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Local infiltration of Vitamin D 3 does not accelerate orthodontic tooth

movement in humans: A preliminary study

Article in The Angle Orthodontist · June 2015

DOI: 10.2319/122214-935.1 · Source: PubMed

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 Original Article

Local infiltration of Vitamin D3 does not accelerate orthodontic tooth

movement in humans:
A preliminary study
Abhijith Shettya; Anand K. Patilb; Ameet R.c; Prabhdeep K. Sandhud

ABSTRACT
Objective: To determine the effect of Vitamin D3 on the rate and amount of orthodontic tooth
movement in humans when injected locally at the site.
Materials and Methods: A prospective, split-mouth clinical trial was carried out on 15 subjects
who were referred for bilateral therapeutic extraction of the first premolars followed by canine
retraction in the maxillary arch. Vitamin D3 in a vehicle of local anesthetic solution was injected into
the buccal vestibule immediately distal to the canine to be retracted on the experimental side; on
the contralateral side, only local anesthetic solution as control was injected into the correspnding
site on the 7th, 21st, and 47th days of canine retraction. The amount of canine retraction was
assessed using the palatal rugae as stable landmarks, and the values obtained were compared
using pre- and postcanine retraction occlusograms.
Results: The experimental teeth whose gingivae had received injections containing Vitamin D3
had moved considerably less than had the matched control teeth (P , .001).
Conclusions: Localized injection of vitamin D3 produces a significantly decreased rate and
amount of tooth movement in humans. (Angle Orthod. 0000;00:000–000.)
KEY WORDS: Vitamin D3; Canine retraction; Orthodontic tooth movement; Occlusograms; Palatal
rugae

INTRODUCTION movement. These clinical methods range from elec-

tro-magneto-mechanical devices (eg, lasers, 1 , 2
One of the primary factors in orthodontic therapy is
electromagnetic fields,3 direct electrical current,4 me-
treatment time. Several methods, both biological and
chanical vibrations5,6) to surgical means (eg, distrac-
mechanical, have been used to accelerate tooth
tion,7,8 interseptal alveolar surgry,9 corticotomy,10
piezocision technique11) to pharmacological means
a
Private Practitioner, SDM College of Dental Sciences & (local or systemic drugs, eg, prostaglandins, 12,13
Hospital, Dharwad, Karnataka, India. corticosteroids,14 nitro-L-arginine,15 PTH,16 nicotine17).
b
Professor and Head, Department of Orthodontics & Dento- Even clinical studies have shown that local application
facial Orthopedics, SDM College of Dental Sciences & Hospital,
of vitamin D3 accelerates tooth movement, but these
Dharwad, Karnataka, India.
c
Associate Professor, Department of Orthodontics & Dento- were carried out on animals.18,19 Therefore, the present
facial Orthopedics, SDM College of Dental Sciences & Hospital, study was designed with the hypothesis that local
Dharwad, Karnataka, India. injection of vitamin D3 will accelerate the rate and
d
Postgraduate Student, Department of Orthodontics & Den- amount of orthodontic tooth movement in humans
tofacial Orthopedics, SDM College of Dental Sciences &
Hospital, Dharwad, Karnataka, India.
also.
Corresponding author: Dr Abhijith Shetty, Private Practitioner,
Department of Orthodontics & Dentofacial Orthopedics, SDM
College of Dental Sciences & Hospital, Dharwad, Karnataka
MATERIALS AND METHODS
580009, India The study was a prospective, split-mouth clinical trial
(e-mail: dentist_bhushan1@rediffmail.com; drbhushansheor-
anmds@gmail.com) involving 15 subjects aged 13–25 years who had
reported to the Department of Orthodontics and
Accepted: March 2015. Submitted: December 2014.
Published Online: June 2, 2015
Dentofacial Orthopedics requiring fixed orthodontic
G 0000 by The EH Angle Education and Research Foundation, treatment. Informed consent was obtained from the
Inc. patients prior to treatment. Ethical Institutional Review

DOI: 10.2319/122214-935.1 1 Angle Orthodontist, Vol 00, No 00, 0000

2 SHETTY, PATIL, AMEET R, SANDHU
Figure 1. Showing (a) calibration of force using Dontrix gauge, (b) placement of NiTi closed coil spring, and (c) local injection of Vitamin D3 in the
labial vestibule distal to the canine.
Board approval was obtained from the SDM College of
Dental Sciences & Hospital, Dharwad, Karnataka,
India. Healthy subjects with no radiographic evidence
of periodontal disease (probing depth values less than
3 mm for the entire dentition) and referred for
therapeutic extraction of bilateral maxillary first pre-
molars (Angle Class II division 1 cases, with crowding
and bimaxillary protrusion) and who had not used anti-
inflammatory drugs, steroids, or antibiotics over the
prior 3 months were selected for the study. The
exclusion criteria were subjects with systemic/bone/
metabolic/hormonal disease, hypersensitivity to vita-
min D or its analogues/derivatives, or subjects who
had undergone a major surgical procedure or who had
artificial valves or joints.
Procedure
Each subject’s maxillary arch was divided into right-
left and randomly allocated as experimental and
control sides. The subjects were orthodontically
treated using a preadjusted edgewise appliance
(0.022 3 0.028-inch slot, MBT prescription, 3M Unitek,
Monrovia, Calif). Initial leveling and aligning were
carried out using 0.016-inch nickel titanium (Optima,
Orthodontic Supplies Ltd, Leicestershire, UK) and
0.018-inch round stainless steel wires (AJ Wilcock,
Whittlesea, Victoria, Australia). After complete healing
of the alveolar sockets, individual canine retraction
was carried out on 0.019 3 0.025-inch stainless steel
wire (Optima), using NiTi closed coil springs (Ortho-
force, G&H Wire Co, Franklin, Ind) placed between the
maxillary first molars and canines, delivering 150 g of
force. The force was calibrated using a Dontrix gauge
(Libral Traders Pvt Ltd, New Delhi, India) (Figure 1a,b).
After the alignment stage, anchorage was reinforced
using transpalatal arches on the maxillary first molars in
all cases.
Preparation of the Solution
The normal circulating level of vitamin D3 in humans
is 15 pg/mL (1 pg 5 1025 g). The recommended dietary
allowance of vitamin D in human adults is 400 IU
Angle Orthodontist, Vol 00, No 00, 0000
(10 mg)/day.18 Vitamin D3 is a safe drug for human
beings,20,21,22 and it can be either injected intramuscu-
larly20,21 or administered by local infiltration into the oral
cavity.22 One mL of commercially available Vitamin D3
(Arachitol-6l, Solvay Pharma India Pvt Ltd, Mumbai,
India) containing 15 mg of Vitamin D3 per mL of
solution was dissolved in 999 mL of 2% Xylocaine
containing adrenaline 1:200,000 (AstraZeneca
Pharma Ltd, New Delhi, India) to prepare a stock
solution having 15 mg (600 IU) of Vitamin D3 per mL of
solution for local injection.
Administration of the Solution (Figure 1C)
Experimental side. One milliliter of the prepared
stock solution was injected into the buccal vestibule at
the level of the distal margin of the root of the canine
using a commercially available 2-mL syringe with a 1
1/2-inch, 26-gauge needle (Unolok Luer lock syringe,
Hindustan Syringes & Medical Devices Ltd, New Delhi,
India).
Control side. One milliliter of the control solution of
the local anesthetic was administered at a similar site
on the distal portion of the contralateral canine. One
milliliter of the stock solution was injected three times
during treatment (on the 7th, 21st, and 47th days of
canine retraction) on both sides.
Data Collection
The exact amount of canine retraction was assessed
with occlusograms using the palatal rugae as stable
landmarks for taking readings of tooth movements
before and after 60 days of canine retraction.
Fabrication of Occlusograms (Figure 2A)
The pre- and postretraction casts were scanned
using a flatbed scanning machine (Scanjet G3010,
Hewlett-Packard, Palo Alto, Calif) along with two
15-cm metal rulers placed on the x- and y-axes to
help ascertain the magnification error. The scanned
images were then printed. The printouts were traced
on cellulose acetate paper using a 0.3-mm black lead
pencil (micro pencil; Staedtler Mars GmbH & Co,
ROLE OF VITAMIN D3 IN ORTHODONTICS
Figure 2. Showing (a) fabrication of occlusograms and (b) points marked on the traced images. (a–b) midpalatal suture, (c) medial end of right
third palatal ruga, (d) medial end of left third palatal ruga, (e) central fossa of maxillary right first permanent molar, (f) central fossa of maxillary left
first permanent molar, (g) cusp tip of right maxillary canine, and (h) cusp tip of left maxillary canine.
Nuernberg, Germany). Points were marked on the
traced images as shown in Figure 2b. The amount of
canine distalization was then measured on each
postretraction cast using a digimatic caliper (Mitutoyo
Corp, Kawasaki, Japan), and the magnification error
correction applied.
RESULTS
The collected data were analyzed statistically using
the Mann-Whitney U-test. The results clearly show that
the mean tooth movement on the control side (1.86
mm) was greater than that on the experimental side
(1.14 mm) for the total observational time period of 60
days (P , .001). Thus, tooth movement was slower on
the experimental side than on the control side
(Figure 3).
Figure 3. Comparison of canine distalization in vitamin D3 and
control groups.
3
DISCUSSION
Orthodontic tooth movement is brought about by
alveolar bone and periodontal ligament remodeling
(bone resorption on the pressure side and bone
formation on the tension side). The two principal types
of cells—osteoblasts and osteoclasts—maintain this
balance between bone resorption and deposition
during remodeling of the alveolar bone. Hence, one
of the potent adjuncts used along with biomechanical
forces is the one that selectively activates osteoclasts
in the pressure zone, hastening tooth movement.
Vitamin D (calcitriol) in its active form—1,25-dihydrox-
ycholecalciferol (1,25D)—is one of the known potent
stimulators of osteoclastic activity.23 Therefore, it was
tested for its ability to enhance the rate of orthodon-
tically specific resorption and tooth movement. Collins
and Sinclair demonstrated that intraligamentary injec-
tions of vitamin D metabolite (1,25-dihydroxy-chole-
calciferol) resulted in an increase in the number of
osteoclasts and a 60% increase in tooth movement
during canine retraction with light forces in cats.18 Kale
and colleagues studied local applications of PGE 2 and
1,25-dihydroxy-cholecalciferol on the rate of tooth
movement in rats and observed that the latter is more
effective in modulating bone turnover, as its effects on
bone formation and resorption are well balanced.19 But
the receptors for vitamin D have been demonstrated
not only in osteoclasts but are present in osteoblasts,
also. The results of some clinical trials also indicate
that vitamin D3 increases bone mass, and is in use for
the treatment of osteoporosis.24,25 Because of this
beneficial effect on bone tissue, we can assume that
this pharmacological agent can inhibit orthodontic
movement.
Angle Orthodontist, Vol 00, No 00, 0000
4 SHETTY, PATIL, AMEET R, SANDHU
Kawakami and Takamo-Yamamoto observed an
increase in the mineral appositional rate on alveolar
bone after orthodontic force application, and they
suggested that local application of Vitamin D could
intensify the reestablishment of supporting alveolar
bone after orthodontic treatment.26 This creates
confusion as to whether Vitamin D3 has a role in
bone resorption or in deposition/mineralization
around the tooth undergoing orthodontic movement,
so this was kept as the main objective in the present
clinical study.
Secondly, all previous trials have been carried out
on animals; therefore, we were committed to check
the effects of vitamin D3 in human beings. The
results of this study show that local application of
vitamin D 3 produces a significantly decreased
amount of tooth movement after a 60-day experi-
mental period, contrary to results obtained by animal
studies done previously. No obvious local or sys-
temic side effects were noted. It is hypothesized that
the injection of vitamin D3 resulted in stimulating
osteoblasts, leading to bone deposition on the distal
surface of the canine, thus slowing down its
movement. Similar effects on bone such as miner-
alization of osteoid, increases in bone mineral
density measurements, and reduced fracture rates
are seen in vitamin-deficient patients when
replenished with vitamin D.
Our study had a few limitations: Although NiTi coil
springs were used for optimum force delivery on 0.019
3 0.025-inch stainless steel wire for translation of the
canines, these teeth may have tipped, which might
have registered on the occlusograms. This was
a short-term study carried out for only 60 days.
Genetic and environmental factors may have influ-
enced the response of the canines, which was not
considered. The intraligamentous route of delivery was
avoided because of the possibility of pain. However,
that would have been a more accurate method of drug
delivery (more local and closer to the area of interest).
The results might have been affected by the dosage or
therapeutic regimen, especially considering the kinet-
ics of bone remodeling during tooth movement.
Nonetheless, for future studies, a larger sample size
with long-term evaluation is required, using varied
doses of Vitamin D3. A molecular-level study could
also help explain these contrary results. Furthermore,
the gingival crevicular fluid can be studied to determine
changes at the cellular level. Also, studies should be
performed to determine the role of this solution in
periodontally compromised orthodontic cases, opening
up new avenues of treatment. Its potential application
for anchorage augmentation might be another exciting
avenue to explore.
Angle Orthodontist, Vol 00, No 00, 0000
CONCLUSION
N Localized injections of vitamin D3 produced a signif-
icantly decreased rate and amount of tooth move-
ment after a 60-day experimental period.
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Angle Orthodontist, Vol 00, No 00, 0000