Immunosuppressants: Implications in Orthodontics - Dental Press
Immunosuppressants: Implications in Orthodontics - Dental Press
Immunosuppressants: Implications in Orthodontics - Dental Press
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orig<strong>in</strong>al article<strong>Immunosuppressants</strong>: <strong>Implications</strong> <strong>in</strong> orthodonticswho showed greater tooth movement <strong>in</strong> animals subjectedto these medications. As occurs with glucocorticoids,Cyclospor<strong>in</strong>e affects alveolar bone caus<strong>in</strong>gdeleterious periodontal effects that may be due tothe reduction <strong>in</strong> bone volume and number of osteoblasts,and <strong>in</strong>crease <strong>in</strong> osteoclasts. 29 In rats markedg<strong>in</strong>gival growth and bone loss were observed 28 , howevermore uniformly than those observed <strong>in</strong> humanbe<strong>in</strong>gs 13 due to environmental and genetic factors.Recently, Kir<strong>in</strong>o et al 18 <strong>in</strong> a study with animalssubmitted to the application of tacrolimus, observedth<strong>in</strong>ner bone trabeculae, wider medullary cavities 18and <strong>in</strong>crease <strong>in</strong> the number of osteoclasts. 25 Studieshave demonstrated that both Cyclospor<strong>in</strong> and tacrolimusmay <strong>in</strong>duce bone loss both <strong>in</strong> human be<strong>in</strong>gsand <strong>in</strong> experimental animal models, 2 through<strong>in</strong>terleuk<strong>in</strong> gene expression (IL-1, IL-6 and tumornecrosis factor –TNFα), 19 the cytok<strong>in</strong>es that participate<strong>in</strong> bone resorption.Immunosuppressant activity with Rapamic<strong>in</strong>efor long periods 6 or <strong>in</strong> high doses <strong>in</strong>creases bone remodel<strong>in</strong>gand <strong>in</strong>hibits longitud<strong>in</strong>al bone growth, reduc<strong>in</strong>gthe speed of growth by around 30 to 50%, 3 <strong>in</strong>addition to <strong>in</strong>hibit<strong>in</strong>g different cell types, <strong>in</strong>clud<strong>in</strong>gsmooth muscle vascular cells and fibroblasts thatare not part of the immune system. 32 Other immunosuppressantssuch as, Mycophenolate mofetil 10and Azathiopr<strong>in</strong>e 6 showed no deleterious effects onbone m<strong>in</strong>eral density.<strong>Immunosuppressants</strong> represent great advancement<strong>in</strong> the control of different types of diseases, andsuppression of the immune response aga<strong>in</strong>st transplantedorgans, however, a large portion of these medicationsare capable of <strong>in</strong>fluenc<strong>in</strong>g bone metabolismand tooth movement.The orthodontist may frequently encounter patientsthat require prolonged immunosuppressivetherapy and orthodontic treatment. Usually, patients<strong>in</strong> the <strong>in</strong>itial stage of these medications usage maybe advised to delay orthodontic treatment, as therewould be less bone remodel<strong>in</strong>g, or orthodontic activationappo<strong>in</strong>tments should be scheduled at longer<strong>in</strong>tervals. On the other hand, long term medicationtherapy may accelerate tooth movement, thus orthodonticappliances must be adjusted customarily, orwith greater frequency. Medical follow-up with cl<strong>in</strong>icaland densitometry periodic exams are necessary<strong>in</strong> order to obta<strong>in</strong> more predictable and satisfactoryorthodontic results.Conclusion1) <strong>Immunosuppressants</strong> that affect cytok<strong>in</strong>esynthesis (glucocorticoids, cyclospor<strong>in</strong>-CsA,tacrolimus-FK506 and Sirolimus-RAPA) <strong>in</strong>terfere<strong>in</strong> bone metabolism and may <strong>in</strong>fluencetooth movement.2) Interference <strong>in</strong> bone metabolism is dependenton the force applied, dose and duration of immunosuppressanttherapy, <strong>in</strong> addition to the <strong>in</strong>dividualresponse of each patient, except to azathiopr<strong>in</strong>eand Mycophenolate mofetil that haveshown no deleterious effect on bone density.© 2012 <strong>Dental</strong> <strong>Press</strong> Journal of <strong>Orthodontics</strong> 60<strong>Dental</strong> <strong>Press</strong> J Orthod. 2012 Mar-Apr;17(2):55-61
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