Effect of material composition and thickness of orthodontic aligners on the transmission and distribution of forces: an in vitro study

OBJECTIVES

To investigate the effects of material type and thickness on force generation and distribution by aligners.

MATERIALS AND METHODS

Sixty aligners were divided into six groups (n = 10): one group with a thickness of 0.89 mm using Zendura Viva (Multi-layer), four groups with a thickness of 0.75 mm using Zendura FLX (Multi-layer), CA Pro (Multi-layer), Zendura (Single-layer), and Duran (Single-layer) sheets, and one group with a thickness of 0.50 mm using Duran sheets. Force measurements were conducted using Fuji® pressure-sensitive films.

RESULTS

The lowest force values, both active and passive, were recorded for the multi-layered sheets: CA Pro (83.1 N, 50.5 N), Zendura FLX (88.9 N, 60.7 N), and Zendura Viva (92.5 N, 68.5 N). Conversely, the highest values were recorded for the single-layered sheets: Duran (131.9 N, 71.8 N) and Zendura (149.7 N, 89.8 N). The highest force was recorded at the middle third of the aligner, followed by the incisal third, and then the cervical third. The net force between the incisal and cervical thirds (FI-FC) showed insignificant difference across different materials. However, when comparing the incisal and middle thirds, the net force (FI-FM) was higher with single-layered materials. Both overall force and net force (FI-FM) were significantly higher with 0.75 mm compared to those with a thickness of 0.50 mm.

CONCLUSIONS

Multi-layered aligner materials exert lower forces compared to their single-layered counterparts. Additionally, increased thickness in aligners results in enhanced retention and greater force generation. For effective bodily tooth movement, thicker and single-layered rigid materials are preferred.

CLINICAL RELEVANCE

This research provides valuable insights into the biomechanics of orthodontic aligners, which could have significant clinical implications for orthodontists. Orthodontists might use this information to more effectively tailor aligner treatments, considering the specific tooth movement required for each individual patient. In light of these findings, an exchangeable protocol for aligner treatment is suggested, which however needs to be proven clinically. This protocol proposes alternating between multi-layered and single-layered materials within the same treatment phase. This strategy is suggested to optimize treatment outcomes, particularly when planning for a bodily tooth movement.

Numerical biomechanical finite element analysis of different trimming line designs of orthodontic aligners: An in silico study

BACKGROUND

A finite element model was used to investigate the effect of different designs and thicknesses of orthodontic aligner margins on their biomechanical behavior.

METHODS

A three-dimensional data set of an upper jaw was imported into the 3-matic software. The upper right central incisor tooth (Tooth 11) was separated from the remaining model, and its periodontal ligament and surrounding bone were designed. Aligners were designed with four different trimming lines (scalloped, straight, scalloped extended, straight extended), each with four different thicknesses (0.3, 0.4, 0.5, and 0.6 mm). The models were imported into a finite element package (Marc/Mentat). A linear elastic constitutive material model was applied. A facial 0.2 mm bodily malalignment of tooth 11 was simulated.

RESULTS

The maximum resultant force was in the range of 1.0 N to 2.2 N. The straight trimming designs deliver higher resultant forces compared with scalloped trimming designs. Increasing the aligner thickness and/or extending the aligner edge beyond the gingival line leads to an increase in the resultant force. All designs showed an uneven distribution of the normal contact forces over the tooth surface with a predominant concentration toward the cervical third and distal third, particularly with the extended trimming designs. All designs showed uncontrolled tipping of the tooth.

CONCLUSIONS

Based on the current model outcomes, the use of a straight extended trimming line design for aligners is favored because of its positive impact on force distribution and, consequently, the control of tooth movement.

CLINICAL RELEVANCE

These findings provide aligner companies and orthodontists a valuable biomechanical evidence and guidance to enhance control over tooth movement and therefore optimize treatment outcomes. This can be achieved by trimming the edges of aligners with a straight extended design and selecting the appropriate aligner thickness.

Three-dimensional positions of the center of resistance of the maxillary canine distal movement under orthodontic force loading

Using finite-element analysis, we aimed to determine the center of resistance (CRes) of the maxillary canine for setting orthodontic forces. The inclination of the canine was measured by first loading from the mesial to the distal side of the mesial root surface, then the position and direction of the load that minimized the inclination were investigated. The CRes was defined as the set of midpoints of the minimum distances between two inclination lines. Twenty-one CRes values were calculated from a set of seven lines. These CRes data were then aggregated as a 95% confidence ellipsoid of width 0.170×0.016×0.009 mm with center points 4.269, 0.224, and 4.315 mm in the apical, mesial, and lingual directions from the origin, respectively. Further studies are required to effectively apply the CRes identified in this study to clinical applications.

An in vitro evaluation of aligner force decay in artificial saliva

Background/purpose

The present study aimed to compare the force decay of invisible aligners for maxillary anterior teeth with 0.1 mm (D₁), 0.2 mm (D₂), and 0.3 mm (D₃) labial movement within a simulated oral environment over 7 days.

Materials and methods

The prepared invisible aligners were immersed in saliva (S) and subjected to applied force (F) for 7 days. The aligners were set and placed on the maxillary right central incisor with 0.1 mm (D₁), 0.2 mm (D₂), and 0.3 mm (D₃) labial movement. Thin-film pressure sensors were used to measure the aligner force changes. The data were collected and analyzed by statistical methods.

Results

Significant differences were observed in the initial and first-day force between the D₂ and D₃ groups under simulated oral environment force (SF) (P < 0.05). There was a significant difference in force decay between Day 1 and Day 7 for all groups (P < 0.05). The SFD₁ group showed a significant decrease in force on Day 5 (P < 0.05), while the SFD₂ and SFD₃ groups showed significant force decay on Day 4 (P < 0.05). The force decay ratio on Day 7 was higher in the SFD₃ group than in the SFD₁ and SFD₂ groups, but no significant difference was observed.

Conclusion

Larger labial movement of the aligners resulted in higher force decay under artificial saliva environments, and the force decay of invisible aligners was increased by immersion time in artificial saliva.

Effect of trimming line design and edge extension of orthodontic aligners on force transmission: A 3D finite element study

OBJECTIVES

To investigate in a numerical study the effect of the geometry and the extension of orthodontic aligner edges and the aligner thickness on force transmission to upper right central incisor tooth (Tooth 11).

METHODS

A three-dimensional (3D) digital model, obtained from a 3D data set of a complete dentulous maxilla, was imported into 3-matic software. Aligners with four different trimming line designs (scalloped, straight, scalloped extended, straight extended) were designed, each with four different thicknesses (0.3, 0.4, 0.5, and 0.6 mm). The models were exported to a finite element (FE) software (Marc/Mentat). A facial 0.2 mm bodily malposition of tooth 11 was simulated.

RESULTS

The maximum resultant force was in the range of (7.5 - 55.2) N. The straight trimming designs had higher resultant force than the scalloped designs. The resultant force increases with increasing the edge extension of the aligner. The normal contact forces were unevenly distributed over the entire surface and were concentrated in six areas: Incisal, Mesio-Incisal, Disto-Incisal, Middle, Mesio-Cervical, and Disto-Cervical. The resultant force increases super linearly with increasing thickness.

CONCLUSIONS

The design of the trimming line, the edge extension, and the thickness of the aligner affect significantly the magnitude of the resultant force and the distribution of normal contact force. The straight extended trimming design exhibited better force distribution that may favor a bodily tooth movement.

CLINICAL RELEVANCE

A straight extended trimming design of an orthodontic aligner may improve the clinical outcomes. In addition, the manufacturing procedures of the straight design are much simpler compared to the scalloped design.

Computer-aided finite element model for biomechanical analysis of orthodontic aligners

OBJECTIVES

To design a finite element (FE) model that might facilitate understanding of the complex mechanical behavior of orthodontic aligners. The designed model was validated by comparing the generated forces - during 0.2-mm facio-lingual translation of upper left central incisor (Tooth 21) - with the values reported by experimental studies in literature.

MATERIALS AND METHODS

A 3D digital model, obtained from scanning of a typodont of upper jaw, was imported into 3-matic software for designing of aligners with different thicknesses: 0.4, 0.5, 0.6, 0.7 mm. The model was exported to Marc/Mentat FE software. Suitable parameters for FE simulation were selected after a series of sensitivity analyses. Different element classes of the model and different rigidity values of the aligner were also investigated.

RESULTS

The resultant maximum forces generated on facio-lingual translation of Tooth 21 were within the range of 1.3-18.3 N. The force was direction-dependent, where lingual translation transmitted higher forces than facial translation. The force increases with increasing the thickness of the aligner, but not linearly. We found that the generated forces were almost directly proportional to the rigidity of the aligner. The contact normal stress map showed an uneven but almost repeatable distribution of stresses all over the facial surface and concentration of stresses at specific points.

CONCLUSIONS

A validated FE model could reveal a lot about mechanical behavior of orthodontic aligners.

CLINICAL RELEVANCE

Understanding the force systems of clear aligner by means of FE will facilitate better treatment planning and getting optimal outcomes.

Mechanical force regulates root resorption in rats through RANKL and OPG

Background

External root resorption is one of common complications of orthodontic treatment, while internal root resorption is rarely observed, and the difference between pulp and periodontal tissues during orthodontic treatment is still unknown. The purpose of this study was to evaluate the effects of orthodontic forces on histological and cellular changes of the dental pulp and periodontal tissues.

Methods

Orthodontic tooth movement model was established in Forty-eight adult male Wistar rats. The distance of orthodontic tooth movement was quantitatively analyzed. The histological changes of pulp and periodontal tissues were performed by hematoxylin–eosin staining, tartrate-resistant acid phosphate staining was used to analyze the changes of osteoclast number, immunohistochemistry analysis and reverse transcription polymerase chain reaction were used to examine the receptor of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) expression. The width of tertiary dentine was quantitatively analyzed. Tartrate-resistant acid phosphate staining and the erosion area of osteo assay surface plate was used to evaluate osteoclast activity.

Results

The orthodontic tooth movement distance increased in a force dependent manner, and reached the peak value when orthodontic force is 60 g. Heavy orthodontic force increased the RANKL expression of periodontal ligament srem cells (PDLSCs) which further activated osteoclasts and resulted in external root resorption, while the RANKL expression of dental pulp stem cells (DPSCs) was relatively low to activate osteoclasts and result in internal root resorption, and the dental pulp tend to form tertiary dentine under orthodontic force stimulation.

Conclusions

Heavy orthodontic forces activated osteoclasts and triggered external root resorption by upregulating RANKL expression in rat periodontal tissues, while there was no significant change of RANKL expression in dental pulp tissue under heavy orthodontic forces, which prevented osteoclast activation and internal root resorption.

Comparison of surface roughness of root cementum and orthodontically induced root resorption craters from high- and low-fluoridation areas: a 3D confocal microscopy study

Background

Fluoride has a major role in strengthening the structure of enamel against acids. Despite differences between caries and root resorption processes, both events inherently involve acidic dissolution of dental tissues. The aim of the present study was to investigate the effects of water fluoridation levels on the surface roughness of root cementum and resorption craters. The findings provided more insight into the influence of fluoride on the surfaces of intact cementum surface and resorption craters.

Methods

Twenty-eight orthodontic patients were recruited from two cities in Turkey, with high (≥ 2 ppm) and low (≤ 0.05 ppm) water fluoridation. These patients needed bilateral maxillary first premolar extraction as part of their orthodontic treatment and were allocated into two study groups (n = 14 in each group) based on water fluoridation exposure level: the high-fluoride group (HF) and low-fluoride group (LF). 150 g of buccal tipping forces was applied to all maxillary first premolar teeth for 12 weeks with a beta-titanium spring which was reactivated every 4 weeks. All maxillary premolars were removed at the end of the experiment for surface roughness assessment using three-dimensional confocal microscopy and the associated software. The buccal root surface and the largest buccal resorption crater were investigated.

Results

Resorption craters were significantly rougher in LF group compared to HF group (p = 0.002). Craters were rougher than the intact root surfaces (p = 0.000). Cervical and apical regions were significantly rougher than the middle region (p = 0.000 and p = 0.024, respectively).

Conclusions

Higher water fluoridation level of ≥ 2 ppm resulted in significantly smoother root resorption craters than low water fluoridation level of ≤ 0.05 ppm when the teeth were subjected to 150 g of buccal tipping force. Fluoride seems to have a protective role at the interface of root resorption, and further mineral or histological studies may shed light on the exact protective process against root resorption.

Visualization of orthodontic forces generated by aligner-type appliances

Recently, the number of patients who request esthetically pleasing aligner-type orthodontic appliances (referred to as aligners) has been increasing. However, the orthodontic forces generated by these aligners are still unknown. This study aimed to verify whether the orthodontic force in aligners can be estimated by measuring near infrared 2D birefringence, and to visualize the orthodontic force. We measured the mechanical and photoelastic properties of transparent orthodontic thermoplastic specimens to correlate the optical retardation with the applied load. The results confirmed equivalence between the mechanical properties and the photoelasticity. In addition, the 2D retardation distribution that occurred when stress was applied to the sample was mapped and visualized. This indicates that it is possible to estimate and visualize the orthodontic force using the retardation obtained by near infrared 2D birefringence measurement.

Impact of the prefabricated forms of NiTi archwires on orthodontic forces delivered to the mandibular dental arch

BACKGROUND

Although preformed archwires with a variety of arch forms are currently commercially available, the effects of variation in the shape of these archwires on the orthodontic force at each tooth are not well understood. Therefore, we evaluated the forces delivered by various types of commercially available preformed nickel-titanium alloy (NiTi) archwires in a simulated mandibular dental arch.

METHODS

Sixty-three types of 0.019 × 0.025-inch preformed NiTi archwires from 15 manufactures were selected for analysis. The intercanine width (ICW) and intermolar width (IMW) of each archwire were measured at the mean canine and first molar depths of 30 untreated subjects with normal occlusions. Each archwire was placed in a multi-sensor measurement system simulating the mandibular dental arch of subjects with normal occlusions, and orthodontic forces in the facial-lingual direction at the central incisors, canines, and first molars were measured. Correlations between the ICW, IMW, and ICW/IMW ratio of archwires and the delivered forces were analyzed. The archwires were classified into the following four groups according to the ICW and IMW: Control group, ICW and IMW are within the means ± standard deviations of the normal ranges; Ovoid group, narrow ICW and IMW; Tapered group, narrow ICW; and Square group, narrow IMW. The forces were compared among these groups for each tooth.

RESULTS

Significant correlations between the measured archwire width and force to each tooth were found, except between IMW and forces at the central incisors and canines. Significant differences in the forces were found among all groups, except between the Ovoid and Tapered groups at all teeth and between the Ovoid/Tapered and Control groups at the first molar. Significantly greater orthodontic forces in the facial direction were delivered at the central incisors by the archwires in the Ovoid and Tapered groups when compared with the archwires in the other groups.

CONCLUSION

These findings suggest that there is a possible risk of a clinically significant level of unfavorable orthodontic force being delivered to the mandibular incisors in labial inclination when using a preformed archwire with an ICW that is narrower than the dental arch.

Thermal and mechanical characterization of thermoplastic orthodontic aligners discs after molding process

Polymeric aesthetic aligners were introduced in orthodontics as an innovative alternative to fixed appliances, however, their compositions and the thermal molding process may influence the biomechanical characteristics of these aligners. In this study four different clear aligner brands were used, ACE 035 Essix, C + Essix, Crystal 0.75 and Crystal 1.0, whose aim was to identify the thermal-processing influence on the mechanical and physicochemical properties of these materials, and to suggest a orthodontic sequence of wear for these appliances to achieve more effective treatment results. For the tensile tests the sample size calculation was based on probability distributions from the F test. The effect size used was 0.3, type 1 error of 0.05. Statistical Yield strength and Young's Modulus results were evaluated using the Shapiro-Wilk test. The groups were compared using the parametric test of analysis of variance, with Tukey post-test. Differences were statistically considered at the p < 0.05. The Infrared spectroscopy analysis showed no changes in the samples' chemical structure after thermal-processing. However, in the polypropylene aligner, differences were verified in the region attributed to the crystalline phase. Differential Scanning Calorimetry analysis for the same sample showed a crystallinity fraction decrease due to relaxation between polymer chains after molding. In the tensile tests evaluated, the tensile strength and 'Young's modulus presented higher values for aligners containing 100% polyethylene terephthalate glycol. Performing an analogy exercise of the properties of orthodontic wires used in conventional fixed appliances and, relating them to orthodontic plastics, aligners composed of different materials and/or thicknesses could be used in increasing sequence in terms of the modulus of elasticity, starting with C+, which has a lower elastic modulus value, using the ACE 035 as an intermediate and finishing with the Crystal 0.75 and 1.0, providing the desired stiffness to the aligners for the final phase.

Microcracks on the Rat Root Surface Induced by Orthodontic Force, Crack Extension Simulation, and Proteomics Study

Root resorption is a common complication during orthodontic treatment. Microcracks occur on the root surface after an orthodontic force is applied and may be related to the root resorption caused by the orthodontic process. However, the mechanisms underlying root resorption induced by microcracks remain unclear. In this study, a rat orthodontic model was used to investigate the biological mechanisms of root resorption caused by microcracks. First, the first molar was loaded with 0.5-N orthodontic force for 7 days, and microcracks were observed on the root apex surface using a scanning electron microscope. Second, to describe the mechanical principle resulting in microcracks, a finite element model of rat orthodontics was established, which showed that a maximum stress on the root apex can cause microcrack extension. Third, after 7 days of loading in vivo, histological observation revealed that root resorption occurred in the stress concentration area and cementoclasts appeared in the resorption cavity. Finally, proteomics analysis of the root apex area, excluding the periodontal ligament, revealed that the NOX2, Aifm1, and MAPK signaling pathways were involved in the root resorption process. Microcrack extension on the root surface increases calcium ion concentrations, alters the proteins related to root resorption, and promotes cementoclast formation.

Development of a new evaluation method for orthodontic forces generated in individual patients

Numerous experimental studies have examined how much orthodontic force is needed to move teeth more smoothly; however, no reports have examined this clinically in individual, living subjects. We aimed to develop a method for quantifying the force exerted on individual teeth by an orthodontic wire to measure how loads placed on crowded teeth change dynamically over time. Accordingly, we fabricated a series of dental casts of patients undergoing orthodontic treatment (using optical impressions and a three-dimensional printer), fitted these models with nickel-titanium wire, and subjected them to bending load tests. During leveling, nickel-titanium wire is generally considered to exert a weak force due to its low elastic modulus, with a weak orthodontic force applied over a long period of time due to its superelasticity; however, we found that the actual energy exerted by nickel-titanium wire is also largely affected by other factors (e.g., amount of crowding).

Cyclic tensile strain affects the response of human periodontal ligament stromal cells to tumor necrosis factor-α

Objectives

Orthodontic treatment in adult patients predisposed to mild or severe periodontal disease is challenging for orthodontists. Orthodontic malpractice or hyper-occlusal forces may aggravate periodontitis-induced destruction of periodontal tissues, but the specific mechanism remains unknown. In the present study, the combined effect of mechanical stress and tumor necrosis factor (TNF)-α on the inflammatory response in human periodontal ligament stromal cells (hPDLSCs) was investigated.

Materials and methods

hPDLSCs from 5 healthy donors were treated with TNF-α and/or subjected to cyclic tensile strain (CTS) of 6% or 12% elongation with 0.1 Hz for 6- and 24 h. The gene expression of interleukin (IL)-6, IL-8 and cell adhesion molecules VCAM and ICAM was analyzed by qPCR. The protein levels of IL-6 and IL-8 in conditioned media was measured by ELISA. The surface expression of VCAM-1 and ICAM-1 was quantified by immunostaining followed by flow cytometry analysis.

Results

TNF-α-induced IL-6 gene and protein expression was inhibited by CTS, whereas TNF-α-induced IL-8 expression was decreased at mRNA expression level but enhanced at the protein level in a magnitude-dependent manner. CTS downregulated the gene expression of VCAM-1 and ICAM-1 under TNF-α stimulation, but the downregulation of the surface expression analyzed by flow cytometry was observed chiefly for VCAM-1.

Conclusions

Our findings show that mechanical force differentially regulates TNF-α-induced expression of inflammatory mediators and adhesion molecules at the early stage of force application. The effect of cyclic tensile strain is complex and could be either anti-inflammatory or pro-inflammatory depending on the type of pro-inflammatory mediators and force magnitude.

Clinical relevance

Orthodontic forces regulate the inflammatory mediators of periodontitis. The underlying mechanism may have significant implications for future strategies of combined periodontal and orthodontic treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-04039-8.

Forces Between 50 and 100 cN May be Best for Mesiodistal Orthodontic Tooth Movements by Fixed Appliances

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Optimal force magnitude for bodily orthodontic tooth movement with fixed appliances: A systematic review. Theodorou CI, Kuijpers-Jagtman AM, Bronkhorst EM, Wagener FADTG. Am J Orthod Dentofacial Orthop. 2019;156(5):582-592.

SOURCE OF FUNDING

No funding involved.

TYPE OF STUDY/DESIGN

Systematic review.

Effect of PTH and corticotomy on implant movement under mechanical force

Background

Osseointegrated implants are considered as clinically non-movable. Parathyroid hormone (PTH) is known to play a significant role in the regulation of bone remodeling and in intermittent, low doses, result in osteoanabolic effects. This study aimed to investigate the effects of PTH and corticotomy, both under traction force, on osseointegrated implants.

Methods

Four implants—two in each hemimandible—were placed in each of the three study mongrels. Each mongrels were designated as control, normal dose PTH (PTH-1), and high dose PTH (PTH-2) groups, with each groups further subdivided into non-surgery implant and surgery implant. After osseointegration, mechanical force with NiTi closed coil springs (500 g) was applied around each implants. Corticotomy was performed around one of four implants in each mongrels. Parathyroid hormone was administered locally on a weekly basis for 20 weeks. Clinical movement of the implants were evaluated with the superimposed 3D- scanned data, bone- microarchitectural and histologic examinations.

Results

Superimposition analysis showed continuous movement of the non-surgery implant of PTH-1 group. Movement was further justified with lowest bone implant contact (adjusted BIC; 44.77%) in histomorphometric analysis. Upregulation of bone remodeling around the implant was observed in the normal dose PTH group. In the surgery implants, the remarkably higher adjusted BIC compared to the non-surgery implants indicated increased bone formation around the implant surface.

Conclusion

The results indicate that the catabolic and anabolic balance of osseointegrated implants in terms of bone remodeling can be shifted via various interventions including pharmacological, surgical and mechanical force.

Clinical relevance

Upregulated bone remodeling by PTH and corticotomy under continuous mechanical force showed the possible implications for the movement of osseointegrated dental implant.

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Influence of constant strain on the elasticity of thermoplastic orthodontic materials

The aim of this study was to identify a physical property suitable for evaluating the orthodontic force by analyzing the physical properties of thermoplastic materials. Four thermoplastic materials were used: Essix A+^® Plastic (EA), DURAN^® (DU), Erkodur (ER), and Essix C+^® Plastic (EC). Finite element analysis (FEA), a water absorption test, constant strain loading test, X-ray diffraction (XRD) and Fourier transformation infrared spectroscopy analysis were conducted. FEA found a significant correlation between the elastic modulus and the orthodontic force. The water absorption of EC was significantly smaller than the other materials. EC showed no elastic modulus change. The XRD pattern indicated that EC was a crystalline polymer. FEA of thermoplastics showed that the elastic modulus is suitable for the evaluation of orthodontic force. The crystalline thermoplastic EC demonstrated a stable elastic modulus even under strain in a wet environment, suggesting the advantage of its use as an orthodontic aligner material.

Involvement of interleukins-17 and -34 in exacerbated orthodontic root resorption by jiggling force during rat experimental tooth movement

BACKGROUND

Orthodontically induced root resorption (OIRR) is considered as an undesirable and unpredictable sequel of orthodontic treatment. Recent reports demonstrated that interleukin (IL)-17/IL-34, and T cells secrete inflammatory/osteoclastogenic cytokines, which might stimulate osteoclastogenesis/bone resorption. However, little is known about the role played by IL-17/IL-34 in OIRR. The present study was aimed at investigating the odontoclastic expression pattern of IL-17 and IL-34 in resorbed cementum during different experimental tooth movements in vivo.

METHODS

Twenty-four 8-week-old male Wistar rats were divided into four groups: control group, optimal force group (10 g), heavy force group (50 g), and jiggling force group (compression and tension, repetition; 10 g). After 7, 14, and 21 days, the expression levels of IL-17 and IL-34 protein in the resorbed cementum were analyzed using immunohistochemical methods.

RESULTS

On day 21, the immunoreactivity for IL-17 and IL-34 in resorbed roots in the jiggling force group was stronger than that in the heavy force and optimal force groups. Moreover, the number of IL-17-positive and IL-34-positive odontoclasts was significantly increased in the jiggling force group compared with those in the other groups on day 21.

CONCLUSIONS

These results suggest that jiggling forces might exacerbate OIRR compared with heavy forces, as evidenced by the increased expression of IL-17 and IL-34 in odontoclasts obtained from resorbed roots.

Age effect on orthodontic tooth movement rate and the composition of gingival crevicular fluid : A literature review

PURPOSE

To evaluate and form a comprehensive understanding of the effect of patient age on bone remodeling and consequently on the rate of orthodontic tooth movement (OTM).

METHODS

A systematic search in PubMed and Embase from 1990 to December 2017 was performed and completed by a hand search. Prospective clinical trials which investigated the rate of OTM and/or studies assessing age-related changes in the composition of gingival crevicular fluid (GCF) in older compared to younger study groups were included. Study selection, data extraction and risk of bias were assessed by two authors.

RESULTS

Eight studies fulfilled the inclusion criteria. Among them, four evaluated the rate of OTM and six investigated mediators in the GCF (prostaglandin E₂, interleukin [IL]-1β, IL‑6, IL‑1 receptor antagonist, receptor activator of nuclear factor kappa‑Β ligand, osteoprotegerin, granulocyte-macrophage colony-stimulating factor, pentraxin 3). Patient age ranged between 16 and 43 years for older and <16 years for younger groups. In most of the studies, the younger patients showed faster OTM in the first phase of treatment and more pronounced cytokine levels. Older patients had a delayed reaction to orthodontic forces.

CONCLUSION

The small number of included studies and large heterogeneity in study design give limited clinical evidence that the older patients are less responsive to orthodontic force in comparison to younger patients. The initial cellular response to orthodontic force is expected to be delayed in older patients. Control intervals during orthodontic treatment should be adjusted to the individual's treatment response.

Effects of pre-applied orthodontic force on the regeneration of periodontal tissues in tooth replantation

Objective

This study aimed to investigate the effect of pre-applied orthodontic force on the regeneration of periodontal ligament (PDL) tissues and the underlying mechanisms in tooth replantation.

Methods

Orthodontic force (50 cN) was applied to the left maxillary first molars of 7-week-old male Sprague–Dawley rats (n = 32); the right maxillary first molars were left untreated to serve as the control group. After 7 days, the first molars on both sides were fully luxated and were immediately replanted in their original sockets. To verify the effects of the pre-applied orthodontic force, we assessed gene expression by using microarray analysis and real-time reverse transcription polymerase chain reaction (RT-PCR), cell proliferation by using proliferating cell nuclear antigen (PCNA) immunofluorescence staining, and morphological changes by using histological analysis.

Results

Application of orthodontic force for 7 days led to the proliferation of PDL tissues, as verified on microarray analysis and PCNA staining. Histological analysis after replantation revealed less root resorption, a better arrangement of PDL fibers, and earlier regeneration of periodontal tissues in the experimental group than in the control group. For the key genes involved in periodontal tissue remodeling, including CXCL2, CCL4, CCL7, MMP3, PCNA, OPG, and RUNX2, quantitative RT-PCR confirmed that messenger RNA levels were higher at 1 or 2 weeks in the experimental group.

Conclusions

These results suggest that the application of orthodontic force prior to tooth replantation enhanced the proliferation and activities of PDL cells and may lead to higher success rates with fewer complications.

Comparison of BALP, CTX-I, and IL-4 levels around miniscrew implants during orthodontic tooth movement between two different amounts of force

OBJECTIVES

To evaluate the Interleukin-4 (IL-4), bone-specific alkaline phosphatase (BALP), and C-telopeptide of type I collagen (CTX-I) levels in peri-miniscrew crevicular fluid (PMCF) during orthodontic tooth movement between 75 and 150 g of distalization force.

MATERIALS AND METHODS

Thirty miniscrews were placed bilaterally between the maxillary second premolars and first molars. The right and the left maxillary canines were moved distally using either 75 or 150 g of force. PMCF samples were collected before loading (T0); at 2 hours (T1) and 24 hours (T2) later; and on days 7 (T3), 14 (T4), 21 (T5), 30 (T6), and 90 (T7) after force application. Enzyme-linked immunosorbent assay kits were used to determine BALP, CTX-I, and IL-4 levels.

RESULTS

There was no significant difference between the force groups at all time points with respect to BALP, CTX-I, and IL-4 levels (P > .05). There was no significant difference among time points for the two force groups in terms of BALP and IL-4 levels (P > .05). The CTX-I level at T3 was significantly higher than at T0 for both force groups (P < .05).

CONCLUSIONS

Both 75 g and 150 g of orthodontic force are within optimal force limits, and there is no difference in biochemical markers of bone turnover.

Force changes associated with different intrusion strategies for deep-bite correction by clear aligners

OBJECTIVES:

To investigate the relationships among different intrusion patterns of clear overlay aligners and the corresponding orthodontic forces and to provide guidance for clinical treatment.

MATERIALS AND METHODS:

Five sets of removable thermoplastic-formed aligners with the same thickness, designed for different intrusion procedures (G0 aligners as a control group, with no activation; G1 aligners for intruding canines; G2 aligners for intruding incisors; G3 aligners for intruding canines and incisors with the same activations; G4 aligners for intruding canines and incisors with different activation), were manufactured, and the corresponding intrusion forces were measured with a multiaxis force/torque transducer measurement system in real time.

RESULTS:

With the same activation (0.2-mm intrusion) and rectangular attachments placed on the premolars and first molars, the canines experienced the largest intrusive force when intruded alone using G1 aligners. The canines received a larger intrusive force than incisors in G3. The incisors received similar forces in G2 and G3. First premolars endured the largest extrusive forces when all anterior teeth were intruded with G3 aligners. Extrusion forces were exerted on canines and lateral incisors when using G4 aligners.

CONCLUSIONS:

Aligners with different intrusion patterns exert different forces on incisors, canines, and premolars, and the forces were closely related to the designed activation, shape and position of the attachment and relative movement of the adjacent teeth.

Tension force-induced bone formation in orthodontic tooth movement via modulation of the GSK-3β/β-catenin signaling pathway

Orthodontic force-induced osteogenic differentiation and bone formation at tension sites play a critical role in orthodontic tooth movement. However, the molecular mechanism underlying this phenomenon is poorly understood. In the current study, we investigated the involvement of the GSK-3β/β-catenin signaling pathway, which is critical for bone formation during tooth movement. We established a rat tooth movement model to test the hypothesis that orthodontic force may stimulate bone formation at the tension site of the moved tooth and promote the rate of tooth movement via regulation of the GSK-3β/β-catenin signaling pathway. Our results showed that continued mechanical loading increased the distance between the first and second molar in rats. In addition, the loading force increased bone formation at the tension site, and also increased phospho-Ser9-GSK-3β expression and β-catenin signaling pathway activity. Downregulation of GSK-3β activity further increased bone parameters, including bone mineral density, bone volume to tissue volume and trabecular thickness, as well as ALP- and osterix-positive cells at tension sites during tooth movement. However, ICG-001, the β-catenin selective inhibitor, reversed the positive effects of GSK-3β inhibition. In addition, pharmaceutical inhibition of GSK-3β or local treatment with β-catenin inhibitor did not influence the rate of tooth movement. Based on these results, we concluded that GSK-3β/β-catenin signaling contributes to the bone remodeling induced by orthodontic forces, and can be used as a potential therapeutic target in clinical dentistry.

Ultrasound Enhances Dentoalveolar Remodeling in an Ex Vivo Orthodontic, Ovariectomy-Induced Osteoporotic Model

The aim of the study was to investigate the effects of low-intensity pulsed ultrasound (LIPUS) on dentoalveolar structures during application of force to a cultured mandible slice taken from an ovariectomized rat model of osteoporosis. Rats were divided based on whether they had ovariectomy and/or LIPUS application into four groups: control osteoporosis group, control normal group, ultrasound-treated osteoporosis group and ultrasound-treated normal group. The mandibles were dissected, sliced and cultured before application of a 0.5-N force. Tissue specimens from five rats per group received LIPUS; the remaining rats served as untreated controls. Tissue sections were evaluated histologically and histomorphometrically. Osteoporosis significantly affected the alveolar bone without any effect on the dentin-pulp complex. LIPUS enhanced osteoporotic alveolar bone remodeling and increased cementum and predentin thickness. Furthermore, LIPUS application significantly increased odontoblast and periodontal ligament cell counts (p < 0.05) in both groups. Therefore, LIPUS enhances alveolar bone remolding and increases cementum and predentin formation in osteoporotic rat mandible slice organ cultures.

Effect of orthodontic force on expression levels of ten cytokines in gingival crevicular fluid

Various types of inflammatory mediators are involved in the cascade of biological events behind tissue remodeling allowing orthodontic tooth movement. This split-mouth longitudinal study aimed to evaluate the gingival crevicular fluid (GCF) levels of ten cytokines, IL-6, IL-8, IL-10, IL-13, IL-17, IFN-γ, GM-CSF, MCP-1, MIP-1β and TNF-α, during initial orthodontic treatment. The sample comprised 15 healthy patients (9 males and 6 females, 13.9±2.5 years). The lower (test) incisors were moved using fixed appliance carrying a 0.014-inch nickel titanium wire, whereas the upper (control) incisors were bonded without any force. The GCF was collected from the test and control teeth before fixed appliance mounting (baseline) and after 1, 7 and 21days. In 6 sites per tooth, from canine to canine, periodontal conditions were defined as the percentage of sites with visible plaque and bleeding on probing. The total GCF cytokines levels were quantified using multianalysis Luminex technology. Throughout the experimental term, and for both test and control teeth, the mean percentage of sites with visible plaque and bleeding on probing were generally below 25% and 15%, respectively, although variability was also seen. In the test teeth, the GCF levels of all the cytokines remained constant throughout the experimental term. On the contrary, significant reductions were seen in the control teeth for each cytokine. Moreover, significantly greater levels of IL-6, GM-CSF, MCP-1 and TNFα were seen in the test teeth as compared to the control teeth at 7days. The reasons for the differential behavior in the levels of all the investigated cytokines between the test and control teeth may be related to the presence of orthodontic forces and/or subclinical tissue inflammation. Further investigation is needed to elucidate potential roles for these biomarkers in the tissue remodeling incident to orthodontic tooth movement.

Screw-type device diameter and orthodontic loading influence adjacent bone remodeling

OBJECTIVE

To evaluate the effect of diameter and orthodontic loading of a screw-type implantable device on bone remodeling.

MATERIALS AND METHODS

Screw-shaped devices of four distinct diameters, 1.6, 2, 3, and 3.75 mm, were placed into edentulous sites in five skeletally mature beagle dogs (n = 14/dog) following premolar extraction. Using a split-mouth design, devices on one side were loaded using calibrated 2N coil springs. Epifluorescent bone labels were administered intravenous prior to sacrifice. Bone-implant sections (∼ 70 μm) were evaluated to quantify bone formation rate (BFR), and other histomorphometric variables were assessed in the implant supporting bone.

RESULTS

The mean BFR ranged from 10.93 percent per year to 38.91 percent per year. BFR in the bone adjacent to the device was lower for the loaded 1.6-mm screws when compared with the nonloaded 1.6-mm screws (P < .01) and the loaded 2.0-, 3.0-, and 3.75-mm diameter screws (P < .01). No significant differences in BFR were noted, regardless of loading condition, between the 2.0-, 3.0-, and 3.75-mm diameter screws.

CONCLUSIONS

We detected a dramatic reduction in bone remodeling. Although orthodontic loading of 2N did not alter bone remodeling associated with screws with a 2.0-mm diameter or larger, it did decrease bone remodeling adjacent to a loaded 1.6-mm screw. The long-term effect of this diminished remodeling should be further investigated.

Comparisons of orthodontic root resorption under heavy and jiggling reciprocating forces during experimental tooth movement in a rat model

OBJECTIVE

Root mobility due to reciprocating movement of the tooth (jiggling) may exacerbate orthodontic root resorption (ORR). "Jiggling" describes mesiodistal or buccolingual movement of the roots of the teeth during orthodontic treatment. In the present study, buccolingual movement is described as "jiggling." We aimed to investigate the relationship between ORR and jiggling and to test for positive cell expression in odontoclasts in resorbed roots during experimental tooth movement (jiggling) in vivo.

METHODS

Male Wistar rats were divided into control, heavy force (HF), optimal force (OF), and jiggling force (JF) groups. The expression levels of cathepsin K, matrix metalloproteinase (MMP)-9 protein, interleukin (IL)-6, cytokine-induced neutrophil chemoattractant 1 (CINC-1; an IL-8-related protein in rodents), receptor activator of nuclear factor κB ligand (RANKL), and osteoprotegerin protein in the dental root were determined using immunohistochemistry.

RESULTS

On day 21, a greater number of root resorption lacunae, which contained multinucleated odontoclasts, were observed in the palatal roots of rats in the JF group than in rats from other groups. Furthermore, there was a significant increase in the numbers of cathepsin K-positive and MMP-9-positive odontoclasts in the JF group on day 21. Immunoreactivities for IL-6, CINC-1, and RANKL were stronger in resorbed roots exposed to jiggling than in the other groups on day 21. Negative reactivity was observed in the controls.

CONCLUSIONS

These results suggest that jiggling may induce ORR via inflammatory cytokine production during orthodontic tooth movement, and that jiggling may be a risk factor for ORR.

Changes in force associated with the amount of aligner activation and lingual bodily movement of the maxillary central incisor

Objective

The purposes of this study were to measure the orthodontic forces generated by thermoplastic aligners and investigate the possible influences of different activations for lingual bodily movements on orthodontic forces, and their attenuation.

Methods

Thermoplastic material of 1.0-mm in thickness was used to manufacture aligners for 0.2, 0.3, 0.4, 0.5, and 0.6 mm activations for lingual bodily movements of the maxillary central incisor. The orthodontic force in the lingual direction delivered by the thermoplastic aligners was measured using a micro-stress sensor system for the invisible orthodontic technique, and was monitored for 2 weeks.

Results

Orthodontic force increased with the amount of activation of the aligner in the initial measurements. The attenuation speed in the 0.6 mm group was faster than that of the other groups (p < 0.05). All aligners demonstrated rapid relaxation in the first 8 hours, which then decreased slowly and plateaued on day 4 or 5.

Conclusions

The amount of activation had a substantial influence on the orthodontic force imparted by the aligners. The results suggest that the activation of lingual bodily movement of the maxillary central incisor should not exceed 0.5 mm. The initial 4 or 5 days is important with respect to orthodontic treatment incorporating an aligner.

Effects of Low-Intensity Pulsed Ultrasound on Orthodontic Tooth Movement and Orthodontically Induced Inflammatory Root Resorption in Ovariectomized Osteoporotic Rats

This study investigated the effects of low-intensity pulsed ultrasound (LIPUS) on orthodontic tooth movement (OTM) and orthodontically induced inflammatory root resorption (OIRR) in ovariectomized osteoporotic rats. Forty-eight 28-d-old female Wistar rats were divided into ovariectomized and intact groups. In both groups, animals were left untreated; treated with 50 g mesially directed orthodontic force on the maxillary first molars using nickel-titanium closed-coil springs for 28 d; or treated with the same orthodontic protocol along with a 20-min LIPUS application on alternate days for 28 d. Extent of OTM and amount of OIRR of mesial roots were measured on three-dimensionally reconstructed micro-computed tomography images. Ovariectomy increased OIRR (p < 0.05). LIPUS reduced root volumetric loss regardless of ovariectomy status (p < 0.05); only ovariectomized animals had decreased OTM (p < 0.05). LIPUS normalizes OTM and attenuates OIRR in ovariectomized osteoporotic rats. It may therefore be beneficial in women with postmenopausal osteoporosis.

Expression and function of osteogenic genes runt-related transcription factor 2 and osterix in orthodontic tooth movement in rats

OBJECTIVE

To investigate the expression and function of osteogenic genes osterix (OSX) and runt-related transcription factor 2 (RUNX2) in the rat periodontal tissues under orthodontic force for the remodeling of the periodontal tissues.

METHODS

24 Wistar rats were randomly divided into 4 groups of orthodontic tooth movements for 1, 3, and 7 days (experimental groups) and control group (without orthodontic force). The expression of RUNX2 and OSX in the periodontal tissues was analyzed using real time PCR for mRNA and Western blot analysis for protein. The data were also analyzed for involvement of the two genes in signal pathways using bioinformatics tools.

RESULTS

The mRNA levels of RUNX2 and OSX increased in the periodontal tissues after subjected to the orthodontic force for 1 to 7 days, with the highest level occurring at day 7. The relative expression levels of RUNX2 and OSX mRNA were 1.85 ± 0.12, 304 ± 0.06 and 4.16 ± 0.068, and 1.52 ± 0.09, 1.83 ± 0.03 and 2.56 ± 0.06 at day 1, 3 and 7, respectively. The results of Western blot analysis were consistent with the mRNA results.

CONCLUSION

In orthodontic tooth movement, the expression of RUNX2 and OSX was upregulated as a result of external stimulation, suggesting that the two genes is involved in periodontal tissue remodeling and plays an important role in periodontal tissue remodeling.

The effects of low-level laser therapy on orthodontically induced root resorption

The aim of this study was to evaluate the preventive and/or reparative effects of low-level laser therapy (LLLT) on orthodontically induced inflammatory root resorption (OIIRR) in rats. Thirty rats were divided into four groups (short-term control (SC), short-term laser (SL), long-term control (LC), long-term laser (LL)). In all groups, the left first molar was moved mesially for 11 days. At the end of this period, the rats in groups SC and SL were killed in order to observe the resorption lacunas and to evaluate whether LLLT had any positive effect on root resorption. The groups LC and LL were remained for a healing period of 14 days in order to observe spontaneous repair of the resorption areas and investigate whether LLLT had reparative effects on root resorption. A Ga-Al-As diode laser (Doris, CTL-1106MX, Warsaw, Poland) with a wavelength of 820 nm was used. In SL group, the first molars were irradiated with the dose of 4.8 J/cm2 (50 mW, 12 s, 0.6 J) on every other day during force application. In LL group, the irradiation period was started on the day of appliance removal and the first molars were irradiated with the dose of 4.8 J/cm2 on every other day for the next 14 days. LLLT significantly increased the number of osteoblasts and fibroblasts, and inflammatory response in SL group in comparison with SC group (P = .001). The amount of resorption did not represent any difference between the two groups (P = .16). In LL group, LLLT significantly increased the number of fibroblasts and decreased the amount of resorption in comparison with LC group (P = .001; P = .02). Both parameters indicating the reparative and the resorptive processes were found to be increased by LLLT applied during orthodontic force load. LLLT applied after termination of the orthodontic force significantly alleyed resorption and enhanced/accelerated the healing of OIIRR. LLLT has significant reparative effects on OIIRR while it is not possible to say that it definitely has a preventive effect.

Influence of orthodontic forces on human dental pulp: a systematic review

AIM

The aim of the present study was to systematically review the influence of orthodontic force on human dental pulp.

METHODS AND RESULTS

The addressed focused question was "Do orthodontic forces affect the human dental pulp?" which was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a specific question was constructed according to the PICO (Participants, Interventions, Control, Outcomes) principle. Databases were explored from 1952 up to and including August 2014 using different combinations of the following keywords: "orthodontic force"; "dental pulp"; "reaction" and "tooth movement". Literature reviews, letters to the editor, commentaries and case-reports were excluded. Thirty studies were included. Six studies assessed the effect of orthodontic forces on pulpal blood flow and 20 studies investigated the pulpal cellular responses to orthodontic forces. In 4 studies, pulpal responses to orthodontic forces were compared between previously traumatized- and non-traumatized teeth.

CONCLUSIONS

There is insufficient scientific validation regarding the association between orthodontic forces and human dental pulp. However, a history of dental trauma maybe considered a risk factor for loss of pulp vitality during orthodontic treatment.

Cell survival and gene expression under compressive stress in a three-dimensional in vitro human periodontal ligament-like tissue model

This study investigated cell survival and gene expression under various compressive stress conditions mimicking orthodontic force by using a newly developed in vitro model of human periodontal ligament-like tissue (HPdLLT). The HPdLLT was developed by three-dimensional culturing of human periodontal ligament fibroblasts in a porous poly-L-lactide matrix with threefold increased culture media permeability due to hydrophilic modification. In vitro HPdLLTs in experimental groups were subjected to 5, 15, 25 and 35 g/cm(2) compressive stress for 1, 3, 7 or 14 days; controls were cultured over the same periods without compressive stress. Cell morphology and cell apoptosis in the experimental and control groups were investigated using scanning electron microscopy and caspase-3/7 detection. Real-time polymerase chain reaction was performed for seven osteogenic and osteoclastic genes. Similar extracellular matrix and spindle-shaped cells were observed inside or on the surface of in vitro HPdLLTs, with no relation to compressive stress duration or intensity. Similar caspase-3/7 activity indicating comparable apoptosis levels was observed in all samples. Receptor activator of nuclear factor kappa-B ligand and bone morphogenetic protein 2 genes showed characteristic "double-peak" expression at 15 and 35 g/cm(2) on day 14, and alkaline phosphatase and periodontal ligament-associated protein 1 expression peaked at 5 g/cm(2) on day 14; other genes also showed time-dependent and load-dependent expression patterns. The in vitro HPdLLT model system effectively mimicked the reaction and gene expression of the human periodontal ligament in response to orthodontic force. This work provides new information on the effects of compressive stress on human periodontal ligament tissue.

Role of interleukin-6 in orthodontically induced inflammatory root resorption in humans

Objective

To determine the interleukin (IL)-6 levels in gingival crevicular fluid (GCF) of patients with severe root resorption after orthodontic treatment and investigate the effects of different static compressive forces (CFs) on IL-6 production by human periodontal ligament (hPDL) cells and the influence of IL-6 on osteoclastic activation from human osteoclastic precursor (hOCP) cells in vitro.

Methods

IL-6 levels in GCF samples collected from 20 patients (15 and 5 subjects without and with radiographic evidence of severe root resorption, respectively) who had undergone orthodontic treatment were measured by ELISA. The levels of IL-6 mRNA in hPDL cells and IL-6 protein in conditioned medium after the application of different uniform CFs (0, 1.0, 2.0, or 4.0 g/cm² for up to 72 h) were measured by real-time PCR and ELISA, respectively. Finally, the influence of IL-6 on mature osteoclasts was investigated by using hOCP cells on dentin slices in a pit-formation assay.

Results

Clinically, the IL-6 levels were significantly higher in the resorption group than in the control group. In vitro, IL-6 mRNA expression significantly increased with increasing CF. IL-6 protein secretion also increased in a time- and magnitude-dependent manner. Resorbed areas on dentin slices were significantly greater in the recombinant human IL-6-treated group and group cultured in hPDL cell-conditioned medium with CF application (4.0 g/cm²) than in the group cultured in hPDL cell-conditioned medium without CF application.

Conclusions

IL-6 may play an important role in inducing or facilitating orthodontically induced inflammatory root resorption.