Longitudinal evaluation of the association between Insulin-like growth factor-1, Bone specific alkaline phosphatase and changes in mandibular length

Amorphous Calcium Carbonate from Plants Can Promote Bone Growth in Growing Rats

OBJECTIVES

This study aimed to investigate the effect of amorphous calcium carbonate (ACC) supplementation on bone growth in growing rats.

METHODS

We used 3-week-old male Wistar rats to simulate childhood and adolescent growth stages. Rats were divided into four groups as follows: a control group (C), a low-dose group (L, 20.65 mg/kg body weight (BW) ACC), a medium-dose group (M, 206.5 mg/kg BW ACC), and a high-dose group (H, 413 mg/kg BW ACC) administered by gavage. Body length (BL) and BW were measured weekly. The bone mineral density (BMD) of two lumbar vertebrae (L3 and L4) and the left femur were analyzed by micro-computed tomography (μCT) at 0, 4, 8, and 12 weeks. At the end of 12 weeks, the rats were sacrificed. After that, blood samples were collected from the abdominal aorta. Femurs and tibias were collected and weighed, and their lengths were measured. Then, bone samples were used to perform histopathological and histomorphometric analyses.

RESULTS

It showed that ACC supplementation in growing rats increased the trabecular bone thickness and serum bone formation biomarkers. Furthermore, high-dose ACC decreased serum bone resorption biomarkers and increased BMD.

CONCLUSIONS

ACC supplementation can enhance osteoblast metabolism and inhibit osteoclast metabolism, resulting in a higher bone formation rate compared to bone resorption. This led to increased trabecular bone thickness, a higher BMD, and supported bone growth.

Association, diagnostic accuracy and optimal threshold of salivary IGF-1 and vitamin DBP levels for estimation of pubertal growth spurt: A cross sectional study

AIM

To determine the association of salivary IGF-1 and vitamin D Binding Protein with cervical vertebral maturation index (CVMI) across the pubertal stages and to determine the diagnostic accuracy and optimal threshold of these biomarkers for estimation of pubertal growth.

DESIGN

Cross-sectional observational study.

SETTING

Material and methods. All patients in the age group of 8-23 years from the Outpatient Department of Orthodontics and Dentofacial orthopaedics, between the period of July 2020 to December 2020 meeting the eligibility criteria were included. Lateral cephalograms obtained from the patients were divided into pre pubertal, pubertal & post pubertal groups based on CVMI by Baccetti et al. Unstimulated whole saliva was collected by a swab-based method & analyzed with ELISA.

RESULTS

Ninety-four participants were divided in three stages: prebubertal (30), pubertal (33), post pubertal (31). A significant difference was observed in the salivary IGF-1 & DBP across the three stages. Post-hoc test revealed significantly higher mean salivary IGF-1 & DBP in pubertal group than in pre & post-pubertal group. Receiver operator characteristic curve revealed excellent diagnostic accuracy for salivary IGF-1with areas under the curve (AUC) of 0.962, satisfactory for vitamin DBP with AUC of 0.831 and poor diagnostic accuracy for age with AUC of 0.536. Youden index revealed the optimal threshold to be 3.96ng/ml and 124.13pg/ml for salivary IGF-1 and vitamin DBP respectively.

CONCLUSION

The levels of Salivary IGF-1 and Vitamin DBP increased during C3 and C4 stages. Compared to vitamin DBP diagnostic accuracy of salivary IGF-1 was excellent and an optimal threshold of 3.96ng/ml can be utilized to distinguish pubertal & non-pubertal participants.

Biomarkers in Body Fluids as Indicators of Skeletal Maturity: A Systematic Review and Meta-analysis

OBJECTIVES

This review aimed to critically appraise the evidence for biomarkers in blood serum, gingival crevicular fluid (GCF), saliva, and urine in comparison with standard radiographic indices for skeletal maturation assessment.

MATERIALS AND METHODS

A thorough literature search in multiple databases was conducted for biomarkers in body fluids for skeletal maturation assessed with cervical vertebrae in lateral cephalograms or on hand-wrist radiographs. Different combinations including free text, MeSH terms, and Boolean operators were used. Two researchers used strict inclusion and exclusion criteria to screen title, abstract, and full text, and used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 instrument for risk of bias assessment of individual studies. Meta-analysis was performed on eligible studies using RevMan 5 software.

RESULTS

A total of 344 articles were screened, of which 33 met the inclusion criteria and quality assessment. The skeletal maturity indicators included insulin-like growth factors (IGF-1), alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BALP), dehydroepiandrosterone sulfate (DHEAS), vitamin D binding protein (DBP), parathormone-related protein (PTHrP), osteocalcin, metalloproteins, and serotransferrin (TF) along with different metabolites. At puberty, a significant rise was seen in IGF-1, DBP, ALP, osteocalcin, TF, and BALP. However, the serum DHEAS and PTHrP increased from pre-pubertal to post-pubertal stages. Due to the data heterogeneity, a meta-analysis could be performed on seven studies in total on IGF-1 in serum and blood. Of these, five were included for data in males and six in females, and four studies on IGF-1 in serum and blood. A significant difference in IGF-1 levels was seen between stages of peak pubertal growth spurt (CS3 and CS4) and decelerating pubertal growth (CS5) compared with growth initiation stage (CS2).

CONCLUSIONS

Pubertal growth spurts were correlated with peak serum IGF-1 and BALP in both sexes individually. Peak ALP levels in GCF were correlated with the pubertal spurt in a combined sample of males and females. Standard biofluid collection protocols and homogeneity in sampling and methodology are strongly recommended for future research.

Proteomic Identification of Plasma Components in Tachypleus tridentatus and Their Effects on the Longitudinal Bone Growth Rate in Rats

Tachypleus tridentatus (T. tridentatus) is a marine animal and traditional Chinese medicine. T. tridentatus plasma is a valuable resource for important medical and health-based functions. In this experiment, in order to evaluate the effect and mechanism of T. tridentatus plasma with respect to the promotion of bone tissue growth in rats, the processes of ultrafiltration and mass spectrometry were first used to separate and identify the components of T. tridentatus plasma. Then, a comparison of the effects of the T. tridentatus plasma samples, which each possessed different molecular weights, regarding the growth of the long bones of rats was conducted. Finally, transcriptomics, proteomics, and bioinformatics were all used to analyze the biological functions and related signaling pathways of the T. tridentatus plasma in order to promote rat bone growth. The results showed that the contents of amino acid residues in peptides are related to the growth promotion that was contained in the 10-30 kDa plasma group. Moreover, the T. tridentatus plasma samples were found to be higher in this respect than those in the whole plasma group. In addition, the 10-30 kDa plasma group could significantly promote bone growth activity in rats. The proteomic analysis showed that the proteins that were differentially expressed in the 10-30 kDa plasma group were mainly enriched in the PI3K-AKT signal pathway. Our study suggested that the T. tridentatus plasma possesses promising potential for the purposes of clinical use, whereby it can serve the role of a growth-promoting agent.

Mandibular Ramus: An Indicator for Gender Determination

Background The goal of this study is to use digital orthopantomographs (OPGs) to find out the role the mandibular ramus plays in figuring out a person's gender. Methodology Six hundred digital OPGs of patients, aged 21 to 50 years of either gender, fulfilling the exclusion and inclusion criteria, were randomly selected from the department archives exclusively for this digital retrospective study. All the scans were anonymized before the analysis. A total of seven measurements (in mm) were performed on OPGs, namely, minimum and maximum widths of the ramus, minimum and maximum condylar heights, maximum height of the ramus and coronoid, gonial angle bilaterally, and bigonial width. The data obtained was statistically analyzed using IBM SPSS Statistics for Windows, Version 21.0. (IBM Corp., Armonk, NY, USA), by a stepwise discriminant functional analysis for gender determination. Results Linear measurements, including maximum and minimum widths of the ramus, maximum height of the condyle, height of the ramus, and coronoid and bigonial width, revealed more values in males than in females. However, the gonial angle showed higher average values in females than in males. Moreover, all seven parameters showed statistically insignificant age-related changes. Conclusions The mandibular ramus showed high sexual dimorphism, and its analysis on OPG can be a valuable aid in the determination of gender in the fields of forensic odontology and anthropology.

Serum biomarkers associated with radiographic skeletal maturity indicators: A systematic review and meta-analysis

Objective:

To evaluate the relevant scientific literature to determine the association between different serum biomarker levels and radiographic skeletal maturity indicators.

Data Search, Screening and Eligibility:

A literature search was carried out on PubMed, Cochrane Library, Google Scholar, Semantic Scholar, Science Direct and Opengrey.eu up to November 2021 and 7466 records were retrieved via the electronic search. Study selection, data extraction and subsequent risk of bias assessment (RoB) was carried out independently by two authors. In case of any discrepancy, a third author was consulted.

Results:

After the exclusion of duplicates and the application of inclusion exclusion criteria, 19 studies (published in 25 articles) were included in the systematic review out of which 17 had a cross-sectional and two had a cohort study design. For the meta-analysis, based on the homogeneity, five cross-sectional studies measuring serum IGF-1 levels were incorporated. The meta-analysis revealed that the serum IGF-1 levels peak at the CS4 stage (401.77 ng/mL [333.50 – 470.05]) in the pooled group. However, in the subgroup analysis, it was found that the serum IGF-1 levels peak at CS3 in women (422.82 ng/mL [377.46–468.18]) and CS4 in men (487.04 ng/mL [391.83–582.25]).

Conclusion:

Among the various biomarkers evaluated, serum IGF-1 was the most associated with different stages of radiographic skeletal maturity indicators with its levels peaking at CS3 in women and CS4 in men.

Correlation of radiomorphometric indices of the mandible and mandibular angle fractures

This study assessed the correlation of radiomorphometric indices of the mandible and mandibular angle fractures (MAFs) in an Iranian population. This retrospective study was conducted on 3D computed tomography (CT) scans of 118 patients between 18 to 60 years. The images were divided into two groups with MAFs and other types of mandibular fractures (non-MAF). The gonial angle, ramus height, condylar neck width, minimum ramus width, and mandibular length were all measured using MARCO PACS software. Age, gender, and presence and eruption status of third molar at the fracture side were all recorded. The correlation between these parameters and MAF was analyzed using R software (alpha = 0.05). Of all patients, 41 samples had MAF. The two groups were not significantly different regarding the mean age and gender (P > 0.05). The mean size of gonial angle and ramus height in the MAF group were significantly larger, and smaller than the corresponding values in the non-MAF group, respectively (P < 0.001). The median minimum ramus width in the MAF group was significantly smaller than that in the non-MAF group (P = 0.001). Patients with a large gonial angle had 6.6 times higher odds of MAF compared with other fracture types (P = 0.046). Condylar neck width, mandibular length, and erupted third molars had no significant correlation with type of fracture. Presence of impacted third molar increased the odds of MAF by 5.55 times.

Patients with a large gonial angle, short ramus height, minimum ramus width, and impacted third molar are more susceptible to MAF. Surgeons can use these indices to predict the risk of MAF in trauma patients with such facial characteristics, and make a diagnosis by radiographic modalities.

Salivary IGF-1 and Alkaline Phosphatase-Based Modeling for Skeletal Maturity Prediction in Orthodontic Patients

RESULTS

A strong positive correlation was found between CA and cervical stages (r = 0.836, P < 0.001). Based on the regression model analysis, the model which combined IGF-1, ALP, and CA provided the best prediction at P < 0.001 with McFadden's pseudo R 2 value of 0.552 for cervical stage prediction and 0.646 for growth phase prediction. In particular, its predictive ability for the prepubertal, pubertal, and postpubertal growth phases was 95%, 80%, and 90%, respectively.

CONCLUSIONS

A new model with the combination of salivary IGF-1 and ALP with CA can be used as a less invasive method to determine the cervical stage and also growth phase with high predictive ability in healthy subjects.

Estimation of a statistical geometric model for the cervical vertebrae of children aged 10-18 years

Child neck injuries in motor vehicle crashes (MVCs) result in high morbidity and mortality rates. Estimating a statistical cervical vertebrae geometric model and quantifying the variations of the size and shape with age are very important for investigating the dynamic response and injury risk to a child's cervical spine, as well as for providing a geometric basis for developing child anthropomorphic test devices (ATDs) and finite element models (FEMs) of different ages. In this study, spatial geometric points were automatically extracted from the cervical vertebrae computed tomography (CT) scans of 30 children aged 10 to 18 years old (YO), and a statistical geometric model was estimated for the cervical vertebrae as a function of age and neck circumference/neck length according to the method of principal component analysis and regression (PCA&R). Based on this statistical model, geometric point sets representing cervical vertebrae geometries at different ages and percentiles were generated and formed to envelope surfaces. Meanwhile, the size changes of the cervical vertebrae with child growth from 10 to 18 YO were quantified. In general, the anteroposterior length (APL), transverse process width (TPW), vertebral body height (VBH), and vertebral body depth (VBD) of the cervical vertebrae increase with age; the VBH and VBD increase faster than the APL and TPW. Compared with other vertebrae, the APL of C7 is larger, and the rate of increase of C1 with age is evidently slower. The TPWs of C1 and C7 are greater than those of C2 to C6. C7 has higher average values for the VBH and VBD than C3 to C6.

Evaluation of Vitamin D (25OHD), Bone Alkaline Phosphatase (BALP), Serum Calcium, Serum Phosphorus, Ionized Calcium in Patients with Mandibular Third Molar Impaction. An Observational Study

The aim of this study was to evaluate the levels of vitamin D (25OHD) and other bone biomarkers in patients with third molar impaction (TMI). Thirty males and 30 females with unilateral or bilateral impacted mandibular third molar, and 15 males and 15 females as a control group (CG) were recruited. Rx-OPT was used to evaluate dental position and Pederson index to measure the difficulty of the intervention. Bone biomarkers were measured through blood venous sample in TMI group and CG. Mann-Whitney test, Pearson’s correlation coefficient, linear regression model were used to compare the different parameters in the two groups. 25OHD showed lower values in TMI group than in CG (p < 0.05) with values significantly lower in bilateral impaction (p < 0.05). Pearson’s coefficient for 25OHD presented a negative correlation with the Pederson index (ρ = −0.75). Bone alkaline phosphatase (BALP) showed significantly lower dosage in TMI group than CG (p = 0.02), Pearson’s coefficient for BALP presented a negative correlation with the Pederson index. Serum calcium, serum phosphorus, ionized calcium levels in TMI and CG groups were similar and Mann-Whitney test did not significantly differ between TMI and CG. TMI could be a sign of vitamin D deficiency and of low BALP levels that should be investigated.

Orthopaedic and orthodontic treatment with hyrax, Class III elastics on mandibular miniplates, maxillary mini-implants in a Class III adolescent: A case report

BACKGROUND

The treatment of Skeletal Class III malocclusion continues to be considered as one of the biggest challenges in orthodontics as the success of its correction is largely unpredictable. Early diagnosis and treatment are highly recommended to eliminate primary etiological factors and prevent an increase in severity of the existing malocclusion. However, if the diagnosis is delayed until adulthood, treatment becomes restricted to orthognathic surgery due to limited or no remaining growth potential left. The inherent risks involved with the surgical procedures often preclude the patients from opting for it, thus leaving the orthodontist with no option but to perform possible compensatory treatments to improve facial aesthetics and restore functional occlusion.

OBJECTIVE

To report the case of a 15-year old boy (adolescent) with Skeletal Class III malocclusion, a concave facial profile with an anterior crossbite and no incisor visibility during smile.

METHODS

Intra-oral skeletally anchored maxillary protraction (I-SAMP) and mini-implants associated with fixed appliance to aid in the correction of the skeletal bases and subsequently relieve the dental crowding.

RESULTS

After 36 months of treatment, functional normal occlusion with a Class I molar and canine relation was achieved. The consequential increase in upper lip thickness and decrease in lower lip fullness alongwith an increased exposure of maxillary incisors during smile resulted in a significant improvement of the patient's facial profile and an aesthetically pleasing smile.

Different approaches for management of Class III siblings: A long-term follow-up of two case reports

Class III malocclusion can be varied in presentation and progression. This report describes the presentation, course of treatment and long-term follow-up of two siblings with Class III malocclusion. Two cases discussed in this report were different in their presentation. Sibling 1, a 19-year-old male patient had developed skeletal Class III malocclusion with severe maxillomandibular discrepancy, showing both components of maxillary hypoplasia and mandibular prognathism & asymmetry with average growth pattern. Sibling 2, a 13-year-old male patient had developed a Class III malocclusion with maxillary retrognathism with vertical growth pattern. An insight into the similarities and dissimilarities in the presentation, course of treatment and long-term follow-up of the two cases is provided. The two cases were successfully managed with entirely different treatment approaches. Sibling 1 underwent maxillary advancement with Le Fort I surgery and mandibular set back and rotation with bilateral sagittal split osteotomy which was preceded by pre-surgical orthodontic treatment with extraction of upper first premolars for orthodontic decompensation. Sibling 2 was treated with skeletally anchored facemask therapy followed by fixed mechanotherapy. Acceptable clinical outcome with long-term stability of the treatment results was observed in the two siblings. Orthognathic surgery may be completely avoided later if early orthopaedic treatment to advance the maxilla is initiated at an appropriate age.