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PubMed1998

Outcomes of the surgical exposure, bonding and eruption of 82 impacted maxillary canines.

BACKGROUND: Advances in bonding techniques and materials allow for reliable bracket placement on ectopically positioned teeth. This prospective study evaluates the outcome of forced orthodontic eruption of impacted canine teeth in both palatal and labial positions. METHODS: Eighty-two impacted maxillary canines in 54 patients were included in the study and were observed for 18 to 30 months after exposure. Following exposure by means of a palatal flap or an apically repositioned buccal flap, an orthodontic traction hook, with a ligation chain attached, was bonded to each impacted tooth using a light cured orthodontic resin cement. A periodontal dressing was placed over the surgical site for a period of time. RESULTS: All teeth were successfully erupted. Complications consisted of: failure of initial bond, at the time of surgery, which required rebonding; premature debonding at the time of pack removal and; debonding of brackets during orthodontic eruption. There was no infection, eruption failure, ankylosis, resorption or periodontal defect (pocket greater than 3 mm) associated with any of the exposed teeth. Attached gingiva of less than 3 mm was seen in only two of the buccally positioned canines (9%). CONCLUSION: Forced orthodontic eruption of impacted maxillary canines with a well bonded orthodontic traction hook and ligation chain, used in conjunction with a palatal flap or an apically repositioned labial flap, results in predictable orthodontic eruption with few complications.

Adolescent↗
PubMed1999

Interleukin-1beta and beta-glucuronidase in gingival crevicular fluid from molars during rapid palatal expansion.

This study examined whether the inflammatory mediators interleukin (IL-1beta) and beta-glucuronidase (betaG) are present in the gingival crevicular fluid (GCF) of children undergoing rapid palatal expansion and whether their levels vary upon activation of the appliance and movement of the maxillary first molars. Nine adolescent patients who needed palatal expansion were studied. Each patient received a periodontal prophylaxis and instruction in proper home care, including rinsing with chlorhexidine. Four weeks later, a modified Hyrax appliance was inserted. The jackscrew was activated twice daily until the appropriate expansion was achieved. GCF samples were collected at 2 pretreatment observation periods and 9 observation periods after placement of the appliance. Samples were collected with filter paper strips and analyzed by means of ELISA and time-dependent fluorometry for IL-1beta and betaG, respectively. The values recorded at the observation period 2 weeks after the periodontal prophylaxis were used as baseline. Paired t tests were used to compare mediator levels at this baseline to the levels obtained at each of the subsequent observations. The results indicate that (1) betaG and IL-1beta are present in GCF of young, healthy individuals, (2) their levels decrease following a strict regimen of plaque control, (3) orthodontic/orthopedic forces evoke changes in the levels of the inflammatory mediators IL-1beta and betaG in the periodontal tissues that can be detected in GCF. The results of this study support the hypothesis that mechanical stimulus causes an inflammatory reaction within the periodontal tissues, which in turn may trigger the biological processes associated with bone remodeling.

Adolescent↗
PubMed1999

Histological and histochemical quantification of root resorption incident to the application of intrusive force to rat molars.

This study was conducted to investigate the nature of root resorption resulting from intrusive forces applied to the rat lower molars, by means of histological and histochemical techniques with tartrate resistant acid phosphatase (TRAP). Thirty-eight 13-week-old Wistar strain male rats were used. Intrusive force was created by a fixed appliance which was adjusted to exert an initial force of 50 g for the duration of 1, 2, and 3 weeks. The degree of root resorption and distribution of TRAP positive cells were evaluated. On the root surface, the TRAP positive scores were low in the apical regions. Significant differences in the scores were found in the inter-radicular region of the roots between the experimental and control groups for the 2- and 3-week groups. More active resorption of bone occurred during the experimental period, as denoted by greater TRAP positive scores on the bone than on the root surface. Root resorption scores in the apical root region were larger in the 2- and 3-week groups than in the 1-week group. Significant differences in the root resorption scores were also found between the 1- and 3-week groups in the inter-radicular region, indicating that intrusive force application of a longer duration may lead to a higher frequency of root resorption. It is shown that, irrespective of the level of TRAP positive cells and root resorption scores, the degree of root resorption activity is higher in the apical root region than in the inter-radicular area. These results indicate that cellular cementum may be resorbed more easily because of its richer organic components and low mineralized structure.

Acid Phosphatase↗
PubMed1976

The effect of different extraction sites upon incisor retraction.

1. From this study, it was found that in cases treated by the Begg technique one can anticipate greater retraction of the anterior dental units in nonextraction (see article) cases, in both types of premolar extraction cases, and in cases, involving extraction of first molars plus first premolars than would be expected on the basis of root surface area resistance values. 2. There is a likely explanation for this. Molars were maintained upright and allowed to move bodily only while incisors were not only moved bodily but often partially tipped as well. 3. The actual mean anterior retraction in first molar extraction cases exhibited a close approximation to the expected mean anterior retraction values in relation to root surface resistance values. 4. Second premolar extraction is one answer to overretraction and has the added edge of creating even less incisor retraction than second premolar extraction. 5. It was also found that the extraction of premolars alone did not result (see article) in a significant change in the increased eruption of the third molars into functional occlusion. A very significant improvement in the rate of sucessful third molar eruption was found in first molar extraction cases and in cases involving extraction of first molars plus first premolars. 6. The mean ages of the patients in the various treatment categories at the start of treatment were similar enough to each other to suggest that age at the start of treatment had no bearing on the success rate of third molar erup tion. Extraction-site selection seemed to be the dominating factor in successful third molar eruption. 7. It was found that the group of cases that exhibited the least amount of anterior retraction also inhibited the least amount of anterior relapse and, conversely, the group of cases exhibiting the greatest amount of anterior retraction also exhibited the greatest amount of anterior relapse. (see article) 8. The nonextraction cases, with no extraction space to close, were treated in the shortest mean time, while the eight-tooth (first molar plus first premolar) extraction cases having the greatest amount of extraction space required the greatest amount of mean treatment time.9. In conclusion, it can be said that changing the location of the extraction site resulted in a change in relative root surface areas of the opposing anchor units in the anterior and posterior segments. There was a definite and predictable change in the amount of anterior retraction achieved by varying the location of the extraction site. This should be considered in the diagnosis, so that a desired treatment goal for the final position of the incisors within the facial profile can be achieved.

Bicuspid↗
PubMed2003

Differentiation and functions of osteoclasts and odontoclasts in mineralized tissue resorption.

The differentiation and functions of osteoclasts (OC) are regulated by osteoblast-derived factors such as receptor activator of NFKB ligand (RANKL) that stimulates OC formation, and a novel secreted member of the TNF receptor superfamily, osteoprotegerin (OPG), that negatively regulates osteoclastogenesis. In examination of the preosteoclast (pOC) culture, pOCs formed without any additives expressed tartrate-resistant acid phosphatase (TRAP), but showed little resorptive activity. pOC treated with RANKL became TRAP-positive OC, which expressed intense vacuolar-type H(+)-ATPase and exhibited prominent resorptive activity. Such effects of RANKL on pOC were completely inhibited by addition of OPG. OPG inhibited ruffled border formation in mature OC and reduced their resorptive activity, and also induced apoptosis of some OC. Although OPG administration significantly reduced trabecular bone loss in the femurs of ovariectomized (OVX) mice, the number of TRAP-positive OC in OPG-administered OVX mice was not significantly decreased. Rather, OPG administration caused the disappearance of ruffled borders and decreased H(+)-ATPase expression in most OC. OPG deficiency causes severe osteoporosis. We also examined RANKL localization and OC induction in periodontal ligament (PDL) during experimental movement of incisors in OPG-deficient mice. Compared to wild-type OPG (+/+) littermates, after force application, TRAP-positive OC were markedly increased in the PDL and alveolar bone was severely destroyed in OPG-deficient mice. In both wild-type and OPG-deficient mice, RANKL expression in osteoblasts and fibroblasts became stronger by force application. These in vitro and in vivo studies suggest that RANKL and OPG are important regulators of not only the terminal differentiation of OC but also their resorptive function. To determine resorptive functions of OC, we further examined the effects of specific inhibitors of H(+)-ATPase, bafilomycin A1, and lysosomal cysteine proteinases (cathepsins), E-64, on the ultrastructure, expression of these enzymes and resorptive functions of cultured OC. In bafilomycin A1-treated cultures, OC lacked ruffled borders, and H(+)-ATPase expression and resorptive activity were significantly diminished. E-64 treatment did not affect the ultrastructure and the expression of enzyme molecules in OC, but significantly reduced resorption lacuna formation, by inhibition of cathepsin activity. Lastly, we examined the expression of H(+)-ATPase, cathepsin K, and matrix metalloproteinase-9 in odontoclasts (OdC) during physiological root resorption in human deciduous teeth, and found that there were no differences in the expression of these molecules between OC and OdC. RANKL was also detected in stromal cells located on resorbing dentine surfaces. This suggests that there is a common mechanism in cellular resorption of mineralized tissues such as bone and teeth.

Acid Phosphatase↗
PubMed1992

[Progressive pneumatization of the basal maxillary sinus after extraction and space closure].

By superimposing 32 pretreatment and post-treatment orthopantomograms, it proved possible to quantify the progressive pneumatisation of the basal maxillary sinus following extraction and orthodontic space closure. It was shown that if pneumatisation was present prior to treatment (more than 30% of root length), clear extension of the basal antrum could be expected. The tendency towards pneumatisation is significantly higher after molar as compared with premolar extraction. Possible reasons for these findings and their clinical significance are discussed.

Embolism, Air↗
PubMed1991

[Space closure after anterior tooth loss due to trauma].

The orthodontic treatment of space closure after loss of anterior teeth due to trauma asks not only for a dental movement but for careful consideration. These depend on various factors such as age, tooth shape, tooth size, extent of the traumatic damage and the present malocclusion. The possibilities and limits of an orthodontic treatment have to be estimated to allow a correct decision for each patient, whereby some compromise has to be accepted. This is demonstrated with two examples.

Adult↗
PubMed1992

[The periodontal changes following orthodontic tooth movement--a retrospective histological study in humans. 1].

UNLABELLED: The maxilla of a deceased (19 years, female) who was treated with a straight-wire-appliance could be taken in autopsy. The specimen was prepared histologically in the horizontal plane. The type of tooth movement was reconstructed by comparing the treatment documents of the beginning (photo of the cast model, radiograph) with the photo and radiographs of the specimen. In that manner the histological findings could be correlated with the type of tooth movement. RESULTS: Localisation and amount of tissue changes at the roots depend on the type of tooth movement and the morphology of bone. The histological findings are more pronounced than the radiographs show. Histologically verified bony dehiscences in the facial or oral cortical plate are not to be diagnosed by macroscopic inspection of the specimen.

Adult↗
PubMed2003

Movement of periodontally affected teeth after guided tissue regeneration (GTR)--an experimental pilot study in animals.

PURPOSE: The purpose of the present experimental animal study was to examine the relevance of regenerative periodontal therapy (membrane procedure, application of enamel matrix proteins) to subsequent orthodontic tooth movement. MATERIAL AND METHOD: After extraction of the third premolars in four foxhounds, 64 three-wall bony defects were artificially generated at the first and second premolars and colonized by periodontopathogenic microorganisms. After 6 months, regenerative periodontal therapy was performed: scaling, conditioning of the root surfaces with citric acid, combination of enamel matrix protein (Emdogain, Biora, Malmö, Sweden) and resorbable Vicryl membrane (Ethicon, Norderstedt, Germany). The defects at the first premolars served as the control group. In the test group eight second premolars were intruded 1 month after surgical intervention; in addition eight premolars were translatorily distalized, i.e. moved both into the defect (pressure side) and away from the defect (tension side). Qualitative histologic analysis was performed on non-decalcified microsection samples using the polychrome sequential labeling and histomorphometry. RESULTS: The histologic findings revealed extensive periodontal regeneration in the control group, at the intruded root segments, and on the tension sides. Cemento- and osseoneogenesis yielded mean values of 70-80%, whereas values for epithelial down-growth were low. The bony regeneration on the pressure side was markedly reduced; however, nearly 70% new formation of root cementum with Sharpey's fibers was also recorded. CONCLUSION: Periodontal regenerative procedures appear to enhance conditions for the movement of teeth with attachment loss; clinical testing is promising.

Animals↗
PubMed2005

Light microscopic and SEM findings after orthodontic treatment--analysis of a human specimen.

AIM: The hard and soft tissue damage caused by orthodontic forces has so far, for obvious ethical reasons, been investigated in animal models primarily. However, the validity of these results as applied to humans remains controversial. The particular value of this study is that the maxilla of a young adult could be analyzed histologically. Thus it was possible to retrospectively study the effects of a routine orthodontic therapy using light microscopy. MATERIAL AND METHODS: The upper jaw of a 24-year-old patient was investigated. He had been in orthodontic treatment with a straight-wire-appliance using superelastic materials for 18 months. Both posterior segments were analyzed in the horizontal plane using the microsection method according to Donath (toluidine blue staining). Both central incisors were analyzed using a scanning electron microscope (SEM). The examination was performed qualitatively and histomorphometrically. RESULTS: 170 lateral root resorptions were found in the nine posterior teeth, while pressure sites and interference areas with the buccal and sinus cortical bone were predominantly affected. However, the extent of root resorption was minimal: mean length 979 +/- 766 microm, mean depth 208 +/- 133 microm. The lateral root erosions presented high repair potential: 55.6% of resorption length, and 28% of the depth were repaired in 76% of all lesions. CONCLUSION: The incidence of detected root resorptions seems high at first. However, the prognosis of the affected teeth is not critically impaired, due to the lesions' minor extent (length, depth) and their high repair capacity.

Adult↗
PubMed2000

Application of bone remodeling theories in the simulation of orthodontic tooth movements.

A numerical model that calculates bone apposition and resorption around a tooth root on the basis of bone remodeling theories was developed to simulate orthodontic tooth movements. The model was used to calculate different kinds of orthodontic tooth movements, that were then compared with the expected movements based on clinical experience. For simulation of the movements the root of a canine was modeled in an idealized way in the form of an elliptical paraboloid and was processed with a finite element program. The finite element model was loaded with defined force systems. Two model assumptions were used to calculate the bone remodeling process. The mechanical loads firstly in the periodontal ligament and secondly in the alveolar bone were taken to simulate the following tooth movements: 1. mesial tipping around the center of resistance (force system at the bracket: isolated torque MY = 5 Nmm), 2. rotation around the long axis of the tooth (MZ = 5 Nmm), 3. uncontrolled tipping around the root tip (FX = 1 N, MZ = 5 Nmm), 4. canine retraction (FX = 1 N, MY = -9.5 Nmm, MZ = 5 Nmm), 5. and 6. extrusion/intrusion (FZ = +/- 0.5 N, MX = +/- 2.5 Nmm). Comparison with clinical experience was performed by calculating the orthodontic tooth movements based on the assumption of a fixed position of the center of resistance. It could be demonstrated that the numerical model of orthodontic bone remodeling can be used to calculate orthodontic tooth movements. However, the results are strongly dependent on the model assumptions. The model simulating the bone remodeling on the basis of the loading of the periodontal ligament delivers results that are in very good accordance with the biomechanical assumptions of the position of the center of resistance. However, marked side effects occurred with the second model, especially in the simulations of uncontrolled tipping, translation and intrusion/extrusion. Clinically, these side effects cannot be observed.

Bone Remodeling↗
PubMed2003

Sympathectomy causes increased root resorption after orthodontic tooth movement in rats: immunohistochemical study.

Accumulating evidence suggests that the sympathetic nervous system modulates inflammatory responses and bone remodeling. We have studied the effects of sympathectomy and orthodontic tooth movement (OTM) on root resorption, immunocompetent cell recruitment, neuropeptide, neurokinin-1 receptor (NK1-R), and interleukin 6 (IL-6) expression. Experimental rats (n=8) had the right superior cervical ganglion surgically removed, whereas control rats (n=6) underwent sham surgery. Three days later, all rats had the right maxillary first molar moved mesially by an orthodontic appliance. The rats were perfused 13 days later, and the right maxillae were processed for immunohistochemistry by using primary antibodies directed against ED1 antigen, CD43, substance P (SP), NK1-R, neuropeptide Y (NPY), and IL-6. Following OTM, sympathectomized (SCGx) rats had significantly more root resorption (P<0.01) and SP-immunoreactive (IR) fibers (P=0.01) in the compressed periodontal ligament (PDL) compared with control rats. There was a significant decrease in recruitment of CD43+ cells in the pulp after OTM in SCGx rats compared with control rats (P=0.02). An upregulation of NK1-R immunoreactivity was observed surrounding the hyalinized tissue, and an increase in the number of NK1-R IR cells and density of SP-IR fibers was present in first molar pulp of all rats. NPY-IR fibers were absent in the compressed PDL of SCGx and control rats. Thus, OTM induces remodeling not only around the periodontal tissues, but also in the dental pulp. The sympathetic nerves have an inhibitory effect on hard tissue resorption and a stimulatory effect on CD43+ cell recruitment after OTM.

Animals↗
PubMed2004

Local injection of 1,25-dihydroxyvitamin D3 enhanced bone formation for tooth stabilization after experimental tooth movement in rats.

The present investigation evaluated the effect of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) on alveolar bone formation during tooth movement in rats. Orthodontic elastics were inserted between the maxillary first and second molars on bilateral sides in male rats. 1,25(OH)2D3 was injected locally, at the concentration of 10(-10) M, once every 3 days in the submucosal palatal area of the root bifurcation of the molar on the right side. Histomorphometric analysis revealed that tooth movement without application of 1,25(OH)2D3 decreased the mineral appositional rate (MAR) on the compression area at 7 days. Repeated injections of 1,25(OH)2D3 in the orthodontically treated animals distinctly stimulated alveolar bone formation on the mesial side at 14 days. There was a significant increase in MAR associated with elevated osteoblast surface (Ob.S/BS) value on the tension surface. These findings suggest that local application of 1,25(OH)2D3 enhances the reestablishment of supporting tissue, especially alveolar bone of teeth, after orthodontic treatment.

Animals↗
PubMed1975

On optimum orthodontic force theory as applied to canine retraction.

The study reported here was undertaken in an attempt to contribute, from a theoretical standpoint, to the knowledge and understanding of optimum force theory, particularly as it may be relevant to canine retraction. The following statements are derived from my analysis of the applicable published literature and the results of the present investigation: 1. This study lends support to the beliefs, from the findings of previous investigations, 20, 22 that the center of rotation for simple tipping is three tenths to four tenths of the distance from the root apex to the alveolar crest and that the center of resistance is at approximately midroot for the single-rooted tooth. 2. For a given distal driving force, increasing the countertipping couple from zero causes the center of rotation to "move" from a point near the apical end of the middle third of the root to the root apex and then to infinity. That is, the couple to be developed by the appliance to produce crown movement is smaller than required for bodily movement. Also, increasing the rotational stiffness of a canine-retraction appliance will result in greater inherent potential for canine root control and a greater probability of achieving bodily movement. 3. In a specific orthodontic case, an average periodontal stress value (active force divided by root area) can be used as a basis of comparison of suggested active force magnitudes among several single-rooted teeth having different root surface areas, provided all teeth are to experience the same form of displacement (for example, bodily movement). Similarly, differences in average stress magnitudes developed in the periodontium, rather than differences in root surface areas, are actually the basis for the differential force theory. 4. Clinical studies have suggested that the size of active force for bodily movement or root movement of a given tooth be two to three times that employed in simple tipping of the same tooth. Induced stress levels in the periodontium, especially at the root apex and alveolar crest locations, can be related to suggested magnitudes of aplied crown force components.

Activator Appliances↗