INTRODUCTION:

Malocclusion, a problem that can affect the oral condition and create issues in articulation, mastication, and arch development is usually treated using orthodontic treatment.¹Fix orthodontic appliances create intermittent force, which causes bone remodeling, allowing orthodontic tooth movement to occur. Pressure induces resorption in the compression area and apposition in the tension area.^2-6

The American Board of Orthodontics standard states, it takes approximately 24.6 months to complete an orthodontic treatment.^7,8Orthodontic appliances placed in the mouth for an extended time framewill cause bad oral hygiene of the patients, enamel demineralization, root resorption, gingival inflammation, chronic inflammatory enlargement, caries, and periodontitis.^9-11

Patient’swilling to shorten the duration of orthodontic treatment has been investigated by by a study that investigated how long orthodontic treatment takes revealed that 33.2% of adolescent patients wanted their orthodontic treatment to last between 6 and 12 months, While 40.8% preferred that their treatment last no more than 6 months.Adult patients desired between 6 and 12 months in 42.9% of cases, and between 12 and 18 months in 26.5% of cases.¹²

Overcoming these challenges will improve orthodontic treatment quality and motivate people to consider orthodontic treatment.¹³In today's orthodontics, the search for methods to accelerate orthodontic tooth movement without compromising treatment outcomes is an active area of research. One strategy is to maximize biological response, which change tooth movement from being influenced by the rate of bone resorption to being influenced by the rate of osteoclast activation and differentiation.¹⁴To improve tooth movement, many studies have tried a variety of methods, including pharmacological agents such as prostaglandin E2 and calcitriol (the active form of vitamin D3), as well as parathyroid hormone.¹⁵

In 1936, Euler discovered prostaglandins in the glands of sheep vesicles. Subsequently, many researchers found prostaglandins in several tissues in the body, including bone tissue, nerve cells, muscle cells, and reproductive tissue.¹⁶ Prostaglandin is a paracrinehormone that act as messenger molecules in the body. Depending on the receptors they bind to, they have various and important effects. In bone cells, prostaglandins act as a multifunctional regulator of bone metabolism, stimulating bone resorption and formation there.¹⁷ Under mechanical forces, prostaglandin is a crucial regulator of bone remodeling. The osteoclastic process of bone resorption is triggered by the endogenous prostaglandins that are produced and secreted by localized cells as a result of the mechanical strain of orthodontic appliances.¹⁸The aim of this study is to analyze the orthodontic tooth movement accelerated with prostaglandins.

MATERIAL AND METHODS:

Review methodology:

The approach for this scoping review was developed using Arksey and O'Malley's methodological framework and the recommendations given by Levac et alThe review was organized into five primary stages: formulating the research question, locating relevant papers, charting the data, assembling the findings, summarizing them, and reporting them.^19,20

PIO (Participants, Intervention, Outcome) technique was employed to elaborate research question, in which P (participants) to healthy human and animal subjects underwent active orthodontic modeling with fixed orthodontic appliances, I (intervention) to prostaglandin, O (outcome) to numerical data from the distance of tooth movement. Considering the PIO strategy, the following question was asked: “What is the effect of prostaglandins on the acceleration of orthodontic tooth movement based on previous research reports?”

Information sources:

The initial searched was implanted in August, 2021, in four electronic databases: PubMed (US National Library of Medicine, USA), Scopus, EBSCO and ProQuest. The databases were chosen to be extensive and to cover a wide range of fields. The database search was not restricted by year, language (English or Bahasa Indonesia), subject, or type. The search query included terms thought by the authors to characterize the scoping :prostaglandin, enhancement orthodontic tooth movement. The search query was adapted to the particular demands of each database.

Search strategy:

A search technique was established for each database using a similar combination of descriptors and keywords: “Prostaglandin”, “Enhancement Tooth Movement”, “Orthodontic”, and the Booleans “and”, “or” and “not”. Due to the features and amount of productions in each database, different combinations of Booleans were used in each search. The database search approach is shown in Table 1.

Inclusion criteria were full texts of research published in English, and Bahasa Indonesia that addressed the use of prostaglandin in enhancement orthodontic tooth movement and the excluded criteria were review studies, in vitro study, studies that were duplicated, and studies that did not solve the research issue.

Table 1. database search strategies.

Database	Keywords
PubMed	(orthodontic) or (orthodontics) or (fixed appliance) and (prostaglandin) or (prostaglandins) or (prostaglandin analog) and (accelerated) or (acceleration) or (tooth movement) or (orthodontic tooth movement) or (bone remodeling) or (bone turnover)
ProQuest	(orthodontic) or (orthodontics) or (fixed appliance) and (prostaglandin) or (prostaglandins) or (prostaglandin analog) and (accelerated) or (acceleration)) or (tooth movement)) or (orthodontic tooth movement)) or (bone remodeling)) or (bone turnover))
EBSCOhost	(orthodontic) or (orthodontics) or (fixed appliance)) and (prostaglandin) or (prostaglandins) or (prostaglandin analog) and (accelerated) or (acceleration) or (tooth movement) or (orthodontic tooth movement) or (bone remodeling) or (bone turnover)
Scopus	(title-abs-key (orthodontics) or title-abs-key (orthodontic) or title-abs key (fixed and appliance) and title-abs-key (prostaglandin) or title-abs-key (prostaglandins) and title-abs-key (accelerate) or title-abs-key (accelerated) and title-abs-key (tooth and movement) or title-abs-key (orthodontic and tooth and movement)

Study design and selection process:

Only the abstract and title of citations were examined for the first level of screening in order to prevent wasting resources on articles that failed to meet the minimal requirements for inclusion. An abstract and title relevance screening form that the authors prepared was examined by the research team. Each reference's title and abstract were separately reviewed by two reviewers. The data categorization phase includes titles for which no abstract was available so that the complete article may be reviewed later. Reviewers met frequently during the screening process to settle disagreements and talk over any lingering questions about the choice of studies.²⁰

The papers that had been selected for the final sample based on eligibility were reviewed and read again by the researchers. Using the Microsoft Excel 2013 program, titles, study types, publication years, JBI classification levels of evidence,²¹ country of origins, objectives, methods, samples, prostaglandin types, context, and results of publications and documents were organized into a spreadsheet. Following that, a narrative analysis of the data, a discussion of the findings, and a bibliography on the issue were offered.

RESULTS:

There were 661 items found overall from the initial search..Three stages were carried out to filter the article search results, the first stage was to identify based on duplication or similarity of titles so that 141 articles were obtained, the second stage was to identify based on the content of the title so that 17 articles were obtained, and the third stage identified eligibility by reading the abstract or full-text so that 5 served as the review's final representative sample. According to PRISMA-ScR recommendations, Figure 1 shows how the materials that werefoundwerechosen.

DISCUSSION:

This review discovered that prostaglandins influence orthodontic tooth movement by increasing osteoclast activity. PGE1 and PGE2 can be administered orally or intravenously.

Oral administration of prostaglandins with misoprostol is a simple way to improve orthodontic tooth movement. In developing a dose regimen for research involving oral medication administration, three aspects must be taken into considerations. Specifically, the dosage, method, and frequency of drug delivery. Kehoe et al. studied guinea pigs given misoprostol at a dose of 100g/kg orally. Misoprostol did not inhibit PGE2 production, but it did speed up tooth movement, which is related to PGE1's bone resorption activity.²²

Misoprostol, a PGE1 analog, was administered to Sprague-Dawley rats in a study by Sekhavat et al. at a dose of 10g/mL. This study found that misoprostol promotes orthodontic tooth movement in both low and high doses. When compared to the study's control group, misoprostol can speed up tooth movement by an average of 0.3mm at doses of 2.5g/kg to 5.0g/kg and by an average of 0.6mm at doses of 10g/kg to 100g/kg.²³

Gurton et al. conducted a 5-day study in rats with injections of iloprost (PGI2 analog), TxA2 (Thromboxane analog), indomethacin, and imidazole up to 20L/12 hours. According to the findings of this study, both iloprost and TxA2 enhanced the number of multinuclear osteoclasts and the pace of orthodontic tooth movement in rats.Iloprost administration significantly increased the number of osteoclasts compared to the TxA2 analog. When injected at high concentrations, indomethacin, and imidazole slow the rate of tooth movement.²⁴

Yamasaki conducted a human study in which he administered PGE1 injections at a dose of 10g per location in the gingiva near orthodontically treated teeth to three treatment groups of varying ages. The studywas carried out in 3 stages. Stage 1 was examined on the buccal movement of the first premolars with lingual arch spring in 8 males and 1 female with an age range of 10-13years. Stage 2, group with bilateral upper and/or lower canine closure with sectional archwire contraction treatment performed on 2 males and 6 females with an age range of 11-14 years and stage 3, group with continuous archwire with coil spring or ringlet treatment performed on 2 boys and 6 girls with an age range of 10-26years.As a result, tooth movement is enhanced twice as much. The gingiva was found to be healthy both macroscopically and roentgenographically.²⁵

Jain et al also researched humans using prostaglandins in gel form. According to Jain, prostaglandins prepared in the form of a gel are a viable method because of their ease of application and patient compliance without systemic side effects. Jain et al applied 3 micrograms of prostaglandin gel at the distal of the canine. The study found that the canine distalization rate was faster than the control group, with the percentage of tooth movement acceleration being 31% in the canine group and 26% in the control group. The patient's teeth had no serious adverse effects or root resorption. The limitation of this prostaglandin in gel form is it's bioavailability.²⁶

Based on a number of earlier research, Caǧlaroǧlu and Erdem conducted a study to examine the impact of PGE2 injection at various doses to accelerate orthodontic tooth movement.²⁷ On days 0, 3, 5, and 7, Brudvik and Rygh applied 0.1 mL of a 0.1g/mL PGE2 solution.²⁸ On days 0 and 7, Seif et al. administered identical amounts of a 1 mg/mL solution. Boekenoogen et al. further applied dosages of 0.1, 1.0, 5.0, and 10 g.²⁹ Leiker et al. 1995 similarly recommended this amount, said that higher doses increased the chance of root resorption and that doses of 1g or less were most helpful to speed up orthodontic tooth movement. Additionally, they stated that there was no difference in the results of single versus several injections.³⁰

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

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Received on 17.12.2022 Modified on 12.05.2023

Research J. Pharm. and Tech 2024; 17(2):939-943.

DOI: 10.52711/0974-360X.2024.00146