Orthodontic Force Induces Systemic Inflammatory Monocyte Responses

Nociceptor mechanisms underlying pain and bone remodeling via orthodontic forces: toward no pain, big gain

Orthodontic forces are strongly associated with pain, the primary complaint among patients wearing orthodontic braces. Compared to other side effects of orthodontic treatment, orthodontic pain is often overlooked, with limited clinical management. Orthodontic forces lead to inflammatory responses in the periodontium, which triggers bone remodeling and eventually induces tooth movement. Mechanical forces and subsequent inflammation in the periodontium activate and sensitize periodontal nociceptors and produce orthodontic pain. Nociceptive afferents expressing transient receptor potential vanilloid subtype 1 (TRPV1) play central roles in transducing nociceptive signals, leading to transcriptional changes in the trigeminal ganglia. Nociceptive molecules, such as TRPV1, transient receptor potential ankyrin subtype 1, acid-sensing ion channel 3, and the P2X3 receptor, are believed to mediate orthodontic pain. Neuropeptides such as calcitonin gene-related peptides and substance P can also regulate orthodontic pain. While periodontal nociceptors transmit nociceptive signals to the brain, they are also known to modulate alveolar bone remodeling in periodontitis. Therefore, periodontal nociceptors and nociceptive molecules may contribute to the modulation of orthodontic tooth movement, which currently remains undetermined. Future studies are needed to better understand the fundamental mechanisms underlying neuroskeletal interactions in orthodontics to improve orthodontic treatment by developing novel methods to reduce pain and accelerate orthodontic tooth movement-thereby achieving "big gains with no pain" in clinical orthodontics.

Impact of fixed orthodontic appliances on blood count and high-sensitivity C-reactive protein levels: A prospective cohort study

INTRODUCTION

The aim was to elucidate the magnitude of alterations in systemic blood counts in healthy patients during the first 14 days after fixed orthodontic appliance placement.

METHODS

This prospective cohort study consecutively included 35 White Caucasian patients starting orthodontic treatment with fixed appliances. The mean age was 24.48 ± 6.68 years. All patients were physically and periodontally healthy. Blood samples were collected at 3 time points: (1) baseline (exactly before the placement of appliances), (2) 5 days after bonding, and (3) 14 days after baseline. Whole blood and erythrocyte sedimentation rates were analyzed in automated hematology and erythrocyte sedimentation rate analyzer. Serum high-sensitivity C-reactive protein levels were measured by the nephelometric method. Standardized sample handling and patient preparation procedures were adopted to reduce preanalytical variability.

RESULTS

A total of 105 samples were analyzed. All clinical and orthodontic procedures were performed without complications or side effects during the study period. All laboratory procedures were performed per protocol. Significantly lower white blood cell counts were detected 5 days after bracket bonding, compared with baseline (P <0.05). Hemoglobin levels were lower at 14 days than baseline (P <0.05). No other significant shifts or alteration patterns were observed over time.

CONCLUSIONS

Orthodontic fixed appliances led to a limited and transient change in white blood cell counts and hemoglobin levels during the first days after bracket placement. The fluctuation of high-sensitivity C-reactive protein levels was not significant, demonstrating a lack of association between systemic inflammation and orthodontic treatment.

Osteoimmunology in Periodontitis and Orthodontic Tooth Movement

PURPOSE OF REVIEW

To review the role of the immune cells and their interaction with cells found in gingiva, periodontal ligament, and bone that leads to net bone loss in periodontitis or bone remodeling in orthodontic tooth movement.

RECENT FINDINGS

Periodontal disease is one of the most common oral diseases causing inflammation in the soft and hard tissues of the periodontium and is initiated by bacteria that induce a host response. Although the innate and adaptive immune response function cooperatively to prevent bacterial dissemination, they also play a major role in gingival inflammation and destruction of the connective tissue, periodontal ligament, and alveolar bone characteristic of periodontitis. The inflammatory response is triggered by bacteria or their products that bind to pattern recognition receptors that induce transcription factor activity to stimulate cytokine and chemokine expression. Epithelial, fibroblast/stromal, and resident leukocytes play a key role in initiating the host response and contribute to periodontal disease. Single-cell RNA-seq (scRNA-seq) experiments have added new insight into the roles of various cell types in the response to bacterial challenge. This response is modified by systemic conditions such as diabetes and smoking. In contrast to periodontitis, orthodontic tooth movement (OTM) is a sterile inflammatory response induced by mechanical force. Orthodontic force application stimulates acute inflammatory responses in the periodontal ligament and alveolar bone stimulated by cytokines and chemokines that produce bone resorption on the compression side. On the tension side, orthodontic forces induce the production of osteogenic factors, stimulating new bone formation. A number of different cell types, cytokines, and signaling/pathways are involved in this complex process. Inflammatory and mechanical force-induced bone remodeling involves bone resorption and bone formation. The interaction of leukocytes with host stromal cells and osteoblastic cells plays a key role in both initiating the inflammatory events as well as inducing a cellular cascade that results in remodeling in orthodontic tooth movement or in tissue destruction in periodontitis.

Immune System Acts on Orthodontic Tooth Movement: Cellular and Molecular Mechanisms

Orthodontic tooth movement (OTM) is a tissue remodeling process based on orthodontic force loading. Compressed periodontal tissues have a complicated aseptic inflammatory cascade, which are considered the initial factor of alveolar bone remodeling. Since skeletal and immune systems shared a wide variety of molecules, osteoimmunology has been generally accepted as an interdisciplinary field to investigate their interactions. Unsurprisingly, OTM is considered a good mirror of osteoimmunology since it involves immune reaction and bone remolding. In fact, besides bone remodeling, OTM involves cementum resorption, soft tissue remodeling, orthodontic pain, and relapse, all correlated with immune cells and/or immunologically active substance. The aim of this paper is to review the interaction of immune system with orthodontic tooth movement, which helps gain insights into mechanisms of OTM and search novel method to short treatment period and control complications.

CXCL12/CXCR4 Mediates Orthodontic Root Resorption via Regulating the M1/M2 Ratio

Mechanical force-induced external root resorption is a major clinical side effect of orthodontic treatment. Recent work has revealed that M1 macrophages play a vital role in promoting orthodontic root resorption (ORR), but the mechanism of how mechanical force stimulation increases the M1/M2 macrophage ratio in periodontal tissue is poorly understood. In the current study, we showed that C-X-C motif chemokine 12 (CXCL12)⁺ periodontal ligament cells (PDLCs) and C-X-C chemokine receptor type 4 (CXCR4)⁺ monocytes in the periodontal ligament (PDL) were significantly increased after force application with ongoing root resorption, and these effects were partially rescued after force removal in mice. The expression of CXCL12 in PDLCs was increased by force stimulation in a time- and intensity-dependent manner in vitro. Blockage of the CXCL12/CXCR4 axis using CXCR4 antagonist AMD3100 was sufficient to alleviate ORR and reverse the force-enhanced M1/M2 macrophage ratio. Further mechanism exploration showed that Ly6C^hi inflammatory monocytes homed in a CXCL12/CXCR4 axis-dependent manner. The number and proportion of CD11b⁺ Ly6C^hi inflammatory monocytes in cervical lymph nodes were significantly increased by force loading, accompanied by decreased CD11b⁺ Ly6C^hi monocytes in the blood. These changes were blunted by intraperitoneal injection of AMD3100. In addition, blockage of the CXCL12/CXCR4 axis effectively reversed M2 suppression and promoted M1 polarization. Collectively, results indicate that force-induced CXCL12/CXCR4 axis mediates ORR by increasing the M1/M2 ratio in periodontal tissues through attracting Ly6C^hi inflammatory monocytes and modulating macrophage polarization. The results also imply that AMD3100 is potentially inhibitory to root resorption.

Biomechanical and biological responses of periodontium in orthodontic tooth movement: up-date in a new decade

Nowadays, orthodontic treatment has become increasingly popular. However, the biological mechanisms of orthodontic tooth movement (OTM) have not been fully elucidated. We were aiming to summarize the evidences regarding the mechanisms of OTM. Firstly, we introduced the research models as a basis for further discussion of mechanisms. Secondly, we proposed a new hypothesis regarding the primary roles of periodontal ligament cells (PDLCs) and osteocytes involved in OTM mechanisms and summarized the biomechanical and biological responses of the periodontium in OTM through four steps, basically in OTM temporal sequences, as follows: (1) Extracellular mechanobiology of periodontium: biological, mechanical, and material changes of acellular components in periodontium under orthodontic forces were introduced. (2) Cell strain: the sensing, transduction, and regulation of mechanical stimuli in PDLCs and osteocytes. (3) Cell activation and differentiation: the activation and differentiation mechanisms of osteoblast and osteoclast, the force-induced sterile inflammation, and the communication networks consisting of sensors and effectors. (4) Tissue remodeling: the remodeling of bone and periodontal ligament (PDL) in the compression side and tension side responding to mechanical stimuli and root resorption. Lastly, we talked about the clinical implications of the updated OTM mechanisms, regarding optimal orthodontic force (OOF), acceleration of OTM, and prevention of root resorption.

Immune Changes Induced by Orthodontic Forces: A Critical Review

Orthodontic tooth movement (OTM) is generated by a mechanical force that induces an aseptic inflammatory response in the periodontal tissues and a subsequent coordinated process of bone resorption and apposition. In this review, we critically summarize the current knowledge on the immune processes involved in OTM inflammation and provide a novel insight into the relationship between classical inflammation and clinical OTM phases. We found that most studies focused on the acute inflammatory process, which ignites the initial alveolar bone resorption. However, the exact mechanisms and the immune reactions involved in the following OTM phases remain obscure. Recent studies highlight the existence of a typical innate response of resident and extravasated immune cells, including granulocytes and natural killer (NK), dendritic, and γδT cells. Based on few available studies, we shed light on an active, albeit incomplete, process of resolution in the lag phase, supported by continuously elevated ratios of M1/M2 macrophage and receptor activator of nuclear factor κB ligand/osteoprotegerin ratio. This partial resolution enables tissue formation and creates the appropriate environment for a transition between the innate and adaptive arms of the immune system, essential for the tissue's return to homeostasis. Nevertheless, as the mechanical trigger persists, the resolution turns into a low-grade chronic inflammation, which underlies the next, acceleration/linear OTM phase. In this stage, the acute inflammation dampens, and a simultaneous process of bone resorption and formation occurs, driven by B and T cells of the adaptive immune arm. Excessive orthodontic forces or tooth movement in periodontally affected inflamed tissues may hamper resolution, leading to "maladaptive homeostasis" and tissue loss due to uncoupled bone resorption and formation. The review ends with a brief description of the translational studies on OTM immunomodulation. Future studies are necessary for further uncovering cellular and molecular immune targets and developing novel strategies for controlling OTM by local and sustained tuning of the inflammatory process.

SLPI in periodontal Ligament is not sleepy during biophysical force-induced tooth movement

AIM

We aimed to identify a key molecule that maintains periodontal tissue homeostasis during biophysical force-induced tooth movement (BTM) by orchestrating alveolar bone (AB) remodelling.

MATERIALS AND METHODS

Differential display-PCR was performed to identify key molecules for BTM in rats. To investigate the localization and expression of the identified molecules, immunofluorescence, real-time RT-PCR and Western blotting were performed in rats and human periodontal ligament (PDL) cells. Functional test and micro-CT analysis were performed to examine the in vivo effects of the identified molecules on BTM.

RESULTS

Secretory leucocyte peptidase inhibitor (SLPI) in the PDL was revealed as a key molecule for BTM-induced AB remodelling. SLPI was enhanced in the PDL under both compression and tension, and downregulated by an adenyl cyclases inhibitor. SLPI induced osteoblastogenic genes including runt-related transcription factor 2 (Runx2) and synergistically augmented tension-induced Runx2 expression. SLPI augmented mineralization in PDL cells. SLPI induced osteoclastogenic genes including receptor activator of nuclear factor kappa-Β ligand (RANKL) and synergistically augmented the compression-induced RANKL and macrophage colony-stimulating factor (MCSF) expression. Finally, the in vivo SLPI application into the AB significantly augmented BTM.

CONCLUSIONS

SLPI or its inhibitors might serve as a biological target molecule for therapeutic interventions to modulate BTM.

Remote Corticotomy Accelerates Orthodontic Tooth Movement in a Rat Model

Introduction

With an increasing demand for orthodontic treatment for adult patients, orthodontic professionals are constantly seeking novel strategies and technologies that can accelerate tooth movement in order to shorten the treatment period. For instance, in recent years, the influences of different surgical techniques on orthodontic tooth movement in the ipsilateral side of surgery were intensively investigated. Here, we attempt to examine if corticotomy could also affect the rate of tooth movement in the contralateral side of the surgery by using a rodent model.

Materials and Methods

72 eight-week-old Sprague-Dawley rats were randomly divided into three groups as follows: the Control group (orthodontic treatment devices delivered only, no tooth movement), the orthodontic tooth movement (OTM) group (orthodontic treatment devices delivered and orthodontic treatment performed), and the Corticotomy + OTM group (remote corticotomy performed, orthodontic treatment devices delivered, followed by orthodontic treatment). The surgical procedure was conducted on the right side of the maxilla at the time of appliance placement and a force of 60 g was applied between the maxillary left first molar and maxillary incisors using nickel-titanium springs to stimulate OTM. The OTM distance and speed were tracked at 3, 7, 14, and 28 days post-surgery, followed by histological and immunohistochemical assessments.

Results

In comparison with orthodontic treatment only, the contralateral corticotomy significantly accelerated OTM. Furthermore, animals undergoing corticotomy + OTM presented with a greater number of osteoclasts on the compression side, stronger staining of the osteogenic marker on the tension side, and higher expression of an inflammatory marker than the OTM group animals.

Conclusion

Our current study demonstrates that remote corticotomy effectively accelerates alveolar bone remodeling and OTM. The study enriches our understanding of the regional acceleratory phenomenon (RAP) and offers an alternative strategy for accelerating OTM to shorten the orthodontic treatment period.

Antibiotic administration alleviates the aggravating effect of orthodontic force on ligature-induced experimental periodontitis bone loss in mice

BACKGROUND AND OBJECTIVES

It is recognized that orthodontic force (OF) has an aggravating effect on the progression of destructive periodontitis if periodontitis have not been well controlled. However, the underlying mechanism is not completely clear. This study was to investigate the effect of antibiotic administration on OF-aggravated, ligature-induced experimental periodontitis in mice.

MATERIAL AND METHODS

C57BL/6 mice (male, 8 wk old) were divided into three groups (n = 8). Silk ligatures (SL) were tied around the maxillary right (group 1) or both (groups 2 and 3) first molars on day 0, removed on day 8 and systemic antibiotics was administered through drinking water (group 3) since day 8. OF was applied on the maxillary right first molars since day 13 (groups 2 and 3). All mice were killed on day 20.

RESULTS

Total oral bacteria load was significantly higher in group 2 when compared to group 1 on day 20, whereas such count was greatly reduced in group 3 when antibiotics were administered. Periodontal bone loss was significantly increased on SL side vs. control side in group 1. Periodontal bone loss was significantly increased on OF + SL side vs. SL side in group 2 (p < 0.05) but not in group 3 when systemic antibiotics were administered. Gingival mRNA and protein expressions of receptor activator of nuclear factor kappa-B ligand/osteoprotegerin were significantly increased on OF + SL side vs. SL side in group 2 (p < 0.01) but not in group 3. However, comparable levels of tartrate-resistant acid phosphatase-positive cell formation within periodontal space and tooth movement were observed on OF + SL side in groups 2 and 3.

CONCLUSION

Our results suggest that reduction of oral bacterial load by antibiotic administration alleviate orthodontic force-aggravated periodontitis bone loss.

Force-Induced H2S by PDLSCs Modifies Osteoclastic Activity during Tooth Movement

Hydrogen sulfide (H₂S), a gasotransmitter, has been recently linked to mesenchymal stem cell (MSC) function and bone homeostasis. Periodontal ligament stem cells (PDLSCs) are the main MSCs in PDL, which respond to mechanical force to induce physiological activities during orthodontic tooth movement (OTM). However, it is unknown whether mechanical force might induce endogenous H₂S production by PDLSCs to regulate alveolar bone homeostasis. Here, we used a mouse OTM model to demonstrate that orthodontic force-induced endogenous H₂S production in PDL tissue was associated with macrophage accumulation and osteoclastic activity in alveolar bone. Then, we showed that mechanical force application induced cystathionine β-synthase (CBS) expression and endogenous H₂S production by PDLSCs. Moreover, blocking endogenous H₂S or systemically increasing H₂S levels could decrease or enhance force-induced osteoclastic activities to control tooth movement. We further revealed how force-induced H₂S production by PDLSCs contributed to the secretion of monocyte chemoattractant protein-1 (MCP-1) and the expression of receptor activator of nuclear factor-κB ligand/osteoprotegerin (RANKL/OPG) system by PDLSCs. The secretion and expression of these factors controlled macrophage migration and osteoclast differentiation. This study demonstrated that PDLSCs produced H₂S to respond to and transduce force signals. Force-induced gasotransmitter H₂S production in PDLSCs therefore regulated osteoclastic activities in alveolar bone and controlled the OTM process through the MCP-1 secretion and RANKL/OPG system.

Effect of intraoral mechanical stress application on the expression of a force-responsive prognostic marker associated with system disease progression

OBJECTIVES

Malocclusion may be corrected nonsurgically by mechanical tooth movement. The plasma protein profiles of human subjects receiving the first phase of orthodontic treatment were examined to test the hypothesis that application of mechanical stresses to teeth induces systemic proteomic alterations.

METHODS

Tandem mass tag-based liquid chromatography-mass spectrometry (LC-MS/MS) was used to examine systemic proteomic alterations in subjects undergoing controlled stress application (N=10) and in volunteers not receiving treatment (N=7) at 3 time intervals within 24h. Proteins differentially expressed by the tooth movement group were functionally analyzed with "Gene Ontology" (GO) and "Search Tool to Retrieve Interacting Genes/proteins" (STRING) softwares. Enzyme-Linked Immunosorbent Assay and Western-blot were used to validate the in vivo protein alterations. An in vitro model consisting of human periodontal ligament cells (hPDLCs) under compression was used to validate the force-responsive characteristics of galectin-3 binding protein (LGALS3BP).

RESULTS

Sixteen out of the 294 proteins identified by LC-MS/MS were differentially expressed in the plasma of subjects receiving controlled mechanical stresses for moving teeth. Those proteins were clustered in biological processes related to acute inflammatory response and vesicle-related transportation. Serotransferrin, fibronectin and LGALS3BP were processed for confirmation in vivo; LGALS3BP was significantly increased in the tooth movement group. In vitro secretion of LGALS3BP in PDLCs was force-responsive.

CONCLUSIONS

Regional application of mechanical stresses stimulates systemic proteomic changes. Because serum LGALS3BP is over-expressed in different systemic diseases, including cancer, further work is needed to examine how systemic up-regulation of LGALS3BP affects the progression of those diseases.

Cellular and Molecular Pathways Leading to External Root Resorption

External apical root resorption during orthodontic treatment implicates specific molecular pathways that orchestrate nonphysiologic cellular activation. To date, a substantial number of in vitro and in vivo molecular, genomic, and proteomic studies have supplied data that provide new insights into root resorption. Recent mechanisms and developments reviewed here include the role of the cellular component-specifically, the balance of CD68⁺, iNOS⁺ M1- and CD68⁺, CD163⁺ M2-like macrophages associated with root resorption and root surface repair processes linked to the expression of the M1-associated proinflammatory cytokine tumor necrosis factor, inducible nitric oxide synthase, the M1 activator interferon γ, the M2 activator interleukin 4, and M2-associated anti-inflammatory interleukin 10 and arginase I. Insights into the role of mesenchymal dental pulp cells in attenuating dentin resorption in homeostasis are also reviewed. Data on recently deciphered molecular pathways are reviewed at the level of (1) clastic cell adhesion in the external apical root resorption process and the specific role of α/β integrins, osteopontin, and related extracellular matrix proteins; (2) clastic cell fusion and activation by the RANKL/RANK/OPG and ATP-P2RX7-IL1 pathways; and (3) regulatory mechanisms of root resorption repair by cementum at the proteomic and transcriptomic levels.

microRNA-21 Contributes to Orthodontic Tooth Movement

microRNAs could be mechanosensitive and emerge as critical posttranscriptional regulators in the bone-remodeling process. During orthodontic tooth movement (OTM), the application of mechanical force induces alveolar bone remodeling, but whether microRNAs respond to orthodontic force and contribute to OTM is unknown. microRNA-21 (miR-21) has been previously reported in vitro to mediate stretch-induced osteogenic differentiation of periodontal ligament stem cells and support osteoclast differentiation. In this study, the authors show that miR-21 responded to orthodontic force in periodontal tissue in a dose- and time-dependent manner and regulated the osteogenesis of human periodontal ligament stem cells following OTM. Using mmu-miR-21-deficient (miR-21-/-) mice, the authors discovered that mmu-miR-21 deficiency inhibited OTM and prevented force-induced maxillary bone loss. The authors found that miR-21-/- mice showed a normal skeletal phenotype in development and a similar alveolar bone formation rate to wild-type mice postnatally. During OTM, mmu-miR-21 regulated force-induced alveolar osteoblastogenesis in the tensile side, while no effects were detected in the compressive side. However, miR-21-/- mice showed inhibited alveolar osteoclastogenesis when compared with wild-type mice. During OTM, mmu-miR-21 deficiency blocked alveolar bone resorption in both the compressive and tensile sides. To dissect the mechanism by which miR-21 regulates alveolar bone remodeling, the authors screened the reported functional targets of miR-21 and found that periodontal expression of programmed cell death 4 ( Pdcd4) was inhibited following OTM. Furthermore, mmu-miR-21 deficiency removed the suppression of Pdcd4 at both the mRNA and protein levels in the periodontium, resulting in upregulation of the downstream effector C-fos. Further analysis of OTM under lipopolysaccharide-induced periodontal inflammation showed that mmu-miR-21 mediated lipopolysaccharide (LPS)-accelerated OTM and that mmu-miR-21 deficiency blocked lipopolysaccharide-induced maxillary bone loss. In summary, these findings reveal a previously unrecognized mechanism that a microRNA can modulate OTM and alveolar bone remodeling under both normal and inflammatory microenvironments in vivo.

Orthodontic Forces Induce the Cytoprotective Enzyme Heme Oxygenase-1 in Rats

Orthodontic forces disturb the microenvironment of the periodontal ligament (PDL), and induce craniofacial bone remodeling which is necessary for tooth movement. Unfortunately, orthodontic tooth movement is often hampered by ischemic injury and cell death within the PDL (hyalinization) and root resorption. Large inter-individual differences in hyalinization and root resorption have been observed, and may be explained by differential protection against hyalinization. Heme oxygenase-1 (HO-1) forms an important protective mechanism by breaking down heme into the strong anti-oxidants biliverdin/bilirubin and the signaling molecule carbon monoxide. These versatile HO-1 products protect against ischemic and inflammatory injury. We postulate that orthodontic forces induce HO-1 expression in the PDL during experimental tooth movement. Twenty-five 6-week-old male Wistar rats were used in this study. The upper three molars at one side were moved mesially using a Nickel-Titanium coil spring, providing a continuous orthodontic force of 10 cN. The contralateral side served as control. After 6, 12, 72, 96, and 120 h groups of rats were killed. On parasagittal sections immunohistochemical staining was performed for analysis of HO-1 expression and quantification of osteoclasts. Orthodontic force induced a significant time-dependent HO-1 expression in mononuclear cells within the PDL at both the apposition- and resorption side. Shortly after placement of the orthodontic appliance HO-1 expression was highly induced in PDL cells but dropped to control levels within 72 h. Some osteoclasts were also HO-1 positive but this induction was shown to be independent of time- and mechanical stress. It is tempting to speculate that differential induction of tissue protecting- and osteoclast activating genes in the PDL determine the level of bone resorption and hyalinization and, subsequently, “fast” and “slow” tooth movers during orthodontic treatment.

Current advances in orthodontic pain

Orthodontic pain is an inflammatory pain that is initiated by orthodontic force-induced vascular occlusion followed by a cascade of inflammatory responses, including vascular changes, the recruitment of inflammatory and immune cells, and the release of neurogenic and pro-inflammatory mediators. Ultimately, endogenous analgesic mechanisms check the inflammatory response and the sensation of pain subsides. The orthodontic pain signal, once received by periodontal sensory endings, reaches the sensory cortex for pain perception through three-order neurons: the trigeminal neuron at the trigeminal ganglia, the trigeminal nucleus caudalis at the medulla oblongata and the ventroposterior nucleus at the thalamus. Many brain areas participate in the emotion, cognition and memory of orthodontic pain, including the insular cortex, amygdala, hippocampus, locus coeruleus and hypothalamus. A built-in analgesic neural pathway—periaqueductal grey and dorsal raphe—has an important role in alleviating orthodontic pain. Currently, several treatment modalities have been applied for the relief of orthodontic pain, including pharmacological, mechanical and behavioural approaches and low-level laser therapy. The effectiveness of nonsteroidal anti-inflammatory drugs for pain relief has been validated, but its effects on tooth movement are controversial. However, more studies are needed to verify the effectiveness of other modalities. Furthermore, gene therapy is a novel, viable and promising modality for alleviating orthodontic pain in the future.

The effect of calcitriol on high mobility group box 1 expression in periodontal ligament cells during orthodontic tooth movement in rats

High mobility group box 1 (HMGB1) is a late inflammatory cytokine that plays an important role in periodontal tissue remodeling during orthodontic tooth movement. Calcitriol (1,25-dihydroxyvitamin D3 [1α,25 (OH)2D3]) is a systemic calcium-regulating hormone shown to downregulate expression of multiple proinflammatory cytokines in human periodontal ligament cells in response to orthodontic force. The purpose of this study was to investigate the effect of 1α,25(OH)2D3 on the expression of HMGB1 in periodontal ligament (PDL) cells during orthodontic tooth movement. Seven-week-old male Wistar rats were used for experimentation. Tooth movement was assessed using a nickel-titanium coil spring to apply mechanical loading to the tooth for 5 days. This was followed by administration of either 1α,25(OH)2D3 or normal saline by gavage every other day for up to 28 days. Immunohistochemistry was used to analyze the expression of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6 and HMGB1. After discontinuation of orthodontic force, expression of the early inflammatory cytokines IL-6 and TNF-α were time-dependently reduced in the 1α,25(OH)2D3 group compared with the control group at each time point. Similarly, expression of HMGB1 was decreased over time in both the 1α,25(OH)2D3 and normal saline groups, and 1α,25(OH)2D3 administration enhanced this decline. These findings indicate that administration of 1α,25(OH)2D3 might provide a favorable microenvironment for orthodontic tooth movement by downregulating expression of HMGB1 in PDL cells.