Orthodontic micro-implant stability under continuous or intermittent loading: a histomorphometric and biomechanical evaluation

doi:10.3969/j.issn.2095-4344.1275

Abstract

Abstract:

BACKGROUND: During the orthodontic treatment process, many scholars believe that intermittent force can achieve the same or even greater effect of tooth movement than persistent force, and reduce the occurrence of root resorption and other adverse reactions. However, the above conclusions are mostly from in vitro cell experiments or clinical case study, and there is still a lack of scientifically designed and large-scale animal experiments.

OBJECTIVE: To evaluate the influence of continuous or intermittent force of two modes on osseointegration and biostability of orthodontic micro-implant.

METHODS: Forty-eight beagles (provided by Laboratory Animal Center of Sichuan University) were selected and mini-implants were implanted bilaterally in intraradicular zones of mandibular first molar and second premolar. The beagles were randomly allotted into four groups: loadings were delivered consecutively in continuous group, and pauses were given for the last 3 or 7 days of each reactivation period for intermittent group A and B, respectively. The group unloaded served as control. Loading protocol and period: loading force was applied by installing nickel-titanium closed coil springs on two mini-implants with ligating wires, and 2-week was set as a loading period, for 4 periods. After 2, 4, 6 and 8 weeks, the mandible tissues were obtained for micro-CT, histological observation and pull-out test. The study was approved by the Experimental Animal Ethics Committee of Sichuan University.

RESULTS AND CONCLUSION: (1) The values of peak load at extraction (F_max) at various loading time points in the control group were higher than those in the continuous group (P < 0.05). F_max of the intermittent group B was higher than that in the continuous group at week 2, 4 and 6 (P < 0.05); and the F_max at week 2 in the intermittent group A was higher than the continuous group (P < 0.05). (2) At the same loading time point, the ossointegration, bone volume/tissue volume and intersection surface in the unloaded control were higher than those in the continuous group (P < 0.05). The ossointegration and bone volume/tissue volume in the intermittent group B at 2, 4, 6 and 8 weeks were higher than those in the continuous group (P < 0.05). At 2, 4 and 6 weeks, the intersection surface was higher than in the continuous group (P < 0.05). The ossointegration in the intermittent group A at 2 and 4 weeks was higher than that in the continuous group (P < 0.05).The bone volume/tissue volume was higher than in the continuous group at 2, 4 and 6 weeks (P < 0.05). The intersection surface was higher than in the continuous group at 2 weeks (P < 0.05). (3) Bone remodeling was observed in all groups after 8 weeks of loading, and the bone remodeling was best in the unloaded control group, followed by intermittent groups B and A and poorest in the continuous group. (4) In summary, intermittent loading regimen is more favorable for obtaining stability than continuous force, and the 7-day/7-day loading cycle is more beneficial for bone-implant integration than the 11-day/3-day protocol.

Key words: mini-implants, continuous force, intermittent force, osseointegration, stability, peak pull-out, animal experiment, micro-CT

CLC Number:

R459.9','1');return false;" target="_blank">
R459.9

R783.5

R318.19

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Wu Yeke, Gao Ranran, Zhao Lixing. Orthodontic micro-implant stability under continuous or intermittent loading: a histomorphometric and biomechanical evaluation[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(22): 3488-3494.

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Figures/Tables 4

2.1 微种植体植入情况  各组Beagle犬的所有微种植体均成功植入，植入后2 d，持续组有2枚微种植体出现Ⅰ度微动，间断A组有1枚微种植体出现Ⅰ度-Ⅱ度松动，后期逐渐恢复稳定。 2.2 显微CT和力学拉拔试验结果显微CT检测显示随愈合时间延长，持续组、间断A组、间断B组和未加力组的微种植体骨整合和微种植体周围骨密度均显著提高，见图7。加载2周后，持续组的骨整合、骨体积分数、相交表面及峰值拉拔力均明显低于其他3组(P < 0.05)，两个间断组居中，且间断A、B两组间各指标比较差异无显著性意义(P > 0.05)；持续组、间断B组的骨整合平均值分别为24.31%，33.78%，Fmax分别为302.94，361.26 N，见图8。加载4周后，4组的所有测量指标上升情况类似；间断B组的骨整合、骨体积分数、相交表面及峰值拉拔力均明显高于持续组(P < 0.05)，间断A、B两组间各指标比较差异无显著性意义(P > 0.05)，见图8。加载6周后，间断B组的骨整合、骨体积分数、相交表面及峰值拉拔力仍明显高于持续组(P < 0.05)，而间断A组只有骨体积分数高于持续组间(P < 0.05)；纵观实验过程，持续组的各指标随愈合时间推移表现出线性增长趋势，明显不同于间断组的曲线减速式变化，因此持续组与间断组间的差距从第4-6周逐步缩小，见图8。加载8周后，间断B组的骨整合、骨体积分数仍显著高于持续组(P < 0.05)，间断A组的骨整合、骨体积分数、相交表面及峰值拉拔力与持续组比较差异无显著性意义(P > 0.05)；未加力组的骨整合、骨体积分数、相交表面及峰值拉拔力仍高于持续组和间断组，见图8。此外，还观察到骨整合、骨体积分数、相交表面的增长趋势有所放缓，Fmax在第6周达到顶峰后发生回落，间断B组骨整合均值为55.63%，显著高于持续组的48.19%(P < 0.05)；持续组和未加力组的Fmax分别为392.35，61.76 N。 "

"

2.3 甲苯胺蓝染色实验结果   组织形态学实验结果显示，经过8周正畸应力加载后，所有组的种植体周围区域均观察到不同程度的骨重塑：①持续组：微种植体周围的松质骨和皮质骨内均有明显的吸收性陷窝，由较少胶原纤维充填，而胶原纤维沉积、非成熟性类骨质形成等骨重塑现象也有发生；②间断A组：微种植体周围的松质骨和皮质骨内同样观察到明显的吸收性陷窝，但胶原纤维沉积、非成熟性类骨质形成等情况优于持续组，另外，在皮质骨区域还发现一些新骨；③间断B组：骨小梁、皮质骨和骨-种植体界面均有明显的胶原纤维沉积，皮质骨有新形成的哈佛氏系统，其排列方向不同于原板层骨；④未加力组：松质骨和皮质骨的变化与间断B组类似，哈佛氏系统形成更为成熟，活跃的成骨细胞和非成熟性类骨质也比其他组更多，非矿化性胶原和新形成的编织骨排列于微种植体周围，见图9。"

2.4 相关性实验统计结果   结果显示，所有指标对均有统计学意义(P < 0.05)。骨整合、Fmax与应力载荷模式及微种植体愈合时间相关，骨整合、Fmax与应力载荷模式的相关系数分别为r=0.276，0.319，骨整合、Fmax与微种植体愈合时间的相关系数分别为r=0.594，0.263，表明骨整合和愈合时间之间具有中等的相关性。骨整合和Fmax间的相关系数为0.371，提示较弱的相关性，见表2。"

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Orthodontic micro-implant stability under continuous or intermittent loading: a histomorphometric and biomechanical evaluation

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[1]	Chen Zehua, Ye Xiangling, Chen Weijian, Du Jianping, Liu Wengang, Xu Xuemeng. Effect of pronated foot posture on proprioception and postural stability based on foot posture index [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1324-1328.
[2]	Zhang Chao, Lü Xin. Heterotopic ossification after acetabular fracture fixation: risk factors, prevention and treatment progress [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1434-1439.
[3]	Tang Hui, Yao Zhihao, Luo Daowen, Peng Shuanglin, Yang Shuanglin, Wang Lang, Xiao Jingang. High fat and high sugar diet combined with streptozotocin to establish a rat model of type 2 diabetic osteoporosis [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(8): 1207-1211.
[4]	Xu Yulin, Shen Shi, Zhuo Naiqiang, Yang Huilin, Yang Chao, Li Yang, Zhao Heng, Zhao Lu. Biomechanical comparison of three different plate fixation methods for acetabular posterior column fractures in standing and sitting positions [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(6): 826-830.
[5]	Wang Jiangna, Zheng Huifen, Sun Wei. Changes in dynamic stability, motor coordination and joint mechanics of the lower extremity during stair descent and performing phone task [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(6): 837-843.
[6]	Li Chenjie, Lü Linwei, Song Yang, Liu Jingna, Zhang Chunqiu. Measurement and statistical analysis of trabecular morphological parameters of titanium alloy peri-prosthesis under preload [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(4): 516-520.
[7]	Shi Xiaoxiu, Mao Shilong, Liu Yang, Ma Xingshuang, Luo Yanfeng. Comparison of tantalum and titanium (alloy) as orthopedic materials: physical and chemical indexes, antibacterial and osteogenic ability [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(4): 593-599.
[8]	Shu Qihang, Liao Yijia, Xue Jingbo, Yan Yiguo, Wang Cheng. Three-dimensional finite element analysis of a new three-dimensional printed porous fusion cage for cervical vertebra [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(24): 3810-3815.
[9]	Wang Xinting, Xu Dandi, Zhang Junxia, Su Hailong Wang Qi. Stability of load-bearing cross barrier of different arch structures [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(24): 3838-3843.
[10]	Zhou Yuanbo, Wang Jindong. Etiology and treatment of femoral trochlear dysplasia: congenital genetic determination or stress stimulation of patella [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(24): 3908-3913.
[11]	Liu Fang, Shan Zhengming, Tang Yulei, Wu Xiaomin, Tian Weiqun. Effects of hemostasis and promoting wound healing of ozone sustained-release hydrogel [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(22): 3445-3449.
[12]	Huo Hua, Cheng Yuting, Zhou Qian, Qi Yuhan, Wu Chao, Shi Qianhui, Yang Tongjing, Liao Jian, Hong Wei. Effects of drug coating on implant surface on the osseointegration [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(22): 3558-3564.
[13]	Qiu Feng, Xu Xilin, Ma Xiangyang, Fang Zhouqun, Jiang Weicheng, Tian Shuzhao, Zheng Zelong. Biomechanical comparison of atlantoaxial crossed rod and parallel rod fixation technique for C₂ unilateral lamina screws [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(12): 1805-1809.
[14]	Zhao Binbin, Zhong Weijian, Ma Guowu, Li Yongqi, Wang Ning. Comparison of the osteogenic effect of three different bone graft materials [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(10): 1507-1510.
[15]	Su Tingshu, Tang Ying, Sun Jian. Application of intraoral scanning and 3D printing in the manufacture of removable partial dentures [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(4): 544-548.