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Liang W, Liang B, Yan K, Zhang G, Zhuo J, Cai Y. Low-Intensity Pulsed Ultrasound: A Physical Stimulus with Immunomodulatory and Anti-inflammatory Potential. Ann Biomed Eng 2024; 52:1955-1981. [PMID: 38683473 DOI: 10.1007/s10439-024-03523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/20/2024] [Indexed: 05/01/2024]
Abstract
Ultrasound has expanded into the therapeutic field as a medical imaging and diagnostic technique. Low-intensity pulsed ultrasound (LIPUS) is a kind of therapeutic ultrasound that plays a vital role in promoting fracture healing, wound repair, immunomodulation, and reducing inflammation. Its anti-inflammatory effects are manifested by decreased pro-inflammatory cytokines and chemokines, accelerated regression of immune cell invasion, and accelerated damage repair. Although the anti-inflammatory mechanism of LIPUS is not very clear, many in vitro and in vivo studies have shown that LIPUS may play its anti-inflammatory role by activating signaling pathways such as integrin/Focal adhesion kinase (FAK)/Phosphatidylinositol 3-kinase (PI3K)/Serine threonine kinase (Akt), Vascular endothelial growth factor (VEGF)/endothelial nitric oxide synthase (eNOS), or inhibiting signaling pathways such as Toll-like receptors (TLRs)/Nuclear factor kappa-B (NF-κB) and p38-Mitogen-activated protein kinase (MAPK). As a non-invasive physical therapy, the anti-inflammatory and immunomodulatory effects of LIPUS deserve further exploration.
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Affiliation(s)
- Wenxin Liang
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, People's Republic of China
- College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China
| | - Beibei Liang
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, People's Republic of China
| | - Kaicheng Yan
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, People's Republic of China
| | - Guanxuanzi Zhang
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, People's Republic of China
| | - Jiaju Zhuo
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, People's Republic of China
- College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China
| | - Yun Cai
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, People's Republic of China.
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Zhang X, Guan M, Yi W, Li X, Ding X, He Y, Han W, Wang Z, Tang Q, Liao B, Shen J, Han X, Bai D. Smart Response Biomaterials for Pain Management. Adv Healthc Mater 2024:e2401555. [PMID: 39039990 DOI: 10.1002/adhm.202401555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/12/2024] [Indexed: 07/24/2024]
Abstract
The intricate nature of pain classification and mechanism constantly affects the recovery of diseases and the well-being of patients. Key medical challenges persist in devising effective pain management strategies. Therefore, a comprehensive review of relevant methods and research advancements in pain management is conducted. This overview covers the main categorization of pain and its developmental mechanism, followed by a review of pertinent research and techniques for managing pain. These techniques include commonly prescribed medications, invasive procedures, and noninvasive physical therapy methods used in rehabilitation medicine. Additionally, for the first time, a systematic summary of the utilization of responsive biomaterials in pain management is provided, encompassing their response to physical stimuli such as ultrasound, magnetic fields, electric fields, light, and temperature, as well as changes in the physiological environment like reactive oxygen species (ROS) and pH. Even though the application of responsive biomaterials in pain management remains limited and at a fundamental level, recent years have seen the examination and debate of relevant research findings. These profound discussions aim to provide trends and directions for future research in pain management.
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Affiliation(s)
- Xinyu Zhang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Mengtong Guan
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Weiwei Yi
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Xinhe Li
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Xiaoqian Ding
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Yi He
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Wang Han
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Zijie Wang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Qiuyu Tang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Bo Liao
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Jieliang Shen
- Department of Rehabilitation Medicine, Bishan Hospital of Chongqing Medical University, Bishan Hospital of Chongqing, Chongqing, 402760, P. R. China
| | - Xiaoyu Han
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Dingqun Bai
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
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Crossman J, Lai H, Kulka M, Jomha N, Flood P, El-Bialy T. The Effect of Low-Intensity Pulsed Ultrasound on Temporomandibular Joint Arthritis in Juvenile Rats. Tissue Eng Part A 2024. [PMID: 38517092 DOI: 10.1089/ten.tea.2024.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Juvenile idiopathic arthritis is an inflammatory disease that can affect the temporomandibular joint (TMJ) and lower jaw growth. Better treatment options are needed, so this study investigated the effect of low-intensity pulsed ultrasound (LIPUS) on TMJ arthritis. Seventy-two 3-week-old male Wistar rats were in vivo microcomputed tomography (micro-CT) scanned and divided into eight groups (n = 9). These groups were Group 1-TMJ arthritis and immediate LIPUS treatment (20 min/day, 4 weeks); Group 2-immediate LIPUS treatment and no TMJ arthritis; Group 3-TMJ arthritis and no LIPUS; Group 4-no TMJ arthritis and no LIPUS; Group 5-TMJ arthritis and LIPUS treatment with a delayed start by 4 weeks; Group 6-Delayed LIPUS and no TMJ arthritis; Group 7-TMJ arthritis and no (delayed) LIPUS; and Group 8-no TMJ arthritis and no (delayed) LIPUS. Ex vivo micro-CT scanning was completed, and samples were prepared for tissue analysis. Synovitis was observed in the TMJ arthritis (collagen-induced arthritis [CIA]) groups, but the severity appeared greater in the groups without LIPUS treatment. Fibrocartilage and hypertrophic cell layer thicknesses in the CIA group without LIPUS treatment were significantly greater (p < 0.05). Proteoglycan staining appeared greater in the LIPUS groups. Immediate LIPUS treatment increased the expression of type II collagen, type X collagen, and transforming growth factor-beta 1 (TGF-β1) immunostaining, and CIA (no LIPUS) increased MMP-13, vascular endothelial growth factor, and interleukin-1 beta (IL-1β) immunostaining. LIPUS treatment prevented growth disturbances observed in the CIA groups (no LIPUS) (p < 0.005). Our results have contributed to the understanding of the uses and limitations of the CIA juvenile rat model and have demonstrated the effects of LIPUS on the TMJ and mandibular growth. This information will help in designing future studies for investigating LIPUS and TMJ arthritis, leading to the development of new treatment options for children with juvenile arthritis in their TMJs.
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Affiliation(s)
- Jacqueline Crossman
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hollis Lai
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marianna Kulka
- Department of Medical Microbiology & Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Quantum and Nanotechnologies Research Center, The National Research Council Canada, Ontario, Canada
| | - Nadr Jomha
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Flood
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tarek El-Bialy
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Vaddamanu SK, Alhamoudi FH, Vyas R, Gurumurthy V, Siurkel Y, Cicciù M, Minervini G. Attenuation of orthodontically induced inflammatory root resorption by using low-intensity pulsed ultrasound as a therapeutic modality- a systematic review. BMC Oral Health 2024; 24:67. [PMID: 38200481 PMCID: PMC10782536 DOI: 10.1186/s12903-023-03741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
Ultrasound is an effective tool for both diagnostic and therapeutic applications. As an imaging tool, ultrasound has mostly been used for real-time noninvasive diagnostic imaging. As ultrasound propagates through a material, a reflected radio-frequency (RF) signal is generated when encountering a mismatch in acoustic impedance. While traditionally recognized for its diagnostic imaging capabilities, the application of ultrasound has broadened to encompass therapeutic interventions, most notably in the form of Low-Intensity Pulsed Ultrasound (LIPUS). Low-Intensity Pulsed Ultrasound (LIPUS) is a form of mechanical energy transmitted transcutaneously by high-frequency acoustic pressure waves. The intensity of LIPUS (30 mW/cm2) is within the range of ultrasound intensities used for diagnostic purposes (1-50 mW/cm2) and is regarded as non-thermal, non-destructive, permeating living tissues and triggering a cascade of biochemical responses at the cellular level. The LIPUS device produces a 200 µs burst of 1.5 MHz acoustic sine waves, that repeats at a modulation frequency of 1 kHz and provides a peak pressure of 30 mW/cm2. Low-intensity pulsed ultrasound (LIPUS) forms one of the currently available non-invasive healing-enhancing devices besides electro-stimulation (pulsed electro-magnetic field, PEMF). This modality has been leveraged to enhance drug delivery, expedite injury recovery, improve muscle mobility, alleviate joint stiffness and muscle pain, and enhance bone fracture healing. Although LIPUS has been embraced within various medical disciplines, its integration into standard dental practices is still in its nascent stages, signifying an unexplored frontier with potentially transformative implications. Low-intensity pulsed ultrasound (LIPUS) has emerged as an attractive adjuvant therapy in various dental procedures, such as orthodontic treatment and maxillary sinus augmentation. Its appeal lies in its simplicity and non-invasive nature, positioning LIPUS as a promising avenue for clinical innovation. One particular area of interest is orthodontically induced inflammatory root resorption (OIIRR), an oftenunavoidable outcome of the orthodontic intervention, resulting in the permanent loss of root structure. Notably, OIIRR is the second most common form of root resorption (RR), surpassed only by root resorption related to pulpal infection. Given the high prevalence and potential long-term consequences of OIIRR, this literature review seeks to evaluate the efficacy of LIPUS as a therapeutic approach, with an emphasis on assessing its capacity to reduce the severity of OIIRR to a level of clinical significance. To conduct this systematic review, a comprehensive automated literature search was executed across multiple databases, including MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, SciELO, Cochrane, PubMed, trials registries, 3ie, and Google Scholar. Both forward and backward citation tracking was employed, encompassing studies published from database inception through January 2009 to April 2023. The review focused on randomized controlled trials (RCTs) that specifically evaluated the effects of low-intensity pulsed ultrasound therapy on orthodontically induced inflammatory root resorption (OIIRR), without restrictions of publication date. A stringent selection criterion was applied, and only studies demonstrating high levels of statistical significance were included. Ultimately, fourteen studies met the inclusion criteria and were subjected to further analysis. The overall quality of the included randomized controlled trials (RCTs) was rigorously assessed utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. This analysis revealed certain methodological limitations that posed challenges in drawing definitive conclusions from the available evidence. Despite these constraints, the review offers invaluable insights that can inform and guide future research. Specifically, it delineates recommendations for targeted populations, necessary interventions, appropriate outcome measures, suitable study designs, and essential infrastructure to facilitate further investigations. The synthesis of these insights aims to enhance the development and application of low-intensity pulsed ultrasound therapy within the field of dentistry, thereby contributing to improved patient outcomes.
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Affiliation(s)
- Sunil Kumar Vaddamanu
- Department of Dental Technology, College of Applied Medical Sciences, King Khalid University, Abha, 62529, Saudi Arabia.
| | - Fahad Hussain Alhamoudi
- Department of Dental Technology, College of Applied Medical Sciences, King Khalid University, Abha, 62529, Saudi Arabia
| | - Rajesh Vyas
- Department of Dental Technology, College of Applied Medical Sciences, King Khalid University, Abha, 62529, Saudi Arabia
| | - Vishwanath Gurumurthy
- Department of Dental Technology, College of Applied Medical Sciences, King Khalid University, Abha, 62529, Saudi Arabia
| | - Yulia Siurkel
- International European University School of Medicine, Akademika Hlushkova Ave, 42В, Kyiv, 03187, Ukraine.
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, 95123, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India.
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Caserta, 81100, Italy.
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Sasaki R, Sakamoto J, Honda Y, Motokawa S, Kataoka H, Origuchi T, Okita M. Low-intensity pulsed ultrasound phonophoresis with diclofenac alleviated inflammation and pain via downregulation of M1 macrophages in rats with carrageenan-induced knee joint arthritis. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2024; 15:100148. [PMID: 38174056 PMCID: PMC10758990 DOI: 10.1016/j.ynpai.2023.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/27/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
Objective This study aimed to investigate the effects of low-intensity pulsed ultrasound (LIPUS) phonophoresis with diclofenac on inflammation and pain in the acute phase of carrageenan-induced arthritis in rats. Design 60 male Wistar rats were randomly divided into the arthritis, diclofenac, LIPUS, phonophoresis, and sham-arthritis control groups. LIPUS and transdermal diclofenac gel were applied to the lateral side of the inflamed knee for 7 days, initiated postinjection day 1. In the phonophoresis group, diclofenac gel was rubbed onto the skin, followed by LIPUS application over the medication. Knee joint transverse diameters, pressure pain thresholds (PPTs), and paw withdrawal thresholds (PWT) were evaluated. The number of CD68-, CD11c-, and CD206-positive cells, and IL-1β and COX-2 mRNA expression were analyzed 8 days after injection. Results In the phonophoresis group, the transverse diameter, PPT, PWT significantly recovered at the day 8 compared to those in the LIPUS and diclofenac groups. The number of CD68- and CD11c-positive cells in the phonophoresis group was significantly lower than that in the LIPUS and diclofenac groups, but no significant differences were observed among three groups in CD206-positive cells. IL-1β and COX-2 mRNA levels were lower in the phonophoresis group than in the arthritis group, although there were no differences among the LIPUS, diclofenac, and phonophoresis groups. Conclusion LIPUS phonophoresis with diclofenac is more effective to ameliorate inflammation and pain compared to diclofenac or LIPUS alone, and the mechanism involves the decrease of M1 macrophages.
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Affiliation(s)
- Ryo Sasaki
- Department of Rehabilitation, Juzenkai Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Junya Sakamoto
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yuichiro Honda
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Satoko Motokawa
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Rehabilitation, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Hideki Kataoka
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Tomoki Origuchi
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Minoru Okita
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Liu XH, Ding JY, Zhu ZH, Wu XC, Song YJ, Xu XL, Ding DF. Recent advances in enzyme-related biomaterials for arthritis treatment. Front Chem 2022; 10:988051. [PMID: 36051622 PMCID: PMC9424673 DOI: 10.3389/fchem.2022.988051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/21/2022] [Indexed: 12/27/2022] Open
Abstract
Arthritis is a group of highly prevalent joint disorders, and osteoarthritis (OA) and rheumatoid arthritis are the two most common types. The high prevalence of arthritis causes severe burdens on individuals, society and the economy. Currently, the primary treatment of arthritis is to relieve symptoms, but the development of arthritis cannot be effectively prevented. Studies have revealed that the disrupted balance of enzymes determines the pathological changes in arthritis. In particular, the increased levels of matrix metalloproteinases and the decreased expression of endogenous antioxidant enzymes promote the progression of arthritis. New therapeutic strategies have been developed based on the expression characteristics of these enzymes. Biomaterials have been designed that are responsive when the destructive enzymes MMPs are increased or have the activities of the antioxidant enzymes that play a protective role in arthritis. Here, we summarize recent studies on biomaterials associated with MMPs and antioxidant enzymes involved in the pathological process of arthritis. These enzyme-related biomaterials have been shown to be beneficial for arthritis treatment, but there are still some problems that need to be solved to improve efficacy, especially penetrating the deeper layer of articular cartilage and targeting osteoclasts in subchondral bone. In conclusion, enzyme-related nano-therapy is challenging and promising for arthritis treatment.
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Affiliation(s)
- Xin-Hao Liu
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Ying Ding
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhi-Heng Zhu
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xi-Chen Wu
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yong-Jia Song
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Ling Xu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
- *Correspondence: Xiao-Ling Xu, ; Dao-Fang Ding,
| | - Dao-Fang Ding
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xiao-Ling Xu, ; Dao-Fang Ding,
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Ungur RA, Ciortea VM, Irsay L, Ciubean AD, Năsui BA, Codea RA, Singurean VE, Groza OB, Căinap S, Martiș (Petruț) GS, Borda C, Borda IM. Can Ultrasound Therapy Be an Environmental-Friendly Alternative to Non-Steroidal Anti-Inflammatory Drugs in Knee Osteoarthritis Treatment? MATERIALS (BASEL, SWITZERLAND) 2021; 14:2715. [PMID: 34064094 PMCID: PMC8196736 DOI: 10.3390/ma14112715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022]
Abstract
The non-steroidal anti-inflammatory drugs (NSAIDs) are the most used drugs in knee OA (osteoarthritis) treatment. Despite their efficiency in pain and inflammation alleviation, NSAIDs accumulate in the environment as chemical pollutants and have numerous genetic, morphologic, and functional negative effects on plants and animals. Ultrasound (US) therapy can improve pain, inflammation, and function in knee OA, without impact on environment, and with supplementary metabolic beneficial effects on cartilage compared to NSAIDs. These features recommend US therapy as alternative for NSAIDs use in knee OA treatment.
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Affiliation(s)
- Rodica Ana Ungur
- Department of Medical Specialties, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.A.U.); (L.I.); (A.D.C.); (V.E.S.); (O.B.G.); (I.M.B.)
| | - Viorela Mihaela Ciortea
- Department of Medical Specialties, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.A.U.); (L.I.); (A.D.C.); (V.E.S.); (O.B.G.); (I.M.B.)
| | - Laszlo Irsay
- Department of Medical Specialties, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.A.U.); (L.I.); (A.D.C.); (V.E.S.); (O.B.G.); (I.M.B.)
| | - Alina Deniza Ciubean
- Department of Medical Specialties, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.A.U.); (L.I.); (A.D.C.); (V.E.S.); (O.B.G.); (I.M.B.)
| | - Bogdana Adriana Năsui
- Department of Community Health, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Răzvan Andrei Codea
- Faculty of Veterinary Medicine, University of Agricultural Science and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (R.A.C.); (C.B.)
| | - Victoria Emilia Singurean
- Department of Medical Specialties, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.A.U.); (L.I.); (A.D.C.); (V.E.S.); (O.B.G.); (I.M.B.)
| | - Oana Bianca Groza
- Department of Medical Specialties, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.A.U.); (L.I.); (A.D.C.); (V.E.S.); (O.B.G.); (I.M.B.)
| | - Simona Căinap
- Department of Mother and Child, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | | | - Cristin Borda
- Faculty of Veterinary Medicine, University of Agricultural Science and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (R.A.C.); (C.B.)
| | - Ileana Monica Borda
- Department of Medical Specialties, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.A.U.); (L.I.); (A.D.C.); (V.E.S.); (O.B.G.); (I.M.B.)
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8
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Effectiveness of low-intensity pulsed ultrasound on osteoarthritis of the temporomandibular joint: A review. Ann Biomed Eng 2020; 48:2158-2170. [PMID: 32514932 DOI: 10.1007/s10439-020-02540-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/26/2020] [Indexed: 01/15/2023]
Abstract
Loading is indispensable for the growth, development, and maintenance of joint tissues, including mandibular condylar cartilage, but excessive loading or reduced host adaptive capacity can considerably damage the temporomandibular joint (TMJ), leading to temporomandibular joint osteoarthritis (TMJ-OA). TMJ-OA, associated with other pathological conditions and aging processes, is a highly degenerative disease affecting the articular cartilage. Many treatment modalities for TMJ-OA have been developed. Traditional clinical treatment includes mainly nonsurgical options, such as occlusal splints. However, non-invasive therapy does not achieve joint tissue repair and regeneration. Growing evidence suggests that low-intensity pulsed ultrasound (LIPUS) accelerates bone fracture healing and regeneration, as well as having extraordinary effects in terms of soft tissue repair and regeneration. The latter have received much attention, and various studies have been performed to evaluate the potential role of LIPUS in tissue regeneration including that applied to articular cartilage. The present article provides an overview of the status of LIPUS stimulation used to prevent the onset and progression of TMJ-OA and enhance the tissue regeneration of mandibular condylar cartilage. The etiology and management of TMJ-OA are explained briefly, animal models of TMJ-OA are described, and the effectiveness of LIPUS on cell metabolism and tissue regeneration in the TMJ is discussed.
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Zhou HY, Li Q, Wang JX, Xie YJ, Wang SQ, Lei L, Gao YQ, Huang MM, Hu Y, Xu FY, Zhang C. Low-intensity pulsed ultrasound repair in mandibular condylar cartilage injury rabbit model. Arch Oral Biol 2019; 104:60-66. [DOI: 10.1016/j.archoralbio.2019.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/13/2019] [Accepted: 05/21/2019] [Indexed: 01/24/2023]
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10
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Crossman J, Alzaheri N, Abdallah MN, Tamimi F, Flood P, Alhadainy H, El-Bialy T. Low intensity pulsed ultrasound increases mandibular height and Col-II and VEGF expression in arthritic mice. Arch Oral Biol 2019; 104:112-118. [PMID: 31177013 DOI: 10.1016/j.archoralbio.2019.05.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/09/2019] [Accepted: 05/31/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a chronic inflammatory disease involving persistent inflammation resulting in cartilage and bone damage. RA can affect the temporomandibular joint (TMJ), and damage to the TMJ condyle can lead to craniofacial developmental disturbances, causing micrognathia, malocclusion, retrognathia, and increased overjet. Current treatments of TMJ arthritis are unsatisfactory. This pilot study aimed to investigate the effect of low intensity pulsed ultrasound (LIPUS) on the mandible and TMJ condyles in an RA mouse model using micro-computed tomography (Micro-CT), histologic, and immunohistochemical analyses. METHODS MRL-lpr/lpr mice received LIPUS application to their TMJs for 20 min/day for 2 and 4 weeks. Micro-CT analysis measured condylar length and width, posterior mandibular height (P.M.H), mandibular ramus length (M.R.L), effective mandibular length (Ef.M.L), angular process length (A.P.L), mandibular plane (M.P), mandibular axis (M.Ax), and lower incisor height (L.I.H). Condylar cartilage thickness was histologically measured, and type II collagen (Col-II), vascular endothelial growth factor (VEGF), nuclear factor kappa-B ligand (RANKL), and osteoprotegerin (OPG) expression was analyzed using immunohistochemistry. RESULTS Comparing the LIPUS-treated group with the control, P.M.H, M.R.L, and M.P were significantly greater in the LIPUS-treated group. Immunostaining for Col-II and VEGF was stronger in the LIPUS-treated group after 4 weeks. OPG showed slightly more expression in the LIPUS group. CONCLUSIONS LIPUS may enhance mandibular and TMJ condylar bone formation in this RA mouse model by preventing any growth disturbances involved in inflammation. Further studies are recommended to analyze the effect of LIPUS on TMJ of RA in other animal models.
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Affiliation(s)
| | - Nadia Alzaheri
- King Saudi Medical City, Ministry of Health, Riyadh, Saudi Arabia.
| | | | | | - Patrick Flood
- School of Dentistry, University of Alberta, AB, Canada.
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Fujita M, Sato-Shigeta M, Mori H, Iwasa A, Kawai N, Hassan AH, Tanaka E. Protective Effects of Low-Intensity Pulsed Ultrasound on Mandibular Condylar Cartilage Exposed to Mechanical Overloading. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:944-953. [PMID: 30732913 DOI: 10.1016/j.ultrasmedbio.2018.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/04/2018] [Accepted: 12/17/2018] [Indexed: 06/09/2023]
Abstract
The aim of this study was to assess the effect of low-intensity pulsed ultrasound (LIPUS) application on rat temporomandibular joints (TMJs) with early-stage of osteoarthritis-like conditions induced by mechanical overloading. Fifteen-week-old male Wistar rats were divided into two experimental groups and a control group (n = 10 each). Both TMJs of all rats in one experimental group were subjected to mechanical overloading for 5 d, and those in the other experimental group were exposed to LIPUS for 20 min/d after overloading. Condyles were assessed using micro-computed tomography, histology and histomorphometry. LIPUS treatment attenuated cartilage degeneration, decreased the number of osteoclastic cells and restored the expression of aggrecan after an initial decrease induced by mechanical overloading. These results indicate that LIPUS may have a protective effect on the early progression of TMJ osteoarthritis.
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Affiliation(s)
- Mutsumi Fujita
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Oral Sciences, Tokushima, Japan.
| | - Minami Sato-Shigeta
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Hospital, Tokushima, Japan
| | - Hiroki Mori
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Hospital, Tokushima, Japan
| | - Akihiko Iwasa
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Nobuhiko Kawai
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ali H Hassan
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Eiji Tanaka
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Chondro-protective effects of low intensity pulsed ultrasound. Osteoarthritis Cartilage 2016; 24:1989-1998. [PMID: 27364595 PMCID: PMC5071131 DOI: 10.1016/j.joca.2016.06.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/26/2016] [Accepted: 06/13/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Cartilage is a highly mechano-responsive tissue. Chondrocytes undergo a series of complex changes, including proliferation and metabolic alteration as the target of external biomechanical and biochemical stimuli. IL-1β is known to regulate chondrocyte metabolism and plays an important role in the pathogenesis of osteoarthritis (OA). The objective of this study was to employ low-intensity pulsed ultrasound (LIPUS) as a localized mechanical stimulus and assess its effects on chondrocyte migration, proliferation, metabolism, and differentiation, as well as its ability to suppress IL-1β mediated catabolism in cartilage. METHODS Human cartilage explants and chondrocytes were stimulated by LIPUS in the presence and absence of IL-1β to asses cartilage degradation, chondrocytes metabolism, migration, and proliferation. Western blot analyses were conducted to study IL-1β the associated NFκB pathway in chondrocytes. RESULTS LIPUS stimulation increased the proteoglycan content in human cartilage explants and inhibited IL-1β induced loss of proteoglycans. LIPUS stimulation increased rates of chondrocyte migration and proliferation, and promoted chondrogenesis in mesenchymal stem cells (MSC). Further, LIPUS suppressed IL-1β induced activation of phosphorylation of NFκB-p65 and IĸBα leading to reduced expression of MMP13 and ADAMT5 in chondrocytes. CONCLUSIONS Collectively, these data demonstrate the potential therapeutic effects of LIPUS in preventing cartilage degradation and treating OA via a mechanical stimulation that inhibits the catabolic action of IL-1β and stimulates chondrocyte migration, proliferation, and differentiation.
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Effects and Mechanisms of Low-Intensity Pulsed Ultrasound for Chronic Prostatitis and Chronic Pelvic Pain Syndrome. Int J Mol Sci 2016; 17:ijms17071057. [PMID: 27376284 PMCID: PMC4964433 DOI: 10.3390/ijms17071057] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 01/15/2023] Open
Abstract
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is one of the most common urologic diseases, and no curative treatments have been identified. Low-intensity pulsed ultrasound (LIPUS) has been successfully used in promoting tissue healing, inhibiting inflammation and pain, differentiating stem cells, and stimulating nerve regeneration/muscle regeneration, as well as enhancing angiogenesis. Very recently, LIPUS has been proven an effective approach for CP/CPPS. This review summarizes the possible mechanisms responsible for the therapeutic effect of LIPUS for CP/CPPS. To search publications relevant to the topics of this review, the search engine for life sciences of Entrez was used. We reviewed the available evidence from 1954 through 2015 concerning LIPUS for CP/CPPS. According to the literature, both transrectal and transperineal approaches of LIPUS are effective for CP/CPPS.
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Xin Z, Lin G, Lei H, Lue TF, Guo Y. Clinical applications of low-intensity pulsed ultrasound and its potential role in urology. Transl Androl Urol 2016; 5:255-66. [PMID: 27141455 PMCID: PMC4837316 DOI: 10.21037/tau.2016.02.04] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Low-intensity pulsed ultrasound (LIPUS) is a form of ultrasound that delivered at a much lower intensity (<3 W/cm2) than traditional ultrasound energy and output in the mode of pulse wave, and it is typically used for therapeutic purpose in rehabilitation medicine. LIPUS has minimal thermal effects due to its low intensity and pulsed output mode, and its non-thermal effects which is normally claimed to induce therapeutic changes in tissues attract most researchers’ attentions. LIPUS have been demonstrated to have a rage of biological effects on tissues, including promoting bone-fracture healing, accelerating soft-tissue regeneration, inhibiting inflammatory responses and so on. Recent studies showed that biological effects of LIPUS in healing morbid body tissues may be mainly associated with the upregulation of cell proliferation through activation of integrin receptors and Rho/ROCK/Src/ERK signaling pathway, and with promoting multilineage differentiation of mesenchyme stem/progenitor cell lines through ROCK-Cot/Tpl2-MEK-ERK signaling pathway. Hopefully, LIPUS may become an effective clinical procedure for the treatment of urological diseases, such as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), erectile dysfunction (ED), and stress urinary incontinence (SUI) in the field of urology. It still needs an intense effort for basic-science and clinical investigators to explore the biomedical applications of ultrasound.
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Affiliation(s)
- Zhongcheng Xin
- 1 Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China ; 2 Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA
| | - Guiting Lin
- 1 Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China ; 2 Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA
| | - Hongen Lei
- 1 Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China ; 2 Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA
| | - Tom F Lue
- 1 Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China ; 2 Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA
| | - Yinglu Guo
- 1 Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China ; 2 Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA
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Padilla F, Puts R, Vico L, Guignandon A, Raum K. Stimulation of Bone Repair with Ultrasound. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:385-427. [PMID: 26486349 DOI: 10.1007/978-3-319-22536-4_21] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This chapter reviews the different options available for the use of ultrasound in the enhancement of fracture healing or in the reactivation of a failed healing process: LIPUS, shock waves and ultrasound-mediated delivery of bioactive molecules, such as growth factors or plasmids. The main emphasis is on LIPUS, or Low Intensity Pulsed Ultrasound, the most widespread and studied technique. LIPUS has pronounced bioeffects on tissue regeneration, while employing intensities within a diagnostic range. The biological response to LIPUS is complex as the response of numerous cell types to this stimulus involves several pathways. Known to-date mechanotransduction pathways involved in cell responses include MAPK and other kinases signaling pathways, gap-junctional intercellular communication, up-regulation and clustering of integrins, involvement of the COX-2/PGE2 and iNOS/NO pathways, and activation of the ATI mechanoreceptor. Mechanisms at the origin of LIPUS biological effects remain intriguing, and analysis is hampered by the diversity of experimental systems used in-vitro. Data point to clear evidence that bioeffects can be modulated by direct and indirect mechanical effects, like acoustic radiation force, acoustic streaming, propagation of surface waves, heat, fluid-flow induced circulation and redistribution of nutrients, oxygen and signaling molecules. One of the future engineering challenge is therefore the design of dedicated experimental set-ups allowing control of these different mechanical phenomena, and to relate them to biological responses. Then, the derivation of an 'acoustic dose' and the cross-calibration of the different experimental systems will be possible. Despite this imperfect knowledge of LIPUS biophysics, the clinical evidence, although most often of low quality, speaks in favor of the clinical use of LIPUS, when the economics of nonunion and the absence of toxicity of this ultrasound technology are taken into account.
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Affiliation(s)
| | - Regina Puts
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Föhrerstr. 15, 13353, Berlin, Germany
| | - Laurence Vico
- Inserm U1059 Lab Biologie intégrée du Tissu Osseux, Université de Saint-Etienne, St-Etienne, 42023, France
| | - Alain Guignandon
- Inserm U1059 Lab Biologie intégrée du Tissu Osseux, Université de Saint-Etienne, St-Etienne, 42023, France
| | - Kay Raum
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Föhrerstr. 15, 13353, Berlin, Germany
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Raza H, Major P, Dederich D, El-Bialy T. Effect of low-intensity pulsed ultrasound on orthodontically induced root resorption caused by torque: A prospective, double-blind, controlled clinical trial. Angle Orthod 2015; 86:550-7. [DOI: 10.2319/081915-554.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
Objectives:
To evaluate the effects of low-intensity pulsed ultrasound (LIPUS) on orthodontically induced tooth root resorption caused by torque in human subjects.
Materials and Methods:
Ten healthy patients (12–35 years of age) who required extraction of all first premolars as a part of their routine orthodontic treatment were recruited. A 15° twist was applied in the arch wire using 0.019 × 0.025-inch TMA in a 0.022-inch bracket system (Synergy R) that produced a buccal root torque of approximately 5 N/mm at the bracket level. Using a split mouth design, randomization, and blinding, one side of the arch received LIPUS for 20 minutes per day for 4 weeks at an incident intensity of 30 mW/cm2 of the transducers’ surface area. The other side served as a self-control, which received a sham transducer. After 4 weeks, all first premolars were extracted and micro–computed tomographic analysis was performed on these extracted teeth. A linear mixed-model statistical analysis was used.
Results:
LIPUS-treated teeth showed significantly less total volume of resorption lacunae compared to control teeth by a mean difference of (0.54 ± 0.09 mm3) (P < .001) and percentage of root resorption by a mean difference of (0.33 ± 0.05 mm3) (P < .001). In addition, significantly fewer resorption lacunae were found on all root surfaces in the LIPUS group compared to the control except in the instance of the distal surface.
Limitations:
This study was performed on limited number of cases during a 4-week period.
Conclusions:
LIPUS minimizes root resorption when applied during torque tooth movement over a 4-week period.
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Affiliation(s)
- Hasnain Raza
- Former Graduate Student, Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Paul Major
- Professor and Chair, School of Dentistry, Senior Associate Dean, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas Dederich
- Professor of Periodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tarek El-Bialy
- Associate Professor, Department of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Low-intensity pulsed ultrasound in dentofacial tissue engineering. Ann Biomed Eng 2015; 43:871-86. [PMID: 25672801 DOI: 10.1007/s10439-015-1274-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/04/2015] [Indexed: 02/04/2023]
Abstract
Oral and maxillofacial diseases affect millions of people worldwide and hence tissue engineering can be considered an interesting and clinically relevant approach to regenerate orofacial tissues after being affected by different diseases. Among several innovations for tissue regeneration, low-intensity pulsed ultrasound (LIPUS) has been used extensively in medicine as a therapeutic, operative, and diagnostic tool. LIPUS is accepted to promote bone fracture repair and regeneration. Furthermore, the effect of LIPUS on soft tissues regeneration has been paid much attention, and many studies have performed to evaluate the potential use of LIPUS to tissue engineering soft tissues. The present article provides an overview about the status of LIPUS stimulation as a tool to be used to enhance regeneration/tissue engineering. This review consists of five parts. Part 1 is a brief introduction of the acoustic description of LIPUS and mechanical action. In Part 2, biological problems in dentofacial tissue engineering are proposed. Part 3 explores biologic mechanisms of LIPUS to cells and tissues in living body. In Part 4, the effectiveness of LIPUS on cell metabolism and tissue regeneration in dentistry are summarized. Finally, Part 5 relates the possibility of clinical application of LIPUS in orthodontics. The present review brings out better understanding of the bioeffect of LIPUS therapy on orofacial tissues which is essential to the successful integration of management remedies for tissue regeneration/engineering. To develop an evidence-based approach to clinical management and treatment of orofacial degenerative diseases using LIPUS, we would like to be in full pursuit of LIPUS biotherapy. Still, there are many challenges for this relatively new strategy, but the up to date achievements using it promises to go far beyond the present possibilities.
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