Assessing the Alkaline Phosphatase Levels as A Bone Biomarker in Gingival Crevicular Fluid during Semi-Rapid Expansion: Alkaline Phosphatase Levels in Gingival Crevicular Fluid during Expansion

Ahmad Shamim; Asmi Shaheen; Muhammad Azeem; Noman Atiq; Shabbir Hussain; Shaker Mahmood

doi:10.54393/pjhs.v6i1.2277

Authors

Ahmad Shamim Department of Orthodontics, De ’Montmorency College of Dentistry, Lahore, Pakistan
Asmi Shaheen Department of Orthodontics, De ’Montmorency College of Dentistry, Lahore, Pakistan
Muhammad Azeem Department of Orthodontics, De ’Montmorency College of Dentistry, Lahore, Pakistan
Noman Atiq Department of Orthodontics, Shadi International Dental and Orthodontic Center, Abu Dhabi
Shabbir Hussain Department of Orthodontics, Rashid Latif Dental College, Lahore, Pakistan
Shaker Mahmood Department of Maxillo Facial, De ’Montmorency College of Dentistry, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i1.2277

Keywords:

Biomarker, Gingival Crevicular Fluid, Alkaline Phosphatase, Bone Remodeling

Abstract

In orthodontics, the expansion of the maxilla is done to treat transverse maxillary deficiency in childhood. The cause of maxillary constriction may be genetic or environmental leading to crowding of teeth, cross bite and development of malocclusions. This expansion leads to increased maxillary dimensions. Objectives: To detect changes in alkaline phosphatase level as a bone biomarker in crevicular fluid during the phases of semi-rapid palatal expansion. Methods: Fifteen growing patients with an age range from 8-13 years were selected who needed maxillary semi-rapid palatal expansion as a part of orthodontic treatment. This quasi-experimental study was based on a non-probability purposive sampling technique conducted from August 2023 to July 2024. The samples were collected by inserting paper points in the gingival sulcus. The Periodontal status was evaluated before starting the sampling. The probing depths were recorded at different levels throughout the study until the completion of the retention period. The alkaline phosphatase levels in the gingival crevicular fluid were measured at buccal and palatal sites before, during and in the retention period after treatment. The alkaline phosphatase values were compared using the ANOVA test at different points in time with p<0.05 considered as statistically significant. Results: The ANOVA test showed a statistically significant increase in enzyme activity at different sites throughout maxillary semi-rapid palatal expansion treatment. Conclusions: It was concluded that the enzyme alkaline phosphatase as a biomarker is an indicator of active bone metabolism in growing children while going through the maxillary semi-rapid palatal expansion treatment.

References

Banker AM, Thakkar MN, Desai BB, Huja SS. Post-Expansion and End of Treatment Outcomes of Semi-Rapid Maxillary Expansion with a Modified Removable Appliance. Indian Journal of Dental Research. 2022 Jan; 33(1): 63-8. doi: 10.4103/ijdr.ijdr_210_21.

Rutili V, Mrakic G, Nieri M, Franceschi D, Pierleoni F, Giuntini V et al. Dento-Skeletal Effects Produced by Rapid Versus Slow Maxillary Expansion Using Fixed Jackscrew Expanders: A Systematic Review and Meta-Analysis. European Journal of Orthodontics. 2021 Jun; 43(3): 301-12. doi: 10.1093/ejo/cjaa086.

Singh BP, Chaturvedi S, Goyal D, Kararia V, Chowdhary S, Singh D. CBCT Evaluation of Buccal Bone Plate Thickness Following Rapid Maxillary Expansion and Semi Rapid Maxillary Expansion: A Comparative in Vivo Study. International Journal of Applied Dental Sciences. 2022 Apr; 8(2): 330-336. doi: 10.22271/oral.2022.v8.i2e.1527.

Somani D, Desai B, Muchhadia RP. Vertical, Sagittal and Transverse Effects of Semi Rapid Maxillary Expansion Protocol Using a Removable Expansion Appliance: A Cephalometric and Model-Based Study. Journal of Contemporary Orthodontics. 2020 Apr; 4(2): 53-9. doi: 10.18231/j.jco.2020.018.

Arun V and Varma AJ. Rapid Maxillary Expansion and Its Effects on Stomato-Gnathic System. Journal of Scientific Dentistry. 2022 Dec; 12(1): 27-34. doi: 10.5005/jp-journals-10083-1011.

Ronsivalle V, Leonardi R, Lagravere M, Flores-Mir C, Grippaudo C, Bonetti GA et al. Medium-Term Effects of Rapid Maxillary Expansion On Nasal Cavity and Pharyngeal Airway Volumes Considering Age as A Factor: A Retrospective Study. Journal of Dentistry. 2024 May; 144: 104934. doi: 10.1016/j.jdent.2024.104934.

Cardozo AK and Carruitero MJ. Non-Surgical Rapid Maxillary Expansion with Mini-Implants in Adults: A Narrative Review. Journal of Oral Research. 2022; 11(6): 11. doi: 10.17126/joralres.2022.064.

Liu W, Zhou S, Yen E, Zou B. Comparison of Changes in the Nasal Cavity, Pharyngeal Airway, and Maxillary Sinus Volumes After Expansion and Maxillary Protraction with Two Protocols: Rapid Palatal Expansion Versus Alternate Rapid Maxillary Expansion and Constriction. Korean Journal of Orthodontics. 2023 May; 53(3): 175-84. doi: 10.4041/kjod22.075.

Xie B, Zhang L, Lu Y. The Role of Rapid Maxillary Expansion in Pediatric Obstructive Sleep Apnea: Efficacy, Mechanism and Multidisciplinary Collaboration. Sleep Medicine Reviews. 2023 Feb; 67: 101733. doi: 10.1016/j.smrv.2022.101733.

Abate A, Ugolini A, Maspero C, Silvestrini-Biavati F, Caprioglio A, Lanteri V. Comparison of the Skeletal, Dentoalveolar, and Periodontal Changes After Ni-Ti Leaf Spring Expander and Rapid Maxillary Expansion: A Three-Dimensional CBCT Based Evaluation. Clinical Oral Investigations. 2023 Sep; 27(9): 5249-62. doi: 10.1007/s00784-023-05144-6.

Lanteri V, Farronato M, Ugolini A, Cossellu G, Gaffuri F, Parisi FM et al. Volumetric Changes in the Upper Airways After Rapid and Slow Maxillary Expansion in Growing Patients: A Case-Control Study. Materials. 2020 May; 13(10): 2239. doi: 10.3390/ma13102239.

Colak C, Aras B, Cheng LL, Elekdag-Turk S, Turk T, Darendeliler MA. Effects of Rapid and Slow Maxillary Expansion On Root Resorption: A Micro-Computed Tomography Study. European Journal of Orthodontics. 2021 Dec; 43(6): 682-9. doi: 10.1093/ejo/cjab024.

Adobes Martin M, Lipani E, Alvarado Lorenzo A, Bernés Martínez L, Aiuto R, Dioguardi M et al. The Effect of Maxillary Protraction, with or without Rapid Palatal Expansion, On Airway Dimensions: A Systematic Review and Meta-Analysis. European Journal of Pediatric Dentistry. 2020; 21(4): 262-70. doi:

23804/ejpd.2020.21.04.2.

Lale B, Yildirim M, Altindağ A, Aydoğdu D. Evaluation of Bone Thickness and Density Values in Resistance Regions in Rapid Maxillary Expansion Using Computed Tomography. Journal of Craniofacial Surgery. 2024 Jun; 35(4): 1244-8. doi: 10.1097/SCS.0000000000010068.

Niu X, Motro M, Will LA, Cornelis MA, Cattaneo PM. Does Rapid Maxillary Expansion Enlarge the Nasal Cavity and Pharyngeal Airway? A Three‐Dimensional Assessment Based On Validated Analyses. Orthodontics and Craniofacial Research. 2021 Dec; 24: 124-33. doi: 10.1111/ocr.12526.

Topal R and Arslan SG. Effect of Three Different Maxillary Expansion Appliances On Root Resorption. International Dental Research. 2023 Apr; 13(1): 19-26. doi: 10.5577/idr.2023.vol13.no1.4.

Rabah N, Al-Ibrahim HM, Hajeer MY, Ajaj MA. Evaluation of Rapid Versus Slow Maxillary Expansion in Early Adolescent Patients with Skeletal Maxillary Constriction Using Cone-Beam Computed Tomography: A Short-Term Follow-Up Randomized Controlled Trial. Dental and Medical Problems. 2022 Sep; 59(4): 583-91. doi: 10.17219/dmp/133513.

Chen S, Wang J, Xi X, Zhao Y, Liu H, Liu D. Rapid Maxillary Expansion Has a Beneficial Effect On the Ventilation in Children with Nasal Septal Deviation: A Computational Fluid Dynamics Study. Frontiers in Pediatrics. 2022 Feb; 9: 718735. doi: 10.3389/fped.2021.718735.

Chung-man WO, Yun ZH, Xiao-bing LI. Efficacy of Early Maxillary Slow Expansion in Mixed Dentition On Maxillary Teeth and Alveolar Crest in the Central Segment. Shanghai Journal of Stomatology. 2023 Oct; 32(5): 501.

Jeon JY, Choi SH, Chung CJ, Lee KJ. The Success and Effectiveness of Miniscrew-Assisted Rapid Palatal Expansion Are Age- and Sex-Dependent. Clinical Oral Investigations. 2022 Mar; 26(3): 2993-3003. doi: 10.1007/s00784-021-04281-0.

Alkadhi OH, Alotaibi LH, Alrashoud RR, Almutairi MH, Al Matar HA, Mallineni SK. Effect of Maxillary Expansion on the Maxillary Arch Width in Patients with Bilateral Cleft Palate: A Review. Children. 2023 Apr; 10(5): 762. doi: 10.3390/children10050762.

Oliva G, Huanca Ghislanzoni L, Dalessandri D, Silvestrini‐Biavati A, Ugolini A. Palatal Changes in Cross-bite Patients Treated with Rapid Maxillary Expansion Vs Untreated Ones: A Geometric Morphometric Study. Orthodontics and Craniofacial Research. 2020 Nov; 23(4): 439-44. doi: 10.1111/ocr.12387.

Gokturk M and Yavan MA. Comparison of the Short-Term Effects of Tooth–Bone-Borne and Tooth-Borne Rapid Maxillary Expansion in Older Adolescents. Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopädie. 2024 Jan; 85(1): 43-55. doi: 10.1007/s00056-022-00401-x.

Nota A, Caruso S, Caruso S, Sciarra FM, Marino A, Daher S et al. Rapid Maxillary Expansion in Pediatric Patients with Sleep-Disordered Breathing: Cephalometric Variations in Upper Airway’s Dimension. Applied Sciences. 2022 Feb; 12(5): 2469. doi: 10.3390/app12052469.

Barriga C, Muñoz G, Sandoval P, Lara A, Copello F. The Clinical Management of Traumatic Palatal Ulcers in an Adolescent Patient: A Common Lesion in Mini-Implant-Assisted Rapid Maxillary Expansion. Medicina. 2024 Oct; 60(11): 1784. doi: 10.3390/medicina60111784.

Calvo-Henriquez C, Sandoval-Pacheco V, Chiesa-Estomba C, Lechien JR, Martins-Neves S, Esteller-More E et al. Pediatric Maxillary Expansion Has a Positive Impact On Hearing? A Systematic Review and Meta-Analysis. European Annals of Otorhinolaryngology, Head and Neck Diseases. 2023 Jan; 140(1): 31-8. doi: 10.1016/j.anorl.2022.07.007.