Biomarkers in External Apical Root Resorption: An Evidence-based Scoping Review in Biofluids

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Abstract

Background

External apical root resorption (EARR), an unwanted sequela of orthodontic treatment, is difficult to diagnose radiographically. Hence, the current scoping review was planned to generate critical evidence related to biomarkers in oral fluids, i.e. gingival crevicular fluid (GCF), saliva, and blood, of patients showing root resorption, compared to no-resorption or physiologic resorption.

Methods

A literature search was conducted in major databases along with a manual search of relevant articles in the library, and further search from references of the related articles in March 2021. The initial search was subjected to strict inclusion and exclusion criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Results

Following PRISMA guidelines, 20 studies were included in the final review. The studies included human clinical trials and cross-sectional and prospective studies with/without control groups with no date/language restriction. Various biomarkers identified in EARR included dentinal proteins, enzymes, cytokines, and salivary proteins. Severe resorption had higher dentin sialoprotein (DSP) and resorption protein concentrations as well as lower granulocyte-macrophage colony-stimulating factor (GM-CSF) as compared with mild resorption. Increased DSP and dentin phosphophoryn (DPP) expression was found in physiologic resorption. Compared to controls, resorbed teeth showed a higher receptor activator of nuclear factor kappa B ligand/osteoprotegerin (RANKL/OPG) ratio. In contrast, levels of anti-resorptive mediators (IL-1RA, IL-4) was significantly decreased. Differences in force levels (150 g and 100 g) showed no difference in resorption, but a significant rise in biomarkers (aspartate transaminase [AST] and alkaline phosphatase [ALP]) for 150 g force. Moderate to severe resorption in young patients showed a rise in specific salivary proteins, requiring further validation. Limitations of the studies were heterogeneity in study design, biomarker collection, sample selection, and confounding inflammatory conditions.

Conclusions

Various biomarkers in biofluids indicate active resorption, while resorption severity was associated with DSP and GM-CSF in GCF, and a few salivary proteins. However, a robust study design in the future is mandated.

Related collections

Most cited references 41

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Root resorption associated with orthodontic tooth movement: a systematic review.

Belinda Weltman, Katherine Vig, Henry Fields … (2010)

This systematic review evaluated root resorption as an outcome for patients who had orthodontic tooth movement. The results could provide the best available evidence for clinical decisions to minimize the risks and severity of root resorption. Electronic databases were searched, nonelectronic journals were hand searched, and experts in the field were consulted with no language restrictions. Study selection criteria included randomized clinical trials involving human subjects for orthodontic tooth movement, with fixed appliances, and root resorption recorded during or after treatment. Two authors independently reviewed and extracted data from the selected studies on a standardized form. The searches retrieved 921 unique citations. Titles and abstracts identified 144 full articles from which 13 remained after the inclusion criteria were applied. Differences in the methodologic approaches and reporting results made quantitative statistical comparisons impossible. Evidence suggests that comprehensive orthodontic treatment causes increased incidence and severity of root resorption, and heavy forces might be particularly harmful. Orthodontically induced inflammatory root resorption is unaffected by archwire sequencing, bracket prescription, and self-ligation. Previous trauma and tooth morphology are unlikely causative factors. There is some evidence that a 2 to 3 month pause in treatment decreases total root resorption. The results were inconclusive in the clinical management of root resorption, but there is evidence to support the use of light forces, especially with incisor intrusion. Copyright (c) 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

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The Roles of Interleukin-6 in the Pathogenesis of Rheumatoid Arthritis

Misato Hashizume, Masahiko Mihara (2011)

Several clinical studies have demonstrated that the humanized anti-interleukin-6 (IL-6) receptor antibody tocilizumab (TCZ) improves clinical symptoms and prevents progression of joint destruction in rheumatoid arthritis (RA). However, the precise mechanism by which IL-6 blockade leads to the improvement of RA is not well understood. IL-6 promotes synovitis by inducing neovascularization, infiltration of inflammatory cells, and synovial hyperplasia. IL-6 causes bone resorption by inducing osteoclast formation via the induction of RANKL in synovial cells, and cartilage degeneration by producing matrix metalloproteinases (MMPs) in synovial cells and chondrocytes. Moreover, IL-6 is involved in autoimmunity by altering the balance between Th17 cells and Treg. IL-6 also acts on changing lipid concentrations in blood and on inducing the production of hepcidin which causes iron-deficient anemia. In conclusion, IL-6 is a major player in the pathogenesis of RA, and current evidence indicates that the blockade of IL-6 is a beneficial therapy for RA patients.

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Three-dimensional localization of maxillary canines with cone-beam computed tomography.

Leah Walker, Reyes Enciso, James Mah (2005)

Precise 3-dimensional (3D) localization of impacted canines is central to their clinical management. Recently introduced dental 3D volumetric imaging systems make precise localization possible. The purpose of this study was to describe the spatial relationship of impacted canines by using images obtained with the NewTom QR-DVT 9000 (QR Srl, Verona, Italy). Unilaterally and bilaterally impacted canines (n = 27) from 19 consecutive patients (15 female, 4 male) were evaluated on images taken with the NewTom QR-DVT 9000. The spatial relationships of the impacted canines relative to adjacent structures and incisor resorption were assessed with 3D visualization software. Most (92.6%) of the 27 impactions were palatal. Incisor resorption adjacent to the impacted canine was present in 66.7% of the lateral incisors and 11.1% of the central incisors. Follicle size did not play a major role in influencing impacted canine position. The alveolus was narrower at the impacted canine side compared with the erupted canine side; however, the width of the alveolus on the impacted canine side is independent of the deciduous canines. A correlation was found between the proximity of the impacted canine to the incisors and their resorption. There was no common location where eruption was arrested, and great variation in the inclination of the impacted canine was found. 3D volumetric imaging of impacted canines can show the following: presence or absence of the canine, size of the follicle, inclination of the long axis of the tooth, relative buccal and palatal positions, amount of the bone covering the tooth, 3D proximity and resorption of roots of adjacent teeth, condition of adjacent teeth, local anatomic considerations, and overall stage of dental development. In short, 3D imaging is clearly advantageous in the management of impacted canines.

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Author and article information

Journal

Journal ID (nlm-ta): Rambam Maimonides Med J

Journal ID (iso-abbrev): Rambam Maimonides Med J

Journal ID (publisher-id): RMMJ

Title: Rambam Maimonides Medical Journal

Publisher: Rambam Health Care Campus

ISSN (Electronic): 2076-9172

Publication date Collection: 2022

Publication date (Electronic): 27 October 2022

Volume: 13

Issue: 4

Electronic Location Identifier: e0027

Affiliations

[1 ]School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India

[2 ]Department of Orthodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India

[3 ]Department of Oral Pathology and Microbiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India

[4 ]Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India

[5 ]Department of Oral Pathology and Microbiology, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India

Author notes

[* ] To whom correspondence should be addressed. E-mail: pkapoor@ 123456jmi.ac.in

Article

Publisher ID: rmmj-13-3-e0027

DOI: 10.5041/RMMJ.10482

PMC ID: 9622392

PubMed ID: 36112165

SO-VID: aab5b1a2-056c-4aa6-a54b-08411febc9ec

License:

This is an open-access article. All its content, except where otherwise noted, is distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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