[Periodontal reactions to orthodontic forces in the diabetic metabolic state]

Awareness of Orthodontists Toward Management of Orthodontic Patients Suffering with Diabetes Mellitus in Central India Population: A Cross-Sectional Survey

Objectives

To evaluate orthodontists' awareness and knowledge about management of orthodontic patients with diabetes mellitus (DM) and determine if the treatment approach is according to the international guidelines.

Methods

This cross-sectional survey was conducted in Central India from January 2023to December 2023 and included 60 orthodontists from different dental clinics in private practice. Data were collected using a self-administered questionnaire, with questions about the orthodontic management of patients with DM. Data analysis was performed using Statistical Package for Social Sciences statistical software, version 22.

Results

Significant variation is seen while evaluating the HB1Ac, maintaining oral hygiene, and consideration for optimal control of periodontitis in DM.

Conclusion

Controlled DM is not a contraindication for orthodontic treatment. During orthodontic treatment, special consideration is obligatory concerning periodontal problems and proper oral hygiene to prevent the progression of periodontal breakdown.

The effect of low intensity pulsed ultrasound on dentoalveolar structures during orthodontic force application in diabetic ex-vivo model

OBJECTIVE

This study aimed to investigate the effect of the low intensity pulsed ultrasound (LIPUS) on the dentoalveolar structures during orthodontic force application in ex-vivo model using mandible slice organ culture (MSOC) of diabetic rats.

DESIGN

18 male Wistar rats with a mean weight (275 g) were randomly divided into three main groups: 1) normal rats, 2) Insulin treated diabetic rats, and 3) diabetic rats. Diabetes mellitus (DM) was induced by streptozotocin. Four weeks later, rats were euthanized, mandibles were dissected, divided into 1.5-mm slices creating mandible slice organ cultures (MSOCs). MSOCs were cultured at 37 °C in air with 5 % CO₂. The following day, orthodontic spring delivering a 50-g of force was applied to each slice. In each group, rats were randomly assigned to 2 subgroups; one received 10 min of LIPUS daily and the other was the control. Culture continued for 7 days, and then the sections were prepared for histological and histomorphometric analysis.

RESULTS

For all study groups (Normal, Insulin Treated Diabetic and Diabetic), LIPUS treatment significantly increased the thickness of predentin, cementum, and improved bone remodeling on the tension side and increased odontoblast, sub-odontoblast, and periodontal ligaments cell counts and bone resorption lacunae number on the compression side.

CONCLUSIONS

Application of LIPUS treatment for 10 min daily for a week enhanced bone remodeling and repair of cementum and dentin in normal as well as diabetic MSOCs.

Evidence on the effect of uncontrolled diabetes mellitus on orthodontic tooth movement. A systematic review with meta-analyses in pre-clinical in- vivo research

OBJECTIVE

The aim of this review was to appraise the existing evidence from pre- clinical research on tooth movement under the condition of hyperglycemic status.

DESIGN

Electronic search was conducted in 8 databases in October 13, 2019, to identify related pre- clinical animal research with keywords being: "diabetes mellitus", "tooth movement". Eligibility criteria involved controlled animal studies, entailing tooth movement under diabetic status compared to control healthy animals. Primary endpoints involved all outcomes related to tooth movement. Risk of bias (RoB) was assessed through the SYstematic Review Centre for Laboratory animal Experimentation tool (SYRCLE), while quantitative synthesis was planned after exploration of heterogeneity, through random effects meta-analyses of standardized mean differences (SMDs) with 95 % confidence intervals (CIs).

RESULTS

Of an initial number of 290 articles retrieved, 14 papers were eligible for inclusion in the qualitative synthesis, while 9 contributed to meta-analyses. Heterogeneity of experimental conditions in individual studies was evident. The risk of bias overall was rated as unclear to high. There was no evidence of a significant effect of diabetes mellitus when tooth movement was assessed macroscopically (6 studies, SMD: 1.47; 95 % CI: -0.60, 3.53; p = 0.16). However, attenuation of osteoblastic differentiation within the periodontal ligament was detected, as there was evidence of reduction of osteopontin expression (2 studies, SMD: -3.77; 95 %CI: -4.89, -2.66; p < 0.001).

CONCLUSIONS

There is currently a paucity of solid evidence with regard to alterations of the equilibrium of the implicated structures under the status of diabetes mellitus, when mechanical stimulation of teeth is attempted, with sporadic inferences from animal research. Significant research insights in how the disease impacts on orthodontic tooth movement are invaluable, at present.

Effects of diabetes on tooth movement and root resorption after orthodontic force application in rats

OBJECTIVE

To investigate the effects of diabetes on orthodontic tooth movement and orthodontically induced root resorption in rats.

SETTING AND SAMPLE POPULATION

Twenty-three 10-week-old male Sprague-Dawley rats divided into control (n = 7), diabetes (n = 9), and diabetes + insulin (n = 7) groups.

MATERIALS AND METHODS

Diabetes was induced by administering a single intraperitoneal injection of streptozotocin. Rats with a blood glucose level exceeding 250 mg/dl were assigned to the diabetes group. Insulin was administered daily to the diabetes + insulin group. A nickel-titanium closed-coil spring of 10 g was applied for 2 weeks to the maxillary left first molar in all rats to induce mesial tooth movement. Tooth movement was measured using microcomputed tomography images. To determine the quantity of root resorption, the mesial surfaces of the mesial and distal roots of the first molar were analyzed using both scanning electron microscopy and scanning laser microscopy.

RESULTS

After 2 weeks, the amount of tooth movement in the diabetic rats was lower than that in the control rats. Root resorption was also significantly lower in the diabetic rats. These responses of the rats caused by diabetes were mostly diminished by insulin administration.

CONCLUSIONS

Diabetes significantly reduced orthodontic tooth movement and orthodontically induced root resorption in rats. The regulation of blood glucose level through insulin administration largely reduced these abnormal responses to orthodontic force application.

Bone response to orthodontic forces in diabetic Wistar rats

INTRODUCTION

Patients with type 1 diabetes have shown decreased bone mineral density (BMD) values. The need for orthodontic treatment in diabetic patients is usually associated with occlusal problems and the occurrence of abnormalities in the development of the jaws. The aim of this study was to analyze bone response of insulin-treated and untreated diabetic rats after applying orthodontic forces.

METHODS

Wistar rats were divided into 3 groups: experimental orthodontics, experimental diabetes and orthodontics, and experimental diabetes treated with insulin and experimental orthodontics. Orthodontic forces were applied the first day of the seventh week. Forty-eight hours after placement, all the animals were killed, and the maxillae were excised and processed using routine histologic techniques.

RESULTS

Bone activity in the periodontal cortex of the dental alveolus showed a significant decrease in bone formation and erosive areas in diabetic animals as compared with controls. A recovery of these parameters could be observed in the group with experimental diabetes treated with insulin and experimental orthodontics. Bone volume in the interradicular bone showed no significant differences among groups.

CONCLUSIONS

People with diabetes should not receive orthodontic treatment until their metabolic status normalizes. Bone response to orthodontic forces in insulin-treated diabetic subjects does not differ significantly from that observed in healthy subjects.

Periodontal ligament remodeling and alveolar bone resorption during orthodontic tooth movement in rats with diabetes

BACKGROUND

Pathological displacement of teeth caused by periodontitis-related bone loss in patients with diabetes is often corrected with orthodontic treatments. However, recovery from orthodontic therapy is often delayed for unclear reasons. This study explored effects of streptozotocin-induced diabetes in rats on protein expression involved in remodeling of the periodontal ligament (PDL) and alveolar bone during orthodontic tooth movement.

METHODS

Forty-eight Sprague-Dawley rats were randomly divided into two experimental groups: "normal" and "diabetes" (n = 24 each). Diabetes was induced by a single dose of streptozotocin (65 mg/kg). Animals were euthanized at 3, 7, and 14 days after orthodontic induction. Changes in expression of collagen type I (Col-I), matrix metalloproteinase type 1 (MMP-1), and tissue inhibitor of MMP-1 (TIMP-1) were measured immunohistochemically in the pressure side. Col-I and collagen type III (Col-III) fibers were assessed by picrosirius red staining in the tension side. Osteoclasts were observed on the surface of the alveolar bone.

RESULTS

Diabetes increased expression of MMP-1 and Col-III and decreased expression of Col-I in PDL. After the orthodontic induction, osteoclast action was delayed, and higher Col-III/Col-I and MMP-1/TIMP-1 ratios persisted in the diabetes group compared with the normal group. The ratio of MMP-1/TIMP-1 in the diabetes group reached a peak on Day 7, whereas the ratio remained at near control levels in the normal group. The diabetes group appeared to have worse recovery from damage caused by orthodontic movement.

CONCLUSIONS

Under mechanical forces, diabetes prolonged duration of degradation of PDL and remodeling of PDL and resorption of alveolar bone.

Geometric influence of the sagittal and vertical apical base relationship on the ANB angle

OBJECTIVE

The objective of this study consisted in determining the variability of the ANB angle in relation to the position of the A- and B-points in the sagittal vertical plane.

MATERIALS AND METHODS

Using a theoretical model, we varied the position of the cephalometric points A and B in the sagittal vertical plane while its sagittal relationship was kept constant (Wits value = 0 mm). For this purpose, seven lines were erected perpendicular to the occlusal plane on a lateral cephalogram. The position of points A and B were determined on each of the vertical lines by calculating one anterior and one posterior angle in each case. In this way, the positions of all A- and B-points were clearly defined in the sagittal vertical plane.

RESULTS

The characteristic of the ANB angle in the sagittal vertical plane was graphically represented by determining both points A and B using two angles instead of one. This revealed that the ANB angle for the same sagittal base relationship was characterized by major variations depending on the position of the A- and B-points in relation to the anterior cranial base. The larger the SNA and SNB angles were, the larger the corresponding ANB angle. At the same time, the absolute value of ANB increased with the length of the vertical distance between the points A and B.

CONCLUSION

The ANB angle is strongly influenced by geometric factors. Accurate diagnosis of the sagittal base relationship should thus take the individual character of the ANB angle into account.

Orthodontic treatment considerations in patients with diabetes mellitus

Diabetes mellitus (DM) is diagnosed in 3% to 4% of the population. This metabolic disorder is characterized by hyperglycemia caused by the body's deficient management of insulin. Two main types of DM exist: type 1 is a total deficiency in insulin secretion, and type 2 is a combination of resistance to insulin action and inadequate compensatory insulin secretion. Diagnosis and monitoring of DM is based on blood glucose concentration or glycosylated hemoglobin concentration. The dental practitioner should be aware of the oral manifestations of DM in order to spot initial symptoms of the disease. When treating DM patients, the practitioner must understand the consequences of the disease in relation to dental treatment. In this review, we examine the implications of DM when orthodontic treatment is planned.