The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
1. The role of inflammation in
orthodontic tissue remodeling
www.indiandentalacademy.com
2. Hypothesis
Orthodontic forces strain paradental
tissues, causing release of vasoactive
neurotransmitters from trigeminal nerve
endings, which stimulate endothelial cells
to bind circulating leukocytes, thus
triggring an inflammatory reaction in
both areas of PDL tension and
compression.
www.indiandentalacademy.com
78. What could possibly be the role of
CGRP in tooth movement?
Aside from being a vasoactive
neurotransmitter, ushering leukocytes
into the strained PDL, we found it bound
to osteoblasts, fibroblasts, and
osteoclasts. In PDL tension sites it may
promote apposition of new alveolar bone,
while in compression sites it may act as a
signal for slowing down or terminating
bone resorption.
www.indiandentalacademy.com
80. Cytokines
Non-antibody proteins secreted by
inflammatory leukocytes and some non-
leukocytic cells, that act as intercellular
mediators. They differ from classical
hormones in that they are produced by a
number of tissue or cell types rather than
by specialized glands. They generally act
locally in a paracrine or autocrine rather
than endocrine manner.
www.indiandentalacademy.com
81. Cytokines
In our in vivo and in vitro experiments we
targeted cytokines that had been found to
affect the processes of bone remodeling.
This list included interleukin 1 (IL-1), IL-
2, IL-3, IL-6, gamma interferon (IFN-γ),
and tumor necrosis factor alpha (TNF-α).
www.indiandentalacademy.com
110. Summary
The main findings were:
1. In terms of cellular staining intensity
for IL-1α, there was no significant
difference between paradental cells
near untreated (control) canines and
cells in areas of PDL tension or
compression.
www.indiandentalacademy.com
111. Summary
2. In terms of the number of PDL cells
stained for IL-1α, it was clearly much
greater in strained than in control PDL.
This observation applied to both areas
of compression and tension, and to both
fibroblasts and osteoblasts.
www.indiandentalacademy.com
112. Summary
3. Extensive root resorption was found in
canines treated by mechanical forces
for 56 days. The numerous
odontoclasts in the resorptive lacunae
were stained distinctly for IL-1α.
www.indiandentalacademy.com
113. Conclusions
1. The main effect of orthodontic forces
on the IL-1α concentration in strained
PDL cells is an increase in the number
of positively stained cells in areas of
tension and compression. This increase
may result from the effect of the force
itself, from local effects of paracrines
and autocrines, or from both.
www.indiandentalacademy.com
114. Conclusions
2. The positive staining of odontoclasts for
IL-1α suggests that this cytokine
participates actively in the process of
orthodontic root resorption. It is,
therefore, reasonable to propose that
blocking the IL-1α receptors may
reduce the risk for this destructive
activity.
www.indiandentalacademy.com
161. Summary of findings
Significant increases in cellular staining
intensity for TNF-α were found in PDL
fibroblasts and osteoblasts at both sites of
compression and tension.
These increases did not occur in the early
hours after the application of force, like
in the case of IL-1, but rather 12-24
hours later.
www.indiandentalacademy.com
162. Interpretation of findings
1. The increased concentrations of TNF-α
in sites of PDL tension and compression
suggest that this cytokine participates
in modulating both processes of
resorption and apposition. It probably
promotes the former and inhibits the
latter.
www.indiandentalacademy.com
163. Interpretation of findings
2. The relatively late onset of TNF-α
increases suggests that its synthesis
results from activation of late-
responding genes. Our in vitro
experiments revealed that TNF-α
inhibits the effect of IL-1β in PDL
fibroblasts. This inhibition can be
avoided if TNF-α arrives late.
www.indiandentalacademy.com
164. What do the experiments with
cytokines tell us?
These experiments support the hypothesis that
inflammation is an integral part of the
biological mechanism of tissue remodeling
in orthodontics.
Clinically, this hypothesis is supported by the
presence of at least two of the cardinal signs
of inflammation: pain and reduced function.
www.indiandentalacademy.com
167. Growth factors
Proteins involved in cell differentiation and
growth. They are essential to the cell
cycle, and are thus vital elements in the
life of animals from conception to death.
Among other things, they mediate fetal
development, play a role in maintenance
and repair of tissues, stimulate
production of blood cells, and, gone
awry, participate in cancerous processes.
www.indiandentalacademy.com
211. A response to this statement
Ignoring physiological data in orthodontic
practice is tantamount to neglect, that
may endanger the well being of our
patients. After all, the mouth and face
are part of the human body. We may
wish that our patients behave like
typodonts, but they don’t! Therefore,
orthodontics based on mechanics alone is
like a one hand clapping…
www.indiandentalacademy.com
219. Concluding comment
Normal life is based upon a continuous
balance between numerous physiological,
psychological, and socio-economic
variables. When therapy is required for
correction of an anomaly, the physician
or dentist evaluate these factors in terms
of their potential effects on the diagnosis,
treatment planning, and the outcome of
therapy.
www.indiandentalacademy.com
220. Concluding comment
In orthodontics, where the application of
mechanical forces to teeth is the chief
therapeutic tool, research has revealed
that inflammation is an important part of
the biological response to force,
suggesting that this process is a good
research target for those who wish to
improve clinical efficacy and safety.
www.indiandentalacademy.com