Yilan Miao
| Yilan Miao |
Yilan Miao1
Yu-Cheng Chang1, Nipul Tanna2, Nicolette J Almer2, Chun-Hsi Chung2, Min Zou3, Zhong Zheng4
Chenshuang Li1
1Periodontics, University of Pennsylvania School of Dental Medicine; 2Department of Orthodontics, University of Pennsylvania School of Dental Medicine; 3Department of Orthodontics, Xi'an Jiaotong University; 4School of Dentistry, University of California, Los Angeles; 5Department of Orthodontics, Penn Dental Medicine; 6Department of Orthodontics, Penn Dental Medicine;
Introduction
Sufficient alveolar bone is a determinant in the outcome of orthodontic treatment, as orthodontically moving the tooth into bone defects could cause periodontal complication or tooth loss. Bone grafting is often indicated before orthodontic treatment to enhance bone regeneration in pre-conditions such as periodontal bone resorption, alveolar cleft, bone defects due to long-term tooth loss/trauma, and thin biotype. Many new types of bone graft materials are being developed and tested, yet their efficacies on bone regeneration and orthodontic tooth movement remain unknown. This study aims to review novel bone graft materials with potential applications in orthodontics, and to evaluate their osteogenic potential and effects on tooth movement.
Methods
We conduct a comprehensive literature search (published between 2010 and 2022) in PubMed and other databases with keywords “orthodontics,” “tooth movement,” “graft,” and “regeneration.” After initial quality assessments, 81 publications are included in the current review. Properties including impacts on regenerated bone volume/density, cellular response, tooth movement rate, and adverse effects are evaluated.
Results
Recent advancements in bone graft materials include bioactive proteins, platelet-rich fibrin (PRF), stem cell-based graft, synthetic inorganic materials, and 3D printed scaffolds. Bone morphogenetic protein-2 (BMP-2), the only FDA-approved osteoinductive growth factor, shows similar effects in promoting bone regeneration and orthodontic movement compared with autografts (gold standard), yet adverse effects such as bone resorptions on the pressure side are implicated. Combinatory approaches of BMP-2 with biomimetic calcium phosphate (BioCap) granules or vascular endothelial growth factors can further improve orthodontic outcomes while reducing bone resorption. PRF contains endogenous fibrin scaffold and growth factors that promote regenerative cell migration. However, post-injection pain is common. Grafts containing bone marrow derived mesenchymal stem cells can facilitate bone remodeling by activating osteoclastogenesis, which accelerates orthodontic tooth moment and cannot be achieved with other graft materials. Synthetic inorganic materials represent a low-cost and accessible source of graft materials while eliminating the risk of infectious disease transmission. Furthermore, 3D printed scaffolds provide additional mechanical stability by mimicking natural anatomical and histological arrangements of bones, which may be potentially combined with other graft materials to maintain tissue volume during orthodontic treatment.
Conclusion
Most novel graft materials promote bone regeneration and accelerate orthodontic tooth movement, therefore shortening the treatment duration. A multi-targeting combination of graft materials displayed favorable activities on bone regeneration and tooth movement with reduced adverse effects. However, high-quality randomized controlled trials, larger sample size, and longer follow-up periods are required for future investigations.