Locally Inhibition of Orthodontic Relapse by Injection of Carbonated Hydroxy Apatite-Advanced Platelet Rich Fibrin in a Rabbit Model


Article Preview

Relapse is considered a significant failure after orthodontic treatment. In response to relapse, RANKL expressions will increase, while OPG expressions will decrease. CHA is thought to be one of an ideal candidate for enhancing bone formation. Moreover, a-PRF is a source high levels of growth factors that play a central role in the bone remodeling. This research was intended to investigate the effect of hydrogel CHA-aPRF in preventing relapse. Hydrogel-CHA was initially designed, with its degradation profile and FTIR (Fourie’s Transform Infrared) spectra were investigated as the basis to find out optimum formulation before incorporated with aPRF. Hydrogel-CHA microspheres were prepared in 3 different compositions: those were encoded 30-CHA, 40-CHA, and 50-CHA. After the hydrogel formulation and characterization were completed, 10 mL blood samples were collected, then centrifuged at 1500 rpm for 14 min. At the end of the centrifugation process, the aPRF clot was isolated and then pressed to obtain their releasate. The releasate aPRF was then loaded into the best formulation candidate of hydrogel CHA. The hydrogel incorporated aPRF was then gently injected on the mesial side of incisor gingival sulcus of the rabbit after orthodontic tooth movement. The FTIR analysis showed that carbonated apatite was successfully developed during the fabrication process of hydrogel-CHA microspheres. It was also known that degradation profile of 30-CHA was considered ideal compared to the other compositions. The application of CHA-aPRF (group C) was proven to significantly prevent relapse, indicated by lowest percentage of relapse 21 days after debonding (29.95±3.91%) compared to control group. Furthermore, it has been found that expressions of RANKL were significantly lowest (p<0.05) in group C on day 0, 3, and 7, while OPG expressions showed significantly highest (p<0.05) in group C on day 14 and 21 after debonding. These results indicate that incorporation of hydrogel-CHA has potential effect to enhance alveolar bone remodeling and prevent orthodontic relapse by stimulates OPG expression and suppresses RANKL expression.



Main Theme:

Edited by:

Christian Rey, Christèle Combes and Christophe Drouet




A. A. Alhasyimi et al., "Locally Inhibition of Orthodontic Relapse by Injection of Carbonated Hydroxy Apatite-Advanced Platelet Rich Fibrin in a Rabbit Model", Key Engineering Materials, Vol. 758, pp. 255-263, 2017

Online since:

November 2017




* - Corresponding Author

[1] Y. Yu, J. Sun, W. Lai, T. Wu, S. Koshy, Z. Shi, Interventions for managing relapse of the lower front teeth after orthodontic treatment, Cochrane Database Syst. Rev., 6 (2013) CD008734.

DOI: https://doi.org/10.1002/14651858.cd008734.pub2

[2] N. Zhao, J. Lin, H. Kanzaki, J. Ni, Z. Chen, W. Liang, Y. Liu, Local osteoprotegerin gene transfer inhibits relapse of orthodontic tooth movement, Am. J. Orthod. Dentofacial. Orthop., 141 (2012) 30–40.

DOI: https://doi.org/10.1016/j.ajodo.2011.06.035

[3] G.S. Dolci, L.V. Portela, D.O. de Souza, A.C.M. Fossatic, Atorvastatin-induced osteoclast inhibition reduces orthodontic relapse, Am. J. Orthod. Dentofacial. Orthop., 51 (2017) 528–38.

DOI: https://doi.org/10.1016/j.ajodo.2016.08.026

[4] X. Li, M. Li, J. Lu, Y. Hu, L. Cui, D. Zhang, Age-related effects on osteoclastic activities after orthodontic tooth movement, Bone. Joint. Res., 5 (2016) 492–9.

DOI: https://doi.org/10.1302/2046-3758.510.bjr-2016-0004.r2

[5] K. Hara, K. Fujisawa, H. Nagai, N. Takamaru, G. Ohe, K. Tsuru, K. Ishikawa, Y. Miyamoto, Fabrication and physical evaluation of gelatin-coated carbonate apatite foam, Materials, 9 (2016) 1.

DOI: https://doi.org/10.3390/ma9090711

[6] E. Kobayashi, L. Flückiger, M. Fujioka, K. Sawada, A. Sculean, B. Schaller, R.J. Miron, Comparative release of growth factors from comparative release of growth factors from PRP, PRF, and advanced-PRF, Clin. Oral. Invest., 25 (2016) 1-8.

DOI: https://doi.org/10.1007/s00784-016-1719-1

[7] S. Ghanaati, P. Booms, A. Orlowska, A. Kubesch, J. Lorenz, J. Rutkowski, C. Landes, R. Sader, C. Kirkpatrick, J. Choukroun, Advanced platelet-rich fibrin: a new concept for cell-based tissue engineering by means of inflammatory cells, J. Oral. Implantol., 40 (2014).

DOI: https://doi.org/10.1563/aaid-joi-d-14-00138

[8] M. Matsui, Y. Tabata, Enhanced angiogenesis by multiple release of platelet-rich plasma contents and basic fibroblast growth factor from gelatin hydrogels, Acta biomater, 8 (2012) 1792-801.

DOI: https://doi.org/10.1016/j.actbio.2012.01.016

[9] Y. Tabata, Biomaterials design of culture substrates for cell research, Inflamm. Regen., 31 (2011) 137-45.

[10] S. Galav, K.T. Chandrashekar, R. Mishra, V. Tripathi, R. Agarwal, A. Galav, Comparative evaluation of platelet-rich fibrin and autogenous bone graft for the treatment of infrabony defects in chronic periodontitis: Clinical, radiological, and surgical reentry, Indian J. Dent. Res., 27 (2016).

DOI: https://doi.org/10.4103/0970-9290.195634

[11] D.M. Dohan, J. Choukroun, A. Diss, S.L. Dohan, A.J. Dohan, J. Mouhyi, B. Gogly, Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: Technological concepts and evolution, Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. Endod., 101 (2006).

DOI: https://doi.org/10.1016/j.tripleo.2005.07.008

[12] R.L. Aggour, L. Gamil, The antimicrobial potential of antimicrobial effects of Platelet-rich plasma against selected oral and periodontal pathogens, PJM, 66 (2017) 31–7.

DOI: https://doi.org/10.5604/17331331.1235227

[13] C.Y. Su, Y.P. Kuo, Y.H. Tseng, C. Su, T. Burnouf, In vitro release of growth factors from platelet-rich fibrin (PRF): a proposal to optimize the clinical applications of PRF, Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. Endod., 108 (2009).

DOI: https://doi.org/10.1016/j.tripleo.2009.02.004

[14] T. Burnouf, C. Lee, C. Luoc, Y. Kuod, M. Choue, Y. Wud, Y. Tseng, Human blood-derived fibrin releasates: composition and use for the culture of cell lines and human primary cells, Biologicals, 40 (2012) 21–30.

DOI: https://doi.org/10.1016/j.biologicals.2011.09.017

[15] S. Nomura, K. Tsuru, A. Valanezhad, S. Matsuya, I. Takahashi, K. Ishikawa, Fabrication of carbonate apatite block from calcium sulfate by hydrothermal treatment, Key. Eng. Mater., 493 (2012) 139-42.

DOI: https://doi.org/10.4028/www.scientific.net/kem.493-494.139

[16] T. Saito, Y. Tabata, Preparation of gelatin hydrogels incorporating low-molecular-weight heparin for anti-fibrotic therapy, Acta Biomater., 8 (2012) 646–52.

DOI: https://doi.org/10.1016/j.actbio.2011.10.025

[17] I.C. Chang, C.H. Tsai, Y.C. Chang, Platelet-rich fibrin modulates the expression of extracellular signal-regulated protein kinase and osteoprotegerin in human osteoblasts, J. Biomed. Mater. Res. A., 95 (2010) 327–32.

DOI: https://doi.org/10.1002/jbm.a.32839

[18] L. Otero, D.A. García, L. Wilches-Buitrago, Expression and presence of OPG and RANKL mRNA and protein in human periodontal ligament with orthodontic force, Gene. Regul. Syst. Bio., 10 (2016) 15–20.

DOI: https://doi.org/10.4137/grsb.s35368

[19] F. d'Apuzzo, S. Cappabianca, D. Ciavarella, A. Monsurrò, A. Silvestrini-Biavati, L. Perillo L, Biomarkers of periodontal tissue remodeling during orthodontic tooth movement in mice and men: overview and clinical relevance, Scientific World J., 105873 (2013).

DOI: https://doi.org/10.1155/2013/105873

[20] Y. Nakano, M. Yamaguchi, S. Fujita, M. Asano, K. Saito, K. Kasai, Expressions of RANKL/RANK and M-CSF/c-fms in root resorption lacunae in rat molar by heavy orthodontic force, Eur. J. Orthod., 33 (2011) 335–43.

DOI: https://doi.org/10.1093/ejo/cjq068

[21] S.S. Kohli, V.S. Kohli, Role of RANKL–RANK/osteoprotegerin molecular complex in bone remodeling and its immunopathologic implications, Indian J. Endocr. Metab., 15 (2011) 175-81.

DOI: https://doi.org/10.4103/2230-8210.83401