Effect of orthodontic forces on levels of enzymes in gingival crevicular fluid (GCF): A systematic review.

OBJECTIVE: Orthodontic force application releases multiple enzymes in gingival crevicular fluid (GCF) for activation, resorption, reversal, deposition of osseous elements and extracellular matrix degradation. The current systematic review critically evaluated all existing evidence on enzymes in orthodontic tooth movement. METHODS: Literature was searched with predetermined search strategy on electronic databases (PubMed, Scopus, Embase), along with hand search. RESULTS: Initial search identified 652 studies, shortlisted to 52 studies based on PRISMA. Quality assessment further led to final inclusion of 48 studies (13 moderately and 35 highly sensitive studies). Primary outcomes are significant upregulation in GCF levels of enzymes-aspartate aminotransferase (AST), alkaline phosphatase (ALP), matrix metalloproteinases (MMPs), lactate dehydrogenase (LDH), ß-glucuronidase (ßG), tartrate resistant acid phosphatase (TRAP), acid phosphatase (ACP) and down regulation in cathepsin B (Cb). Site specificity is shown by ALP, TRAP, AST, LDH, MMP9 with levels at compression site increasing earlier and in higher quantities compared with tension site. ALP levels are higher at tension site only in retention. A positive correlation of LDH, ALP and AST is also observed with increasing orthodontic force magnitude. CONCLUSIONS: A strong evidence of variation in enzymes (ALP, AST, ACP TRAP, LDH, MMPs, Cb) in GCF is found in association with different magnitude, stages and sites of orthodontic force application.

Effect of orthodontic forces on levels of enzymes in gingival crevicular fluid (GCF): A systematic review

Abstract Objective: Orthodontic force application releases multiple enzymes in gingival crevicular fluid (GCF) for activation, resorption, reversal, deposition of osseous elements and extracellular matrix degradation. The current systematic review critically evaluated all existing evidence on enzymes in orthodontic tooth movement. Methods: Literature was searched with predetermined search strategy on electronic databases (PubMed, Scopus, Embase), along with hand search. Results: Initial search identified 652 studies, shortlisted to 52 studies based on PRISMA. Quality assessment further led to final inclusion of 48 studies (13 moderately and 35 highly sensitive studies). Primary outcomes are significant upregulation in GCF levels of enzymes-aspartate aminotransferase (AST), alkaline phosphatase (ALP), matrix metalloproteinases (MMPs), lactate dehydrogenase (LDH), β-glucuronidase (βG), tartrate resistant acid phosphatase (TRAP), acid phosphatase (ACP) and down regulation in cathepsin B (Cb). Site specificity is shown by ALP, TRAP, AST, LDH, MMP9 with levels at compression site increasing earlier and in higher quantities compared with tension site. ALP levels are higher at tension site only in retention. A positive correlation of LDH, ALP and AST is also observed with increasing orthodontic force magnitude. Conclusions: A strong evidence of variation in enzymes (ALP, AST, ACP TRAP, LDH, MMPs, Cb) in GCF is found in association with different magnitude, stages and sites of orthodontic force application.

Resumo Objetivo: a aplicação da força ortodôntica libera múltiplas enzimas no fluído crevicular gengival (FCG), desencadeando a ativação, reabsorção, reversão, deposição de elementos ósseos e degradação da matriz extracelular. A presente revisão sistemática avaliou criticamente toda a evidência disponível sobre os níveis de enzimas durante a movimentação ortodôntica. Métodos: utilizando-se estratégias predeterminadas, foram realizadas buscas em bases de dados eletrônicas (PubMed, Scopus, Embase), sendo também feitas buscas manuais. Resultados: a busca inicial identificou 652 estudos e, com base nas diretrizes do PRISMA, foram selecionados 52 estudos. A avaliação qualitativa resultou na inclusão final de 48 estudos (13 estudos com moderada sensibilidade e 35 com alto nível de sensibilidade). Os desfechos primários foram o aumento significativo dos níveis no FCG das enzimas aspartato aminotransferase (AST), fosfatase alcalina (FA), metaloproteinases de matriz (MMPs), lactato desidrogenase (LDH), β-glucuronidase (βG), fosfatase ácido-resistente ao tartarato (TRAP), fosfatase ácida (FAC) e baixa regulação de catepsina B (Cb). Especificidade quanto ao local foi mostrada para FA, TRAP, AST, LDH e MMP9 com os níveis no lado de compressão aumentando mais rápido e em maiores quantidades, quando comparado ao lado de tensão. Os níveis de FA foram maiores no lado de tensão somente no período de contenção. Uma correlação positiva de LDH, FA e AST também foi observada à medida que a magnitude de força ortodôntica aumentou. Conclusões: há fortes evidências indicando que as variações nas enzimas (FA, AST, FAC, TRAP, LDH, MMPs, Cb) presentes no FCG estão associadas a diferentes magnitudes, estágios e locais de aplicação da força ortodôntica.

Impact of altered gingival characteristics on smile esthetics: Laypersons' perspectives by Q sort methodology.

INTRODUCTION: Smile esthetics includes the white esthetics related to the teeth and the pink esthetics related to the mucosa. Many surveys have been conducted to evaluate laypersons' perceptions to altered dental characteristics, but few have focused on the soft tissue factors. This study was designed to determine the perceptions of laypeople to variations in soft tissue esthetics during smile. METHODS: An ideal smile photograph was intentionally altered to produce variations in gingival inflammation, pigmentation, contour, position of free gingival margins (with and without recession), zeniths, and interdental papilla. Sixty-seven images thus produced were rated for attractiveness by 100 laypersons with the Q sort technique. RESULTS: Variations in interdental papilla (black triangles) were the most negatively ranked gingival factor by laypersons closely followed by color changes of the gingiva due to inflammation and pigmentation. Alteration of gingival contour and gingival zenith had the least impact on smile esthetics, and changes in the free gingival margin with and without recession were moderately perceived. Furthermore, laypersons considered unilateral or asymmetric alterations more unesthetic compared with bilateral or generalized alterations for factors such as free gingival margin without the recession, and color changes caused by inflammation and pigmentation. CONCLUSIONS: Laypersons have considerable negative perception to asymmetric gingival alterations and to optical color changes caused due to black triangles, inflammation, and pigmentation of the gingiva. Whereas alteration in gingival contour and zenith have least impact on smile esthetics.

Demirjian approach of dental age estimation: Abridged for operator ease.

BACKGROUND: Present times have seen an alarming increase in incidence of crimes by juveniles and of mass destruction that Highlight the preponderance of individual age estimation. Of the numerous techniques employed for age assessment, dental age estimation (DAE) and its correlation with chronological age (CA) have been of great significance in the recent past. Demirjian system, considered as gold standard in DAE is a simple and convenient method for DAE, though,, although, referring to multiple tables make it cumbersome and less eco friendly due to excessive paper load. AIM: The present study was aimed to develop a comprehensive chart (DAEcc) inclusive of all Demirjian tables and developmental stages of teeth and also to as well as to test the operator ease of 50 undergraduate dental students in performing DAE using this chart. MATERIALS AND METHODS: The study was performed in two stages, wherein the first stage was aimed at formulation of the comprehensive chart (DAECC) which included pictorial representation of calcification stages, the Federation Dentaire Internationale notation of the teeth, and the corresponding scores for each stage with a concluding column at the end to enter the total score. The second stage assessed the applicability of the ease of DAE by DAECC, whereby fifty 2nd year BDS students were asked to trace the calcification stages of the seven permanent left mandibular teeth on a panorex, identify the correct stage, assign the corresponding score, and to calculate the total score for subsequent dental age assessment. RESULTS AND CONCLUSIONS: showed that average time taken by the students for tracing seven mandibular teeth was 5 min and for assessment of dental age was 7 min. The total time taken for DAE was approximately 12 min, thus making the procedure less time consuming. Hence, this study proposes the use of DAEcc for age estimation due to ease in comprehension and execution of Demirjian system.

Transverse changes in lateral and medial aspects of palatal rugae after mid palatal expansion: A pilot study.

INTRODUCTION: Palatal rugae has established role in forensic identification of an individual due to its stability in growth as well as orthodontic treatment. However effect of orthodontic mid-palatal expansion on rugae stability still requires further investigation. Hence, this study was aimed at evaluating the stability of palatal rugae in transverse dimension in adolescent patients of mid-palatal expansion. MATERIALS AND METHODS: The study sample consists of 14 subjects (10F,4M, age 12.4 ± 2.0 years) with transverse maxillary constriction, treated with bonded and banded rapid maxillary expansion (RME) appliance. 1(st) to 3(rd) rugae on pre- and post-expansion casts were recorded synchronously. Inter-medial and inter-lateral rugae distance were measured with digital calipers to record the transverse positional rugae changes. RESULTS: There was a statistically significant (p < 0.05) increase in values after expansion between medial aspects of 2(nd) (p = 0.002) and 3(rd) rugae (p = 0.005) and lateral aspects of 1(st) (p = 0.015), 2(nd) (p = 0.006) and 3(rd) (p = 0.001) rugae. The transverse changes were recorded in the order of 3(rd) rugae >2(nd) rugae >1(st) rugae. CONCLUSION: This pilot study does not support stability of medial and lateral ruga points of 2(nd) and 3(rd) primary rugae for forensic identification in individuals treated with mid palatal expansion.

Effect of orthodontic forces on cytokine and receptor levels in gingival crevicular fluid: a systematic review.

This systematic review aimed to generate evidence on role of potent markers of inflammation [cytokines, chemokines, their associated receptors and antagonists] following the application of orthodontic forces. Subsequent to registration with PROSPERO, literature search followed a predetermined search strategy to key databases along with hand search (HS). Seventy-seven articles from PubMed (P), 637 from Scopus (S), 51 from Embase (E), and 3 from hand search (HS) were identified. A total of 39 articles were shortlisted that met strict inclusion and exclusion criteria and quality assessment. Each study was evaluated for participant characteristics, study design, oral hygiene regimen, and gingival crevicular fluid (GCF) handling. Among these studies, biomarkers in the order of frequency were interleukin (IL)-1ß (N=21), tumor necrosis factor (TNF)-α (N=10), IL-8,IL-6(N=8), receptor activator of nuclear factor kappa-B ligand (RANKL) (N=7), monocyte chemoattractant protein (MCP)-1 (N=3), IL-2 (N=4), IL-4, IL-10, RANTES (N=2), IL-1, IL-5, IL-1α, IP-10, osteopontin (OPN) (N=1) and receptors and their antagonists in the order of osteoprotegerin (OPG) (N=8), IL-1RA (N=5), and RANK (N=1). Results revealed an immediate release of inflammatory bone-resorptive mediators, IL-1ß and TNF-α, where IL-1ß increased as early as 1 min to 1 h reaching peak at 24 h while TNF-α increased at 1 h or 1 day. This was accompanied by a fall in bone-protective mediator (OPG) levels at 1 h and 24 h after orthodontic force application. Continuous forces were accompanied by a decrease in mediator levels after attaining peak levels (most commonly at 24 h) while repeated activations in interrupted force upregulated their secretion. Significant correlations of IL-1ß levels with pain intensity, rate of orthodontic tooth movement (OTM) and of activity index (AI) (IL-1ß/IL-1RA) with velocity of tooth movement and growth status of individuals have also been deduced. A greater AI and RANKL/OPG ratio was seen in juveniles as compared to adults or non-growers that were associated with faster rate of OTM in juveniles. None of the studies addressed the effect of estrous cycle in female subjects. Lack of homogeneity in several parameters calls for a better controlled research on the biology of OTM.