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VOLUME 21 , ISSUE 12 ( December, 2020 ) > List of Articles


Correlation between Pain Perception and CGRP Expression during Initial Tooth Alignment Using either a Self-ligating or a Pre-adjusted Bracket System

Arief Johanes, Retno Widayati, Nurtami Soedarsono, Benny M Soegiharto

Keywords : Calcitonin gene-related peptide, Cohort study, Orthodontic tooth movement, Pain, Passive self-ligating, Pre-adjusted

Citation Information : Johanes A, Widayati R, Soedarsono N, Soegiharto BM. Correlation between Pain Perception and CGRP Expression during Initial Tooth Alignment Using either a Self-ligating or a Pre-adjusted Bracket System. J Contemp Dent Pract 2020; 21 (12):1312-1315.

DOI: 10.5005/jp-journals-10024-2947

License: CC BY-NC 4.0

Published Online: 13-04-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Aim and objective: Orthodontic tooth movement (OTM) occurs when the force applied to the tooth stimulates inflammation and alveolar bone remodeling. Less friction is produced by passive self-ligating (PSL) brackets compared to pre-adjusted edgewise (PE) brackets; therefore, PSL bracket use is thought to result in less pain than the use of PE brackets. The neuropeptide calcitonin gene-related peptide (CGRP), isolated from gingival crevicular fluid (GCF), can be used as a pain biomarker for OTM. Pain perception can be subjectively evaluated using the visual analog scale (VAS). This study aimed to analyze pain perception, using the VAS and CGRP levels, and to examine the correlation between VAS scores and CGRP levels. Materials and methods: A total of 15 patients were included in this study (a PSL group, a PE group, and a control group). GCF was collected from the lower anterior teeth, at interproximal sites, before bracket insertion and 2 hours, 24 hours, and 168 hours after lower archwire engagement. Pain perception was recorded using the VAS. CGRP concentrations were analyzed using an enzyme-linked immunosorbent assay (ELISA). Results: The VAS scores of the PE and PSL groups increased 2 hours after archwire engagement, peaked after 24 hours, and returned to baseline after 168 hours, and the PE group had high scores than the PSL group, with the highest score being recorded at the 24 hour time point. CGRP concentrations were also the highest at the 24 hour time point compared to the other time points. Conclusion: These results showed that both the VAS score and the CGRP concentration increased during initial orthodontic tooth alignment when using either the PSL or the PE bracket systems. Pain perception scores and CGRP concentrations were weakly positively correlated. Clinical significance: The type of bracket system used influenced the patients’ pain perception scores and the release of CGRP.

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  1. Orthodontic forces increase tumor necrosis factor alpha in the human gingival sulcus. Am J Orthod Dentofac Orthod 1995;108(5):519–524. DOI: 10.1016/s0889-5406(95)70052-8.
  2. Contemporary orthodontics. In: Proffit WR, Fields HW, Sarver DM, eds. Contemporary orthodontics. 5th ed. USA: Elsevier; 2015. pp. 375–376.
  3. Systemized orthodontic treatment mechanics. London: Mosby; 2001.
  4. Management of permanent dentition. In: Handbook of orthodontics. Philadelphia: Mosby; 2010. pp. 427–434.
  5. Selecting forces in orthodontics. Trans Eur Orthodontic Soc 1956;32:309–317.
  6. Orthdontic tooh movement. In: Handbook of orthodontic. 2nd ed., 2016. pp. 134–143.
  7. Perception of pain during orthodontic treatment with fixed appliances. Eur J Orthod 2004;26(1):79–85. DOI: 10.1093/ejo/26.1.79.
  8. Self-ligating brackets in orthodontics: A systematic review. Angle Orthod 2010;80(3):575–584. DOI: 10.2319/081009-454.1.
  9. Perception of discomfort during initial orthodontic tooth alignment using a self-ligating or conventional bracket system: A randomized clinical trial. Eur J Orthod 2008;30(3):227–232. DOI: 10.1093/ejo/cjm131.
  10. Pain: a review of three commonly used pain rating scales. J Clin Nurs 2005;14(7):798–804. DOI: 10.1111/j.1365-2702.2005.01121.x.
  11. Expression of substance P, calcitonin gene-related peptide, B-endorphin and methionine-enkephalin in human dental pulp tissue after orthodontic intrusion: A pilot study. Angle Orthod 2014;84(3):521–526. DOI: 10.2319/060313-423.1.
  12. Quantitative analysis of substance P, neurokinin A and calcitonin gene-related peptide in pulp tissue from painful and healthy human teeth. Int Endod J 2002;35(1):30–36. DOI: 10.1046/j.1365-2591.2002.00451.x.
  13. Peptidergic nerves in human dental pulp. Histochemistry 1990;95(2):115–121. DOI: 10.1007/BF00266583.
  14. Neuropeptides in the dental pulp: distribution, origins and correlations. J Endod 1990;16(2):67–69. DOI: 10.1016/S0099-2399(06)81566-9.
  15. Identification of bradykinin, substance P, and Neurokinin A in human dental pulp. J Endod 1997;23(4):201–204. DOI: 10.1016/S0099-2399(97)80045-3.
  16. Pain discomfort and crevicular fluid changes induced by orthodontic elastic separators in children. J Pain 2006;7(5):367–376. DOI: 10.1016/j.jpain.2005.12.008.
  17. Experience of pain during an orthodontic procedure. Eur J Oral Sci 2002;110:92–98. DOI: 10.1034/j.1600-0722.2002.11193.x
  18. Prevalence and type of pain during conventional and self-ligating orthodontic treatment. Eur J Orthod 2009;31:380–384.
  19. Quantification of neuropeptides (calcitonin gene-related peptide, substance P, neurokinin A, neuropeptide Y and vasoactive intestinal polypeptide) expressed in healthy and inflamed human dental pulp. Int Endod J 2006;39(5):394–400. DOI: 10.1111/j.1365-2591.2006.01093.x.
  20. Expression of neuropeptides (CGRP, Substance P) during and after orthodontic tooth movement in the rat. Eur J Orthod 1995;17(4):311–325. DOI: 10.1093/ejo/17.4.311.
  21. Gallium diffusion in human root dentin: Quantitative measurements by pulsed Nd : YAG laser ablation combined with an inductively coupled plasma mass spectrometer. J Clin Laser Med Surg 2000;18(4):173–183. DOI: 10.1089/10445470050144029.
  22. Migration of materials in the dental pulp of monkeys. J Endod 1978;4(6):273–277. DOI: 10.1016/S0099-2399(78)80171-X.
  23. Angiogenesis in human dental pulp following orthodontic tooth movement. J Dent Res 1996;75(10):1761–176. DOI: 10.1177/00220345960750100901
  24. Neuropeptides regulate expression of angiogenic growth factors in human dental pulp fibroblasts. J Endod 2009;35(6):829–833. DOI: 10.1016/j.joen.2009.03.005
  25. The effect of orthodontic forces on calcitonin gene-related peptide expression in human dental pulp. J Endod. 2011;37(7):934–937. DOI: 10.1016/j.joen.2011.03.035.
  26. Substance P and CGRP expression in dental pulps with irreversible pulpitis. Aust Endod J 2010;36(2):59–63. DOI: 10.1111/j.1747-4477.2009.00186.x.
  27. CGRP may play a causative role in migraine. Cephalalgia 2002;22(1):54–61. DOI: 10.1046/j.1468-2982.2002.00310.x
  28. Dihydroergotamine and sumatriptan attenuate levels of CGRP in plasma in rat superior sagittal sinus during electrical stimulation of the trigeminal ganglion. Neuropharmacology 1991;30(11):1193–1200. DOI: 10.1016/0028-3908(91)90165-8
  29. Neurotransmitters and neuropeptides in headache. Curr Opin Neurol 1996;9(3):206–210. DOI: 10.1097/00019052-199606000-00009.
  30. The trigeminovascular system and migraine; studies characterizing cerebrovascular and neuro-peptide changes seen in humans and cats. Ann Neurol 1993;33(1):48–56. DOI: 10.1002/ana.410330109.
  31. Nitric oxide (NO) and nociceptive processing in the spinal cord. Pain 1993;52(2):127–136. DOI: 10.1016/0304-3959(93)90124-8.
  32. Dural vasodilation causes a sensitization of rat caudal trigiminal neurones in vivo that is blocked by a 5HT 1B/1D agonist. Br J Pharmacol 1999;126(6):1478–1486. DOI: 10.1038/sj.bjp.0702444.
  33. A nitric oxide donor(Nitroglycerin) triggers genuine migraine attacks. Eur J Neurol 1994;1(1):73–80. DOI: 10.1111/j.1468-1331.1994.tb00053.x.
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