Article

Impact of extracorporeal shock wave therapy (ESWT) on orthodontic tooth movement—a randomized clinical trial

Springer Nature
Clinical Oral Investigations
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Abstract

This randomized clinical trial investigated the effect of extracorporeal shock waves on the amount of orthodontic tooth movement and periodontal parameters. Twenty-six adult orthodontic patients participated in this clinical trial; all of them receiving lower second molar mesially directed movement. The fixed orthodontic device included superelastic coil springs (200 cN) and miniscrews as temporary anchorage device. The active treatment group received a single shock wave treatment with 1,000 impulses in the region of tooth movement. The placebo group was treated with deactivated shock wave applicator with an acoustic sham. The study period lasted 4 months with a monthly data exploration. No statistically significant difference in posterior-anterior tooth movement between the treatment and placebo group was seen during observation period. Gender had no significant influence on tooth movement in either group. No significant difference occurred in mesio-distal tipping and rotation, but a significant difference (p = 0.035) in bucco-lingual tipping of the molars was found. Periodontal status of the patients (sulcus probing depth, gingival index) did not significantly differ in both groups. The plaque index showed a significant difference (p = 0.003). Single application of extracorporeal shock wave treatment was associated neither with a statistically significant acceleration of tooth movement nor with an altered periodontal status in vivo. Shock waves showed no harmful effects in the investigated area. Their clinical use for lithotripsy during orthodontic therapy might be permitted.

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... The positive regenerative effect of shock wave therapy is the leading cause for its recent interest and use [17]. It is possible to have an insignificant effect [20] or no effect using ESWT [21][22][23]. It is often related to ESWT parameters used in dose-effect settings. ...
... However, a randomized clinical trial explored the effect of a single round of ESWT on orthodontic molar movement in the posterior-anterior direction, as well as tipping and rotation movement [22]. It revealed no difference between the treatment and control groups in terms of accelerating the tooth movement. ...
... The only significance the authors reported, as a minor clinical relevance, was in the buccolingual movement of the molars. Importantly, the study reported no complications or adverse events associated with ESWT during the study [22]. In the same controlled clinical trial, a different study reported the effect of ESWT on the stability of temporary anchorage devices (TADs) utilized for orthodontic movement. ...
Article
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Extracorporeal shock wave therapy (ESWT) has been studied and applied extensively in medical practice for various applications including musculoskeletal, dermal, vascular, and cardiac indications. These indications have emerged from primary ESWT use in treating urolithiasis and cholelithiasis. Likewise, dental medicine has had its share of utilizing ESWT in various investigations. This review aimed to provide an up-to-date summary of ESWT use in preclinical and clinical dental medicine. There is growing interest in ESWT use stemming from its non-invasiveness, low cost, and safe qualities in addition to its proven regenerative biostimulating aspects. Targeted tissue and parameters of ESWT delivery continue to be an integral part of successful ESWT treatment to attain the clinical value of the anticipated dose’s effect.
... The most commonly used devices are based on the following mechanisms: low level laser irradiation 22 ; pulsed electromagnetic field (PEMF) 21 ; extracorporeal shock waves therapy (ESWT) 19 ; and electrical current 20 . ...
... Non-surgical manipulations include a wide variety of transmucosal interventions [15][16][17][18] represented by low-level laser therapy (LLLT), device-assisted treatments [19][20][21][22] and pharmacological therapies 23 . ...
... Detailed characteristics of studies according to interventions are described in Table 2, Table 3 and Table 4 for corticotomy, LLLT and devices-assisted/substance-injection procedures, respectively. Nine studies had a split-mouth design 8,[13][14][15][16][17][18]20,21 , five a parallel study design [10][11][12]19,23 , and one had a combined design (both parallel and split-mouth) 9 . Ten investigations included mainly adolescents and young adults, two included also older adults 19,23 , and three others reported only the mean age of the patients 10,13,20 . ...
Article
To conduct a systematic review of randomised controlled trials (RCTs) evaluating the effect of surgical and non-surgical procedures on the acceleration of orthodontic tooth movement (OTM) as an adjunct to orthodontic therapy (OT) in order to estimate the efficacy of these procedures and the benefit of their use in everyday orthodontic practice. Literature search was performed on PubMed, Scopus, Web of Science and Cochrane databases up to July 2014. Inclusion criteria were: (1) RCTs; (2) orthodontic therapy on permanent dentition; (3) application of adjunctive surgical or non-surgical procedures for accelerating OTM; (4) measurement of tooth movement. The primary outcome measure was tooth movement expressed as cumulative tooth movement (CTM), rate of tooth movement (RTM) or time of tooth movement (TTM). Pain and discomfort, periodontal health, anchorage loss, bone and root changes, and undesired tooth movement were evaluated as secondary outcomes. Literature research identified 184 studies. After screening of titles, abstracts and full-text studies, fifteen fulfilled the inclusion criteria and were included in this review. Six of the included studies investigated the effect of corticotomies, one of interseptal bone reduction, four of lowlevel laser therapy (LLLT), three of intraoral/extraoral devices releasing extracorporeal shock waves (ESWT), pulsed electromagnetic field (PEMF) and electrical current, respectively, and one of injected substances (relaxin) as an adjunct to OT. Three studies resulted of high methodological quality, six of medium, and six of low quality. Interseptal bone reduction was reported to increase RTM during the first 2 months (P = 0.002) and CTM at 3 months (P = 0.003). Studies investigating corticotomy reported significantly increased RTM (up to 2.3 times) during the first months after intervention, whereas results on TTM and CTM were quite controversial ranging from non-significant to highly significant (up to three times of TTM increase). The heterogeneity between studies investigating corticotomy could not allow for quantitative synthesis of the findings. Out of four studies investigating LLLT three reported positive effect on OT. Due to inadequate statistical analysis of data from original articles, results could not be summarised in meta-analyses. Effects of both electrical current devices and PEMF devices on CTM were reported to be larger on the experimental sides than on the control sides (P < 0.001). The other interventions were reported to be of no statistical or clinical relevance. In the short term, corticotomy can accelerate OTM whereas long-term effects are questionable, thus no firm conclusions can be made on its efficacy and benefit of clinical use. There is some evidence that LLLT can slightly accelerate OTM but this result is not significant and the effect estimated is not clinically relevant. The very limited research-based evidence suggesting beneficial effects of interseptal bone reduction, electrical current and PEMF on OTM does not allow for solid conclusions. More high quality clinical research is required in order to estimate the efficacy of adjunctive interventions on accelerating OTM and their potential clinical use.
... However, it was reported to accelerate periodontal remodeling via increasing the release of IL-1β and VEGF, so it may also increase orthodontic tooth movement 26,27 . This result was supported by a clinical study 28 . Although shock waves have been reported to increase regional blood flow and induce neovascularization 29 , there are no findings that they improve pulpal blood flow after orthodontic treatment 30 . ...
... At the end of the third week, and especially as a result of the 300 and 1000 impulse shock wave therapy, a significant increase was found in alveolar bone levels and this effect was reported to continue for 6 weeks 33 . The fact that shock wave application in a clinical trial did not cause a difference in sulcus depth and gingival index but caused a significant decrease in plaque index, is evidence of the bactericidal effect of ESWT on oral bacteria 28 . In a different study of the same researchers, it was stated that ESWT was associated with a significant decrease in probing depth and bleeding in the study group 32 ( Table 2). ...
Article
Full-text available
This review intends to provide researchers with a brief summary of extracorporeal Shock Wave Therapy (ESWT), and to bring new perspectives by systematic reviewing of the available data on the results of the various effects of ESWT regarding dentistry and the maxillofacial area. Literature search was conducted on December 2017 using the PubmedMedline, Google Scholar, Scopus and Web of Science databases.Articles between 1989 and 2018 were included.Search was performed using the keywords ‘alveolar, dentoalveolar, maxilla, mandibular, oral and sialolthiasis’ words in combination with ‘shock wave or shockwave’. The studies that were decided to include to this systematic review (n: 35) mostly consist of experimental and clinical studies. The current systematic review stated that ESWT has a success rate of up to 50% in the treatment of sialolithiasis. Shock wave therapy has also different dose-dependent effects on each tissue in the intraoral region. Shock wave parameters that will bring optimal biological effect to any treatment indication are yet to be clarified.International Journal of Human and Health Sciences Vol. 03 No. 04 October’19 Page : 186-195
... Recently ESWT has been reported to induce interleukin-1β (IL-1β), a potent cytokine for bone resorption, during 3 days of tooth movement in rats and no long-term observation was studied [19]. However, a study in humans failed to show any accelerated effect on second mandibular mesialization [20] after a single treatment of ESWT. Though ESWT promotes healing and induces tissue regeneration, the effect on tooth movement is controversial with different parameters /applications and tested species and subjects [19,20]. ...
... However, a study in humans failed to show any accelerated effect on second mandibular mesialization [20] after a single treatment of ESWT. Though ESWT promotes healing and induces tissue regeneration, the effect on tooth movement is controversial with different parameters /applications and tested species and subjects [19,20]. This study evaluated whether ESWT affects tooth movement in a rat model to gain better insight into underlying mechanisms. ...
Article
Full-text available
Background: Accelerated tooth movement has been a topic of interest for orthodontic research recently. Surgically facilitated orthodontic treatment has been shown to be an effective approach to accelerate tooth movement; however, it remains invasive, requires additional surgery, and may increase post-operative complications. In this study, we evaluate the effects of extracorporeal shockwave treatment (ESWT), a non-invasive approach to regenerate alveolar bone, on orthodontic tooth movement in rats. Materials and methods: Seventy-two male rats, aged 10 weeks old, were subjected to 10-cN closed-coil nickel-titanium springs for unilateral maxillary first molar tooth movement. One group of rats received a single treatment of extracorporeal shockwave treatment at 500 impulses at energy flux density 0.1 mJ/mm2, with a pulse rate of 5 pulses per second immediately after spring installation while the non-ESWT-treated group served as a control group. The rats were sacrificed at day 3, 7, 14, 21 and 28 for tooth movement evaluation and sample analyses. Faxitron radiography, histological, double bone labeling and gene expression analyses were performed. Serum biochemistry was evaluated at day 3, 7 and 28 of the study. Kruskal-Wallis analysis of variance was used to determine the mean difference among groups, and multiple comparisons were analyzed by Mann-Whitney-U tests with a significance level = 0.05. Results: The results demonstrated that tooth movement in the ESWT-treated rats (0.11 ± 0.07 mm) was impeded compared to the tooth movement in the non-ESWT-treated rats (0.44 ± 0.09 mm). ESWT up-regulated several osteoblastic and osteoclastic gene markers and cytokines; however, the effects on osteoclasts were only transient. Double-fluorescence bone labeling demonstrated that osteoblastic activity increased after ESWT treatment. There was no difference in systemic RANKL/OPG ratio between groups. Conclusions: ESWT at 500 impulse at energy flux density 0.1 mJ/mm2 increased osteoblast and osteoclast activities and imbalanced bone remodeling resulting in impeded tooth movement in rats.
... Among the PCSs there was 1 split mouth study. Five studies, two RCTs and three PCSs were not included in the meta-analysis due to a lack of the statistical information needed to compute the effect sizes (37,47,56,58,79). However, they were included in the quality assessment of the studies. ...
... The remaining studies were judged to have unclear risk of bias because no information was reported to allow judgment. The summary judgment of risk of bias was assessed to be low in four trials only (36)(37)(38)(39). The remaining trials were judged to have overall high risk of bias after all six domains' assessment was performed (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). ...
Article
Full-text available
Background: Miniscrews in orthodontics have been mainly used for anchorage without patient compliance in orthodontic treatment. The literature has reported changing failure rates. Objective: The aim of this review was to provide a precise estimation of miniscrew failure rate and the possible risk factors of the mechanically-retained miniscrews. Search method: Electronic search in database was undertaken up to July 2017 through the Cochrane Database of Systematic Reviews, MEDLINE, Scopus, and Ovid. Additional searching for on-going and unpublished data, hand search of relevant journals and grey lietraure were also undertaken, authors were contacted, and reference lists screened. Eligibility criteria: Randomised controlled trials (RCTs) and prospective cohort studies (PCSs), published in English were obtained, which reported the failure rate of miniscrews, as orthodontic anchorage, with less than 2 mm diameter. Data collection and analysis: Blind and induplicate study selection, data extraction, and risk of bias assessment were undertaken in this research. Failure rates and relevant risk factors of miniscrews with the corresponding 95 per cent confidence intervals (CIs) were calculated by using the random-effects model. The heterogeneity across the studies was assessed using the I2 and Chi2 test. The risk of bias was assessed using Cochrane risk of bias and Newcastle-Ottawa Scale. Subgroup and sensitivity analyses were performed in order to test the robustness of the results in meta-analysis. Results: The 16 RCTs and 30 PCSs were included in this research. Five studies were not included in the meta-analysis due to a lack of the statistical information needed to compute the effect sizes. About 3250 miniscrews from 41 studies were pooled in a random-effect model. The overall failure rate of miniscrews was 13.5 per cent (95% CI 11.5-15.9). Subgroup analysis showed that miniscrews 'diameter, length and design, patient age, and jaw of insertion had minimal effect on rate of miniscrews failure while the type of the gingivae and smoking had statistically significant effect. Conclusion: Miniscrews have an acceptably low failure rate. The findings should be interpreted with caution due to high-level of heterogeneity and unbalanced groups in the included studies. High quality randomized clinical trial with large sample sizes are required to support the findings of this review.
... In another study, Phimon Atsawasuwan et al. 9 showed that ESWT impeded tooth movement. A human study by Frank Falkensammer et al. 10 demonstrated that ESWT did not signi cantly accelerate tooth movement. Conversely, another study by Hazan-Molina et al. 11 presented that the addition of ESWT to the orthodontic force more than doubled the average tooth movement compared to the orthodontic force group after 21 days. ...
Preprint
Full-text available
Introduction: To date, studies exploring shockwave-assisted orthodontic tooth movement and tooth mobility have produced inconclusive results, largely attributable to varying methodologies and a lack of standardized reporting. This inconsistency hinders the ability to compare findings across studies and draw definitive conclusions. Objective: The aim of this review is reporting the gaps in shockwave and orthodontic tooth movement/tooth mobility studies and the future opportunities. Methods: Our search was conducted using PubMed, Scopus, Embase, and Web of Science up to August 2024. Searches were performed without restrictions on year, publication status, or language. Results: Upon reviewing the full texts of the articles, only six related studies were found, including four animal studies and two human studies. Key parameters, such as shockwave system characteristics (e.g., type of shockwave system, energy flux density, pulse frequency, focal area, focal distance), patient characteristics (e.g., facial soft tissue thickness, pulpal blood flow changes, salivary gland secretion changes), and study characteristics (e.g., long-term follow-up, tooth movement/mobility measurement tools and their error, number of shockwave episodes, distance of the shockwave system from the face, distance of the shockwave system from the target tooth, the phase during which shockwave is applied), are often not thoroughly described. Conclusions: This review emphasizes the need for standardized methodologies and comprehensive reporting in future studies to enable meaningful comparisons and reliable conclusions.
... Sono noti solo effetti collaterali minori associati all'applicazione di onde d'urto quali gonfiore, emorragie petecchiali ed ematomi [20] . Le onde [22] , l'efficacia della ESWT sul movimento ortodontico di molari inferiori [23] , la mobilità dei denti in pazienti che avevano completato il trattamento ortodontico con apparecchi fissi [24] e, infine, il flusso di sangue a livello pulpare (PBF) mediante analisi laser Doppler a partire dal giorno in cui erano stati rimossi i bracket [25] . sull'espressione di alcune citochine [1,27,28] . ...
... ESWT is a treatment method for the application of high-level sound waves to the body that stimulates the expression of cytokines during OTM (36). ESWT has a regenerative ability with no obvious adverse effects in the oral cavity (37). These shock waves can be an effective therapy option for accelerating OTM. ...
Article
Full-text available
The purpose of orthodontic treatment is to enhance patients’ life quality by improving their dentofacial functions and aesthetics. Minimal histological damage and pain, rapid tooth movement, short treatment duration, and stability of results are the major criteria for successful treatment. In recent years, the demand for orthodontic treatment has been increasing gradually. Prolonged duration of orthodontic treatment affects the psychological motivation of the patients and leads to several undesirable situations, such as caries, gingival recession, and root resorption. Thus, in recent years, related research has investigated the acceleration of orthodontic tooth movement. However, despite the various laboratory and clinical interventions designed to achieve faster tooth movement, uncertainties and unanswered questions about these techniques persist and warrant further investigation. Several surgical techniques as well as physical and chemical applications have been reported by previous studies to accelerate orthodontic tooth movement, most of which have been conducted on animals, with debatable applicability on humans. However, as tooth movement is a multifactorial phenomenon, further research is needed in the future. In this review, we describe the orthodontic tooth movement acceleration methods reported thus far.
... ESWT is a treatment method for the application of high-level sound waves to the body that stimulates the expression of cytokines during OTM (36). ESWT has a regenerative ability with no obvious adverse effects in the oral cavity (37). These shock waves can be an effective therapy option for accelerating OTM. ...
Article
Teeth are subject to a variety of mechanical forces and vectors. The periodontal ligament (PDL), fibrous tissue that connects the cementum of the tooth to the bony socket, plays a decisive role in transmitting force to alveolar bone via Sharpey fibers, transforming and converting these forces into biological signals. This interaction effects significant osteoblastic and osteoclastic responses via autocrine proliferative and paracrine responses. Recent discoveries of receptors for temperature and touch by the Nobel laureates David Julius and Ardem Patapoutian, respectively have a profound impact on orthodontics. Transient receptor vanilloid channel 1 (TRPV1), initially described as a receptor for temperature, has been proposed to participate in the sensing of force. TRPV4, another ion channel receptor, perceives tensile forces as well as thermal and chemical stimuli. Piezo1 and 2, the classic receptors for touch, in addition to the aforementioned receptors, have similarly been described on PDL-derived cells. In this text, we review the role of the temperature-sensitive ion channels and mechanosensitive ion channels on their biological function and influence in orthodontic treatment.
Article
OBJECTIVE The objective was to investigate the effect of extracorporeal shock wave therapy (ESWT) on the magnitude of orthodontic tooth movement, in a rat model, based on a previously established treatment protocol. DESIGN In conjunction with orthodontic force commencement, rats underwent ESWT. The amount of tooth movement along with different microarchitectural parameters were measured after three weeks by means of microcomputed tomography. In addition, the percentage of cells expressing vascular endothelial growth factor, the number of tartrate-resistant acid phosphatase (TRAP) positive cells/area and blood vessel density were evaluated both for the pressure and tension sides. RESULTS The addition of ESWT to the orthodontic force after three weeks more than doubled the average tooth movement. The addition of ESWT on the pressure side induced a significant decrease in volumetric bone mineral density. Blood vessel density and the number of TRAP positive cells were higher after the application of ESWT. CONCLUSION The induction of ESWT during orthodontic tooth movement in a rat model increases the rate of tooth movement by accelerating bone resorption on the pressure side and possibly enhances bone formation on the tension side.
Article
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In this proof-of-principle study, we established and implemented a cross-modality imaging (CMI) pipeline to characterize and compare bisphosphonate (BIS)-treated jawbones of Sprague-Dawley rats after tooth extraction after physical therapies (photobiomodulation and extracorporeal shockwave therapy (PBMT and ESWT)). We showcase the feasibility of such a CMI approach and its compatibility across imaging modalities to probe the same region of interest (ROI) of the same jawbone. Jawbones were imaged in toto in 3D using micro-Computed Tomography to identify ROIs for subsequent sequential 2D analysis using well-established technologies such as Atomic Force Microscopy and Scanning Electron Microscopy, and recent imaging approaches in biomedical settings, such as micro-X-Ray Fluorescence Spectroscopy. By combining these four modalities, multiscale information on the morphology, topography, mechanical stiffness (Young's modulus), and calcium, zinc and phosphorus concentrations of the bone was collected. Based on the CMI pipeline, we characterized and compared the jawbones of a previously published clinically relevant rat model of BIS-related osteonecrosis of the jawbone (BRONJ) before and after treatment with BISs, PBMT and ESWT. While we did not find that physical therapies altered the mechanical and elemental jawbone parameters with significance (probably due to the small sample size of only up to 5 samples per group), both ESWT and PBMT reduced pore thicknesses and bone-to-enamel distances significantly compared to the controls. Although focused on BIS-treated jawbones, the established CMI platform can be beneficial in the study of bone-related diseases in general (such as osteoarthritis or -porosis) to acquire complementary hallmarks and better characterize disease status and alleviation potentials.
Article
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The purpose of this animal study is to investigate the quantitative effects of extracorporeal shock waves applied at two different impulses and with two different applicators on orthodontic tooth movement. Thirty-five New Zealand rabbits were randomly divided into five groups (n = 7): the four experimental extracorporeal shock wave groups—focused/500 impulses, focused/1000 impulses, unfocused/500 impulses, and unfocused/1000 impulses—and the control group. Orthodontic tooth movement was achieved by application of reciprocal force between two maxillary incisors. In the experimental groups, animals received 500 or 1000 impulses of extracorporeal shock waves at 0.19 mJ/mm ² with focused or unfocused applicators depending on the group to which they belonged. These experiments were conducted on days 0, 7, and 14. Orthodontic tooth movement was measured with 0.01 mm accuracy at one-week intervals. On days 7 and 21, the bone-specific alkaline phosphatase levels were measured from blood samples. After 21 days, the animals were sacrificed and the area between the two maxillary incisors was stereologically examined. Orthodontic tooth movement in the focused/500 impulses and focused/1000 impulses groups was significantly increased compared to the control group. A significant difference in bone-specific alkaline phosphatase levels between the unfocused/500 impulses and control groups was found at 21st day. Stereological analysis showed that there were significant increases of the formation of new bone, connective tissue, and vessels in the experimental groups. The application of extracorporeal shock waves, especially with a focused applicator, could accelerate orthodontic tooth movement.
Chapter
Extracorporeal shockwaves are noninvasive mechanical forms of sound wave treatment. They were introduced in medical therapy approximately 30 years ago in order to disintegrate kidney stones. Over the last 15 years, extracorporeal generated shockwaves have been used in many fields of medicine due to their versatility and ability to stimulate healing processes by inducing neovascularization and differentiate stem cells into cells of the injured tissue to allow proper healing and regeneration.
Article
Introduction: Enhancement of bone regeneration is crucial to dental implantology. Growth factors play a significant role during osteogenesis and angiogenesis. Extracorporeal shock wave therapy (ESWT) enhances bone healing; however, no studies have yet been performed in oral implantology. Materials and methods: Twenty patients who underwent bilateral mandibular wisdom tooth removal were included. ESWT was applied to 1 side of the jaw. Blood samples were collected from the peripheral vein (PB), mandibular bone marrow without and with ESWT (BM-/+SW). Quantity and quality of the growth factors bone morphogenetic protein (BMP)-2, BMP-4, insulin-like growth factor 1 (IGF-1), vascular endothelial growth factor (VEGF), and transforming growth factor-beta (TGF-β) were investigated via ELISA and cell proliferation assay. Results: ELISA revealed superior amounts of IGF-1 and VEGF in BM-/+SW compared to PB (P < 0.05). TGF-β demonstrated no variance. Levels of BMP-2 and BMP-4 were too low for adequate detection in the ELISA. No difference was noticed upon ESWT. The cell proliferation assay did not identify any changes comparing PB versus BM-SW versus BM + SW. Conclusion: IGF-1 and VEGF are present at higher levels in mandibular bone marrow than in peripheral blood (PB). This study did not identify any benefits of extracorporeal shock wave therapy to increase the investigated growth factors.
Article
Current systematic reviews are important for health care providers in supporting their evidence-based practice decisions. Equally important is the ability to determine when a new systematic review is needed in view of the rapid publication output. The current best evidence from a 2013 systematic review suggests that certain treatments may accelerate orthodontic tooth movement. Our aim was to determine if an updated systematic review is needed on this topic by applying the modified Ottawa method. A systematic search of Pubmed, Embase, CENTRAL, and Web of Science databases, identical to the previous systematic review, was executed. Two authors performed screening for inclusion/exclusion of studies and selected full-text articles were reviewed. Qualitative and quantitative criteria were applied to assess studies describing the following types of interventions to accelerate tooth movement: electrical, photobiomodulation, micro-osteoperforations, vibration, corticotomy, and low-level laser therapy. The Ottawa method showed that studies produced since 2011 have (1) potentially invalidating evidence and description of new methods and (2) combined new data that would enhance the precision of the existing evidence on low-level laser therapy. These collectively indicate the need for a new systematic review on adjunct procedures to accelerate orthodontic tooth movement, which may offer new evidence and techniques not previously mentioned.
Data
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Introduction: Recently, several reviews have been published on the effects of medications on bone physiology and the clinical side effects in orthodontics. However, the effects of medications on the rate of orthodontic tooth movement have not been evaluated. Methods: A systematic literature review on the effects of medications and dietary supplements on the rate of experimental tooth movement was performed by using PubMed (1953-Oct 2007), Web of Science, and Biosis, complemented by a hand search. Results: Forty-nine articles were included in the review, but their interpretation was hindered by the variability in experimental design, magnitude of force applied during tooth movement, and medication regimens. Therapeutic administration of eicosanoids resulted in increased tooth movement, whereas their blocking led to a decrease. Nonsteroidal anti-inflammatory drugs (NSAIDs) decreased tooth movement, but non-NSAID analgesics, such as paracetamol (acetaminophen), had no effect. Corticosteroid hormones, parathyroid hormone, and thyroxin have all been shown to increase tooth movement. Estrogens probably reduce tooth movement, although no direct evidence is available. Vitamin D3 stimulates tooth movement, and dietary calcium seemed to reduce it. Bisphosphonates had a strong inhibitory effect. Conclusions: Medications might have an important influence on the rate of tooth movement, and information on their consumption is essential to adequately discuss treatment planning with patients. (Am J Orthod Dentofacial Orthop 2009;135: 16-26) R ecently, several reviews have been published about the biologic processes related to orth-odontic tooth movement (OTM). 1-4 These re-views describe similar reactions of periodontal cells and extracellular matrices to orthodontic force applica-tion. Briefly, the principal trigger for OTM is probably strain of the periodontal ligament cells, bone-related cells, and the extracellular matrix. 3 This strain leads to changes in gene expression in the cells by interactions between the cells and the extracellular matrix, whereby integrins play an important role. 2 Various cell-signaling pathways are activated, which ultimately lead to stim-ulation of periodontal ligament turnover, and localized bone resorption and bone deposition. 2-4 In addition, recent reviews by several authors have been published on the effects of systemic or local application of medications and the intake of dietary supplements, such as vitamins and minerals, during OTM. 5-7 In most cases, these reviews distinguish 2 categories of effects: those related to general bone physiology in terms of bone density, bone mineraliza-tion, bone turnover rate, and osteoclast differentiation; and clinical side effects induced by medications, such as gingival hyperplasia, xerostomia, and external root resorption. 5-7 Most reviews, however, did not report experimental data on the effects of medications or dietary supplements on the rate of OTM. 7-10 Nonetheless, such information is important for clinicians in communications with patients, because many patients use prescription and over-the-counter medications, as well as dietary supplements daily. Consequently, these substances can affect both the rate of OTM and the expected duration of treatment. 6,7,11 Therefore, we performed a systematic literature review based on experimental data on the sequelae of pharmaceutical interventions and the use of dietary supplements on the rate of OTM. Unfortunately, only a few human clinical trials have been published. 12-14 As a result, this review focuses mainly on well-controlled animal studies. Our review is organized around several regulatory systems of which disturbances might lead to pathologic
Article
Full-text available
Objective: To evaluate the effectiveness of interventions on accelerating orthodontic tooth movement. Materials and methods: We searched the databases of PubMed, Embase, Science Citation Index, CENTRAL, and SIGLE from January 1990 to August 2011 for randomized or quasi-randomized controlled trials that assessed the effectiveness of interventions on accelerating orthodontic tooth movement. The processes of study search, selection, and quality assessment were conducted independently in duplicate by two review authors. Original outcome data, if possible, underwent statistical pooling by using Review Manager 5. Results: Through a predefined search strategy, we finally included nine eligible studies. Among them, five interventions were studied (ie, low-level laser therapy, corticotomy, electrical current, pulsed electromagnetic fields, and dentoalveolar or periodontal distraction). Six outcomes were evaluated in these studies (ie, accumulative moved distance or movement rate, time required to move tooth to its destination, anchorage loss, periodontal health, pulp vitality, and root resorption). Conclusion: Among the five interventions, corticotomy is effective and safe to accelerate orthodontic tooth movement, low-level laser therapy was unable to accelerate orthodontic tooth movement, current evidence does not reveal whether electrical current and pulsed electromagnetic fields are effective in accelerating orthodontic tooth movement, and dentoalveolar or periodontal distraction is promising in accelerating orthodontic tooth movement but lacks convincing evidence.
Article
Full-text available
This study evaluated the effect of low-level laser irradiation on the speed of orthodontic tooth movement of canines submitted to initial retraction. Twenty-six canines were retracted by using NiTi spring (force of 150 g/side). Thirteen of those were irradiated with diode laser (780 nm, 20 mW, 10 sec, 5 J/cm(2)) for 3 days, and the other 13 were not irradiated and thus were considered the control group. Patients were followed up for 4 months, and nine laser applications were performed (three each month). The movement of the canines was evaluated through 3D casts, and the statistical analysis was performed with ANOVA and Tukey tests (p < 0.05). Periapical radiographs of the studied teeth were submitted to Levander, Malmgreen, and alveolar bone ridge analyses to evaluate tissue integrity and were compared with the Wilcoxon test (p < 0.05). A statistically significant increase in the movement speed of irradiated canines was observed in comparison with nonirradiated canines in all evaluation periods. No statistically significant difference was observed in bone and root resorption of canines, whether irradiated or not. The diode laser used within the protocol guidelines increased the speed of tooth movement. This might reduce orthodontic treatment time.
Article
Full-text available
Recently, several reviews have been published on the effects of medications on bone physiology and the clinical side effects in orthodontics. However, the effects of medications on the rate of orthodontic tooth movement have not been evaluated. A systematic literature review on the effects of medications and dietary supplements on the rate of experimental tooth movement was performed by using PubMed (1953-Oct 2007), Web of Science, and Biosis, complemented by a hand search. Forty-nine articles were included in the review, but their interpretation was hindered by the variability in experimental design, magnitude of force applied during tooth movement, and medication regimens. Therapeutic administration of eicosanoids resulted in increased tooth movement, whereas their blocking led to a decrease. Nonsteroidal anti-inflammatory drugs (NSAIDs) decreased tooth movement, but non-NSAID analgesics, such as paracetamol (acetaminophen), had no effect. Corticosteroid hormones, parathyroid hormone, and thyroxin have all been shown to increase tooth movement. Estrogens probably reduce tooth movement, although no direct evidence is available. Vitamin D3 stimulates tooth movement, and dietary calcium seemed to reduce it. Bisphosphonates had a strong inhibitory effect. Medications might have an important influence on the rate of tooth movement, and information on their consumption is essential to adequately discuss treatment planning with patients.
Article
Full-text available
This report describes the orthodontic treatment of a 20-year-old woman with missing mandibular first molars. Titanium screws were placed in the buccal alveolar bone between the roots of the first and second premolars to provide absolute anchorage for protraction of the second molars into the atrophic edentulous areas. More than 8 mm of protraction was done in 15 months without significant lingual tipping of the incisors. Increases in alveolar ridge width and vertical bone height were noted mesial to the second molar. Good posterior occlusion was achieved and has been maintained for 1 year after active treatment.
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It has been reported that both vascular endothelial growth factor (VEGF) and macrophage colonystimulating factor (M-CSF) can induce osteoclast recruitment. Thus, VEGF and M-CSF are considered to be closely involved in the bone remodeling process. The purpose of this study was to evaluate changes in VEGF and M-CSF expression during orthodontic treatment. The expression of VEGF and M-CSF mRNA in osteoblasts and fibroblasts was detected by in situ hybridization during experimental tooth movement in mice. Furthermore, the canine retraction side and the control side of orthodontic patients were compared, revealing a statistically significant increase in both VEGF and M-CSF concentrations in gingival crevicular fluid. These results suggest that orthodontic tooth movement causes an increase in VEGF and M-CSF levels. These factors may induce bone remodeling via osteoclastic bone resorption.
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The aim of this study was to perform a meta-analysis of the literature concerning the optimal force or range of forces for orthodontic tooth movement. Over 400 articles both on human research and animal experiments were found in Medline and by hand searching of main orthodontic and dental journals. Articles on animal experiments were in the majority. A wide range of animal species such as rat, cat, rabbit, beagle dog, monkey, mouse, and guinea pig were used. Besides variation in species, there was also a wide range of force magnitudes, teeth under study, directions of tooth movement, duration of experimental period, and force reactivation. Furthermore, hardly any experiments were reported that provide information on the relation between the velocity of tooth movement and the magnitude of the applied force. Data from human research on the efficiency of orthodontic tooth movement appeared to be very limited. The large variation in data from current literature made it impossible to perform a meta-analysis. Therefore, we have systematically reviewed the literature. It appeared that no evidence about the optimal force level in orthodontics could be extracted from literature. Well-controlled clinical studies and more standardized animal experiments in the orthodontic field are required to provide more insight into the relation between the applied force and the rate of tooth movement.
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The first experimental investigation of orthodontic tooth movement was published by Sandstedt in 1904-1905. After 100 years, there is a good understanding of the sequence of events at both tissue and cellular levels and now the current focus of research is at the molecular level. The techniques of reverse transcription-polymerase chain reaction and in situ hybridization to detect mRNAs of interest have revolutionized tooth movement studies and an expanding list of antibodies and enzyme-linked immunosorbent assays directed against human and animal proteins will facilitate their identification in tissue sections and/or culture supernatants. Nevertheless, although this technology has greatly simplified research for the clinical and laboratory investigator, message is not always translated into protein, and the presence of a protein does not necessarily mean it is biologically active. In vivo and in vitro methods have been widely used in tooth movement studies. However, data from in vitro models, in which the mechanical stimulus can be carefully controlled (tension versus compression; intermittent versus continuous), should be correlated with in vivo data from animal models. The current evidence suggests that downstream from the initial mechanotransduction event at focal adhesions which link the extracellular matrix to the cytoskeleton, mechanically induced remodelling is mediated by a complex feedback mechanism involving the synthesis of cytokines such as interleukin-1 (IL-1), IL-6, and receptor activator of nuclear factor k B ligand by cells of the osteoblast and/or fibroblast lineages. These in turn act in an autocrine/paracrine fashion to regulate the expression of transcription factors, cytokines, growth factors, enzymes, and structural molecules involved in the differentiation, proliferation, and function of mesenchymal and other cell types. Contrary to the impression gained from the literature, tooth movement is not confined to events within the periodontal ligament. Orthodontic tooth movement involves two interrelated processes: (1) deflection or bending of the alveolar bone and (2) remodelling of the periodontal tissues.
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Unlabelled: Periodontal inflammation with alveolar bone resorption is a hallmark of periodontitis. We hypothesized that extracorporeal shock wave therapy (ESWT) could promote the regeneration of alveolar bone following Porphyromonas gingivalis-induced periodontitis in rats. Rats were infected with P. gingivalis for 10 wks, which caused alveolar bone resorption. The rats were then treated with a single episode of 100, 300, or 1000 impulses of shock wave on both cheeks at energy levels 0.1 mJ/mm(2). Alveolar bone levels were determined at 0, 3, 6, and 12 wks following ESWT and compared with those in untreated controls. Infected rats treated with 300 and 1000 impulses demonstrated significantly improved alveolar bone levels at 3 wks compared with untreated controls, and the improved levels remained for at least 6 wks in most rats. The results demonstrated effective regeneration of alveolar bone by ESWT and suggested that ESWT should be evaluated as an adjunct in the regeneration of periodontal tissues following periodontal disease. Abbreviations: ESWT, extracorporeal shock wave therapy; PCR, polymerase chain-reaction.
Article
The first experimental investigation of orthodontic tooth movement was published by Sandstedt in 1904-1905. After 100 years, there is a good understanding of the sequence of events at both tissue and cellular levels and now the current focus of research is at the molecular level. The techniques of reverse transcription-polymerase chain reaction and in situ hybridization to detect mRNAs of interest have revolutionized tooth movement studies and an expanding list of antibodies and enzyme-linked immunosorbent assays directed against human and animal proteins will facilitate their identification in tissue sections and/or culture supernatants. Nevertheless, although this technology has greatly simplified research for the clinical and laboratory investigator, message is not always translated into protein, and the presence of a protein does not necessarily mean it is biologically active. In vivo and in vitro methods have been widely used in tooth movement studies. However, data from in vitro models, in which the mechanical stimulus can be carefully controlled (tension versus compression; intermittent versus continuous), should be correlated with in vivo data from animal models. The current evidence suggests that downstream from the initial mechanotransduction event at focal adhesions which link the extracellular matrix to the cytoskeleton, mechanically induced remodelling is mediated by a complex feedback mechanism involving the synthesis of cytokines such as interleukin-1 (IL-1), IL-6, and receptor activator of nuclear factor K B ligand by cells of the osteoblast and/or fibroblast lineages. These in turn act in an autocrine/paracrine fashion to regulate the expression of transcription factors, cytokines, growth factors, enzymes, and structural molecules involved in the differentiation, proliferation, and function of mesenchymal and other cell types. Contrary to the impression gained from the literature, tooth movement is not confined to events within the periodontal ligament. Orthodontic tooth movement involves two interrelated processes: (1) deflection or bending of the alveolar bone and (2) remodelling of the periodontal tissues.
Article
Objective: This study aimed to investigate PDL's cytokine concentration fluctuations after induction of orthodontic force with and without extracorporeal shock wave therapy in a rat model. Materials and methods: An orthodontic appliance was fabricated and applied between the molars and the incisors of rats. The rats were treated by a single episode of 1000 shock waves and gingival crevicular fluid was collected for 3 days. The expression and concentration of IL-1β and VEGF were evaluated by ELISA assay. On day 3 all rats were sacrificed and histologic and immunohistochemical assays were applied. Results: IL-1β concentration rose in both the treated and non treated shockwave groups on the first day, however it was statistically significantly higher in the treated group on day 2. No statistically significant difference was detected between the groups on day 3. The number/area of TRAP positive cells was higher in the non shockwave group than in the treated group. The percentage of cells expressing VEGF displayed the opposite trend. The findings regarding the immunohistochemical assay for IL-1β corresponded with those of the ELISA assay on day 3. Conclusion: The application of shockwaves during orthodontic tooth movement influences the expression of IL-1β and VEGF and may alternate the periodontal remodelling expected rate.
Article
Patients with functional disorders of the temporomandibular apparatus often show painful myogelosis, especially of the masseter muscle. The cause is hypertonia of the affected muscle. The aim of the presented single-blinded clinical trial was to analyze the effects of low-energy extracorporeal shock waves on patients with pain sensitivity in this region. Participating in the trial were 50 patients with painfull, palpable and sonographically evident myogelosis of the masseter muscle. Half of the patients received a single application of 250 impulses of 0.04 mJ/mm2. The second half received an equivalent placebo treatment with the shock-wave impact being inhibited by a neopreninsert. It was shown that in 64% of the patients significant alleviation of pain with palpable and sonographically evident softening of the myogelosis could be achieved. In 40% of the patients the therapeutic result could be conserved over a period of 2 weeks. The difference from the placebogroup was statistically highly significant. ESWT is thus an easy-to-use, non-invasive method of initial pain therapy for patients with functional disorders. To preserve the long-term therapeutic result, additional functional therapy is nevertheless necessary.
Article
Moving teeth rapidly and avoiding posttreatment relapse are fundamental goals of orthodontic treatment. In-vitro and animal studies suggest that the human hormone relaxin might increase the rate of movement and the stability through its effect on the periodontal ligament. The purpose of this study was to compare relaxin and a placebo with regard to tooth movement and stability in human subjects. A single-center, blinded, placebo-controlled, randomized clinical trial was used to examine the effect of relaxin on tooth movement and stability. Forty subjects were randomized 1:1 and received weekly injections of 50 μg of relaxin or a placebo for 8 weeks. Aligners programmed to move a target tooth 2 mm during treatment were dispensed at weeks 0, 2, 4, and 6. Movement was measured weekly on polyvinyl siloxane impressions that were scanned and digitized. The subjects were followed through week 12 to assess relapse. Tooth movement over the 8-week treatment period did not differ by treatment group (P = 0.995). By using an intent-to-treat analysis, we found that the mean tooth movement for both groups was 0.83 mm (SE, 0.08 for relaxin and 0.09 for the placebo). Relapse from weeks 8 to 12 was the same in both groups (P = 0.986), and the mean was -0.75 (SE, 0.07 for relaxin and 0.08 for theplacebo). No differences in tooth movement over 8 weeks of treatment or relapse at 4 weeks posttreatment were detected when comparing subjects who received weekly injections of relaxin with those who received a placebo. In both groups, an average of less than half of the programmed tooth movement was obtained after 8 weeks of treatment. The local doses of relaxin might have been too low to affect tooth movement or short-term relapse.
Article
During orthodontic tooth movement, activation of the vascular system in the compressed periodontal ligament (PDL), which becomes hypoxic, is essential for periodontal tissue remodelling. PERIOSTIN, an extracellular matrix protein, is expressed in PDL and its concentration is increased on the compressive side during orthodontic tooth movement. PERIOSTIN promotes angiogenesis through upregulation of matrix metalloproteinase (MMP)-2, which has been shown to be expressed via αvβ3 integrin/extracellular signal-related kinase (ERK) signalling pathway and vascular endothelial growth factor (VEGF). Therefore, we hypothesized that hypoxia-induced PERIOSTIN promotes MMP-2 expression via αvβ3 integrin/ERK signalling and VEGF in PDL cells. Human PDL cells were cultured in condition medium containing desferrioxamine (DFO) to mimic hypoxia. The total RNA, cell lysates or supernatant were collected, and MMP2 and VEGF expression, PERIOSTIN expression and ERK phosphorylation, and MMP-2 activity were analysed by real-time RT-PCR, western blot analysis, and zymography, respectively. A recombinant human PERIOSTIN or PERIOSTIN siRNA was applied to the cells, then the total RNA was extracted to measure MMP-2 and VEGF expression. The cells were treated with αvβ3 integrin-blocking antibody or ERK inhibitor followed by PERIOSTIN stimulation. MMP-2 expression was measured by real-time RT-PCR. PERIOSTIN was upregulated in a time-dependent manner in human PDL cells treated with DFO, a chemical hypoxia mimic. MMP-2 and VEGF expression, and MMP-2 activity were increased by DFO or PERIOSTIN treatment, and decreased by PERIOSTIN silencing. PERIOSTIN treatment also induced ERK phosphorylation, and PERIOSTIN-induced MMP-2 was reduced by αvβ3 integrin-blocking antibody or ERK inhibitor. These data suggest that PERIOSTIN upregulates MMP-2 expression via the αvβ3 integrin/ERK signalling pathway and VEGF expression in human PDL cells.
Article
The purpose of this study was to clinically evaluate miniscrew implant-supported maxillary canine retraction with corticotomy-facilitated orthodontics. The sample consisted of 13 adult patients (5 men, 8 women; mean age, 19 years) exhibiting Class II Division 1 malocclusion with increased overjet requiring the therapeutic extraction of the maxillary first premolars, with subsequent retraction of the maxillary canines. Corticotomy-facilitated orthodontics was randomly assigned to 1 side of the maxillary arch at the canine-premolar region, and the other side served as the control. By using miniscrews as anchorage, canine retraction was initiated via closed nickel-titanium coil springs applying 150 g of force per side. The following variables were examined over a 4-month follow-up period: rate of tooth movement, molar anchorage loss, plaque index, gingival index, probing depth, attachment loss, and gingival recession. The average daily rate of canine retraction was significantly higher on the corticotomy than the control side by 2 times during the first 2 months after the corticotomy surgery. This rate of tooth movement declined to only 1.6 times higher in the third month and 1.06 times higher by the end of the fourth month. No molar anchorage loss occurred during canine retraction on either the operated or the nonoperated side. There was no statistically significant difference between preoperative and postoperative measurements of plaque index, probing depth, attachment loss, and gingival recession. Corticotomy-facilitated orthodontics can be a feasible treatment modality for adults seeking orthodontic treatment with reduced treatment times.
Article
We have recently demonstrated that extracorporeal shock-wave therapy (ESWT) is effective in promoting the healing of dermal wounds and in regenerating alveolar bone lost through periodontal disease. The objective of the present study was to determine any antibacterial effect of ESWT on oral bacteria. Monoculture suspensions of 6 bacterial species were treated with 100 to 500 pulses of ESWT at energy flux densities (EFD) of 0.12 mJ/mm(2), 0.22 mJ/mm(2), and 0.3 mJ/mm(2). Following treatment, aliquots were plated for viability determination and compared with untreated controls. ESWT showed a significant microbicidal effect for Streptococcus mutans and an unencapsulated strain of Porphyromonas gingivalis following as few as 100 pulses at 0.3 mJ/mm(2) (p <or= 0.001). In addition, a significant disruption of bacterial aggregates was observed at lower EFDs. No significant reduction in viability was observed for all other bacteria at EFDs and pulses tested (p > 0.05). These findings suggest that low-energy ESWT may be bactericidal for selected oral bacteria.
Article
The rate of movement of the maxillary canines into the healed or recent extraction alveolus of the first premolar was measured in 22 patients aged 10–27 years. On one side of the dental arch, the first premolar was extracted. After a median time of 86 days, the contralateral first premolar was extracted and the distalization of both canines started using Gjessing canine retraction springs. The experiment was ended when one of the two canines had been sufficiently distalized. Recordings of the positions of the canines at the beginning of the study, at the start of the distalization and at the end were made from dental casts and standardized intraoral radiographs. The canine on the recent extraction side moved faster than that on the healed side, but also tipped somewhat more. The reasons for the increased tipping and the faster movement are discussed.
Article
Patients with functional disorders of the temporomandibular apparatus often show painful myogelosis, especially of the masseter muscle. The cause is hypertonia of the affected muscle. The aim of the presented single-blinded clinical trial was to analyze the effects of low-energy extracorporeal shock waves on patients with pain sensitivity in this region. Participating in the trial were 50 patients with painful, palpable and sonographically evident myogelosis of the masseter muscle. Half of the patients received a single application of 250 impulses of 0.04 mJ/mm2. The second half received an equivalent placebo treatment with the shock-wave impact being inhibited by a neopren insert. It was shown that in 64% of the patients significant alleviation of pain with palpable and sonographically evident softening of the myogelosis could be achieved. In 40% of the patients the therapeutic result could be conserved over a period of 2 weeks. The difference from the placebo group was statistically highly significant. ESWT is thus an easy-to-use, non-invasive method of initial pain therapy for patients with functional disorders. To preserve the long-term therapeutic result, additional functional therapy is nevertheless necessary.
Article
Extracorporeal-generated shock waves were introduced approximately 20 years ago to disintegrate kidney stones. This treatment method substantially changed the treatment of urolithiasis. Shock waves have become the treatment of choice for kidney and ureteral stones. Urology, however, is not the only medical field for the potential use of shock waves for problems. Shock waves subsequently have been used in orthopaedics and traumatology to treat various insertional tendinopathies (enthesiopathies) and delayed unions and nonunions of fracture. Shock wave application also has been used in the treatment of tendinopathies in veterinary conditions (race horses). The concept of orthopaedic disorders is that shock waves stimulate or reactivate healing processes in tendons, surrounding tissue and bones, probably through microdisruption of avascular or minimally vascular tissues to encourage revascularization, release of local growth factors, and the recruitment of appropriate stem cells conducive to more normal tissue healing. The current author will give an overview of history and basic research of the application of shock waves in medicine.
Article
Despite the success in clinical application, the exact mechanism of shock wave therapy remains unknown. We hypothesized that shock wave therapy induces the ingrowth of neovascularization and improves blood supply to the tissues. The purpose of this study was to investigate the effect of shock wave therapy on neovascularization at the tendon-bone junction. Fifty New Zealand white rabbits with body weight ranging from 2.5 to 3.5 kg were used in this study. The right limb (the study side) received shock wave therapy to the Achilles tendon near the insertion to bone. The left limb (the control side) received no shock wave therapy. Biopsies of the tendon-bone junction were performed in 0, 1, 4, 8 and 12 weeks. The number of neo-vessels was examined microscopically with hematoxylin-eosin stain. Neovascularization was confirmed by the angiogenic markers including vessel endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOS) expressions and endothelial cell proliferation determined by proliferating cell nuclear antigen (PCNA) expression examined microscopically with immunohistochemical stains. The results showed that shock wave therapy produced a significantly higher number of neo-vessels and angiogenesis-related markers including eNOS, VEGF and PCNA than the control without shock wave treatment. The eNOS and VEGF began to rise in as early as one week and remained high for 8 weeks, then declined at 12 weeks; whereas the increases of PCNA and neo-vessels began at 4 weeks and persisted for 12 weeks. In conclusion, shock wave therapy induces the ingrowth of neovascularization associated with early release of angiogenesis-related markers at the Achilles tendon-bone junction in rabbits. The neovascularization may play a role to improve blood supply and tissue regeneration at the tendon-bone junction.
Article
Tooth movement has been studied largely with respect to the force required for tipping when pressure distribution varies along the length of the periodontal ligament. But important factors for effective canine translation include the nature and magnitude of applied stress and the patient's cell biology. The purpose of this research was to test 3 hypotheses: (1) the velocity of tooth translation (v(t)) is related to applied stress and growth status, (2) a threshold of stress accounts for the lag phase, and (3) v(t) is correlated with the ratio (AI) of 2 cytokines (IL-1beta, IL-1RA) measured in gingival crevicular fluid (GCF) and stimulated whole blood (SWB). Continuous maxillary canine retraction stresses of 13 kPa and 4, 26, or 52 kPa were applied bilaterally in 6 growing and 4 adult subjects for 84 days. Dental models and GCF samples were collected at 1- to 14-day intervals. Cytokines were measured in GCF and SWB cell cultures. V(t) was positively related to stress and was higher in growing subjects (P = .001). It was also related to AI(GCF) in growers (R2= 0.56) and nongrowers (R2= 0.72). Canines moved with 52 kPa showed a lag phase, and postlag phase AI(GCF) was twice that of lag phase AI(GCF). Mean v(t) and associated AI(GCF) during the postlag phase were nearly double the values for canines moved with 13 and 26 kPa. SWB production of cytokines was dose-dependent. For growing subjects, SWB IL-1RA was correlated with v(t) (R = 0.70-0.72), and AI(SWB) and IL-1beta concentrations were correlated with AI(GCF) (R = 0.73-0.78). V(t) varied with growth status and stresses < or = 52 kPa; stresses of < 52 kPa showed no lag phase; and equivalent stresses yielded subject-dependent differences in v(t), which correlated with cytokines in GCF and SWB.
Article
Our recent studies demonstrated that local administration of recombinant human vascular endothelial growth factor (rhVEGF) during experimental tooth movement enhanced the number of osteoclasts and the rate of tooth movement. The purpose of this study was to examine the effect of anti-VEGF polyclonal antibody on osteoclastic differentiation, the amount of tooth movement, and the degree of tooth relapse in 30-day-old mice. First, these mice were subjected to various doses of anti-VEGF polyclonal antibody, with tooth movement for three days. In the next study, daily injections of 10-microg antibody were administered for 18 days during the experimental tooth movement. The amount of tooth movement was measured as in our previous study. Furthermore, in the third study, we administered daily injection of 10-microg antibody and measured tooth relapse after the experimental tooth movement for 45 days. The osteoclasts number in 10- and 50-microg antibody two-time injection group was significantly smaller than that in the controls (P < .05). The number of osteoclasts was decreased more substantially by daily injection of 10-microg antibody, showing more significant differences from the controls (P < .01). The amount of tooth movement was significantly less in the experimental group than in the controls on days 15 and 18 (P < .05). Furthermore, the amount of relapse in the experimental group was significantly less than that in the controls on days 9 and 11 after removal of the appliance (P < .05). These results show that the treatment of anti-VEGF polyclonal antibody markedly reduced the osteoclasts number and inhibited the amount of tooth movement and relapse of moved teeth.
Article
To test the hypothesis that mechanical forces combined with low-level laser therapy stimulate the rate of orthodontic tooth movement. This study was a double blind, randomized placebo/control matched pairs clinical trial to test the efficacy of GaAlAs low-level laser therapy (LLLT) on 12 young adult patients who required retraction of maxillary canines into first premolar extraction spaces using tension coil springs with fixed edgewise appliance. LLLT was applied on the mucosa buccally, distally and palatally to the canine on the test side and using a pseudo-application on the placebo side. Dental impressions and casts were made at the commencement of the trial and at the end of the first, second and third months after starting the trial. Measurement of tooth movements was made on each stage model using a stereo microscope. There was no significant difference of means of the canine distal movement between the LLLT side and the placebo side for any time periods (p-value = 0.77). The energy density of LLLT (GaAlAs) at the surface level in this study (25 J/cm(2)) was probably too low to express either stimulatory effect or inhibitory effect on the rate of orthodontic tooth movement.
Article
Adaptive biochemical response to applied orthodontic force is a highly sophisticated process. Many layers of networked reactions occur in and around periodontal ligament and alveolar bone cells that change mechanical force into molecular events (signal transduction) and orthodontic tooth movement (OTM). Osteoblasts and osteoclasts are sensitive environment-to-genome-to-environment communicators, capable of restoring system homeostasis disturbed by orthodontic mechanics. Five micro-environments are altered by orthodontic force: extracellular matrix, cell membrane, cytoskeleton, nuclear protein matrix, and genome. Gene activation (or suppression) is the point at which input becomes output, and further changes occur in all 5 environments. Hundreds of genes and thousands of proteins participate in OTM. Gene-directed protein synthesis, modification, and integration form the essence of all life processes, including OTM. Bone adaptation to orthodontic force depends on normal osteoblast and osteoclast genes that correctly express needed proteins at the right times and places. Cell membrane receptor-ligand docking is an important initiator of signal transduction and a discovery target for new bone-enhancing drugs. Despite progress in identification of regulatory molecules, the genetic mechanism of "orchestrated synthesis" between different cells, tissues, and systems remains largely unknown. Interpatient variation in mechanobiological response is most likely due to differences in periodontal ligament and bone cell populations, genomes, and protein expression patterns. Discovery of mutations in OTM-associated genes of orthodontic patients, including those regulating osteoclast bone-matrix acidification, chloride channel function, and osteoblast-derived mineral and protein matrices, will permit gene therapy to restore normal matrix and protein synthesis and function. Achieving selectivity in targeting abnormal genes, cells, and tissues is a major obstacle to safe and effective clinical application of gene engineering and stem-cell mediated tissue growth. Orthodontic treatment is likely to evolve into a combination of mechanics and molecular-genetic-cellular interventions: a change from shotgun to tightly focused communication with OTM cells.
Article
Molecules produced in various diseased tissues, or drugs and nutrients consumed regularly by patients, can reach the mechanically stressed paradental tissues through the circulation, and interact with local target cells. The combined effect of mechanical forces and one or more of these agents may be inhibitory, additive or synergistic. The objective of this review is to outline the mechanisms of action and effects of some commonly used drugs on tissue remodeling and orthodontic tooth movement. All the existing published literature on the effects of various drugs that are prescribed by orthodontists, which are consumed by patients for systemic diseases and those that are known to promote and retard the tooth movement process was obtained and subjected to thorough review process. All the drugs reviewed have therapeutic effects, as well as side effects, that may influence the cells targeted by orthodontic forces. Therefore, it is imperative that the orthodontist pays close attention to the drug consumption history of each and every patient, before and during the course of orthodontic treatment. When the use of drugs is revealed, their effects and side effects on tissue systems should be explored, to determine their potential influence on the outcome of mechanotherapy. Drug-consumption history must be an integral part of every orthodontic diagnosis and treatment plan.
Article
The variables affecting speed of tooth movement are unquantified. In particular, the effects of stress and human biological variations are unknown. Therefore, our objectives in this study were to determine relationships between (1) stress and velocity of tooth translation (v(t)), and (2) interleukin-1 (IL-1) gene cluster polymorphisms, IL-1beta and IL-1 receptor antagonist (IL-1RA) in gingival crevicular fluid (GCF), and v(t). Ten subjects had their maxillary first premolars extracted and cheek wipe samples genotyped. In each subject, a maxillary canine received 26 kPa and the other received 13 or 52 kPa of stress. GCF samples and tooth movements were measured at 9 or 10 visits over 84 days. Mean v(t) for canines retracted by 13, 26, and 52 kPa were 0.054, 0.072, and 0.064 mm per day, respectively. Faster v(t) was shown from 26 kPa than 13 kPa (P = .015) and 52 kPa (P = .030), with higher IL-1beta/IL-1RA in GCF at experimental relative to control sites, and in subjects with homozygosity for allele 1 (A1,A1) compared with at least 1 copy of A2 (A2+) at IL-1RN(VNTR(86 bp)) (P = .032), and with A2+ compared with A1,A1 at IL-1B(+3954) (P = .051). Stress, IL-1beta/IL-1RA in GCF, and IL-1 gene cluster polymorphisms are related to v(t).
Article
Orthodontic treatment induces a distortion of the extracellular matrix of the periodontium, resulting in alterations in cytoskeletal configuration. Cytokines are known to facilitate this process by inducing cellular proliferation, differentiation, and stimulation of periodontal remodeling. The aim of the present study was to measure a panel of proinflammatory cytokines (PICs) in crevicular fluid (GCF) samples during tooth movement of short and long durations. Twelve patients (11 to 27 years of age) participated in this study: six patients each for tooth movement of short and long duration. GCF sampling was done at different times, ranging from 24 hours to 4 months after force application. The profiles of PICs were analyzed with a multiplex technique. PICs were elevated significantly in the early stage of tooth movement but at different time points. Interleukin (IL)-1beta and -6 and tumor necrosis factor-alpha (TNF-alpha) reached significant levels at 24 hours; IL-8 reached a significant elevation at 1 month. During the linear stage of tooth movement, all cytokines were diminished to their baseline levels. The results demonstrated that IL-1beta, -6, and -8 and TNF-alpha play a significant role during the early stage of tooth movement but not during the linear stage. Once the microenvironment of periodontal tissue is activated by an orthodontic force, several key PICs are produced to trigger a cascade of cellular events. The periodontal system stabilizes at a new physiological homeostasis as indicated by the downregulation of the early-phase PICs.
Article
Extracorporeal shock wave treatment appears to be effective in patients with avascular necrosis of the femoral head. However, the pathway of biological events whereby this is accomplished has not been fully elucidated. The purpose of this study was to investigate the effect of extracorporeal shock waves on vascular endothelial growth factor (VEGF) expression in necrotic femoral heads of rabbits. VEGF expression was assessed by immunohistochemistry, quantitative real-time PCR, and Western blot analysis. The degree of angiogenesis was also assessed, as determined by the microvessel density (MVD), the assessment of which was based on CD31-expressing vessels. Bilateral avascular necrosis of femoral heads was induced with methylprednisolone and lipopolysaccharide in 30 New Zealand rabbits. The left limb (the study side) received shock wave therapy to the femoral head. The right limb (the control side) received no shock wave therapy. Biopsies of the femoral heads were performed at 1, 2, 4, 8, and 12 weeks. Western blot analysis and real-time PCR showed that shock wave therapy significantly increased VEGF protein and mRNA expression, respectively, in the subchondral bone of the treated necrotic femoral heads. Compared with the contralateral control without shock wave treatment, the VEGF mRNA expression levels increased to a peak at 2 weeks after the shock wave treatment and remained high for 8 weeks, then declined at 12 weeks, whereas the VEGF protein expression levels increased to a peak at 4 weeks after the shock wave treatment and remained high for 12 weeks. The immunostaining of VEGF was weak in the control group, and the immunoreactivity level in the shock-wave-treated group increased at 4 weeks and persisted for 12 weeks. The most intensive VEGF immunoreactivity was observed in the proliferative zone above the necrotic zone. At 4, 8, and 12 weeks after the shock wave treatment, MVD in subchondral bone from treated femoral heads was significantly higher than that in subchondral bone from untreated femoral heads. These data clearly show that extracorporeal shock waves can significantly upregulate the expression of VEGF. The upregulation of VEGF may play a role in inducing the ingrowth of neovascularization and in improving the blood supply to the femoral head.
Article
Nonhealing wounds are a major, functionally-limiting medical problem impairing quality of life for millions of people each year. Various studies report complete wound epithelialization of 48 to 56% over 30 to 65 d with different treatment modalities including ultrasound, topical rPDGF-BB, and composite acellular matrix. This is in contrast to comparison control patients treated with standard wound care, demonstrating complete epithelialization rates of 25 to 39%. Extracorporeal shock wave therapy (ESWT) may accelerate and improve wound repair. This study assesses the feasibility and safety of ESWT for acute and chronic soft-tissue wounds. Two hundred and eight patients with complicated, nonhealing, acute and chronic soft-tissue wounds were prospectively enrolled onto this trial between August 2004 and June 2006. Treatment consisted of debridement, outpatient ESWT [100 to 1000 shocks/cm(2) at 0.1 mJ/mm(2), according to wound size, every 1 to 2 wk over mean three treatments], and moist dressings. Thirty-two (15.4%) patients dropped out of the study following first ESWT and were analyzed on an intent-to-treat basis as incomplete healing. Of 208 patients enrolled, 156 (75%) had 100% wound epithelialization. During mean follow-up period of 44 d, there was no treatment-related toxicity, infection, or deterioration of any ESWT-treated wound. Intent-to-treat multivariate analysis identified age (P = 0.01), wound size < or =10 cm(2) (P = 0.01; OR = 0.36; 95% CI, 0.16 to 0.80), and duration < or =1 mo (P < 0.001; OR = 0.25; 95% CI, 0.11 to 0.55) as independent predictors of complete healing. The ESWT strategy is feasible and well tolerated by patients with acute and chronic soft tissue wounds. Shock wave therapy is being evaluated in a Phase III trial for acute traumatic wounds.
Article
This study tested the hypothesis that shock wave (SW) therapy applied to bone marrow-derived mononuclear cells (BMDMNCs) enhances the formation of vascular endothelial growth factor (VEGF) and positively stained CD31 (CD31+) cells, an endothelial phenotype. The BMDMNCs (approximately 1.2 x 10(6) cells/2 femoral bones) were obtained from adult male Sprague-Dawley rats and SW therapy was applied once to BMDMNCs in group I (140 SW: defined as 140 shots in total, given at 0.09 mJ/mm2), group II (280 SW), and group III (560 SW). Group IV was not treated by SW and served as the control group. Six experiments were done in each group. The BMDMNCs were cultured following SW therapy and the supernatants were collected on days 1, 3, 7 and 14 for assessment of VEGF levels. Immunocytochemical staining and flow cytometric measurement were performed on days 0 and 14. Experimental results demonstrated that VEGF levels were significantly higher in groups I-III than in group IV, and in group II than in group I at all intervals, and in group II than in group III on day 14 (all p values <0.005). Additionally, the number of positively stained VEGF cells on days 1, 3 and 14 and the number of newly formed CD31+ cells on day 14 were significantly higher in group II than in group IV (all p values <0.001). These data suggest that application of SW to BMDMNCs significantly enhanced VEGF production and promoted differentiation of BMDMNCs into endothelial phenotype cells.
Article
To assess the relationship between periodontal parameters and cervical root resorption in orthodontically moved teeth. In a standardized experimental tooth movement in 16 periodontally healthy subjects, 29 pre-molars were tipped buccally for 8 weeks. Eighteen contralateral pre-molars not subjected to orthodontic movement served as controls. Plaque Index (PI), Gingival Index (GI), probing depth and bleeding on probing were assessed three times before and six times during the experimental phase. Teeth were extracted and scanned in a micro-computed tomography scanner. The presence or absence, and the severity of cervical root resorption were evaluated on the three-dimensional reconstruction of the scans by two calibrated examiners. Overall, periodontal parameters were not different between the test and the control teeth. Clear signs of buccal cervical resorption were detected on 27 of 29 orthodontically moved teeth and on one control tooth. Ten subjects had perfect oral hygiene and no gingivitis, whereas six subjects showed a moderate level of plaque and gingivitis (>20% occurrences of PI or GI with >0). No relationship could be demonstrated between resorption and periodontal parameters. Nearly all orthodontically moved teeth showed signs of cervical resorption. Periodontal parameters were unrelated to this important side effect of orthodontic treatment.
Article
To review recent literature to determine strength of clinical evidence concerning the influence of various factors on the efficiency (rate of tooth movement) of closing extraction spaces using sliding mechanics. A comprehensive systematic review on prospective clinical trials. An electronic search (1966-2006) of several databases limiting the searches to English and using several keywords was performed. Also a hand search of five key journals specifically searching for prospective clinical trials relevant to orthodontic space closure using sliding mechanics was completed. Outcome Measure - Rate of tooth movement. Ten prospective clinical trials comparing rates of closure under different variables and focusing only on sliding mechanics were selected for review. Of these ten trials on rate of closure, two compared arch wire variables, seven compared material variables used to apply force, and one examined bracket variables. Other articles which were not prospective clinical trials on sliding mechanics, but containing relevant information were examined and included as background information. CONCLUSION - The results of clinical research support laboratory results that nickel-titanium coil springs produce a more consistent force and a faster rate of closure when compared with active ligatures as a method of force delivery to close extraction space along a continuous arch wire; however, elastomeric chain produces similar rates of closure when compared with nickel-titanium springs. Clinical and laboratory research suggest little advantage of 200 g nickel-titanium springs over 150 g springs. More clinical research is needed in this area.