The effects of dietary loading on the transdifferentiation of condylar chondrocytes.

INTRODUCTION: Transdifferentiation of chondrocytes into bone cells explains most condylar growth during prenatal and early postnatal stages, but the mechanisms regulating chondrocyte transdifferentiation during late postnatal growth remain unknown. This study aimed to quantify the effects of dietary loading on chondrocyte-derived osteogenesis during late postnatal condylar growth. METHODS: Two compound mouse lines were used to trace the fate of chondrocyte lineage in vivo. Twelve 3-week-old male Aggrecan-CreERT2 (AcanLineage); R26RTdTomato; 2.3 Col10a1-GFP and twelve 3-week-old male Col10a1-Cre (Col10a1Lineage); R26RTdTomato; 2.3Col1a1-GFP were randomly divided into experimental (soft-food diet, n = 6) and control (hard-food diet, n = 6) groups and kept for 6 weeks. One time, tamoxifen injections were given to AcanLineage mice at 3 weeks. Radiographic, microcomputed tomographic, and histomorphometric analyses were performed. RESULTS: Radiologic analysis showed that mice with a soft-food diet had smaller mandible lengths as well as decreased bone volume and density for their condylar process. Histologically, mice with soft diets had reduced activity in chondrocyte proliferation and maturation compared with the controls. Cell lineage tracing results showed the number of AcanLineage-derived bone cells (293.8 ± 39.8 vs 207.1 ± 44.6; P = 0.005), as well as total bone cells (445.6 ± 31.7 vs 360.7 ± 46.9; P = 0.004), was significantly higher in the hard-diet group than in the soft-diet group, whereas the number of non-AcanLineage-derived bone cells was not significantly different among groups (P = 0.938). Col10a1Lineage mice showed the same trend. CONCLUSIONS: Dietary loading directly affects condyle chondrogenesis and chondrocyte transdifferentiation, which alters the extent of condylar growth and remodeling.

Short-term effects of mechanical loading on the transdifferentiation of condylar chondrocytes.

INTRODUCTION: Transdifferentiation of chondrocytes into bone cells explains most of the prenatal and early postnatal condylar growth, but its role during later postnatal growth and the mechanisms regulating transdifferentiation remain unknown. This study aimed to quantify the effects of mechanical loading on chondrocyte-derived osteogenesis during late postnatal condylar growth using a short-term mandibular laterotrusion model. METHODS: Thirty 4-week-old Aggrecan-CreERT2, R26RtdTomato, and 2.3Col1a1-GFP compound mice received tamoxifen injections and were divided into control and experimental groups. Appliances were bonded to shift the mandibles of the experimental mice for 5 days, causing protrusion and retrusion of the right and left condyles, respectively. Radiographic, microcomputed tomographic, and histomorphometric analyses were performed. RESULTS: The experimental and control groups showed substantial transdifferentiation of chondrocytes into bone cells. The experimental mice developed asymmetric mandibles, with the protrusive side significantly longer than the retrusive side. The protrusive condyles showed significantly increased chondrogenesis and greater numbers of chondrocyte-derived osteogenic cells, especially in the posterior third. The opposite effects were seen on the retrusive side. CONCLUSIONS: Transdifferentiation of chondrocytes into bone cells occurs during late postnatal condylar growth. Laterotrusion regulates condylar chondrogenesis and chondrocyte transdifferentiation, which alters the amount and direction of condylar growth. Our study demonstrated that chondrocytes are key players in condylar bone formation and should be the focus of studies to control and further understand condylar growth.

Keys to Class II correction: A comparison of 2 extraction protocols.

INTRODUCTION: The purpose of this study was to evaluate the effects of 2 extraction patterns on incisor and molar movements in patients with growing Class II Division 1. METHODS: The sample included 54 patients 10-17 years of age treated by 2 private practice orthodontists using Tweed directional force mechanics, 4 premolar extractions, J-hook headgears, and Class II elastics or Saif springs. The sample was divided on the basis of having maxillary and mandibular first premolars (4/4) or maxillary first and mandibular second premolars (4/5) extracted. Each group included 27 patients. Treatment lasted 2.8 ± 0.60 years and 2.6 ± 0.54 years for the 4/4 and 4/5 groups, respectively. Pretreatment (T1) and posttreatment lateral cephalograms and dental casts were evaluated. Cranial base, mandibular, and maxillary superimpositions were performed to quantify tooth movements and displacements. RESULTS: There were no statistically significant T1 between-group differences in crowding or in the SNA, SNB, ANB, and MPA angles. Analyses of covariance, controlling for statistically significant (P <0.05) differences in T1 mandibular incisor position, showed that mandibular first premolars extractions produced greater (1.6 mm) mandibular incisor retraction than second premolar extractions. The mandibular first molars were protracted significantly more (0.7 mm) after the second premolar than the first premolar extractions. Within-group changes of the MPA, between-group differences in the changes in MPA, and the amount of vertical eruption of the maxillary and mandibular molars were not significantly different between the 2 extraction patterns. CONCLUSIONS: Extraction of mandibular second premolars enhances Class II molar correction, with greater mesial first molar movement and less distal incisor movement. Neither extraction pattern has an effect on the MPA or the vertical dimension (ie, there was no "wedge effect").

Correlation between adolescent orthodontic quality of life and ABO Discrepancy Index in an orthodontic treatment-seeking population: A cross-sectional study.

OBJECTIVE: To evaluate the association between adolescents' orthodontic quality of life before initiating orthodontic treatment and their objective case complexity as measured by the American Board of Orthodontics' Discrepancy Index (DI). DESIGN AND SETTING: A single-centre, cross-sectional survey study. METHODS: The Orthodontic Quality of Life Assessment Survey (OQoLAS) was administered to 240 adolescents (aged 11-14 years) during their record-gathering appointment. After completion of the survey, a DI score was calculated for each patient based on pretreatment measurements. Pearson correlation coefficients, r, were used to assess the association of DI scores with OQoLAS total and subdomain scores. A multiple linear regression of OQoLAS total scores adjusting for age, gender and DI scores was conducted. RESULTS: The study did not find a strong correlation between OQoLAS and DI scores (r = 0.10; P = 0.6497). On average, the OQoLAS scores (functional, emotional and social subdomains of OQoLAS) were slightly higher among girls than among boys but there was no statistical difference for total OQoLAS score between boys and girls (42.4 vs. 45.4, P = 0.2005). However, there was a significant difference in oral health perception rating between boys and girls, with girls being more likely to rate their oral health positively (adjusted P = 0.0226). The total DI scores of boys with respect to girls were not statistically different (P = 0.4256). The components of the DI that showed highest score were for cephalometric measures, followed by overjet; and the lowest scores were for lateral open bite and buccal posterior crossbite. The measure of association analysis did not show any strong correlation between the OQoLAS (total score and subdomain scores), and DI score or any of its components. CONCLUSION: Malocclusion severity was not found to be correlated with orthodontic quality of life in adolescents aged 11-14 years seeking orthodontic treatment.

A preliminary 3-D comparison of rapid and slow maxillary expansion in children: A randomized clinical trial.

BACKGROUND: This study compared the effects of rapid maxillary expansion (RME) and slow maxillary expansion (SME) using cone-beam computed tomography (CBCT). AIM: To evaluate the skeletal and dentoalveolar effects produced by two different maxillary expansion protocols. DESIGN: Eligibility criteria included maxillary transverse deficiencies in children (mean age, 8.18 years old), randomly assigned to either RME or SME. At the outcome analysis phase, a sample of 29 subjects were analysed (RME group, N = 16 and SME group, N = 13). CBCT scans taken before expansion and 6 months later were evaluated. Five posterior and 6 anterior transverse measurements were made at different vertical levels. Treatment changes were analysed using paired t tests; independent t tests were used to compare the two groups. RESULTS: There were statistically significant (P<.05) increases in maxillary width at the skeletal, alveolar, and dental levels for both groups, with significantly smaller increases at the more superior than inferior levels. The RME group exhibited statistically larger width increases than the SME group for all measures except interorbital width, anterior alveolar process width, and intercanine width. The group differences were greater for anterior than posterior apical base widths. CONCLUSIONS: Rapid maxillary expansion produced greater orthopaedic effects than slow maxillary expansion, with the greatest effects occurring in the anterior apical base.

Effects of transverse bodily movements of maxillary premolars on the surrounding hard tissue.

INTRODUCTION: This experimental study was designed to (1) produce buccal translation of maxillary premolars and (2) evaluate the effects on the buccal alveolar bone. METHODS: A randomized split-mouth study was designed based on 7 adult male beagle dogs. The experimental side received a custom cantilever appliance fabricated to produce a translatory force through the maxillary second premolar's center of resistance. The contralateral second premolar received no appliance and served as the control. The premolars underwent 6-7 weeks of buccal translation, followed by 3 weeks of fixed retention. Biweekly tooth movements were evaluated using intraoral and radiographic measurements. Pretreatment and posttreatment models were measured to assess tipping. Three-dimensional microscopic tomography was used to quantify the amount and density of buccal bone. Bone formation and turnover were assessed using fluorescent labeling, hematoxylin and eosin staining, tartrate-resistant acid phosphatase staining, and bone sialoprotein immunostaining. RESULTS: The applied force (100 g of force) translated (1.4 mm) and minimally tipped (4°) the experimental teeth. Lateral translation produced dehiscences at the mesial and distal roots, with 2.0 mm and 2.2 mm loss of vertical bone height, respectively. Bone thickness decreased significantly (P < 0.05) at the apical (∼0.4 mm), midroot (∼0.4 mm), and coronal (∼0.2 mm) levels. Fluorescent imaging, hematoxylin and eosin staining, and immunostaining for bone sialoprotein all showed new bone formation extending along the entire periosteal surface of the second premolar's buccal plate. Tartrate-resistant acid phosphatase staining demonstrated greater osteoclastic activity on the experimental than that of control sections. CONCLUSIONS: New buccal bone forms on the periosteal surface during and after tooth translation, but the amount of bone that forms is less than the amount of bone loss, resulting in a net decrease in buccal bone thickness and a loss of crestal bone.

The prevalence of clinically meaningful malocclusion among US adults.

OBJECTIVE: The primary purpose of this study was to statistically evaluate age, ethnic and sex differences in the prevalence of clinically meaningful malocclusions among adults. SETTING AND SAMPLE POPULATION: A random sample of 8804 untreated US adults between 17 and 46 years of age was selected from the Third National Health and Nutrition Examination Survey data. MATERIALS & METHODS: Three ethnic (non-Hispanic White, non-Hispanic Black and Mexican Americans) and three age (17-26, 27-36 and 37-46 years) groups were evaluated. Subjects with and without clinically meaningful malocclusions were categorized based on the established cut-off values. Chi-square analyses were performed to determine differences in prevalence. RESULTS: The prevalence of clinically meaningful mandibular incisor irregularity, overjet and overbite increased significantly (P < 0.05) with age, while posterior crossbite decreased. There were statistically significant ethnic differences in the prevalence of incisor irregularity, overbite, overjet, open bite and reverse overjet. Males had a significantly higher prevalence of clinically meaningful mandibular incisor irregularity, overbite, open bite and reverse overjet than females. One-third of US adults exhibited no clinically meaningful malocclusions. CONCLUSIONS: There are age, ethnic and sex differences in the prevalence of clinically meaningful malocclusions that characterize approximately two-thirds of untreated US adults.

Low-level laser therapy (830 nm) on orthodontic pain: blinded randomized clinical trial.

The objective of this research was to compare the effect single low-level laser therapy (LLLT) irradiation on pain perception in patients having fixed appliance treatment in the clinic of orthodontics. Sixty-two patients were recruited to participate in this randomized, double-blinded, placebo-controlled study. The patients were assigned to four groups: group I-laser on the right side; group II-placebo on the right side; group III-laser on the left side; group IV-placebo on the left. The laser or placebo was applied before separation, 24 and 48 h after separation of their first permanent molars in the lower arch. Just after the separation, the average of the pain for the placebo group was 1.6, significantly greater than the average of 1.1 registered for the laser group (p = 0.013). After 24 h and before the new irradiation, the values registered among the different groups did not show any differences. In relation to the gender, only after the first irradiation in placebo group, the female had a level of pain (0.1) significantly higher (p = 0.04) compared to male, and after 48 h, the group where the laser was applied had a difference (p = 0.04) among the gender with a value of lower pain for men (0.6) than for women (1.6).The laser irradiation to minimize the pain was only effective when applied immediately after treatment and separation. In general way, there were no differences between the genders, except after the first placebo group irradiation in which the female had a significantly higher level of pain compared to male and after 48 h. The pain cycle observed in this study had its peak in 24 h, both for laser's and placebo's group.

Effects of micro-osteoperforations on tooth movement and bone in the beagle maxilla.

PURPOSE: The purpose of this study was to determine how micro-osteoperforations (MOPs) affect tooth movements, bone turnover, bone density, and bone volume. METHODS: A split-mouth experimental design with 7 beagle dogs was used to evaluate bone surrounding maxillary second premolars that had been retracted for 7 weeks. One month after the maxillary third premolars were extracted, 8 MOPs (1.5 mm wide and 7 mm deep) were created without flaps with the use of the Propel device (6 were placed 3 mm distal to the second premolar and 2 were placed in the premolar furcation) on one randomly chosen side. The maxillary second premolars were retracted bilaterally with the use of 200 g nickel-titanium closed coil springs. Tooth movements were measured intraorally and radiographically. Microscopic computed tomography was used to evaluate the material density and volume fraction of bone distal to the premolars. Hematoxylin and eosin-stained and fluorescent sections were used to examine the bone remodeling. RESULTS: Neither the intraoral (P = 0.866) nor radiographic (P = 0.528) measures showed statistically significant side differences in tooth movements. There also were no statistically significant differences in the density (P = 0.237) or volume fraction (P = 0.398) of bone through which the premolars were being moved. Fluorescent and histologic evaluations showed no apparent differences in osteoblasts, osteoclasts, or mineralization of bone near the teeth being moved. Bone healing was evident in and near the MOP sites, which had nearly but not completely healed after 7 weeks. Regions of acellular bone were evident extending ∼0.8 mm from the MOP sites. CONCLUSIONS: MOPs placed 3 mm away from teeth do not increase tooth movements and have limited and transitory effect on bone.

Localizing the osseous boundaries of micro-osteoperforations.

INTRODUCTION: The aim of this work was to determine how far the effects of micro-osteoperforations (MOPs) extend within bone by quantifying the damage caused and the short-term bony adaptations that occur in and around the injury site. METHODS: With the use of a split-mouth design, 34 MOPs (Propel) were randomly placed in the mandibular furcal bone of 13 beagle dogs either 2 or 4 weeks before killing them. The control side received no treatment. Vickers hardness microindentation, microscopic computed tomography, and histologic analyses were performed to evaluate the bone surrounding the MOPs. RESULTS: Microfractures produced during insertion extended ∼0.6 mm from the MOP sites. Cortical and trabecular bone were significantly less dense on the experimental than on the control side up to 4.2 mm from the edge of the MOP, but side differences were small (<5%) beyond 1.5 mm from the MOP. Experimental cortical bone was significantly softer than the control bone up to 0.8 mm from the MOP after 2 weeks of healing, and up to 0.5 mm from the MOP after 4 weeks of healing. Hematoxylin and eosin stained sections of cortical and trabecular bone showed small areas of woven bone within the MOP sites after 2 weeks, and acellular areas of bone extending ∼0.5 mm from the MOP. After 4 weeks of healing, there were greater amounts of woven bone, as well as early signs of lamellar bone, in and around the MOP sites. Markedly increased TRAP activity extending up to 2.5 mm from the MOP was evident after 2 weeks, but not after 4 weeks. Vital fluorescence staining showed diffuse bone deposition on the experimental side up to 1.5 mm from the MOP margin. CONCLUSIONS: When MOPs are performed in beagle dogs, demineralization is transient and healing of the injured area, as well as remineralization of bone affected by MOP placement, begins during the first 2 weeks. Although the transient effects extend farther, the principal effects extend only ∼1.5 mm from the MOP site.

Mandibular alignment changes after full-fixed orthodontic treatment: a systematic review and meta-analysis.

BACKGROUND: Although post-treatment mandibular alignment has been extensively investigated, the findings remain controversial. OBJECTIVES: The objective was to assess mandibular alignment changes, as measured by the irregularity index, of patients who underwent full-fixed orthodontic treatment and were followed up at least 1 year after retention. SEARCH METHODS: MEDLINE, EMBASE, and Cochrane library, in addition, the reference lists of included studies, were screened. The search was conducted up to April 2018. SELECTION CRITERIA: The study designs included both interventional and observational studies of orthodontic patients who received either extraction or non-extraction treatment. DATA COLLECTION AND ANALYSIS: The interventional studies were assessed using the Cochrane Collaboration's risk of bias assessment tool. The quality of the observational studies was evaluated using National Institution of Health quality assessment tools. The first two authors independently applied the eligibility criteria, extracted the data, and assessed the risk of bias. Any conflicts were resolved with consensus discussion with the third author. RESULTS: The search retrieved 11 326 articles, 170 of which were assessed for eligibility. There were 44 studies included in the qualitative assessments and 30 in the meta-analyses. The studies included 1 randomized control trial (RCT) and 43 observational studies. The RCT was judged to have a high risk of bias and all of the observational studies had either fair or poor quality. The meta-analysis was based on studies judged to be of fair quality, including a total of 1859 patients. All meta-analyses were performed using random-effect models. The standardized mean difference between post-treatment and post-retention irregularity was 1.22 (95% CI, 1.04-1.40) and 0.85 (95% CI, 0.63-1.07) after extraction and non-extraction treatments, respectively. There was a substantial heterogeneity for the extraction (I2 = 75.2%) and non-extraction (I2 = 70.1%) studies. The follow-up duration (1-10 versus 10-20 years) explained 33% of the heterogeneity, with longer follow-up studies showing more irregularity. LIMITATIONS: The quality of evidence provided by the studies was low. There was a risk of publication bias, and the search was limited to English language. CONCLUSIONS AND IMPLICATIONS: Post-treatment mandibular irregularity increases are limited. Irregularity increases are slightly greater in patients treated with mandibular premolars extractions, and in patients followed up over longer periods of time. REGISTRATION: The study protocol was not registered.

Effects of bone grafting, performed with corticotomies and buccal tooth movements, on dehiscence formation in dogs.

INTRODUCTION: A randomized split-mouth experiment was performed in dogs to determine the effects of bone grafting, together with corticotomies and buccal tooth movements, on dehiscence formation. METHODS: Bilateral full-thickness mucoperiosteal buccal flaps were raised, and corticotomies were performed with a piezosurgery unit adjacent to the maxillary second premolars in 7 dogs. The experimental (graft+) side received a demineralized freeze-dried allograph and a resorbable collagen membrane. The second premolars were expanded with archwires for 9 weeks, followed by 3 weeks of consolidation. Soft tissue measurements included probing depths, attachment loss, and recession. Tooth movements were monitored using intraoral, radiographic, and model measurements. Bone surrounding the second premolars was evaluated with microcomputed tomography. New bone formation was analyzed histologically using calcein and alizarin fluorescent labels, and hematoxylin and eosin stains. RESULTS: Postsurgical healing progressed normally with no signs of infection. The graft+ and control (graft-) second premolars underwent similar amounts of expansion (about 2.5 mm intraorally; about 1.7 mm radiographically) and tipping, with no statistically significant side differences. The soft tissue periodontium was not affected on either side. There were bony dehiscences on both the graft+ and graft- sides, with slightly but significantly (P = 0.038) more bone loss over the mesial root on the graft- side. Bone material density was significantly (P = 0.028) greater on the graft+ side. Buccal bone apposition was evident surrounding graft particles, and mineralized particulate graft material was present at the apical aspect of the roots on the graft+ side. CONCLUSIONS: Bone grafting does not prevent dehiscence formation because only a limited amount of new bone is formed, primarily at the more apical aspects of the tooth's roots.

Prevalence of gingival recession after orthodontic tooth movements.

INTRODUCTION: This study was designed to evaluate the long-term prevalence of gingival recession after orthodontic tooth movements, focusing on the effects of mandibular incisor proclination and expansion of maxillary posterior teeth. METHODS: Records of 205 patients (162 female, 43 male) were obtained from 2 private practice orthodontists. Using pretreatment (age, 14.0 ± 5.9 years) and posttreatment (age, 16.5 ± 6.0 years) lateral cephalograms and dental models, mandibular incisor proclination and maxillary arch widths were measured. Gingival recession was measured based on posttreatment and postretention (age, 32.3 ± 8.5 years) intraoral photographs and models. Associations between tooth movements and gingival recession were evaluated statistically. RESULTS: Only 5.8% of teeth exhibited recession at the end of orthodontic treatment (only 0.6% had recession >1 mm). After retention, 41.7% of the teeth showed recession, but the severity was limited (only 7.0% >1 mm). There was no relationship between mandibular incisor proclination during treatment and posttreatment gingival recession. Incisors that finished treatment angulated (IMPA) at 95° or greater did not show significantly more recession than did those that finished less than 95°. There were weak positive correlations (r = 0.17-0.41) between maxillary arch width increases during treatment and posttreatment recession. CONCLUSIONS: Orthodontic treatment is not a major risk factor for the development of gingival recession. Although greater amounts of maxillary expansion during treatment increase the risks of posttreatment recession, the effects are minimal.

Longitudinal cephalometric growth of untreated subjects with Class II Division 2 malocclusion.

INTRODUCTION: Our objective was to evaluate the craniofacial growth of subjects with untreated Class II Division 2 malocclusion. METHODS: A mixed longitudinal sample of 39 white Class II Division 2 subjects was analyzed at 5 time points: T1 (6 or 7 years), T2 (9 or 10 years), T3 (12 or 13 years), T4 (15 or 16 years), and T5 (18 or 19 years). They were compared with an age- and sex- matched sample of Class I controls. Seventeen measurements (12 angular, 5 proportional) were computed. Multilevel modeling procedures were used to statistically describe the growth changes and to evaluate group differences. RESULTS: There were no group differences in the relative sizes and anteroposterior positions of the jaws during childhood, adolescence, or early adulthood. Subjects with Class II Division 2 malocclusion demonstrated significantly (P <0.05) smaller mandibular plane angles, smaller palatal-to-mandibular plane angles, larger posterior-to-anterior facial height ratios, smaller gonial angles, smaller cranial base angles, larger interincisal angles, and more retroclined maxillary incisors than did the Class I subjects. The hypodivergent patterns were established early and became more pronounced over time. Group differences in the mandibular plane angle, palatal-to-mandibular plane angle, gonial angle, interincisal angle, and maxillary incisor-to-cranial base angle, as well as the posterior-to-anterior facial height ratio all increased over time; the difference in the cranial base angle remained unchanged over time. Retroclination of the maxillary incisors occurred primarily during the early mixed dentition. CONCLUSIONS: Subjects with Class II Division 2 malocclusion are more hypodivergent and have more upright maxillary incisors than do subjects with Class I occlusion. Hypodivergence establishes itself early and increases progressively through early adulthood; maxillary incisor retroclination occurs early.

Elevation of a full-thickness mucoperiosteal flap alone accelerates orthodontic tooth movement.

INTRODUCTION: Our objective was to determine whether the elevation of a full-thickness mucoperiosteal flap alone, without cortical cuts, decreases the amount of bone around teeth and accelerates mesial tooth movements. METHODS: The mandibular second premolars of 7 beagle dogs were extracted, and on a randomly selected side, a full-thickness mucoperiosteal buccal flap extending from the distal aspect of the third premolar to the mesial aspect of the first premolar was elevated. The other side did not receive flap surgery. The mandibular third premolars were protracted with orthodontic appliances. Tooth movements were analyzed biweekly over an 8-week period with calipers and radiographs. The amount and density of bone were analyzed using microcomputed tomography; bone remodeling was evaluated with histologic sections. RESULTS: Experimental tooth movements measured intraorally between cusp tips were significantly greater (25.3%) than control tooth movements. The approximate center of resistance measured radiographically also moved significantly more (about 31%) on the experimental than on the control side. The experimental premolar tipped more than the control premolar (10.5° vs 8.7°), but the difference was not statistically significant. The medullary bone volume fraction mesial to the third premolar was significantly less (9.1%) and the bone was significantly less dense (9%) on the experimental side than on the control side. Histology showed no apparent side differences in the numbers of osteoclasts and osteoblasts evident in the medullary bone. CONCLUSIONS: Elevation of a full-thickness mucoperiosteal flap alone (ie, without injury to bone) decreases the amount and density of medullary bone surrounding the tooth and accelerates tooth movement. Due to its limited effects, elevation of a flap alone to increase tooth movements may not be justified.

Evaluation of marginal alveolar bone in the anterior mandible with pretreatment and posttreatment computed tomography in nonextraction patients.

INTRODUCTION: Our objectives were to evaluate marginal alveolar bone height in the anterior mandible after orthodontic treatment and to assess any correlations between morphologic and treatment changes. METHODS: We used 57 pretreatment and posttreatment cone-beam computed tomography images (17 male and 40 female subjects; 22 Class I, 35 Class II; average age, 18.7 ± 10.8 years; average treatment time, 22.7 ± 7.3 months) to measure cortical bone thickness, ridge thickness, distance from the apex to the labial cortical bone, and the distance from the cementoenamel junction to the marginal bone crest. Changes in the cementoenamel junction to the marginal bone crest distance were correlated with pretreatment measurements and treatment changes. RESULTS: Although there were great variations, the average facial and lingual vertical bone losses were 1.16 ± 2.26 and 1.33 ± 2.50 mm, respectively. The incisor-mandibular plane angle changes were also highly variable, averaging 2.4°. CONCLUSIONS: Orthodontic treatment causes changes in alveolar bone height and cortical bone thickness around the mandibular incisors. Although pretreatment cortical bone thickness, ridge width thickness, and specific tooth movements all play roles in what happens to the bone during treatment, incisor inclination was not correlated with alveolar bone height changes.

Flapless cortical bone damage has no effect on medullary bone mesial to teeth being moved.

INTRODUCTION: In this study, we evaluated the effects of bone awl-induced damage to bone surrounding a tooth that was moved. METHODS: A randomized split-mouth design with 7 foxhounds was performed to evaluate protraction of the mandibular third premolars for 56 days with 200 g of orthodontic force. Before initiating tooth movements, a bone awl was used on the experimental side to create 60 buccal and lingual microfracture injuries to the cortical bone without a periosteal flap. Tooth movements were performed on the control and experimental sides. Microcomputed tomography and histology were used to assess bone morphology and modeling. Radiographic and caliper measures were used to assess tooth movements. RESULTS: The awl-induced injuries produced significant damage and microfractures (95 mm(3)). Buccal and lingual cortical bone volume fractions and densities were significantly less and cortical modeling was significantly greater on the experimental sides than on the control sides. Bone volume fractions and densities mesial to the third premolars were the same on the experimental and control sides. Experimental side tooth movements (1.40 ± 0.25 mm) were statistically the same as the control side tooth movements (1.57 ± 0.45 mm). CONCLUSIONS: The effects of flapless, bone awl-induced damage were limited to the cortical bone. Because there was no effect on the medullary bone mesial to the tooth being moved, no differences in tooth movements were produced.

Effects of pilot holes on longitudinal miniscrew stability and bony adaptation.

INTRODUCTION: The purposes of this study were to longitudinally evaluate the effects of pilot holes on miniscrew implant (MSI) stability and to determine whether the effects can be attributed to the quality or the quantity of bone surrounding the MSI. METHODS: Using a randomized split-mouth design in 6 skeletally mature female foxhound-mix dogs, 17 MSIs (1.6 mm outer diameter) placed with pilot holes (1.1 mm) were compared with 17 identical MSIs placed without pilot holes. Implant stability quotient measurements of MSI stability were taken weekly for 7 weeks. Using microcomputed tomography with an isotropic resolution of 6 µm, bone volume fractions were measured for 3 layers of bone (6-24, 24-42, and 42-60 µm) surrounding the MSIs. RESULTS: At placement, the MSIs with pilot holes showed significantly (P <0.05) higher implant stability quotient values than did the MSIs placed without pilot holes (48.3 vs 47.5). Over time, the implant stability quotient values decreased significantly more for the MSIs placed with pilot holes than for those placed without pilot holes. After 7 weeks, the most coronal aspect of the 6- to 24-µm layer of cortical bone and the most coronal aspects of all 3 layers of trabecular bone showed significantly larger bone volume fractions for the MSIs placed without pilot holes than for those placed with pilot holes. CONCLUSIONS: MSIs placed with pilot holes show greater primary stability, but greater decreases in stability over time, due primarily to having less trabecular bone surrounding them.

How does the amount of surgical insult affect bone around moving teeth?

INTRODUCTION: The purpose of this study was to determine how the amount of surgical insult affects the quantity and maturity of dentoalveolar bone around teeth that have been orthodontically moved. METHODS: A split-mouth design with 8 foxhound dogs was used to evaluate bone surrounding maxillary second premolars that were protracted for 15 days and retained for 7 weeks. The maxillary first premolars were extracted, and the interseptal bone was removed to within 1 mm of the second premolars; on the insult (lesser surgical insult) side, buccal and lingual vertical grooves were made in the extraction socket to undermine the mesial root of the second premolar; the insult+ (greater surgical insult) side was flapped and had modified corticotomies extending to, but not through, the lingual cortex 1 mm distal to the distal root, and 3 to 5 mm apical to both roots. Microcomputed tomography analyses were used to evaluate the material density, bone volume fraction, and trabecular characteristics of surrounding bone. Hematoxylin and eosin sections were used to determine osteoclast numbers, bone surface areas, and bone volumes. RESULTS: After 7 weeks of consolidation, there was significantly (P <0.05) less bone on the insult+ side; it was less dense and less mature than the bone on the insult side. Relative to the control bone, bone on the insult+ side was significantly less dense but showed no differences in bone volume. Preliminary histologic evaluations indicated increased numbers of osteoclasts and greater bone surface areas on the insult+ side than the insult side, but no differences in bone volume. CONCLUSIONS: Increased surgical insults produce less dense and less mature bone but have no effect on bone volume at 9 weeks after surgery.

Local application of zoledronate enhances miniscrew implant stability in dogs.

INTRODUCTION: The primary purposes of this study were to evaluate how locally delivered zoledronate affects the longitudinal stability of miniscrew implants (MSIs) and the healing of bone around MSIs. METHODS: Using a randomized split-mouth design, 60 unloaded MSIs (5 × 1.6 mm) were placed in skeletally mature male foxhound-mixed breed dogs. The MSIs were randomly assigned to bilateral pairs of pilot holes (1.1 mm) that had been injected with either bisphosphonate zoledronate (n = 30, experimental group) or buffered saline solution (n = 30, control group). MSI stability was evaluated weekly for 8 weeks using resonance frequency analyses (Osstell Mentor; Integration Diagnostics, Göteborg, Sweden). Microcomputed tomography (6-µm voxel size) was used to determine the bone volume fractions of 3 layers of bone (6-24, 24-42, and 42-60 µm) surrounding the MSIs. RESULTS: Resonance frequency analysis showed that the control MSIs were significantly (P <0.05) less stable than the experimental MSIs. Although there was little or no change in stability over time for the MSIs treated with zoledronate, the stability of the control MSIs decreased during the first 4 weeks, increased through week 6, and then decreased again. The 6- to 24-µm layer closest to the MSIs, on both the experimental and the control sides, showed significantly (P <0.05) less bone than did the 24- to 42-µm and the 42- to 60-µm layers. After 8 weeks, there was significantly more cortical bone surrounding the control than the experimental MSIs. In contrast, there was significantly more trabecular bone surrounding the experimental than the control MSIs. CONCLUSIONS: One small locally delivered dose of zoledronate maintained the stability of MSIs over time, primarily because of greater amounts of trabecular bone surrounding the MSIs. Even though zoledronate enhanced the stability of MSIs in dogs, it should not be used clinically until further studies confirm its safe use in patients.