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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE
KARNATAKA
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE CANDIDATE Dr. SRIKANTH.S
AND ADDRESS (IN BLOCK POST GRADUATE STUDENT
LETTERS)
DEPARTMENT OF ORTHODONTICS AND
DENTOFACIAL ORTHOPAEDICS,
A.M.E’S DENTAL COLLEGE AND HOSPITAL,
BIJENGERE ROAD,
RAICHUR
KARNATAKA-584103
2.
NAME OF THE
A.M.E’S DENTAL COLLEGE, HOSPITAL AND
INSTITUTION
RESEARCH CENTER,
BIJENGERE ROAD, RAICHUR-584103
KARNATAKA.
3.
COURSE OF STUDY AND
MASTER OF DENTAL SURGERY (MDS) IN
SUBJECT
ORTHODONTICS
AND
DENTOFACIAL
ORTHOPAEDICS
4.
DATE OF ADMISSION TO 27/05/2013
COURSE
5.
TITLE OF THE TOPIC
EVALUATING THE RATE OF ORTHODONTIC
TOOTH
MOVEMENT
CREVICULAR
FLUID
AND
GINGIVAL
LEVELS
OF
INTERLEUKIN-1β WITH LOW-LEVEL LASER
THERAPY- AN EXPERIMENTAL STUDY.
6 BRIEF RESUME OF THE INTENDED WORK :
6.1 Need for the study :
Today because of the time constraints orthodontic treatment is not favoured and readily
not accepted by the individuals, orthodontic brackets in adults when placed for longer time
becomes unpleasing & socially embarassive, hence there was an increased tendency to focus on
the accelerating methods of tooth movement due to the huge demand of adults for a shorter
orthodontic treatment time. Unfortunately long term orthodontic treatment poses several
disadvantages like higher predisposition to caries, gingival recession & root resorption, this paved
the way to rule out the best method to increase the tooth movement with least possible
disadvantages. Thus many studies were done to view the successful approaches in accelerated
tooth movement and to highlight the newest technique, which comprises of biological approach,
device mediated/ physical approach & surgical approach. Due to the advantages and
disadvantages of each approach further investigations should be done to determine the best
method to accelerate the orthodontic tooth movement.
Despite of the approach there was a seek for non-surgical/ minimally or non-invasive
treatment modality which resulted in accelerated tooth movement. In recent times this line of
treatment has been conquered by the laser therapy, which is considered to be the best among &
has a wide range of application in dentistry. The lasers can be used on both hard tissue and soft
tissue which is performed under specific range of wavelength. Recently Low level laser therapy
(LLLT) has attributed to the increase in orthodontic tooth movement, this LLLT thus minimizes
the orthodontic treatment time & makes orthodontics an approachable option for adults.
Tooth movement by orthodontic force application is dependent on remodeling in
periodontal ligament and alveolar bone. Orthodontic movement should be described as a
continual and balanced process characterized by bone deposition and bone resorption,
respectively on pressure and tension sites. When an orthodontic force is applied to a tooth an
inflammatory response is initiated as a result of which the bone resorption process takes place &
this initiates tooth movement. The appearance of osteoclast and bone resorption are the
responsible factors that initiate tooth movement and various cytokines and hormones do play an
important role in this process.
Interleukins are the most potent biomarkers in bone remodeling & interleukin-1 (IL-1)
is a known cytokine that starts the process of bone resorption by stimulating osteoclasts.
Interleukin-1β is a physiologic form of IL-1 & is mainly secreted by monocytes & partially by
macrophages, endothelial cells and fibroblasts.
Interleukin-1β is implicated in the process of bone remodeling in the acute phase reaction
& it has been proved by the studies that the concentration of interleukin-1β increases with the
Orthodontic tooth movement during early stages (12-24hrs) and the obtained results were
statistically significant.
And hence there is a need to find a co-relation between the LLLT & the rate of tooth
movement and simultaneously to detect the effects of LLLT on the biological mediator
interleukin- 1β.
6.2 Review of literature:
In a study a semiconductor diode laser (Ga-Al-As) of 810 nm was used on 20
patients on 0, 3rd, 7th, 14th of first month and every 15th day till the canine retraction, on obtaining
the results they concluded that an average increase of 30% in the rate of tooth movement was
observed with low intensity laser therapy.1
In a study of 20 patients(14 girls, 6 boys) whose first premolars were extracted and canines
distalized. Gallium-aluminium-arsenide (Ga-Al-As) diode laser of 20 mW, 0.71 Joules/cm2 was
applied on 0, 3rd, 7th, 14th, 21st and 28th day. They concluded that the application of low level laser
therapy accelerated the tooth movement significantly.2
A clinical study was conducted on 26 patients in which retraction was done using Niti spring
(force of 150g/side). Thirteen of those were irradiated with diode laser (780 nm, 20 mW, 10 sec, 5
J/cm2 ) for three days and the other 13 were not irradiated. 9 laser application were performed (3
each month). They concluded that there was a statistical significant increase in the movement
speed of irradiated canines observed in comparison with non-irradiated canines in all evaluation
periods.3
In a study of 15 adult patients, with a treatment plan of extraction of upper and lower
premolars and canine distalization, a diode laser Ga-Al-As(809nm, 100 mW) was applied on 0,
3rd, 7th and 14th day. The retraction spring was reactivated on 21st day for all sides. They
concluded that the low level laser therapy can highly accelerate tooth movement during
orthodontic tooth movement.4
A clinical study was done on 11 patients in whom one half of the upper arcade was
considered control group and received mechanical activation of the canine every 30 days. The
opposite half received the same mechanical activation and was also irradiated with a diode laser at
780 nm, 10 sec at 20 mW and 5 J/cm2 on 4th day of each month. They have concluded that all
patients showed significant higher acceleration of the retraction of canine on the side treated with
low level laser therapy when compared to the control.5
A study conducted on 10 orthodontic patients in which the canines were distalized with
hybrid or Poul Gjessing (PG) retractor in order to evaluate levels of interleukin 1β (IL-1β) &
tumor necrosis factor-α (TNF-α). Gingival crevicular fluid samples were collected from the distal
aspects of the canines at baseline, 1st hour, 1st day, 1st month and 2nd month. In the PG group the
samples were collected at 1st hour and 1 day after reactivation after 1 month. They have concluded
that IL-1β level increased at 1st hour and 2nd month in the upper and lower hybrid groups where as
upper PG group increased at hour 1,1st month+ 1 hour and 2nd month.6
A study was done on 10 patients to examine gingival crevicular fluid (GCF) levels of two
potent bone resorbing mediators, prostaglandin E (PGE) and interleukin 1β (IL-1β) during
orthodontic tooth movement. Each patient had one treatment tooth undergoing orthodontic
movement and a contralateral control tooth. GCF samples were taken before activation at 1, 24,
48 and 168 hours. Significant elevations from baseline in GCF IL-1 β levels (24 hrs) and PGE
levels (24 and 48 hrs) were observed over time in treatment teeth as compared to control teeth.
They concluded that the obtained results demonstrated that bone resorbing PGE and IL-1 β
produced within the periodontium are detectable in GCF during early phases of tooth movement
and return to baseline within 7 days.7
6.3 OBJECTIVES OF THE STUDY :1) To evaluate the efficacy of Low Level Laser Therapy on the rate of tooth movement.
2) To evaluate the effect of Low Level Laser Therapy on interleukin-1β levels in GCF.
7 Materials and Methods:
7.1 Source of data:
Patients reporting to DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL
ORTHOPAEDICS, A.M.E’S DENTAL COLLEGE AND HOSPITAL, RAICHUR for
orthodontic treatment.
7.2 Method of selection of data:
Study will consist of 10 subjects including 8 males and 2 females aged between 16-20 years.
Written consent will be taken from the patients prior to the start of the study.
INCLUSION CRITERIA:
1. Treatment plan with extraction of maxillary first premolars as a part of their orthodontic
treatment.
2. Probing depth not exceeding >3mm in whole dentition.
3. Co-operative patients.
EXCLUSION CRITERIA:
1. Medically compromised patients.
2. Presence of periodontitis.
3. Patients on Non-steroidal anti-inflammatory drugs (NSAIDS) should be excluded.
4. Smokers or patients with tobacco chewing habit.
MATERIALS AND METHODOLOGY:Materials used:
1. A diode laser gallium-alluminium-arsenide (Ga-Al-As) of 810nm,0.25mW-100mW.
2. Nickel titanium(niti) coil springs for canine retraction of 150g constant force.
3. Mini screws for anchorage reinforcement.
4. Micropipettes (toptech biomedicals) for GCF collection.
5. Transport media is ice cooling unit maintained at 40c.
6. Enzyme linked immunosorbent assay (ELISA) kit for assessing interleukin-1β levels in
GCF.
Methodology:Total of 10 samples will be chosen perfectly fulfilling the inclusion and exclusion
criteria. Routine orthodontic diagnostic records will be collected and analysed for all subjects.
The treatment plan for these patients includes extraction of maxillary first premolars to meet the
requirement of space for the retraction of anterior teeth. The study will be done between the right
and left arcades using split mouth design.
The right arch will be considered as experimental group which is meant to be
irradiated and assessed whereas the left arch is considered to be the control group (i.e treated by
conventional method, non-irradiated).
The patients will be subjected to extraction and after 7 days mini screws will be placed for
anchorage reinforcement & can be secured with an elastic module. Pre-adjusted edgewise
brackets of 0.022 in slot will be bonded and cured. Initializing the alignment and leveling will be
done with 0.016in heat activated nickel titanium(niti) wire and later sequence of wire will be
16×22in niti,17×25niti,17×25in stainless steel & 19×25in nickel titanium. After alignment and
leveling final working wire will be placed.
After 21 days of 19×25in stainless steel wire placement, individual canine retraction will be
started with a niti coil spring. A constant force of 150g will be used for canine retraction on both
the control and experimental group.
Low level laser therapy will be started on the experimental side on the same day of
placement of coil spring. Informed consent will be taken from each patient or parents
(patients<18yrs) for laser irradiation. The type of semiconductor diode laser that will be used is
Gallium-Alluminium-Arsenide(Ga-Al-As) at 810nm, 0.25mW to 100mW. All necessary
precautions will be taken both by the operator and the patient. The laser regimen will be applied is
on 0, 3rd, 7th and 14th day of first month and thereafter irradiation will be done on every 15th day
until canine retraction is completed on the experimental side.
Methods to measure canine retraction:Study-model methods:
1. Three models (pretreatment before leveling, pre-retraction, post-retraction) will be made for
each patient, on the models the mesial cusp tips of 1stmolar and canine will be the reference
points and measured vernier calipers.
2. Palatal rugae method using study model/ palatal plug method.
Biomarker assessment:
GCF samples will be collected using micropipettes from the distal aspects of the canine both from
the experimental group and the control group. The time interval for the study will be at 0hrs, 6hrs,
24hrs, 3th day and 7th day of retraction. The samples will be tested for the levels of interleukin-1β
by Enzyme-linked immunosorbent assay ELISA TEST (Quantified) and the results will be
tabulated.
7.2 Does the study require any investigation or intervention to be conducted on patients or
other humans or other animals?
YES
7.3 Has ethical clearance been obtained from your institution in case of 7.3?
YES
List of references:
1. Mehta GD, Patil WA. Efficacy of low-intensity laser therapy in reducing treatment time and
orthodontic pain: a clinical investigation. AJODO 2012;141:289-97.
2. Gene G, Kocaderelli, Taser F, Kjljne K, Els. Sarkarati B. Effect of low level laser therapy
(LLLT) on orthodontic tooth movement. Lasers Med Sci 2013;28(1):41-7.
3. Sousa MV, Scanavini MA, Sannamiva EK, Velaseo LG, Anelieri F. Influence of low level
laser on the speed of orthodontic movement. Photomed Laser Surgery 2011;29(3):191-6.
4.Mohamed Y, Sharif A, Hamadi E,Gutknecht N, Lampert F, Mir M. The effect of low level
laser using orthodontic movement: a preliminary study. Laser Med Sci 2008;23:27-33.
5. Crus DR, Kohara EK, Ribeiro MS, Wetter NU. Effects of low-Intensity laser therapy on the
orthodontic tooth movement velocity of human teeth- a preliminary study. Lasers in Surgery and
Medicine 2004;35:117-120.
6. Aslam BI, Tuncer BB, Dinear M, Demir B, Bozkurt S, Gokmenoglu C, et al. Effects of force
constancy on the distribution of interleukin- 1β & tumor necrosis factor α levels. Turkish J Orthod
2013;26:7-18.
7. Grieve WG, Jhonson GK, Moore RN, Richard A, Reindardt, Dubols LM. Prostaglandin E
(PGE) and Interleukin- 1β levels in GCF during human orthodontic tooth movement. AJODO
1994;105:369-74.