Abstract
Objectives
Nicotine is considered an etiologic factor for chronic inflammatory phenomena within the periodontal ligament that may result in loss of periodontal attachment. Considering that smokers account for 26 % of adult and 12 % of adolescent patients in orthodontic practice, we performed in vivo and in vitro studies as to whether orthodontic forces may add to the nicotine-induced loss of periodontal bone.
Methods
Fourteen male rats (Fischer 344 inbred) were used. Seven of these served as controls, while the other seven received daily subcutaneous injections of 1.89 mg L-nicotine per kg body weight. Both groups were exposed to orthodontic mesialization of the first two upper left molars using a NiTi closed-coil spring, the contralateral side serving as control. Periodontal bone loss was assessed by cone-beam computed tomography (CBCT). Human periodontal fibroblasts were stressed by compression (2 g/cm2) and/or nicotine (3/5/7.5 µmol), and the expression of cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE2), interleukin-6 (IL-6), osteoprotegerin (OPG), and receptor activator of nuclear factor κB ligand (RANKL) was determined at the transcriptional level by quantitative real-time polymerase chain reaction (qRT-PCR) and at the translational level by enzyme-linked immunosorbent assay (ELISA). In addition, differentiation of co-cultured murine RAW264.7 cells to osteoclast-like cells was quantified by tartrate-resistant acid phosphatase (TRAP) staining.
Results
Orthodontic force application in vivo led to a significant increase in nicotine-induced periodontal bone loss, and cell compression in vitro to increased COX-2, PGE2, IL-6, and RANKL expression, reduced OPG expression, and enhanced differentiation of RAW264.7 cells to osteoclast-like cells compared to nicotine alone.
Conclusion
Additional loss of periodontal bone must be expected during orthodontic treatment of smokers. Clinicians should inform their patients of this increased risk and refrain from performing tooth movements before cessation of smoking.
Zusammenfassung
Zielsetzung
Nikotin gilt als ein ätiologischer Faktor chronisch entzündlicher Prozesse im Zahnhalteapparat, die zum Verlust des parodontalen Attachments führen können. Raucher stellen mit 26 % der Erwachsenen und 12 % der Jugendlichen einen hohen Anteil von Patienten in kieferorthopädischer Behandlung. Wir prüften daher in vivo und in vitro die Hypothese, ob die Applikation kieferorthopädischer Kräfte zu einer Steigerung des nikotininduzierten parodontalen Knochenabbaus führt.
Material und Methoden
Sieben männliche Fischer-344-Ratten erhielten tägliche Injektionen von 1,89 mg L-Nikotin pro kg Körpergewicht s.c., 7 weitere Tiere dienten als Kontrolle. In beiden Gruppen erfolgte eine kieferorthopädische Mesialisation der ersten beiden linken oberen Molaren mittels einer NiTi-Zugfeder, während die kontralaterale Oberkieferseite als Kontrolle diente. Der parodontale Knochenverlust wurde mittels digitaler Volumentomografie (DVT) bestimmt. Humane parodontale Fibroblasten wurden einem Druck von 2 g/cm2 und/oder 3/5/7,5 µM Nikotin ausgesetzt. Bestimmt wurde die Expression von COX-2, PGE2, IL-6, OPG und RANKL auf mRNA- (qRT-PCR) und Proteinebene (ELISA) und quantifiziert wurde die Differenzierung von kokultivierten RAW264.7-Zellen zu osteoklastenähnlichen Zellen mittels TRAP-Färbung.
Ergebnisse
Die kieferorthopädische Kraftapplikation führte in vivo zu einer signifikanten Zunahme des nikotininduzierten parodontalen Knochenverlustes sowie in vitro zu einer Steigerung der Expression von COX-2, PGE2, IL-6 und RANKL, einer Hemmung der OPG-Expression sowie einer vermehrten Differenzierung von osteoklastenähnlichen Zellen aus RAW264.7-Zellen gegenüber der alleinigen Wirkung von Nikotin.
Schlussfolgerungen
Bei der kieferorthopädischen Behandlung von Rauchern ist mit einem vermehrten parodontalen Knochenverlust zu rechnen. Der praktizierende Kieferorthopäde sollte die Patienten über die erhöhten Risiken aufklären, und Zahnbewegungen sollten nur nach Einstellen des Nikotinabusus erfolgen.
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Acknowledgments
We wish to thank Ms. Kathrin Bauer for her technical support in performing the cell experiments.
Danksagung
Die Autoren danken Frau Kathrin Bauer für ihre Unterstützung bei der technischen Durchführung der zellbiologischen Untersuchungen.
Compliance with ethical guidelines
Conflict of interest. C. Kirschneck, P. Proff, M. Maurer, C. Reicheneder, and P. Römer state that there are no conflicts of interest.
All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.
Einhaltung ethischer Richtlinien
Interessenkonflikt. C. Kirschneck, P. Proff, M. Maurer, C. Reicheneder und P. Römer geben an, dass kein Interessenkonflikt besteht.
Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.
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This work was awarded the 2014 Arnold Biber Prize.
Diese Arbeit ist 2014 mit Arnold-Biber-Preis ausgezeichnet worden.
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Kirschneck, C., Proff, P., Maurer, M. et al. Orthodontic forces add to nicotine-induced loss of periodontal bone. J Orofac Orthop 76, 195–212 (2015). https://doi.org/10.1007/s00056-015-0283-7
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DOI: https://doi.org/10.1007/s00056-015-0283-7