Download 11.1 Guide: Dr. DHARMA.RM

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
Karnataka
Annexure -I
PROFORMA FOR THE REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
Name of
the
candidate
and
address
[ in block
letters]
DR.RASHMI DHANASHETTI
D/O MR. GOPAL DHANASHETTI
H.NO. 784, K.K. NAGAR,
BIJAPUR-586101
KARNATAKA
2.
Name of
the
institution
D.A.PANDU MEMORIAL R.V. DENTAL COLLEGE,
BANGALORE -560 078
KARNATAKA
3.
Course of
study and
subject
MASTER OF DENTAL SURGERY [M.D.S] IN
4.
Date of
admission
to course
26-05-2013
5
Title of the OSTEOCALCIN LEVELS IN PERI-MINISCREW IMPLANT
topic
CREVICULAR FLUID DURING ORTHODONTIC TOOTH
MOVEMENT- AN IN VIVO STUDY
ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS
6.
Brief Resume Of The Intended Work:
6.1: Need For The Study:-
Mini implants are increasingly used as orthodontic anchorage. Skeletal anchorage with dental
implants provide absolute anchorage for tooth movement during orthodontic therapy. Mini
screw implants have many benefits such as immediate or early loading, ease of placement,
removal and relatively low cost, thus expanding its usage for various orthodontic tooth
movement. Mechanical stimulation of mini implants can initiate and promote bone remodeling.
Osteocalcin is associated with high rates of bone turn over. It is a non
collagenous matrix protein of calcifying and calcified tissue produced by osteoblasts and has
been described as the most specific marker of osteoblasts function.
Peri-miniscrew implant crevicular fluid (MICF) is the inflammatory
transudate that flows out via the miniscrew implant crevice. The composition of peri-miniscrew
implant crevicular fluid (MICF) is similar to that of gingival crevicular fluid. Changes in
gingival crevicular fluid lead to the destruction of periodontal tissues, similarly changes in
peri-miniscrew implant crevicular fluid can cause destruction in peri-implant structures. Thus
leading to failure of implant causing anchorage loss.
Hence, this study is done to evaluate the levels of the enzyme, osteocalcin in
peri-miniscrew implant crevicular fluid (MICF) to reflect biologic responses induced by
mechanical stress caused during the placement and after loading of mini implants.
6.2: Review of literature:
1.A study was done to determine the levels of osteocalcin and cross-linked N-telopeptides
collagen marker (NTx) in the gingival crevicular fluid (GCF) during orthodontic movement.
Twenty patients requiring all first premolars to be extracted were selected and treated with
conventional straight-wire mechanotherapy. The canines were retracted with closed-coil
springs. The maxillary canine on one side acted as the experimental site, and the contralateral
canine was the control. GCF was collected from around the canines before retraction, and
1hour, 1 day, 7 days, 14 days, and 21 days after retraction. Gingival crevicular fluid (GCF)
levels were estimated and compared with the control site. The results showed statistically
significant changes in N-telopeptide and osteocalcin levels on days 7, 14, and 21 when we
compared the experimental and control sides. The peak in all activity of the variables occurred
on day 14 after retraction. The study concluded that N-telopeptide and osteocalcin levels can be
successfully estimated in the GCF, and its increased levels might indicate the active tooth
movement phase in orthodontic therapy. 1
2. A study was done to determine the peri-miniscrew implant crevicular fluid receptor activator
of nuclear factor-lB ligand (RANKL) and osteoprotegerin (OPG) levels around loaded and
unloaded miniscrew implants at different time intervals. Twenty loaded and 16 unloaded
miniscrew implants were included in this study. All miniscrew implants were placed bilaterally
between the maxillary second premolars and first molars as anchorage units for canine
distalization. Peri-miniscrew implant crevicular fluid was taken from the mesiobuccal aspects
of the loaded and unloaded miniscrew implants before loading; at 24, 48, and 168 hours; and
on day 30 after force application. Enzyme-linked immunosorbent assay kits were used to
determine RANKL and OPG levels in the peri-miniscrew implant crevicular fluid samples.
Peri-miniscrew implant crevicular fluid volume was the highest at 48 hours in the loaded
group. Also, the OPG/RANKL ratio in the peri-miniscrew implant crevicular fluid was
significantly decreased in the loaded miniscrew implant group. The OPG and RANKL levels
vary around loaded and unloaded miniscrew implants as a result of force application.2
3.A study was done to evaluate Interleukin 2,6,8 levels around miniscrew during orthodontic
tooth movement. The study included sixteen patients. Three groups were constructed –
Treatment group (upper canine), miniscrew group and control group (upper second premolar).
Peri miniscrew implant crevicular fluid(MICF) and Gingival crevicular fluid (GCF) was
collected at baseline and at 1hr , 24hr ,48hr ,7 day ,21 day and 3 months after force application.
This study concluded , IL-2 levels significantly increased in treatment group,IL-6 was
unchanged in three groups and IL-8 increased at 1 hr, 24 hr, 48 hr in treatment group and
miniscrew group.3
4. A study was done to determine whether interleukin1 levels are elevated around microscrew
implants that are used as anchorage for tooth movement .The study included ten young adults.
The maxillary canines served as the treatment group, and the microscrew implants were
designated as the implant group. The mandibular canines were used as controls. Perimicroscrew implant crevicular fluid (MICF) and gingival crevicular fluid (GCF) were collected
at the beginning of tooth movement , at 24, 48, and 168 hours later; and on days 14 and 21. An
automated enzyme immunoassay was used to measure 1L-1 in the sample. The study
concluded that the mean 1L-1 level in the treatment group was significantly elevated at 24
hours and 48 hours whereas the levels in the control and implant groups did not change
significantly during the experimental period. Also, the mean 1L-1 level of the treatment group
was significantly higher than in both the control and implant groups at 24 and 48 hours. Thus
the microscrew implants did not demonstrate increased 1L-1 levels during tooth movement.
This supports the concept that microscrew implants might be useful as absolute anchorage
devices.4
5.A study was done to monitor changes in chondroitin sulphate (CS; WF6 epitope) levels in
peri-miniscrew implant crevicular fluid (PMICF) during orthodontic loading. Ten patients
participated in the study. Twenty miniscrew implants were placed and Sentalloy closedcoilsprings (50 g) were used to load the miniscrew implants and to move the maxillary canines
distally. During the unloaded period, peri-miniscrew implant crevicular fluid (PMICF )
samples were collected on days 1, 3, 5, and 7 after miniscrew implant placement and on days
14, 21, 28, and 35 during the loaded period. The competitive enzyme-linked immunosorbent
assay was used to detect chondroitin sulphate (CS ;WF6 epitope) levels in the peri-miniscrew
implant crevicular fluid (PMICF) samples. The differences between the chondroitin sulphate
(WF6 epitope) levels during the unloaded and loaded periods were determined . The
chondroitin sulphate (WF6 epitope) levels during the unloaded period ranged from 0.00 to
758.03 ng/ml and those during the loaded period from 0.00 to 1025.11 ng/ml.5
6.3 Objectives Of The Study:
To determine the levels of osteocalcin in peri-miniscrew implant crevicular fluid around
loaded and unloaded miniscrew implants at different time intervals.
7
Materials And Methods:
7.1 Source of Data:
The subjects are selected from out patients available at the Department of Orthodontics and
Dentofacial Orthopaedics , D.A.P.M.R.V. Dental College and Hospital, Bangalore.
7.2 Methods of collection of Data:
Eighteen patients (age 15-25 years ) , who require bilateral maxillary first
premolar extractions and enmass retraction as a part of their orthodontic treatment are
included in this study.
The patients are randomly divided into two groups, loaded and unloaded
miniscrew implants, according to the loading pattern of their implants.
In the loaded miniscrew group, a 150-g distalization force is delivered by
closed-coil springs which is applied horizontally between the miniscrew and the anterior
segment immediately after the insertion of the miniscrew implants. In the unloaded miniscrew
group,the loading is performed 1 month later.
After removal of plaque around the miniscrew implants, peri-miniscrew implant
crevicular fluid (MICF) samples are collected using Calibrated micropipettes by capillary
action from the mesiobuccal aspects of the miniscrew implants. From each test site a
standardized volume of 3µL is collected using the calibration on white colour coded 1 to 5µL
calibrated volumetric microcapillary pipettes (Sigma-Aldrich chemical company, St Louis,
MO, USA). Each sample collection is allotted a maximum of 30 minutes and some test sites
that did not express any volume of peri-mini screw implant crevicular fluid (MICF) within the
allotted time are excluded from the study. The samples are obtained before loading; at 24,168
hours, 21st day later; and on day 30 after force application.
The samples are stored until analysis and assayed with enzyme-linked
immunosorbent assay (ELISA) kits.
Statistical analysis is carried out to determine the Osteocalcin levels in
peri-miniscrew implant crevicular fluid (MICF)
18 PATIENTS
(Age 15-25 years )
9 patients
( Loaded group)
9 patients
(Unloaded group)
Sample is collected using calibrated micropipettes (Sigma-Aldrich chemical company) (3μL)
before loading, 24hrs,168hrs, 21st day and on 30th day after force application from the
mesiobuccal aspect of the miniscrew implant.
Samples are stored until analysis
Enzyme Linked Immunosorbent Assay (ELISA) test is done to measure the levels of
Osteocalcin in peri miniscrew implant crevicular fluid
Inclusion Criteria :
1. All patients should be in good general health with healthy periodontium and
generalized probing depths not exceeding 3 mm, with no radiographic evidence of
periodontal bone loss.
2.Written informed consents were obtained from all patients or the parents of those under
18 years of age.
Exclusion criteria :
1. Patients who had antibiotic therapy within the past 6 months and used antiinflammatory drugs in the month before the study did not participate.
2. Samples contaminated with saliva or blood will be excluded.
7.3 Does the study require any investigations or intervention to be conducted on
Patients or other human or animal?
Yes. Peri-miniscew implant crevicular fluid is collected from eighteen patients with their
informed consent.
7.4 Has ethical clearance been obtained from your institution in case of being applicable?
YES
8
References:1.Alfaqeeh S and Anil S .Osteocalcin and N-telopeptides of type I collagen marker levels in
gingival crevicular fluid during different stages of orthodontic tooth movement.
Am J Orthod Dentofacial Orthop 2011;139:e553-e559
2. Enhos S, Veli I, Cakmak O, Ucar F, Alkan A, Uysal T. OPG and RANKL levels around
miniscrew implants during orthodontic tooth movement. Am J Orthod Dentofacial
Orthop 2013;144:203-9
3.Hamamci N, Kaya F, Uysal E, Yokas B. Identification of interleukin 2,6, and 8 levels around
miniscrews during orthodontic tooth movement. European Journal of Orthodontics
2012;34:357-361.
4. Sari E, Ucar C. Interleukin 1 Levels around Microscrew Implants during Orthodontic Tooth
Movement. Angle Orthodontics 2007;77:6
5. Intachai I , Krisanaprakornkit S, Kongtawelert P, Ong-chai S .Chondroitin sulphate
(WF6 epitope) levels in peri-miniscrew implant crevicular fluid during orthodontic loading .
European Journal of Orthodontics 2010;32:60–65
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Signature of candidate:-
10
Remarks of the guide:-
11
Name and designation :11.1 Guide:
Dr. DHARMA.R.M
PROFESSOR , DEPARTMENT OF ORTHODONTICS
AND DENTOFACIAL ORTHOPAEDICS
D.A.P.M.R.V DENTAL COLLEGE
11.2 Signature:
(Dr. DHARMA.R.M)
.
11.3 Head of the Department:- DR.AMARNATH .B.C
(PROFESSOR & H.O.D)
DEPARTMENT OF ORTHODONTICS
AND DENTOFACIAL ORTHOPAEDICS,
D.A.P.M.R.V. DENTAL COLLEGE,
BANGALORE-560078
11.4 Signature:-
(DR.AMARNATH .B.C)
12
12. 1.Chairman:-
12.2. Principal:- DR. M.R.DINESH
PRINCIPAL
D.A.P.M.R.V. DENTAL COLLEGE
BANGALORE-560078
12.3 Signature:
(DR.M.R.DINESH)
(Annexure II)
PATIENT CONSENT FORM
I, …………………………………………………………………… have been provided with
details for taking part in the project entitled “ OSTEOCALCIN LEVELS IN PERIMINISCREW IMPLANT CREVICULAR FLUID DURING ORTHODONTIC TOOTH
MOVEMENT- AN IN VIVO STUDY” and also been explained to my satisfaction in the
language known to me.
I, hereby give consent to be enrolled in the study.
Signature and Name of Patient/Guardian
Signature and Name of
investigator
Signature of the Witness
Date: