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Influence of E-Cigarette and Cannabis Vaping on Orthodontically Induced Tooth Movement and Periodontal Health in Patients Undergoing Orthodontic Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116518. [PMID: 35682101 PMCID: PMC9180231 DOI: 10.3390/ijerph19116518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 02/05/2023]
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Khalaf RM, Almudhi AA. Effects of vitamin D deficiency on the rate of orthodontic tooth movement: An animal study. Saudi Dent J 2021; 34:129-135. [PMID: 35241902 PMCID: PMC8864377 DOI: 10.1016/j.sdentj.2021.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 10/31/2022] Open
Abstract
Materials and Methods Results Conclusion
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Qin Y, Liu Y, Jiang Y, Mei S, Liu Y, Feng J, Guo L, Du J, Graves D, Liu Y. Cigarette Smoke Exposure Inhibits Osteoclast Apoptosis via the mtROS Pathway. J Dent Res 2021; 100:1378-1386. [PMID: 33978516 PMCID: PMC8723169 DOI: 10.1177/00220345211009471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
It is widely known that smoking is a risk factor for bone loss and plays a key role in osteopenia. Despite this well-known association, the mechanisms by which smoking affects bone have not been definitively established. Since smoking increases bone loss and potentially affects bone resorption in response to mechanical force, we investigated the impact of cigarette smoke on osteoclast numbers and underlying mechanisms in a mouse model of orthodontic tooth movement (OTM). The experimental group was exposed to once-daily cigarette smoke while the control group was not, and tooth movement distance and osteoclast numbers were assessed. In addition, the effect of cigarette smoke extract (CSE) on osteoclast precursor proliferation and osteoclast apoptosis was assessed in vitro. We found that cigarette smoke exposure enhanced bone remodeling stimulated by mechanical force and increased osteoclast numbers in vivo. Also, CSE increased the number of osteoclasts by inhibiting osteoclast apoptosis via the mitochondrial reactive oxygen species/cytochrome C/caspase 3 pathway in vitro. Moreover, exposure of mice to cigarette smoke affected bone marrow cells, leading to increased formation of osteoclasts in vitro. This study identifies a previously unknown mechanism of how smoking has a detrimental impact on bone.
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Affiliation(s)
- Y. Qin
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
| | - Y. Liu
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
| | - Y. Jiang
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
| | - S. Mei
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Y. Liu
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
| | - J. Feng
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
| | - L. Guo
- Department of Orthodontics School of Stomatology, Capital Medical University, Beijing, China
| | - J. Du
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
| | - D.T. Graves
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Y. Liu
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
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Lee SH, Cha JY, Choi SH, Kim BI, Cha JK, Hwang CJ. Effect of nicotine on orthodontic tooth movement and bone remodeling in rats. Korean J Orthod 2021; 51:282-292. [PMID: 34275884 PMCID: PMC8290091 DOI: 10.4041/kjod.2021.51.4.282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/23/2020] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To quantitatively analyze the effect of nicotine on orthodontic tooth movement (OTM) and bone remodeling in rats using micro-computed tomography and tartrate-resistant acid phosphatase immunostaining. Methods Thirty-nine adult male Sprague–Dawley rats were randomized into three groups group A, 0.5 mL normal saline (n = 9, 3 per 3, 7, and 14 days); group B, 0.83 mg/kg nicotine (n = 15, 5 per 3, 7, and 14 days); and group C, 1.67 mg/kg nicotine (n = 15, 5 per 3, 7, and 14 days). Each animal received daily intraperitoneal injections of nicotine/saline from the day of insertion of identical 30-g orthodontic force delivery systems. A 5-mm nickel-titanium closed-coil spring was applied between the left maxillary first molar (M1) and the two splinted incisors. The rate of OTM and volumetric bone changes were measured using micro-computed tomography. Osteoclasts were counted on the mesial alveolar bone surface of the distobuccal root of M1. Six dependent outcome variables, including the intermolar distance, bone volume fraction, bone mineral density, trabecular thickness, trabecular volume, and osteoclast number, were summarized using simple descriptive statistics. Nonparametric Kruskal–Wallis tests were used to evaluate differences among groups at 3, 7, and 14 days of OTM. Results All six dependent outcome variables showed no statistically significant among group-differences at 3, 7, and 14 days. Conclusions The findings of this study suggest that nicotine does not affect OTM and bone remodeling, although fluctuations during the different stages of OTM in the nicotine groups should be elucidated in further prospective studies.
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Affiliation(s)
- Sung-Hee Lee
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jung-Yul Cha
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sung-Hwan Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Baek-Il Kim
- Department of Preventive Dentistry of Public Oral Health, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jae-Kook Cha
- Department of Periodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Chung-Ju Hwang
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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Jyothish S, Athanasiou AE, Makrygiannakis MA, Kaklamanos EG. Effect of nicotine exposure on the rate of orthodontic tooth movement: A meta-analysis based on animal studies. PLoS One 2021; 16:e0247011. [PMID: 33596270 PMCID: PMC7888643 DOI: 10.1371/journal.pone.0247011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/01/2021] [Indexed: 12/09/2022] Open
Abstract
Background Nicotine exposure has been reported to modify bone cell function and the osseous metabolism with potential effects on the rate of orthodontic tooth movement. Objectives To systematically investigate and quantitively synthesize the most recent available evidence from animal studies regarding the effect of nicotine exposure on the rate of orthodontic tooth movement. Search methods Unrestricted searches in 7 databases and hand searching were performed until July 2020 (PubMed, Central, Cochrane Database of Systematic Reviews, SCOPUS, Web of Science, Arab World Research Source, ProQuest Dissertations and Theses Global). Selection criteria We searched for controlled studies on healthy animals investigating the effect of nicotine on the rate of orthodontic tooth movement. Data collection and analysis Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed using the SYRCLE’s Risk of Bias Tool. Exploratory synthesis and meta-regression were carried out using the random effects model. Results From the initially identified records, 5 articles meeting the inclusion criteria were selected and no specific concerns regarding bias were identified. Quantitative data synthesis showed that the rate of orthodontic tooth movement in the nicotine exposed rats was higher than in the control group animals (2 weeks of force application; 0.317 mm more movement in nicotine exposed rats; 95% Confidence Interval: 0.179–0.454; p = 0.000). No effect of the concentration or the duration force application was demonstrated following exploratory meta-regression. Conclusion Rats administered with nicotine showed accelerated rates of orthodontic tooth movement. Although, information from animal studies cannot be fully translated to human clinical scenarios, safe practice would suggest that the orthodontist should be able to identify patients exposed to nicotine and consider the possible implications for everyday clinical practice.
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Affiliation(s)
- Sanjay Jyothish
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | | - Miltiadis A. Makrygiannakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios G. Kaklamanos
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- * E-mail: ,
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Ebersole J, Samburova V, Son Y, Cappelli D, Demopoulos C, Capurro A, Pinto A, Chrzan B, Kingsley K, Howard K, Clark N, Khlystov A. Harmful chemicals emitted from electronic cigarettes and potential deleterious effects in the oral cavity. Tob Induc Dis 2020; 18:41. [PMID: 32435175 PMCID: PMC7233525 DOI: 10.18332/tid/116988] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/20/2019] [Accepted: 01/22/2020] [Indexed: 12/29/2022] Open
Abstract
Use of electronic nicotine delivery systems (ENDS), such as electronic cigarettes (e-cigs), is increasing across the US population and is particularly troubling due to their adoption by adolescents, teens, and young adults. The industry’s marketing approach for these instruments of addiction has been to promote them as a safer alternative to tobacco, a behavioral choice supporting smoking cessation, and as the ‘cool’ appearance of vaping with flavored products (e.g. tutti frutti, bubble gum, and buttered popcorn etc.). Thus, there is a clear need to better document the health outcomes of e-cig use in the oral cavity of the addicted chronic user. There appears to be an array of environmental toxins in the vapors, including reactive aldehydes and carbonyls resulting from the heating elements action on fluid components, as well as from the composition of chemical flavoring agents. The chemistry of these systems shows that the released vapors from the e-cigs frequently contain levels of environmental toxins that considerably exceed federal occupational exposure limits. Additionally, the toxicants in the vapors appear to be retained in the host fluids/tissues at levels often approximating 90% of the levels in the e-cig vapors. These water-soluble reactive toxins can challenge the oral cavity constituents, potentially contributing to alterations in the autochthonous microbiome and host cells critical for maintaining oral homeostasis. This review updates the existing chemistry/environmental aspects of e-cigs, as well as providing an overview of the somewhat limited data on potential oral health effects that could occur across the lifetime of daily e-cig users.
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Affiliation(s)
- Jeffrey Ebersole
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, United States
| | - Vera Samburova
- Organic Analytical Laboratory, Division of Atmospheric Sciences, Desert Research Institute, Reno, United States
| | - Yeongkwon Son
- Organic Analytical Laboratory, Division of Atmospheric Sciences, Desert Research Institute, Reno, United States
| | - David Cappelli
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, United States
| | - Christina Demopoulos
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, United States
| | - Antonina Capurro
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, United States
| | - Andres Pinto
- Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western University, Cleveland, United States
| | - Brian Chrzan
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, United States
| | - Karl Kingsley
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, United States
| | - Katherine Howard
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, United States
| | - Nathaniel Clark
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, United States
| | - Andrey Khlystov
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, United States
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Systematic review of biological therapy to accelerate orthodontic tooth movement in animals: Translational approach. Arch Oral Biol 2019; 110:104597. [PMID: 31739076 DOI: 10.1016/j.archoralbio.2019.104597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/08/2019] [Accepted: 10/29/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To systematically review and evaluate what is known regarding contemporary biological therapy capable of accelerating orthodontic tooth movement (OTM) in animal model. MATERIALS AND METHODS MedLine, Scopus, Web of Science and OpenGrey were searched without restrictions until June 2019. Following study retrieval and selection, relevant data was extracted using a standardized table. Risk of bias (RoB) assessment was performed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool. RESULTS Fifty-one animal studies were included. Two biological therapies were identified as capable of accelerating the OTM: chemical methods (49 studies) and gene therapy (2 studies). The main substances that increased the OTM rate were cytokines (13 studies), followed by growth factors (6 studies) and hormones (5 studies). Most studies were assessed to be at unclear or high RoB. The application protocols, measurement and reporting of outcomes varied widely and methodologies were not adequately reported. CONCLUSIONS Although biological therapies to accelerate OTM have been widely tested and effective in preclinical studies, the validity of the evidence is flawed to support translational of these results. There is a need for well-designed experimental studies to translate these methods for clinical field.
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Gudhimella S, Ibrahim AY, Karanth D, Kluemper AM, Westgate PM, Puleo DA, Huja SS. A rodent model using skeletal anchorage and low forces for orthodontic tooth movement. Am J Orthod Dentofacial Orthop 2019; 155:254-263. [PMID: 30712697 DOI: 10.1016/j.ajodo.2018.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Nonhuman animal models have been used extensively to study orthodontic tooth movement (OTM). However, rodent models have disadvantages, including a reported reduction in bone volume during OTM. The purpose of this study was to determine the viability of a skeletal anchorage and the effect of low force (∼3 cN) on interradicular bone volume during OTM. METHODS Ninety Sprague-Dawley rats were divided into 5 time points. A miniscrew and a nickel titanium coil spring placed a load of 3 cN (experimental) or 0 cN (sham) on the maxillary first molar in a split-mouth design. Displacement of the first molar and bone volume/total volume (BV/TV) in the interradicular region were quantified. RESULTS The success rate of the miniscrew was 98.9% (89 out of 90). Linear and angular tooth movement increased steadily (mean 0.1 mm/wk, 0.48 mm at 40 days). BV/TV was significantly reduced between the tooth movement and non-tooth movement sides in the 3 cN group: by 13%, 23%, 15%, 23%, and 16% at 3, 7, 14, 28, and 40 days, respectively. CONCLUSIONS Our model resulted in efficient OTM without skeletal anchorage failure. BV/TV reduction was lower than in previous reports. This novel validated model is likely to be the basis for future studies.
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Affiliation(s)
- Sudha Gudhimella
- Department of Orthodontics, University of Louisville, Louisville, Ky
| | | | - Divakar Karanth
- Division of Orthodontics, University of Kentucky, Lexington, Ky
| | | | | | - David A Puleo
- School of Engineering, The University of Mississippi, University, Miss
| | - Sarandeep S Huja
- Department of Orthodontics, Medical University of South Carolina, Charleston, SC.
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Araujo CMD, Rocha AC, Araujo BMDMD, Johann ACBR, Pereira LF, Tanaka OM, Guariza Filho O, Camargo ES. Effect of acute administration of nicotine and ethanol on tooth movement in rats. Braz Oral Res 2018; 32:e96. [PMID: 30328897 DOI: 10.1590/1807-3107bor-2018.vol32.0096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/04/2018] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to evaluate the effect of acute administration of nicotine and ethanol on tooth movement in rats. Two hundred rats were divided into eight groups: S: saline; N: nicotine; E: ethanol; NE: nicotine and ethanol; SM: saline with tooth movement; NM: nicotine with tooth movement; EM: ethanol with tooth movement; and NEM: nicotine and ethanol with tooth movement. All the solutions were applied for 32, 44, or 58 days, according to the subgroup. Orthodontic movement (25 cN) was initiated 30 days after solution administration in the groups with tooth movement. The rats were euthanized 2, 14, or 28 days after initiation of tooth movement. Tooth sections were stained using picrosirius and tartrate-resistant acid phosphatase (TRAP). The data were compared by ANOVA using Tukey's HSD and Games-Howell. On day 28 of tooth movement, the NEM group had a lower percentage of type I collagen compared to the SM group (p = 0.0448), and the S group had a higher number of osteoclasts/μm2 compared to the N group (p = 0.0405). Nicotine and ethanol did not affect the tooth movement rate, regardless of induction of orthodontic movement. Nicotine influenced the number of osteoclasts by decreasing their quantity when dental movement was not induced. When nicotine was associated with ethanol, it interfered in the maturation of collagen fibers during orthodontic movement.
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Affiliation(s)
- Cristiano Miranda de Araujo
- Pontifícia Universidade Católica do Paraná - PUC-PR, School of Life Sciences, Postgraduate Program in Dentistry - Orthodontics, Curitiba, PR, Brazil
| | - Adriana Cristina Rocha
- Pontifícia Universidade Católica do Paraná - PUC-PR, School of Life Sciences, Postgraduate Program in Dentistry - Orthodontics, Curitiba, PR, Brazil
| | | | | | - Luiz Fernando Pereira
- Pontifícia Universidade Católica do Paraná - PUC-PR, School of Life Sciences, Postgraduate Program in Dentistry - Physiology, Curitiba, PR, Brazil
| | - Orlando Motohiro Tanaka
- Pontifícia Universidade Católica do Paraná - PUC-PR, School of Life Sciences, Postgraduate Program in Dentistry - Orthodontics, Curitiba, PR, Brazil
| | - Odilon Guariza Filho
- Pontifícia Universidade Católica do Paraná - PUC-PR, School of Life Sciences, Postgraduate Program in Dentistry - Orthodontics, Curitiba, PR, Brazil
| | - Elisa Souza Camargo
- Pontifícia Universidade Católica do Paraná - PUC-PR, School of Life Sciences, Postgraduate Program in Dentistry - Orthodontics, Curitiba, PR, Brazil
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Michelogiannakis D, Rossouw PE, Al-Shammery D, Akram Z, Khan J, Romanos GE, Javed F. Influence of nicotine on orthodontic tooth movement: A systematic review of experimental studies in rats. Arch Oral Biol 2018; 93:66-73. [PMID: 29843070 DOI: 10.1016/j.archoralbio.2018.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/06/2018] [Accepted: 05/21/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The objective of this systematic review was to assess the impact of nicotine administration on orthodontic tooth movement (OTM). METHODS A systematic search was conducted in PubMed, Scopus, EMBASE, MEDLINE (OVID) and Web of Knowledge databases and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies evaluating the influence of nicotine on OTM, and with the presence of a control group (OTM without nicotine administration), were included. Quality assessment of the selected studies was performed following the Animal Research Reporting in Vivo Experiment (ARRIVE) guidelines. RESULTS Six of the initially identified 108 articles fulfilled the inclusion criteria and were selected. All included studies were performed in male rats, which underwent OTM with or without nicotine administration. Since there was a variation among the included studies regarding nicotine dosage and the duration and magnitude of force application during OTM only a qualitative analysis could be performed. The studies reported that nicotine administration accelerated OTM by inducing alveolar bone resorption around the moving teeth. It was also found that nicotine increased root resorption during experimental OTM. More standardized animal research or clinical studies are warranted to further evaluate the impact of nicotine on OTM. CONCLUSIONS On an experimental level, nicotine exposure in rats jeopardizes OTM by increasing alveolar bone loss and root resorption. From a clinical perspective, further studies are needed to assess the impact of habitual use of tobacco products on OTM.
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Affiliation(s)
- Dimitrios Michelogiannakis
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, NY, USA
| | - P Emile Rossouw
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, NY, USA
| | - Deema Al-Shammery
- Department of Orthodontics, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Zohaib Akram
- Department of Periodontology, Ziauddin University, Karachi, Pakistan
| | - Junad Khan
- Department of Orofacial Pain and Temporomandibular Joint Disorders, Eastman Institute for Oral Health, University of Rochester, NY, USA
| | | | - Fawad Javed
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, Rochester, NY, USA.
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