sites of each molar, before (-7 d, 0 d) and immediately after (1 min, 1 h, 1 d, and 7 d) the placement of separators. The levels of IL-1beta, SP, and PGE(2) were determined by enzme-linked immunosorbent assay. At the orthodontically moved teeth, the GCF levels of IL-1beta, SP, and PGE(2) were significantly higher than at the control teeth in both tension and compression sides, and at almost all occasions after insertion of separators. The increase, relative to baseline values, was generally higher in tension sides. For the control teeth, the three mediators remained at baseline levels throughout the experiment. The results suggest that IL-1beta, SP, and PGE(2) levels in the GCF reflect the biologic activity in the periodontium during orthodontic tooth movement.

Non-surgical treatment of peri-implant pathology

INTRODUCTION

Peri-implant pathologies consist of an inflammatory process affecting the soft and hard tissues surrounding the implants. Chlorhexidine is considered the gold standard antiseptic, with a large variety of choice in administration. In this study, a protocol for the irrigation of peri-implant pockets with a chlorhexidine gel, using a plastic needle for the delivery of the product into the peri-implant pockets is described.

STUDY PARTICIPANTS AND METHODS

Nine patients with at least one implant presenting peri-implant pathology (inflamed soft tissue associated with bone loss around the implant) were enrolled in this prospective clinical study, and followed-up for 1 year, where clinical parameters such as modified plaque index, modified bleeding index, probing pocket depths, attachment levels were assessed at baseline, 1 month, and 1 year after implementation of the treatment protocol.

RESULTS

Treatment success was achieved in eight of the nine patients (and in 11 of the 13 implants) according to the success criteria adopted by the authors of this study.

DISCUSSION

Infection control lies at the heart of peri-implant treatment. The control of three factors such as optimal diagnosis, removal of the aetiological factor of the disease (proper removal of debris and decontamination of the peri-implant sulcus/pocket) and a good patient's oral hygiene self-care represents the key to success, resulting in good treatment outcomes when managing peri-implant pathologies. The protocol used (irrigation of peri-implant pockets with chlorhexidine gel delivered by a plastic needle) is considered to be of utility.

Lactate dehydrogenase activity in human gingival crevicular fluid during orthodontic treatment: a controlled, short-term longitudinal study

BACKGROUND

During orthodontic tooth movement, the early response of periodontal tissues to mechanical stress is an acute inflammatory one. This study uses a longitudinal design to examine lactate dehydrogenase (LDH) activity in gingival crevicular fluid (GCF) to determine if GCF LDH can be used as a diagnostic aid in monitoring tooth movement and tissue response during orthodontic treatment.

METHODS

Seventeen patients (mean age: 16.1 years) participated in the study. Each patient was undergoing treatment for distal movement, and an upper first molar served as the test tooth (TT), while the contralateral (CT) and antagonist (AT) teeth were used as controls. The CT was included in the orthodontic appliance, but was not subjected to the distal movement; the AT was free from any orthodontic appliance. The GCF around the experimental teeth was harvested from both mesial and distal tooth sites immediately before appliance activation, and on days 7, 14, and 21. Clinical gingival conditions were also recorded.

RESULTS

Gingival crevicular fluid LDH activity was significantly elevated in all sites of the TT and CT, as compared to the AT, where LDH activity remained at the baseline level throughout the study. Enzyme activity levels were also greater in the TT than in the CT, and in the compression sites.

CONCLUSIONS

Our results suggest that GCF LDH levels reflect the biological activity that takes place in the periodontium during orthodontic movement, and therefore they can be used as a diagnostic tool for monitoring for correct orthodontic tooth movement in clinical practice.