Effect of micro-osteoperforations on the rate of orthodontic tooth movement and expression of biomarkers: a randomized controlled clinical trial

ABSTRACT Introduction: Micro-osteoperforation is a minimally invasive technique that has been used to accelerate orthodontic tooth movement and reduce treatment duration. However, literature presents conflicting reports about this technique. Objective: To evaluate the effectiveness of micro-osteoperforations on the rate of canine retraction and expression of biomarkers in gingival crevicular fluid (GCF). Methods: This was a randomized clinical trial with split-mouth study design. Thirty adult subjects with age above 18 years (20.32 ± 1.96) who required fixed orthodontic treatment and extraction of maxillary first premolars were enrolled and randomly allocated to either the experimental or control group. Randomization was performed by block randomization method, with a 1:1 allocation ratio. The experimental group received three micro-ostoperforations (MOPs) distal to maxillary canine, using the Lance pilot drill. The retraction of maxillary canine was performed with NiTi coil-spring (150g) in both experimental and control groups. The primary outcome was the evaluation of canine retraction rate, measured on study models from the baseline to 16 weeks of canine retraction. Secondary outcomes were the estimation of alkaline and acid phosphates activity in GCF at 0, 1, 2, 3, and 4 weeks. Results: There was a statistically significant difference in the rate of canine retraction only after the first 4 weeks. Subsequently there was no statistically significant difference from the eighth to the sixteenth weeks between MOPs and control group. There was a statistically significant difference in alkaline and acid phosphates activity in GCF between MOPs and control groups during the initial 4 weeks of canine retraction. Conclusion: Micro-ostoperforation increased the rate of tooth movement only for the first 4 weeks; thereafter, no effect was observed on the rate of canine retraction during 8, 12 and 16 weeks. A marked increase in biomarker activity in the first month was observed.

RESUMO Introdução: As micro-osteoperfurações (MOPs) são uma técnica minimamente invasiva que tem sido utilizada para acelerar a movimentação dentária ortodôntica e reduzir o tempo de tratamento. No entanto, existem relatos conflitantes sobre o uso dessa técnica. Objetivo: Avaliar a eficácia das MOPs em acelerar a taxa do movimento de retração de caninos e na expressão de biomarcadores no fluido crevicular gengival (FCG). Métodos: Esse foi um ensaio clínico randomizado com desenho de estudo do tipo boca dividida. Trinta indivíduos adultos com idade acima de 18 anos (20,32 ± 1,96 anos) que necessitavam de tratamento ortodôntico fixo e extração de primeiros pré-molares superiores foram incluídos e aleatoriamente alocados para o grupo experimental ou grupo controle. A randomização foi realizada pelo método de randomização em bloco, com proporção de alocação de 1:1. O grupo experimental recebeu três MOPs distais ao canino superior, utilizando uma broca piloto em formato de lança. A retração do canino superior foi realizada com mola helicoidal de NiTi (150g) nos dois grupos, experimental e controle. O desfecho primário foi a avaliação da taxa de retração dos caninos, medida em modelos de estudo do início da retração até 16 semanas depois. O desfecho secundário foi a estimativa da atividade da fosfatase alcalina e ácida no FCG após 0, 1, 2, 3 e 4 semanas. Resultados: Houve uma diferença estatisticamente significativa na taxa de retração dos caninos somente após as quatro primeiras semanas. Após isso, não houve diferença estatisticamente significativa entre os grupos experimental e controle entre a oitava e a décima sexta semanas. Houve uma diferença estatisticamente significativa na atividade da fosfatase alcaline e ácida no FCG entre os grupos experimental e controle durante as quatro primeiras semanas de retração dos caninos. Conclusão: As micro-osteoperfurações aumentaram a taxa de movimentação dentária apenas nas primeiras quatro semanas; depois disso, nenhum efeito foi observado na taxa de retração dos caninos após 8, 12 e 16 semanas. Houve aumento considerável na atividade do biomarcador no primeiro mês.

A Study on the Role of Oxidative Stress and Prolidase Enzyme in the Clinical Evaluation of Irritable Bowel Syndrome (IBS)

Introduction: Irritable bowel syndrome (IBS), though abenign disorder is highly prevalent and imposes high costand substantial morbidity upon general population. Longconsidered as functional disorder, IBS pathogenesis carries anorganic basis at least in a subset of patients. Altered intestinalimmune response and low grade intestinal inflammation havebeen confirmed as pathophysiology of IBS in few studies.Oxidative stress indicates that there is inflammation and,markers of oxidative stress may be developed as diagnostictool for IBS in future. Study aimed to evaluate oxidativestress in form of total oxidant status (TOS), total anti-oxidantstatus (TAS), oxidative stress index (OSI) and serum prolidaseactivity (SPA) as a marker of intestinal inflammation in IBSpatients and healthy controls.Material and methods: In this case –control study done ata teaching medical institute in north India over a period ofone year, 120 IBS patients (cases) and 40 healthy volunteers(controls) were evaluated for TOS, TAS, OSI and SPA.Patients with IBS were sub-divided into 3 groups (40 each):diarrhea predominant, constipation predominant and mixedtype (IBS-D, C and M respectively). Student t-test, chi-squaretest and ANOVA tests were used for statistical analysis.Results: Mean TOS, TOS/TAS (OSI) and prolidase levelswere significantly higher in IBS group than control with pvalue of <0.001,< 0.001, and <0.01 respectively. Level ofTOS was highest in IBS-D subgroup followed by IBS-M andLowest in IBS-C subgroup showing a significant differencebetween IBS-D and IBS-C, IBS-D and IBS-M and IBS-Mand IBS-C with p values <0.001 for each comparison. OSIwas highest in IBS-D and lowest in IBS-C with significantdifferences between the subgroups (P<0.001). Only IBS-Msubgroup had significantly higher serum prolidase activitywhen compared to controls (p<0.001) IBS-D (P=0.013) andIBS-C (P=0.01). TAS level was significantly higher in controls(P<0.001) than cases. There were significant differencesbetween all four subgroups (p<0.001) except between IBS-Cand IBS-M subgroups (P=0.294).Conclusion: This study observed that there is increasedoxidative stress and decreased antioxidant capacity in patientwith IBS. To support our results further prospective andrandomized controlled trials are necessary.

Determinants of survival in adult HIV patients on antiretroviral therapy in Eastern Uttar Pradesh: A prospective study.

Background & objectives: The National AIDS Control Organization (NACO) of India has been providing free ARV (antiretroviral) drugs since 2004. by 2012, 486,173 patients had received treatment through the antiretroviral therapy (ART) centres. The objective of this observational study was to assess the factors determining survival of patients on ART under routine programme conditions in an ART centre in north India five years after its inception. Methods: Treatment naive HIV positive patients who were enrolled in the ART centre between May 2009 and May 2010 and started on ART as per the Revised NACO guidelines 2009, were included in the study and outcome was assessed after two years of follow up. Results: A total of 1689 patients were included in the analysis, of whom 272 (16.10%) expired, 205 (12.13%) were lost to follow up (LFU), 526 (31.14%) were transferred out to other facilities and 686 (40.63%) were alive at the end of two years. Majority (92%) of the deaths occurred in the first six months of therapy. Age >30 yr, male gender, poor functional status, haemoglobin level <11 g/dl, body weight <45 kg and CD4 count <100/μl at baseline had significantly higher relative hazard of death. Most LFU also occurred in the first six months and these patients had significantly low CD4 count, weight, haemoglobin level and higher number of patients in Stages III and IV as compared to those who survived. Interpretation & conclusions: The study findings revealed poor survival in the first six months of therapy especially in those with severe immunosuppression. This emphasizes the need for early enrolment into the programme. The high LFU occurring early after initiation of therapy suggests the urgent need to build an efficient patient retrieval system in the programme.