Effects of drugs and systemic factors on orthodontic

Effects of drugs and systemic factors on orthodontic

treatmentTyrovola , Spyropoulos

By Ahmad Khalifa

• The purpose of this review is to discuss current data concerning the role of pharmaceutical products (and other systemic factors) known to affect bone tissue and to influence the velocity of orthodontic tooth movement.

EFFECTS OF SYSTEMIC FACTORS ON TOOTH MOVEMENT• Tooth movement depends on the state of calcium metabolism in the

alveolar bone

• Nutritional hyper-parathyroidism, induced in experimental animals by administering a diet with decreased calcium to phosphorus rate, has been shown to increase the ratio of orthodontic tooth movement

Drugs that can influence the rate of tooth movement can be divided into 6 main categories :-

1.Hormones

2.Bisphosphonates

3.Vitamin D metabolites

4.Fluoride

5.Non steroidal anti-inflammatory drugs

6.Eicosanoids

HORMONES Estrogens and androgen• It controls bone remodeling during reproductive life

EstrogensCytokines- IL-l- IL-6- TNF-a

Stimulating ostcoclast formationAnd osteoclastic bone résorption

Decrease of the rate of bone résorption

They also inhibit osteoblasts responsiveness to parathyroid hormone (PTH)

Oral contraceptives, which are taken by Younger women for long periods o f time, can influence the rate o f tooth movement

Androgens also inhibit bone résorption . Thus, the excessive use o f these drugs by athletes, may affect the length And the results o f orthodontic treatment.

Thyroid hormone

• Thyroid hormones are recommended for the treatment of hypothyroidism and are also used after thyroidectomy in substitutive therapy.

• Thyroxine administration seems to lead to increased bone remodeling, increased bone resorptive activity, and reduced bone density.

• It seems possible for the speed of orthodontic tooth movement to be increased in patients undergoing such medication

IL-lBThyroid hormones –low concentrationsOsteoclast formation, and osteoclastic bone résorption

• Low-dosage and short-term thyroxine administrations are also reported to lower the frequency and dimensions of "force-induced“ root résorption lesions.

Caicitonin

• Calcitonin is a peptide hormone secreted by the thyroid in response to hypocalcemia; it targets the kidneys and bones. In bones, calcitonin inactivates osteoclasts and thus inhibits bone résorption. It also stimulates the bone forming activity of osteoblasts.

• Calcitonin is used in the treatment o f hypercalcemia and in osteoporosis; because o f its physioiogical role, it is considered to inhibit tooth movement.

• Consequently, a delay in orthodontic treatment can be expected

Corticosteroid

• Used in the treatment of arthritic, allergic, blood, renal, collagen, or neoplastic diseases.

• The main effect on bone tissue is to be direct inhibition of the osteoblastic function and thus the decrease of total bone formation

• Corticosteroids increase the rate of tooth movement and, since new bone formation can be difficult in treated patients, they decrease the stability of tooth movement and the stability of orthodontic results in general.

• Main side effect o f these drugs is osteoporosis

• in animal models the rate o f active tooth movement is greater, but the tooth movement is less stable.

• A more extensive retention may be helpful in retaining these teeth

BISPHOSPHONATES

• Potent blockers of bone résorption.

• Used in the treatment of metabolic bone diseases that involve increased bone résorption.

• Effect :- Inhibition of osteoclastic metabolism and marked decrease of the number of osteoclasts and affect the structure and function of osteoclasts

• Can inhibit ortbodontic tooth movement and delay the orthodontic treatment

• It seems that topical application o f Bisphosphonates could be helpful in anchoring and retaining teeth under orthodontic treatment.

VITAMIN D3

• Regulates the amount of calcium and phosphorus

• It promotes intestinal calcium and phosphorus absorption and calcium's release from the skeletal system to Blood circulation.

• Vitamin D 3 increases bone mass and thus reduces fractures in osteoporotic patients. So we can assume this pharmacological agent can inhibit orthodontic tooth movement

• Some authors consider vitamin D 3 To be a résorption-promoting agent because it has stimulatory effects on osteoclasts

FLUORIDE

• On the cellular level, fluoride stimulates the growth and synthetic activity o f osteoblasts and bone formation and influences the chemistry o f the bone mineral. In the form of sodium fluoride, it has been shown to inhibit the osteoclastic activity and to reduce the number of active osteoclasts.

• It can influence the velocity o f orthodontic tooth movement.

• Caries preventive treatment with sodium fluoride During orthodontic treatment may delay orthodontic tooth movement and affect the time of the orthodontic therapy.

Increases bone mass and Mineral density

NON STEROIDAL ANTI-INFLAMMATORYDRUGS (SALICYLATES)• It inhibits the résorption process of bone.

• Orthodontic tooth movement is very slow in patients undergoing long-term acetylsalicylic acid therapy, whereas when these patients are taken of medication, a striking difference in orthodontic tooth movement occurs.

• it is recommended that patients undergoing orthodontic treatment should not take aspirin or related compounds for long periods of time during the time of orthodontic treatment, because there is a great possibility o f extension o f the treatment time.

EICOSANOIDSProstaglandins• Prostaglandins may be important mediators of mechanical stress

during orthodontic tooth movement.

• They stimulate bone résorption by increasing the number o f osteoclasts and activating already existing osteoclasts.

• It was found that administration of Prostaglandin 1(PGE 1) or Prostaglandin 2(PGE 2) in experimental models or in orthodontic patients accelerated bone résorption and orthodontic tooth movement.

Leukotrienes

• Metabolites of arachidonic acid

• May also be important mediators of orthodontic tooth movement. It has been demonstrated that they stimulate bone résorption.

• Inhibitors of leukotriene synthesis results in a significant reduction of orthodontic tooth movement.

• Consequently, the use of leukotriene inhibitors can delay orthodontic treatment, whereas leukotrienes and prostaglandins can have future clinical applications that could result in enhanced tooth movement

CONCLUSION

• In addition to applied force ,bone remodeling changes induced by systemic factors such as nutritional factors , metabolic bone diseases, age ,or the use o f drugs, play an important role in regulating the rate of tooth movement.

• Estrogen, androgen, calcitonin, bisphospbonates, vitaminD, fluoride, and salicylates may decrease the velocity of tooth movement.

• Thyroid hormones, corticosteroids, prostaglandins, and leukotrienescan enhance orthodontic tooth movement