Z-plasty surgery combined with orthodontic-prosthodontic approach in the rehabilitation of aberrant frenum with congenitally multiple agenesis: A case report.

INTRODUCTION: Orthodontists often encounter a clinical challenge while dealing with a big space of anterior teeth. Aberrant frenum with congenitally multiple agenesis is a complex case that requires an interdisciplinary approach. The purpose of this paper is to describe the well-synchronized periodontal surgery, orthodontic, and prosthodontic treatment of an aberrant frenum cases with congenitally multiple agenesis. CASE PRESENTATION: A female patient, aged 20, presented with complaints of misaligned, spaced teeth, and several missing teeth. A Class III malocclusion type 1 with a high and hypertrophied maxillary labial frenum was found and diagnosed. A positive blanch test, diastemata, as well as persistent teeth 53, 71, and 81, were detected. Panoramic radiographs confirmed the teeth's agenesis. Orthodontic treatment was performed using the straightwire technique to close the spaces. The frenulum was corrected by a frenectomy utilizing the Z-plasty surgical procedure. Subsequently, prosthodontic treatment involved the fabrication of lucitone dentures to close the remaining space. DISCUSSION: This case alerted periodontists, orthodontists, and prosthodontists that collaboration is essential to intervene in such specific congenital anomalies. An interdisciplinary effort should focus on eliminating the etiology of malocclusion, considering periodontal factors, maintaining dental arch integrity, addressing biomechanical elements, designing appropriate prostheses, ensuring better retention of tooth position, and achieving aesthetic appearance. CONCLUSION: The Z-plasty frenectomy surgery treatment resulted in successful and rapid healing after the operation, with no occurrence of hypertrophic scar formation. The final outcome of orthodontic-prosthodontic treatment was also pleasing for both the patient's aesthetic and functional requirements and the operator's satisfaction.

Potency of hyaluronic acid from eggshell-membrane for open gingival embrasure reconstruction following orthodontic tooth movement (a histomorphological study).

Background: The aim of this research was to assess the effectiveness of eggshell-membrane (ESM)-containing hyaluronic acid (HA) in the treatment of open gingival embrasure (OGE) following orthodontic tooth movement (OTM). Materials and Methods: This study is an in vivo quasi experimental research. A total of 24 Cavia cobaya were equally divided into two groups, treatment (10% HA injection) and control (phosphate-buffered saline [PBS]). A separator was inserted between mandibular incisors to induce an OGE. A volume of 20 µl of either PBS (n = 12) or ESM extract (n = 12) was locally injected within the interdental papilla. Decapitation of animals was made on day 1, 4, and 7 postinjection. The staining was done using hemotoxylin and eosin to observe angiogenesis and Mallory to observe the collagen density. Fourier-transform infrared spectroscopy (FTIR) and thin-layer chromatography (TLC) analysis were performed to detect the amount of HA available in ESM. The results were then compared with independent t-tests and the Mann-Whitney test. The level of statistical significance was set at 0.05. Results: The FTIR and TLC analysis showed that HA was successfully identified in the ESM samples. Local injection of 10% HA induced an increase of angiogenesis compared to the control group on day 1 and 4 postinjection (P < 0.05). Significant differences (P < 0.05) were also noted in the collagen density and the growth of interdental papilla on day 4 and 7 postinjection. Conclusion: ESM has the potential effect of regenerating the interdental papilla construction after OTM by increasing the collagen fiber density and inducing angiogenesis.

Effect of Carbonate Apatite Hydrogel-Advanced Platelet-Rich Fibrin Injection on Osteoblastogenesis during Orthodontic Relapse in Rabbits.

OBJECTIVE: This study aimed to determine the effect of carbonate apatite (CHA) hydrogel-aPRF on osteoblastogenesis during relapse in rabbits. MATERIALS AND METHODS: Forty-five rabbits were divided into three groups (n = 15): the control, CHA, and CHA-autologous platelet-rich fibrin (aPRF) groups. An open-coil spring was compressed between brackets to distalize the lower incisors of the rabbits by delivering a force of 50 cN for 1 week. The new position of the teeth was retained for 14 days, and CHA hydrogel-aPRF was injected every 7 days. The appliances were then debonded to allow relapse. On days 0, 3, 7, 14, and 21 after debonding, transforming growth factor (TGF)-ß1 and bone morphogenetic protein (BMP)-2 expression was examined using immunohistochemistry staining and Runx-2 levels were analyzed by enzyme-linked immunosorbent assay. The data collected were analyzed using analysis of variance and a post hoc Tukey's test (p < 0.05). RESULTS: Histomorphometric analysis revealed that TGF-ß1 expression in the CHA-aPRF group is statistically higher than that in other groups on days 0, 3, and 7 after debonding (p < 0.05). BMP-2 expression in the CHA-aPRF group was also statistically higher than that in the other groups on days 3, 14, and 21 after debonding (p < 0.05). ELISA showed that Runx-2 levels are slightly higher in the CHA-aPRF group than in the other groups (p > 0.05). CONCLUSION: Although injection of CHA-aPRF aids in osteoblastogenesis associated with enhancing TGF-ß1 and BMP-2 expressions, it does not significantly upregulate Runx-2 levels.

Wheat seeds can delay orthodontic tooth movement by blocking osteoclastogenesis in rats.

BACKGROUND: The hormone estrogen can prevent osteoclast differentiation and suppress osteoclastic activity, which can prevent tooth relapse movement. Wheat seeds are a natural material containing phytoestrogens with similar characteristics to estrogen. OBJECTIVE: This study intends to determine the influence of wheat seeds in reducing osteoclastogenesis following orthodontic tooth movement (OTM). MATERIALS AND METHODS: Forty male Sprague Dawley rats were used in this experimental study. The rats were divided into control and treatment groups (n=20). In both groups, the rat maxillary incisors were moved distally using a 0.012 U stainless steel orthodontic appliance with a 2 mm diameter coil and 5 mm wire length. The treatment group received wheat seeds at a dose of 0.6 gram/day. The animals were sacrificed at days 0, 1, 7, and 14 after using the orthodontic appliance (4 subgroups according to observations of days; n=5). RANKL and OPG expressions were determined from the gingival crevicular fluid (GCF) samples using ELISA analysis. Statistical analysis of the data collected was calculated with the independent sample t-test (P<0.05). RESULTS: All the experimental procedures were well-tolerated and did not change the animals' weight. On days 7 and 14, the OTM rate of the treatment group was significantly lower than the control group (P<0.05). ELISA test results showed that the OPG level was significantly higher on days 1, 7, and 14, while the RANKL level was considerably lower on day 14 in the wheat seeds group compared with the control group (P<0.05). CONCLUSION: Wheat seeds can promote osteoclastogenesis inhibition and delay OTM.

Effect of olive oil administration on the level of transforming growth factor ß1 during orthodontic tooth movement in old and young guinea pigs.

Background: Orthodontic tooth movement occurs due to continuous pressure on the teeth, causing the remodeling of the alveolar bone. The tissue will respond to bone growth factors, such as transforming growth factor ß1 (TGF-ß1), fibroblasts, and bone morphogenetic proteins, for new bone formation. The remodeling process is balanced in young adults, but there is an imbalance in older individuals due to decreased differentiation, activity, and life span of osteoblasts, and increased osteoclasts. Olive oil contains lots of antioxidants and can slow down the aging process. This study aims to study the differences in TGF-ß1 levels between old and young guinea pigs, and the difference between olive oil administration on TGF-ß1 levels in old and young guinea pigs with orthodontic tooth movement. Methods: 12 guinea pigs divided into 4 groups: young guinea pigs (4-5 months) not given olive oil; young guinea pigs given olive oil; old guinea pigs (30-31 months) given olive oil; old guinea pigs given olive oil. The teeth were moved using an open coil spring mounted on the brackets on both lower incisors. Gingival sulcus fluid samples were taken on days 0, 7 and 14 of the movement of the teeth. TGF-ß1 levels were analyzed using ELISA. Results: Three-way ANOVA and post hoc statistical tests showed that TGF-ß1 levels in young guinea pigs were significantly higher than old guinea pigs on days 0, 7 and 14 (p<0.05). TGF-ß1 levels in both young and old guinea pigs who were given olive oil was significantly higher than those not given olive oil on days 0, 7 and 14 (p<0.05). Conclusions: TGF-ß1 levels in the younger age guinea pigs were higher than the older age, and olive oil could increase TGF-ß1 levels in the older age guinea pigs.

Different effects of soybean isoflavone genistein on transforming growth factor levels during orthodontic tooth movement among young and old rabbits.

Background: Orthodontic treatment to improve aesthetics and for health reasons is performed in children and adults. Elderly individuals have low levels of estrogen, this results in alveolar bone resorption being greater than alveolar bone apposition. Isoflavones present in soybeans may be able to improve the remodeling process through the induction of osteoblastogenesis by increasing transforming growth factor-ß1 (TGF-ß1) levels. This study aimed to assess the comparative effect of soybean genistein isoflavone to TGF-ß1 during orthodontic tooth movement among juvenile and adult rabbits. Methods: In this study, 12 healthy female rabbits were used. Subjects were divided into four groups (n=3); YG group (young rabbits), YGI group (young rabbits + isoflavones genistein), OG group (old rabbits), and OGI group (old rabbits + isoflavones genistein). Two lower incisors of the rabbit were moved distally using an orthodontic force (50 grams force) delivered by an open coil spring, which was inserted between two brackets. During active movements, the genistein isoflavones were given from the initial installation of the device until days 21, at a dose of 1.2 mg/kg BW once a day. Measurement of TGF-ß levels were performed on days 1, 7, 14, 21 after appliance installation. TGF-ß1 expression was analyzed using enzyme-linked immunosorbent assay (ELISA) and the optical density (OD) of the sample quantifed using a standard curve. The data obtained were analyzed using one-way Anova followed by Tukey HSD test. Results: The TGF-ß1 levels were found to highest in the YGI group, and the TGF-ß levels were significantly lower in the OG group ( p<0.05). ELISA analysis also revealed that TGF-ß1 levels of the OGI group were significantly higher when compared with the OG group ( p<0.05). Conclusion: The administration of soybean genistein isoflavones could improve TGF-ß1 levels in old rabbit's during active orthodontic tooth movement.