Effect of local administration of simvastatin on postorthodontic relapse in a rabbit model

Effect of Simvastatin Combined with Photobiomodulation Therapy on Orthodontic Tooth Movement and the Expression of Metalloproteinases and Inhibitors - An Experimental Study

Statins, such as simvastatin, are commonly used to treat hyperlipidemia and prevent cardiovascular diseases. However, simvastatin may suppress osteoclastogenesis, potentially reducing dental movement during orthodontic treatment. To mitigate this effect, low-level laser irradiation can be used for its photobiomodulatory properties. This study aims to assess the impact of combining simvastatin with photobiomodulation therapy on the regulation of bone metabolism. In this study, 56 male Wistar rats were divided into four groups: G1 - no orthodontic movement or simvastatin (n = 8); G2 - orthodontic movement with simvastatin 2.5 mg/kg (n = 16); G3 - orthodontic movement with saline solution and low-level laser 808 nm 1 J/point (n = 16); and G4 - orthodontic movement with simvastatin and low-level laser 808 nm 1 J/point (n = 16). Simvastatin was administered for 14 days, and dental movement was initiated with mini implants for the length of 7 or 14 days. Photobiomodulation occurred every 48 h during the experiment. The animals were euthanized after 14 and 21 days for clinical, histological, and micro-computed tomography analysis, as well as matrix metalloproteinase 2 (MMP2) and TIMP metallopeptidase inhibitor 1 (TIMP1) quantification. Statistical analysis was conducted using R software with a 5% significance level. Group G2 showed significantly less dental movement than G3 and G4 (p < 0.05). The BV/TV ratio was higher in G4 compared to G1 and G2. MMP2 levels were higher in G4 than G1 and G2 after 14 days, and in G3 compared to G2. After 21 days, MMP2 was higher in G2 and G3 than G1 and G4, and lower in G1 than G4 (p < 0.05). The results suggest that simvastatin reduces dental movement compared to laser-treated groups.

Inhibition of Orthodontic Relapse by Local Application of Simvastatin-Loaded Gelatin Hydrogel in a Rabbit Model

OBJECTIVES

This study aims to determine the effect of gelatin-simvastatin hydrogel application on bone remodelling during relapse.

MATERIALS AND METHODS

Twenty-four rabbits (Oryctolagus cuniculus) were divided into a control group (n = 12) and a treatment group (n = 12). The lower incisors were subjected to orthodontic force and moved distally by an open coil spring. The force (50 cN) was extended for 1 week and retained in a new position for 2 weeks (stabilisation period). The treatment group received a local gelatin-simvastatin hydrogel administration during stabilisation, and the control group received only gelatin hydrogel. The springs were debonded after the stabilisation phase from both groups to facilitate a relapse. The percentage of relapse was measured in a model study using digital callipers. Levels of OPG and RANKL were analysed using ELISA.

RESULTS

The local application of gelatin-simvastatin hydrogel in the treatment group significantly decreases the relapse percentage and RANKL level. Additionally, the gelatin-simvastatin hydrogel significantly increases the level of OPG and ratio of OPG/RANKL.

CONCLUSIONS

Applying gelatin-simvastatin hydrogel in the retention period can induce bone formation, inhibit orthodontic relapse and increase tooth stability (in vivo).

Impact of occlusal contact pattern on dental stability and oromandibular system after orthodontic tooth movement in rats

How to ensure dental stability in new positions and reduce the likelihood of relapse is a major clinical concern in the orthodontic field. Occlusal contacts between arches may affect the transmission of masticatory forces, thereby influencing the biological response of the periodontal and the oromandibular system. Occlusion factors that may influence the stability after orthodontic tooth movement (OTM) remain largely unknown. Hence, this research was conducted in order to investigate the influence of different occlusal contact patterns on tooth stability and oromandibular system including the masseter muscle and the temporomandibular joint following OTM. By modifying the occlusal surfaces, in vivo animal study models with distinct occlusal patterns corresponding to clinical circumstances were established. The relapse distance of teeth and the level of inflammatory factors in the gingival cervical fluid were analyzed. We also closely observed the histological remodeling of periodontal tissue, masseter tissue, and joint tissue after one week of relapse. Moreover, genes expression in the alveolar bone was analyzed to illustrate the potential biological mechanisms of relapse under the influence of different occlusal contact patterns following OTM. Different occlusal contact patterns after OTM in rats were established. The intercuspation contact between cusp and fossa group exhibited the lowest level of relapse movement, inflammatory factors and osteoclast activity (P < 0.05). On the other hand, groups with interferences or inadequate contacts exhibited more relapse movement, and tend to promote inflammation of periodontal tissue and activate bone resorption (P < 0.05). Adequate occlusal contacts without interference may enhance tooth stability and reduce the likelihood of relapse. After active orthodontic treatment, necessary occlusal adjustment should be made to achieve the desired intercuspation contact relationship and ensure adequate contact between the arches. The elimination of occlusal interferences is crucial to achieving optimal stability and promoting overall healthy condition of the oromandibular system.

Periodontal Ligament Stem Cell-Derived Extracellular Vesicles Enhance Tension-Induced Osteogenesis

Tension-induced osteogenesis has great significance in maintaining bone homeostasis and ensuring the efficiency and stability of orthodontic treatment. Recently, extracellular vesicles (EVs) have shown great potential in regulating bone remodeling. Here, we aimed to explore the effects of periodontal ligament stem cell (PDLSC)-derived EVs on tension-induced osteogenesis and the potential mechanism. PDLSC-derived EVs were extracted by ultracentrifugation. In vitro, PDLSC-derived EVs of 10 μg/mL significantly improved the proliferation of MC3T3-E1 cells and enhanced the osteogenic differentiation of osteoblasts under a tensile strain of 2000 uε. Next, a mouse model of orthodontic tooth movement (OTM) was established and treated with subperiosteal injection of PDLSC-derived EVs (1 mg/kg) on the tension side. The results showed that treatment with PDLSC-derived EVs effectively enhanced OTM and promoted osteogenesis on the tension side, including increasing trabecular bone parameters and promoting the expression of osteogenic-related biomarkers (OCN and OPN). More interestingly, we identified several mechano-sensitive miRNAs enriched in PDLSC-derived EVs by high-throughput miRNA sequencing. Bioinformatics analysis indicated that they were related to various osteogenesis-related signaling pathways. Therefore, PDLSC-derived EVs could improve the efficiency of OTM by enhancing tension-induced osteogenesis of osteoblasts. Our study may provide potential evidence for the promoting effects of PDLSC-derived EVs on osteogenesis and offer new insights into the development of treatment strategies for enhancing osteogenesis in orthodontic treatment and other metabolic bone diseases.

The Use of Polymers to Enhance Post-Orthodontic Tooth Stability

Relapse after orthodontic treatment occurs at a rate of about 70 to 90%, and this phenomenon is an orthodontic issue that has not yet been resolved. Retention devices are one attempt at prevention, but they require a considerable amount of time. Most orthodontists continue to find it challenging to manage orthodontic relapse; therefore, additional research is required. In line with existing knowledge regarding the biological basis of relapse, biomedical engineering approaches to relapse regulation show promise. With so many possible uses in biomedical engineering, polymeric materials have long been at the forefront of the materials world. Orthodontics is an emerging field, and scientists are paying a great deal of attention to polymers because of their potential applications in this area. In recent years, the controlled release of bisphosphonate risedronate using a topically applied gelatin hydrogel has been demonstrated to be effective in reducing relapse. Simvastatin encapsulation in exosomes generated from periodontal ligament stem cells can promote simvastatin solubility and increase the inhibitory action of orthodontic relapse. Moreover, the local injection of epigallocatechin gallate-modified gelatin suppresses osteoclastogenesis and could be developed as a novel treatment method to modify tooth movement and inhibit orthodontic relapse. Furthermore, the intrasulcular administration of hydrogel carbonated hydroxyapatite-incorporated advanced platelet-rich fibrin has been shown to minimize orthodontic relapse. The objective of this review was to provide an overview of the use of polymer materials to reduce post-orthodontic relapse. We assume that bone remodeling is a crucial factor even though the exact process by which orthodontic correction is lost after retention is not fully known. Delivery of a polymer containing elements that altered osteoclast activity inhibited osteoclastogenesis and blocking orthodontic relapse. The most promising polymeric materials and their potential orthodontic uses for the prevention of orthodontic relapse are also discussed.

Simvastatin encapsulated in exosomes can enhance its inhibition of relapse after orthodontic tooth movement

INTRODUCTION

Relapse after orthodontic treatment is a major clinical issue in the dental field. Studies indicate that simvastatin may, to some extent, decrease the rate and magnitude of relapse status. Recent evidence demonstrated that exosome-based drug delivery has a broad prospect of clinical application. Hence, this study investigates whether simvastatin encapsulated in exosomes can inhibit relapse after orthodontic tooth movement (OTM).

METHODS

Periodontal ligament stem cells (PDLSCs) and their exosomes (PDLSCs-Exo) were isolated and identified. Exosomal simvastatin was obtained by co-incubation of simvastatin and PDLSCs-Exo. An OTM rat model was established. During the relapse period, rats' local alveolar bone was injected with simvastatin, PDLSCs-Exo, and exosomal simvastatin to examine the effect on relapse. Finally, we analyzed the influence of exosomal simvastatin on osteogenesis at the molecular and histologic levels.

RESULTS

PDLSCs and PDLSCs-Exo were successfully extracted and characterized by multiple means. Simvastatin encapsulated in exosomes can increase the solubility of the drug. Exosomal simvastatin can enhance its inhibition of relapse after OTM in the rat model. The expression level of osteogenic-related genes and proteins in the exosomal simvastatin group is higher than in other groups. Histologic analysis showed a reduction of bone-resorptive lacunae in the exosomal simvastatin group.

CONCLUSIONS

Encapsulating simvastatin into the exosomes derived from PDLSCs can improve simvastatin solubility and enhance the inhibition effect of relapse in the rat model of OTM. Notably, local injection of PDLSCs-Exo alone can also block the relapse after OTM.

Effect of Caffeine Injection on Orthodontic Tooth Movement in Rats: An Experimental Study on Rats

OBJECTIVES

Several studies have investigated the effects of different medications on orthodontic tooth movement (OTM). This study assessed the effect of caffeine injection on OTM in rats.

MATERIALS AND METHODS

Thirty-five male Wistar rats were randomly divided into five groups. Their first molars and central incisors were attached with a nickel-titanium closed coil spring with 50 g load. The rats in the three experimental groups received 25, 50, and 75 mg/kg caffeine intraperitoneally for 21 days. The negative control group did not receive any injection and did not undergo orthodontic treatment. The positive control group underwent orthodontic treatment and received 0.9% NaCl (saline) injection. After 21 days, all rats were sacrificed by chloroform inhalation, and the maxilla was resected. The mean number of Howship's lacunae, blood vessels, osteoclasts, and root resorption lacunae was histologically measured. The bone volume-to-total volume ratio (BV/TV) in maxillary molars was calculated by microcomputed tomography (micro-CT) to quantify bone loss.

RESULTS

The amount of OTM and the number of osteoclasts, blood vessels, and Howship's lacunae significantly increased in rats under caffeine therapy, while the number of root resorption lacunae did not increase. Lower BV/TV in the caffeine groups was in accord with the increased count of osteoclasts.

CONCLUSION

Caffeine injection can significantly increase OTM in rats.

Effect of Methotrexate Injection on Orthodontic Tooth Movement: An Experimental Study on Rats

INTRODUCTION

Knowledge about the effects of medications, vitamins, and various supplements on orthodontic tooth movement (OTM) is imperative for orthodontists. This study aimed to assess the effect of methotrexate (MTX) injection on OTM in rats.

MATERIALS AND METHODS

Twenty-eight male Wistar rats were randomized into four groups (n = 7). The first molar and central incisor were connected using a nickel-titanium (NiTi) coil spring with a 50 g load in each rat. The two experimental groups received 0.75 mg/kg and 1.5 mg/kg MTX, respectively, intraperitoneally for 21 days. The negative control group did not receive any injection and did not undergo orthodontic treatment. The positive control group underwent orthodontic treatment and received 0.9% saline (NaCl) injections for 21 days. All rats were sacrificed with chloroform inhalation after 21 days; their maxilla was resected, and the mean number of Howship's lacunae, blood vessels, osteoclasts, and resorption lacunae was counted. The reduction in bone volume (bone volume to total volume ratio (BV/TV)) at the site of the maxillary molar was quantified by microcomputed tomography (micro-CT).

RESULTS

OTM, the number of osteoclasts, and the number of blood vessels significantly increased in rats treated with MTX (P < 0.05). However, the increase in the number of Howship's lacunae and resorption lacunae was not significant (P > 0.05). Lower BV/TV in the MTX groups was in agreement with the increased number of osteoclasts.

CONCLUSION

Injection of MTX can significantly increase OTM and decrease root resorption in rats.

Raloxifene administration enhances retention in an orthodontic relapse model

BACKGROUND AND OBJECTIVES

Orthodontic relapse is a physiologic process that involves remodelling of the alveolar bone and principle periodontal ligament fibres. Raloxifene is an Food and Drug Administration (FDA)-approved selective oestrogen receptor modulator that inhibits systemic bone loss. In our study, we examined the effects of Raloxifene on alveolar bone modelling and orthodontic relapse in a rodent model.

MATERIALS AND METHODS

The efficacy of raloxifene was evaluated in 15-week-old male Wistar rats, 8 in each group (Control, Raloxifene, Raloxifene + 7-day relapse, Raloxifene + 14-day relapse) for a total of 42 days. All animals had 14 days of orthodontic tooth movement with a closed nickel-titanium coil spring tied from incisors to right first molar applying 5-8 gm of force. On the day of appliance removal, impression was taken with silicon material and the distance between first molar and second molar was filled with light-cured adhesive resin cement for retention phase. Raloxifene Retention, Raloxifene Retention + 7D, Raloxifene Retention + 14D groups received 14 daily doses of raloxifene (2.0 mg/kg/day) subcutaneously after orthodontic tooth movement during retention. After 14 days of retention, the retainer was removed and right first molar was allowed to relapse for a period of 14 days. Raloxifene injection continued for the Raloxifene + 14-day relapse group during relapse phase too. Control group received saline injections during retention. Animals were euthanized by CO2 inhalation. The outcome measure included percentage of relapse, bone volume fraction, tissue density, and histology analysis using tartrate-resistant acid phosphatase staining and determining receptor activator of nuclear factor-кB-ligand (RANKL) and osteoprotegerin expression.

RESULTS

Raloxifene Retention + 14D group had significantly less (P < 0.05) orthodontic relapse when compared with other groups. There was a significant increase (P < 0.05) in bone volume fraction and tissue density in the Raloxifene Retention + 14D group when compared with other groups. Similarly, there was significant decrease in number of osteoclasts and RANKL expression in Raloxifene Retention + 14D group when compared with Raloxifene Retention + 7D group (P < 0.05).

CONCLUSION

Raloxifene could decrease post-orthodontic treatment relapse by decreasing bone resorption and indirectly enhancing bone formation.

Could medications and biologic factors affect post-orthodontic tooth movement changes? A systematic review of animal studies

Immediately after the removal of orthodontic appliances, the teeth might start to drift away from their corrected position in an attempt to reach a new equilibrium. Medications and biologic factors could potentially modulate these processes. The objective of the present systematic review is to systematically investigate and appraise the quality of the evidence regarding the effect of various medications and biologic factors on the rate of relapse following active tooth movement. Search without restrictions in eight databases and hand searching until April 2020 were conducted. Studies performed on animal models investigating the effects of medication and biologic factors on the rate of relapse following orthodontic tooth movement were considered. Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed. Seventeen studies were finally identified, mostly at either high or unclear risk of bias. Ketorolac did not show any significant effects on relapse, while the administration of tetracycline, atorvastatin, psoralen and raloxifene decreased it. Overall, the same result was observed with bisphosphonates with the exception of low dosage of risedronate, which did not have an effect. Osteoprotegerin and strontium resulted in reduced relapse, but not in the immediate post-administration period. Inconsistent or conflicting effects were noted after the use of simvastatin and relaxin. The quality of the available evidence was considered at best as low. It can be concluded that specific medications and biologic factors may have an effect on the rate of relapse following tooth movement. The orthodontist should be knowledgeable about the substances potentially affecting retention.

Effect of pharmacological agents on relapse following orthodontic tooth movement

OBJECTIVES

To investigate and synthesize systematically the evidence from animal studies pertaining to the effect of pharmacological agents on tooth movement relapse following cessation of orthodontic force application.

MATERIALS AND METHODS

An electronic search was conducted in seven online databases (including gray sources) without restrictions until the third week of April 2019, followed by a hand search in the reference lists of eligible articles. Controlled animal studies investigating the effect of pharmacological agents on tooth movement relapse following orthodontic treatment were selected. Relevant data were extracted from eligible studies and the risk of bias assessment was done using SYRCLE's risk of bias tool. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation tool.

RESULTS

The search identified 2354 records, of which 7 studies were deemed eligible for inclusion in the qualitative synthesis, with the majority presenting an unclear risk of bias. Orthodontic relapse was shown to decrease with the administration of pamidronate disodium, atorvastatin, aspirin, and chemically modified tetracycline-3. Inconsistent effects on relapse were observed after the use of simvastatin. The overall quality of retrieved evidence was assessed as low at best.

CONCLUSIONS

The available evidence shows that the investigated pharmacological agents may demonstrate variable effects on tooth movement relapse following cessation of orthodontic force. Additional evidence of higher quality is required to draw definitive conclusions on their effects and to make potential recommendations for clinical application.

The effects of statins on dental and oral health: a review of preclinical and clinical studies

The statin family of drugs are safe and effective therapeutic agents for the treatment of arteriosclerotic cardiovascular disease (CVD). Due to a wide range of health benefits in addition to their cholesterol lowering properties, statins have recently attracted significant attention as a new treatment strategy for several conditions, which are not directly related to normalizing a lipid profile and preventing CVD. Statins exert a variety of beneficial effects on different aspects of oral health, which includes their positive effects on bone metabolism, their anti-inflammatory and antioxidant properties, and their potential effects on epithelization and wound healing. Additionally, they possess antimicrobial, antiviral, and fungicidal properties, which makes this class of drugs attractive to the field of periodontal diseases and oral and dental health. However, to the best of our knowledge, there has been no comprehensive study to date, which has investigated the effects of statin drugs on different aspects of dental and oral health. Therefore, the primary objective of this paper was to review the effect of statins on dental and oral health. Results of our extensive review have indicated that statins possess remarkable and promising effects on several aspects of dental and oral health including chronic periodontitis, alveolar bone loss due to either extraction or chronic periodontitis, osseointegration of implants, dental pulp cells, orthodontic tooth movement, and orthodontic relapse, tissue healing (wound/bone healing), salivary gland function, and finally, anti-cancer effects. Hence, statins can be considered as novel, safe, inexpensive, and widely-accessible therapeutic agents to improve different aspects of dental and oral health.

Effect of statins on orthodontic tooth movement: A systematic review of animal and clinical studies

OBJECTIVE

The objective was to systematically-review the effect of statin drugs on orthodontic-tooth-movement (OTM).

DESIGN

The focused-question was "Does statin therapy affect OTM?" PubMed, Ovid Medline, Cochrane Library, Scopus, EMBASE and Web of Science databases were searched without time and language restrictions using different key words. Studies assessing the effect of adjunctive statin administration on OTM compared with orthodontic treatment alone were included. The search was performed up to and including December 2018. Data regarding the study design/grouping, subjects, age/gender, duration of follow-up, outcome variables and parameters related to OTM and statins administration were evaluated.

RESULTS

Nine studies (1 clinical and 8 studies performed in animal-models) were included. Six studies used Simvastatin, whereas three studies used Atorvastatin. Six experimental studies and one clinical study reported reduction in OTM upon statin administration. Two experimental studies reported no effect of statin administration on OTM. In 90 % of the studies, the risk-of-bias was high.

CONCLUSION

Based upon the high risk-of-bias and methodological inconsistencies among the included studies, the influence of statin delivery on OTM remains debatable.

Effects of orthodontic force magnitude on cell apoptosis and RANKL-induced osteoclastogenesis : Studies in a rat model

PURPOSE

The aim of this study was to evaluate the time course of orthodontic force-induced apoptosis and receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclastogenesis in a rat model under light- and heavy-force conditions.

METHODS

Male Wistar rats were divided into light-force (10 cN) and heavy-force (60 cN) groups (N = 28/group). Each group was divided into four time-course subgroups to evaluate all phases of orthodontic tooth movement. Mesialization appliances were placed on three united maxillary molars unilaterally and activated. Tooth movements were calculated, and periodontal ligament (PDL) widths were measured. Expression of Bax, Bcl‑2, caspase 3, caspase 9, and RANK-RANKL were assessed by immunohistochemistry. Expression levels at the PDL-alveolar bone border were compared between experimental and control groups and force groups.

RESULTS

The rate of tooth movement did not differ between the force groups. PDL widths were higher on the tension side in the heavy-force group in the post-lag phase. Pro-apoptotic protein Bax expression was elevated in the heavy-force group, whereas anti-apoptotic protein Bcl‑2 expression was elevated in the light-force group. RANK expression on days 7 and 21 and RANKL expression on day 21 differed between the force groups.

CONCLUSIONS

Evidence of orthodontic force-induced apoptosis is more robust with stronger forces than with weaker forces. Exuberant RANKL-induced osteoclastogenesis that was seen when applying a low force results from increased RANK and RANKL expression in the post-lag phase.