Leptin reduces in vitro cementoblast mineralization and survival as well as induces PGE2 release by ERK1/2 commitment.

OBJECTIVES: Juvenile obesity is a complex clinical condition that is present more and more frequently in the daily orthodontic practice. Over-weighted patients have an impaired bone metabolism, due in part to their increased levels of circulating adipokines. Particularly, leptin has been reported to play a key role in bone physiology. Leptin is ubiquitously present in the body, including blood, saliva, and crevicular fluid. If, and to what extent, it could influence the reaction of cementoblasts during orthodontic-induced forces is yet unknown. MATERIAL AND METHODS: OCCM-30 cementoblasts were cultivated under compressive forces using different concentrations of leptin. The expression of ObR, Runx-2, Osteocalcin, Rank-L, Sost, Caspase 3, 8, and 9 were analyzed by RT-PCR. Western blots were employed for protein analysis. The ERK1/2 antagonist FR180204 (Calbiochem) was used and cPLA2 activation, PGE2, and cytochrome C release were further evaluated. RESULTS: In vitro, when compressive forces are applied, leptin promotes ERK1/2 phosphorylation, as well as upregulates PGE2 and caspase 3 and caspase 9 on OCCM cells. Blockade of ERK1/2 impairs leptin-induced PGE2 secretion and reduced caspase 3 and caspase 9 expression. CONCLUSIONS: Leptin influences the physiological effect of compressive forces on cementoblasts, exerting in vitro a pro-inflammatory and pro-apoptotic effect. CLINICAL RELEVANCE: Our findings indicate that leptin exacerbates the physiological effect of compressive forces on cementoblasts promoting the release of PGE2 and increases the rate of cell apoptosis, and thus, increased levels of leptin may influence the inflammatory response during orthodontically induced tooth movement.

Facial-profile attractiveness changes in adult patients treated with the Herbst appliance.

AIM: The goal of this study was to compare facial profile attractiveness changes of adult patients treated with the Herbst appliance assessed by orthodontists and laypeople. MATERIALS AND METHODS: The patient sample comprised 28 adult Herbst patients. Facial profile photographs of the patients were randomly divided into two evaluation sets (before T0, after treatment T1). Ten members of the Angle Society of Europe (orthodontists) and 10 dental students in their third semester (laymen) rated both sets of photographs using Visual Analog Scales (VAS) with an interval of 1 day between the ratings. RESULTS: On average, both orthodontists and students found an improvement in facial profile attractiveness through Herbst appliance treatment (VAS T1-T0 = 0.3 ± 1.9 cm). However, the interindividual perception of profile attractiveness varied greatly in the two rater groups. For both time periods (T0, T1), lower VAS ratings were given by students than by orthodontists. CONCLUSION: Herbst therapy in adult patients generally improves facial profile attractiveness. Students rated facial profiles more critically than orthodontists.

Correlation between body mass index and orthodontic treatment outcome.

OBJECTIVE: To determine whether there is a correlation between body mass index (BMI), patient cooperation, and treatment success during multibracket (MB) appliance therapy. MATERIALS AND METHODS: All adolescent MB patients started and finished between 2007 and 2010 were analyzed. The pretreatment BMI was calculated and negative file entries such as bad oral hygiene, missed appointments, and appliance breakage were recorded. According to the number of negative entries, cooperation was classified as good, bad, or poor. Additionally, the treatment duration and the number of appointments were recorded. For the evaluation of treatment success, the pretreatment and posttreatment PAR (peer assessment rating) scores were measured. RESULTS: Of the 77 subjects, 61 had a normal BMI (79.2%) and 16 were considered overweight (20.8%). Whereas 51.7% of the normal-weight children had a good cooperation, only 25% of the overweight patients cooperated sufficiently. Consequently, the number of patients exhibiting bad or poor cooperation was higher in the overweight group (37.5% bad, 37.5% poor) than in the normal-weight group (30.6% bad, 17.7% poor). Patients with an increased BMI had a slightly longer treatment duration (21.4 months) and needed more appointments (19.9) than their normal-weight peers (18.9 months, 18.1 appointments). The PAR (peer assessment rating) score reduction, however, was comparable (normal BMI: 17.8 points, 64.0%; increased BMI: 15.2 points, 65.3%). CONCLUSION: In the present study, children with increased BMI did not cooperate as well during MB therapy as their normal-weight peers, but the treatment outcome was comparable in the two groups.

Orthodontic and dentofacial orthopedic management of juvenile idiopathic arthritis: a systematic review of the literature.

To systematically review the literature published on orthodontic treatment principles in patients with juvenile idiopathic arthritis (JIA). Several electronic databases (PubMed, Medpilot, Web of Science, and DIMDI) and orthodontic and rheumatologic literature were systematically searched for studies published until May 2010. The articles were rated by two independent reviewers and included after three selection steps (title-abstract-full text). Articles had to be studies performed on ≥ 5 patients with a disease onset before the age of 16. The selection process resulted in the inclusion of three publications on dentofacial orthopedics and six on combined surgical orthodontic therapy. The three studies on dentofacial orthopedics aimed to improve the mandibular retrusion by means of removable functional appliances (activator). Whereas these orthodontic approaches comprised relatively large and homogeneous patient samples (14, 22, and 72 subjects, aged 6-16), the surgical studies were basically case series with a large age span of the patients (5-12 subjects, aged 10-44). In these surgical treatment approaches, orthodontics was limited to pre-surgical leveling and post-surgical finishing, while the skeletal discrepancy was treated surgically by a variety of techniques (costochondral grafts, bilateral sagittal spilt osteotomy, Le Fort I, and genioplasty). The treatment goals of both approaches were improvement of esthetics and function and/or pain reduction, and both approaches showed satisfactory results. Because of the heterogeneity of the subject material and the low level of evidence of the papers, it is difficult to draw any conclusions on the orthodontic/dentofacial orthopedic management of JIA. It appears as if removable functional appliances may be beneficial in adolescent patients with JIA.