Author Spotlight: Analyzing Maxillary Bone Remodeling and Dental Root Resorption for Improved Dental Treatments

All procedures strictly adhered to the ethical standards established by the Universidade Federal de Minas Gerais Ethics Committee (No. 166/2022). Before each experiment, a sample size calculation is mandatory. Use 8-10-week-old male C57BL6/J wild-type mice weighing approximately 20-30 g. The mice must be housed in a cage within a room maintained at 25 °C, adhering to a 12 h light/12 h dark cycle. Following coil attachment, the animal should be fed with a soft diet. Daily monitoring should include assessments of body weight and overall health.

1. Mechanically-induced alveolar bone remodeling

1. Using distal cut pliers, cut the 0.25 x 0.76 inches NiTi open-coil spring to the following dimensions of six loops and two loop-shaped ends positioned perpendicular to the spring using orthodontic Weingart pliers.
2. Shape the 0.20 mm diameter round chrome-nickel (CrNi) wire to the desired configuration with loop-shaped ends using Mathieu tweezers and a round-shaped instrument as a size reference.
3. Put together the loop-shaped ends of the coil and the 0.20 mm round CrNi wire.
4. Anesthetize the animal with an intraperitoneal injection of 0.2 mL of solution containing xylazine (10 mg/Kg) and ketamine (100 mg/Kg). Before starting the procedure, evaluate the depth of anesthesia using the pedal reflex. Carefully pinch one of the animal's toes using tweezers. The absence of a reflex indicates an adequate plane of general anesthesia. To avoid corneal injuries and post-operative pain, apply an ocular lubricant after the animal is anesthetized.
5. Position the animal in dorsal decubitus on a surgical table, immobilizing its limbs to restrict movement and enable intraoral access.
6. Utilize a mouth-opener, fashioned from 0.50 mm diameter wire and secured with a 0.08 mm wire, to facilitate full visualization while preventing head movement. Use the right side as the experimental side (OTM side) and the left side as the control without an orthodontic coil (Control side).
   NOTE: Enhanced visualization of intraoral structures must be achieved using a stereomicroscope and an optical light system.
7. Clean and etch the right first molar and incisor surfaces using acetone and a self-etching primer, respectively. The system is self-etching, meaning it does not require prior acid conditioning.
   1. Apply the primer in a single step, which also functions simultaneously as an acid and an adhesive. Using a microbrush, collect a small amount of self-etching primer and apply it to the occlusal surface of the upper first molar and incisors. Care must be taken in this step to ensure that the self-etching primer does not reach the proximal surface between the first and second molars, as this could cause the dental elements to stick together, preventing tooth movement. Light cure the primer at the occlusal surface of the molars and incisors for 30 s.
8. Bond the distal end of a six-loop NiTi open-coil spring to the occlusal surface of the right first maxillary molar with light-cured resin and light cure for 30 s. Add additional resin increment to the edge of the wire to avoid harm to the mice and light cure for 30 s.
9. Activate the coil using a specifically designed apparatus consisting of a rail and crank mechanism attached to the surgical table. This enables longitudinal movement to slide back and forth.
10. Connect the free loop-shaped end of the 0.20 mm round wire to the hook of the tension gauge.
11. Upon activation of the crank, move the surgical table along the rail until the dynamometer registers a force of 0.35 N.
12. Bond the 0.20 mm round wire to both upper incisors to anchor the coil. No further reactivation is performed during the experimental period. Cut the wire to detach the animal from the dynamometer.  Add another increment of resin so the metal edge of the device is not exposed and does not hurt the animal. Light cure for 30 s. Disassemble the animal from the table.
13. The upper right first molar with a device imposing a force of 0.35 N in the mesial direction consists of the experimental side. Use the left side of the maxilla (without an orthodontic appliance) as a control^4,16.
14. Maintain this device for a period of 12 days without any activation being required. Do not use any pain control medication. Orthodontic movement occurs through an inflammatory process, and pain-relieving medication may negatively affect the arachidonic acid cascade, impacting the rate of bone remodeling and potentially invalidating the results.
15. After the end of the surgery, treat the animals with a subcutaneous injection of saline solution to avoid dehydration during the adaptation period with the device. Keep the animal in an individual cage with heating until it is fully recovered and only after this period place the animal in collective cages.
16. Euthanize the mouse on the 12^th day performed by sedation with intraperitoneal injection of a 0.2 mL solution containing xylazine (10 mg/Kg) and ketamine (100 mg/Kg) followed by decapitation with sharp scissors.

2. Micro-CT measurements

1. Harvest the maxillary bone with sharp scissors cutting all soft tissue, the zygomatic bone in the sagittal plane, and the frontonasal suture and the spheno-occipital synchondrosis in the coronal plane. Immerse the maxillary bone in 10% neutral buffered formalin (pH=7.4) for a fixation period of 48 h. After this period, change the formaldehyde solution to 70% alcohol.
2. Perform micro-CT scanning of the maxillary bone with the following parameters for high-resolution scans: isotropic voxel size of 9 to 18 µm, X-ray settings of 50 kV, 0.5 mm aluminum filter, and rotation angle of 0.5°. More than one jaw can be fit during the microCT scanning.
3. Reconstruct the acquired images using the microtomography reconstruction program indicated by the manufacturer of the micro-computed tomography (microCT) used¹⁷.
4. Position the reconstructed images using the 3D Inspection program indicated by the manufacturer of the microtomography used.
5. Quantify OTM by measuring the difference in linear distance between the cement-enamel junction (CEJ) of the first and second molars of the right hemi-maxilla (OTM side) relative to the left hemi-maxilla (control side). Utilize the proper microCT analyzer software with the line tool for this measurement^17,18,19,20.
6. Check the samples for the presence of orthodontic-induced inflammatory root resorption (OIIRR). Select the region of interest (ROI) of the disto-vestibular root of the first maxillary molar by using an irregular, anatomic region of interest drawn manually contouring method. Measure the following parameters: root mineral density (RMD; g/cm³) and percentage of root volume per total volume (RV/TV; %). Utilize the proper microCT analyzer software with the 3D volumetric tool for this measurement^16,21.
7. Conduct the reconstruction of the first maxillary molar using Mimics software and analyze the obtained data to draw conclusions regarding OTM and OIIRR in the experimental model^16,21.