Christian Kirschneck

Strontium ranelate improved tooth anchorage and reduced root resorption in orthodontic treatment of rats.

The anchorage mechanisms currently used in orthodontic treatment have various disadvantages. The objective of this study was to determine the applicability of the osteoporosis medication strontium ranelate in pharmacologically induced orthodontic tooth anchorage. In 48 male Wistar rats, a constant orthodontic force of 0.25 N was reciprocally applied to the upper first molar and the incisors by means of a Sentalloy(®) closed coil spring for two to four weeks. 50% of the animals received strontium ranelate at a daily oral dosage of 900 mg per kilogramme of body weight. Bioavailability was determined by blood analyses. The extent of tooth movement was measured both optometrically and cephalometrically (CBCT). Relative alveolar gene expression of osteoclastic markers and OPG-RANKL was assessed by qRT-PCR and root resorption area and osteoclastic activity were determined in TRAP-stained histologic sections of the alveolar process. Compared to controls, the animals treated with strontium ranelate showed up to 40% less tooth movement after four weeks of orthodontic treatment. Gene expression and histologic analyses showed significantly less osteoclastic activity and a significantly smaller root resorption area. Blood analyses confirmed sufficient bioavailability of strontium ranelate. Because of its pharmacologic effects on bone metabolism, strontium ranelate significantly reduced tooth movement and root resorption in orthodontic treatment of rats. Strontium ranelate may be a viable agent for inducing tooth anchorage and reducing undesired root resorption in orthodontic treatment. Patients under medication of strontium ranelate have to expect prolonged orthodontic treatment times.

Differentiated analysis of orthodontic tooth movement in rats with an improved rat model and three-dimensional imaging

Rat models currently available for analysis of orthodontic tooth movement often lack differentiated, reliable and precise measurement systems allowing researchers to separately investigate the individual contribution of tooth tipping, body translation and root torque to overall displacement. Many previously proposed models have serious limitations such as the rather inaccurate analysis of the effects of orthodontic forces on rat incisors. We therefore developed a differentiated measurement system that was used within a rat model with the aim of overcoming the limitations of previous studies. The first left upper molar and the upper incisors of 24 male Wistar rats were subjected to a constant orthodontic force of 0.25 N by means of a NiTi closed coil spring for up to four weeks. The extent of the various types of tooth movement was measured optometrically with a CCD microscope camera and cephalometrically by means of cone beam computed tomography (CBCT). Both types of measurement proved to be reliable for consecutive measurements and the significant tooth movement induced had no harmful effects on the animals. Movement kinetics corresponded to known physiological processes and tipping and body movement equally contributed to the tooth displacement. The upper incisors of the rats were significantly deformed and their natural eruption was effectively halted. The results showed that our proposed measurement systems used within a rat model resolved most of the inadequacies of previous studies. They are reliable, precise and physiological tools for the differentiated analysis of orthodontic tooth movement while simultaneously preserving animal welfare.

Facial landmark localization by curvature maps and profile analysis

IntroductionThree-dimensional landmarks of the face are important for orthodontic examination, harmony assessment and treatment planning. Currently, facial landmarks are often measured by orthodontists via direct observation and manual soft tissue image analysis. This study wants to evaluate and present an objective method for measuring selected facial landmarks based on an analysis of curvature maps and of sagittal profile obtained by a laser-scanning method.MethodsThe faces of 15 people were scanned in 3D by means of the laser scanner FastSCAN™. It allowed the recording of a curvature map of the face in under a minute, which depicted the distribution of Gaussian and mean curvatures. The median-sagittal profile line of the face was localized in this map, and a mathematical analysis comprising its first and second derivatives was performed. Anatomical landmarks were identified and facial measurements performed. To assess validity the obtained data were compared with manual measurements by orthodontists by means of Lin’s concordance correlation CCC coefficient and reliability was determined by consecutive measurements.ResultsFacial landmarks, such as the soft tissue glabella and nasal tip, could be easily and accurately identified and located. Lin’s CCC showed substantial agreement between digital and manual measurements for 4 of the 7 distances evaluated. Larger discrepancies were due to inadequate image quality and scanning errors. Reliability of consecutive measurements by the same operator was excellent.ConclusionsIn our pilot study the three-dimensional laser-scanning method FastSCAN™ allowed a reliable and accurate identification of anatomical landmarks of the face. The obtained distances between certain landmarks, such as the intercanthal distance, were largely consistent with those from manual measurements. Due to its easy and rapid implementation, the method facilitates facial analysis and could be a clinically valid alternative to manual measurements, when remaining problems in scanning accuracy can be resolved.

Interactive effects of periodontitis and orthodontic tooth movement on dental root resorption, tooth movement velocity and alveolar bone loss in a rat model.

BACKGROUND Many adult orthodontic patients suffer from chronic periodontitis with recurrent episodes of active periodontal inflammation. As their number is steadily increasing, orthodontists are more and more frequently challenged by respective treatment considerations. However, little is currently known regarding interactive effects on undesired dental root resorption (DRR), tooth movement velocity, periodontal bone loss and the underlying cellular and tissue reactions. MATERIAL AND METHODS A total of 63 male Fischer344 rats were used in three consecutive experiments employing 21 animals each (A/B/C), randomly assigned to 3 experimental groups (n=7, 1/2/3), respectively: (A) CBCT; (B) histology/serology; (C) RT-qPCR-(1) control; (2) orthodontic tooth movement (OTM) of the first/second upper left molars (NiTi coil spring, 0.25N); (3) OTM with experimentally induced periodontitis (cervical silk ligature). After 14days of OTM, we quantified blood leukocyte level, DRR, osteoclast activity and relative gene expression of inflammatory and osteoclast marker genes within the dental-periodontal tissue as well as tooth movement velocity and periodontal bone loss after 14 and 28 days. RESULTS The experimentally induced periodontal bone loss was significantly increased by concurrent orthodontic force application. Periodontal inflammation during OTM on the other hand significantly augmented the extent of DRR, relative expression of inflammatory/osteoclast marker genes, blood leukocyte level and periodontal osteoclast activity. In addition, contrary to previous studies, we observed a significant increase in tooth movement velocity. CONCLUSIONS Although accelerated tooth movement would be favourable for orthodontic treatment, our results suggest that orthodontic interventions should only be performed after successful systematic periodontal therapy and paused in case of recurrent active inflammation.

Reference genes for valid gene expression studies on rat dental, periodontal and alveolar bone tissue by means of RT-qPCR with a focus on orthodontic tooth movement and periodontitis

OBJECTIVES To obtain valid results in relative gene/mRNA-expression analyses by RT-qPCR, a careful selection of stable reference genes is required for normalization. Currently there is little information on reference gene stability in dental, periodontal and alveolar bone tissues of the rat, especially regarding orthodontic tooth movement and periodontitis. We therefore aimed to identify the best selection and number of reference genes under these experimental as well as physiological conditions. MATERIALS AND METHODS In 7 male Fischer344-rats the upper left first and second molars were moved orthodontically for 2 weeks and in 7 more animals additionally subjected to an experimental periodontitis, whereas 7 animals were left untreated. Tissue samples of defined size containing both molars (without crowns) as well as the adjacent periodontal and alveolar bone tissue were retrieved and RNA extracted for RT-qPCR analyses. Nine candidate reference genes were evaluated and ranked according to their expression stability by 4 different algorithms (geNorm, NormFinder, BestKeeper, comparative ΔCq). RESULTS PPIB/YWHAZ were the most stabile reference genes for the combined dental, periodontal and alveolar bone tissue of the rat overall, in untreated animals and rats with additional periodontitis, whereas PPIB/B2M performed best in orthodontically treated rats with YWHAZ ranking third. Gene-stability ranking differed considerably between investigated groups. A combination of two reference genes was found to be sufficient for normalization in all cases. CONCLUSIONS The substantial differences in expression stability emphasize the need for valid reference genes, when aiming for meaningful results in relative gene expression analyses. Our results should enable researchers to optimize gene expression analysis in future studies by choosing the most suitable reference genes for normalization.

Expression of glutathione peroxidase 1 in the spheno-occipital synchondrosis and its role in ROS-induced apoptosis

BACKGROUND/OBJECTIVE Chondrogenesis is an integral part of endochondral bone formation, by which the midline cranial base is developed. Reactive oxygen species (ROS) are required in chondrogenic differentiation and antioxidant enzymes regulate their levels. The aim of this study was to localize the antioxidant enzyme glutathione peroxidase 1 (Gpx1) at the spheno-occipital synchondrosis, as well as its effect on ROS challenge and its expression pattern in the course of differentiation. MATERIALS AND METHODS Gpx1 was semiquantified in immunohistochemically stained sections of spheno-occipital synchondroses of rats. The effect of Gpx1 on ROS-induced apoptosis was investigated by manipulating the expression of Gpx1 in ATDC5 cells. The temporal pattern of Gpx1 expression was determined during chondrocyte differentiation for 21 days in vitro. RESULTS Proliferating chondrocytes exhibited the greatest Gpx1 immunoreactivity and hypertrophic ones the lowest (P = 0.02). Cells transfected with Gpx1-siRNA had the highest apoptotic rate, while cells overexpressing Gpx1 the lowest one (P < 0.001). Gpx1 was significantly increased on days 10 (P = 0.02) and 14 (P = 0.01). CONCLUSIONS Hypertrophic chondrocytes have the lowest Gpx1 activity in the spheno-occipital synchondrosis. Gpx1 is implicated in the ROS-induced apoptosis in chondrocytes. Its expression was not constitutive during chondrogenic differentiation.

Regular nicotine intake increased tooth movement velocity, osteoclastogenesis and orthodontically induced dental root resorptions in a rat model

Orthodontic forces have been reported to significantly increase nicotine-induced periodontal bone loss. At present, however, it is unknown, which further (side) effects can be expected during orthodontic treatment at a nicotine exposure corresponding to that of an average European smoker. 63 male Fischer344 rats were randomized in three consecutive experiments of 21 animals each (A/B/C) to 3 experimental groups (7 rats, 1/2/3): (A) cone-beam-computed tomography (CBCT); (B) histology/serology; (C) reverse-transcription quantitative real-time polymerase chain reaction (RT-qPCR)/cotinine serology—(1) control; (2) orthodontic tooth movement (OTM) of the first and second upper left molar (NiTi closed coil spring, 0.25 N); (3) OTM with 1.89 mg·kg−1 per day s.c. of L(−)-nicotine. After 14 days of OTM, serum cotinine and IL-6 concentration as well as orthodontically induced inflammatory root resorption (OIIRR), osteoclast activity (histology), orthodontic tooth movement velocity (CBCT, within 14 and 28 days of OTM) and relative gene expression of known inflammatory and osteoclast markers were quantified in the dental-periodontal tissue (RT–qPCR). Animals exposed to nicotine showed significantly heightened serum cotinine and IL-6 levels corresponding to those of regular European smokers. Both the extent of root resorption, osteoclast activity, orthodontic tooth movement and gene expression of inflammatory and osteoclast markers were significantly increased compared to controls with and without OTM under the influence of nicotine. We conclude that apart from increased periodontal bone loss, a progression of dental root resorption and accelerated orthodontic tooth movement are to be anticipated during orthodontic therapy, if nicotine consumption is present. Thus patients should be informed about these risks and the necessity of nicotine abstinence during treatment.

Craniofacial and Cervical Morphology Related to Sagittal Spinal Posture in Children and Adolescents

Studies on the relationship between body posture and craniofacial parameters often focus on the cervical spine. Thus, less attention has been paid to the morphology of the vertebra C2 that serves as both a structural and functional link between the craniofacial area and the other part of the spine. The objective of this study was to assess the relation of craniofacial features to certain morphological and positional characteristics of the cervical vertebrae and the spine during growth. We determined body posture indices for 69 children and adolescents by means of a radiation-free method (rasterstereography). The morphological and positional analysis of the craniofacial area and the cervical vertebrae was based on standardized lateral X-ray cephalograms. Medium to strong correlations were found between body posture, C2 morphology, and craniofacial parameters. We found significant correlations between the C2 dens axis height and maxillary indices as well as between the C2 dens axis inclination and cephalometrical values of the mandibular area. Similarly the correlation between the C2 dens axis inclination and the postural index flèche cervicale was highly significant (P < 0.05, r = 0.333). These results suggest that morphological features of the odontoid process may serve as valuable predictive markers in interdisciplinary orthopedic-orthodontic diagnostics.

Methodological accuracy of digital and manual model analysis in orthodontics - A retrospective clinical study

INTRODUCTION Computer-based digital orthodontic models are available for clinicians, supplemented by dedicated software for performing required diagnostic measurements. The purpose of this study was to evaluate the accuracy of measurements made on three-dimensional digital models obtained with a CBCT-scanner (DigiModel™, OrthoProof(®), Nieuwegin, The Netherlands). METHODS 66 orthodontic dental casts of primary and early mixed dentitions were selected. Three-dimensional images were obtained on this CBCT-scanner and analyzed by means of the DigiModel™ software. Measurements were made with a digital caliper directly on the conventional casts and also digitally on the virtual models. 6 anatomic dental points were identified, and a total of 11 measurements were taken from each cast, including midline deviation, overjet, overbite and arch widths. Conformity of digital and manual measurements as well as intra-, inter- and repeated-measurement-reliability were evaluated by Lins Concordance Correlation Coefficient, ICC and a Bland-Altman-analysis. RESULTS The agreement and conformity of digital and manual measurements was substantial for all parameters evaluated. Intra-, inter- and repeated-measurement-reliability was excellent. CONCLUSIONS Measurements on digital models obtained by a CBCT scan of conventional casts (DigiModel™, OrthoProof(®)) are suited for reliable diagnostic measurements, which compare well to those obtained from plaster casts, the current gold standard.

Shear bond strength of different retainer wires and bonding adhesives in consideration of the pretreatment process

IntroductionWe aimed to compare the shear bond strength (SBS) of three different retainer wires and three different bonding adhesives in consideration of the pretreatment process of enamel surface sandblasting.Methods400 extracted bovine incisors were divided into 10 groups of 20 paired specimens each. 10 specimens of each group were pretreated by enamel sandblasting. The retainer wires Bond-A-Braid™, GAC-Wildcat®-Twistflex and everStick®ORTHO were bonded to the teeth with the adhesives Transbond™-LR, Tetric-EvoFlow™ and Stick®FLOW and then debonded measuring the SBS.ResultsWhile sandblasting generally increased SBS for all tested combinations, the retainer wires bonded with Transbond™-LR showed the highest SBS both with and without prior sandblasting. Significantly lower SBS were found for Tetric-EvoFlow™ that were comparable to those for everStick®ORTHO.ConclusionsPretreatment of enamel surfaces by sandblasting increased the SBS of all retainer-wires. Transbond™-LR showed the best results compared to Tetric-EvoFlow™ and everStick®ORTHO, while all combinations used provided sufficient bonding strengths for clinical use.