Biomarkers in External Apical Root Resorption: An Evidence-based Scoping Review in Biofluids

Abstract

Background: External apical root resorption (EARR), an unwanted sequela of orthodontic treatment, is difficult to diagnose radiographically. Hence, the current scoping review was planned to generate critical evidence related to biomarkers in oral fluids, i.e. gingival crevicular fluid (GCF), saliva, and blood, of patients showing root resorption, compared to no-resorption or physiologic resorption. Methods: A literature search was conducted in major databases along with a manual search of relevant articles in the library, and further search from references of the related articles in March 2021. The initial search was subjected to strict inclusion and exclusion criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results: Following PRISMA guidelines, 20 studies were included in the final review. The studies included human clinical trials and cross-sectional and prospective studies with/without control groups with no date/ language restriction. Various biomarkers identified in EARR included dentinal proteins, enzymes, cytokines, and salivary proteins. Severe resorption had higher dentin sialoprotein (DSP) and resorption protein concentrations as well as lower granulocyte-macrophage colony-stimulating factor (GM-CSF) as compared with mild resorption. Increased DSP and dentin phosphophoryn (DPP) expression was found in physiologic resorption. Compared to controls, resorbed teeth showed a higher receptor activator of nuclear factor kappa B ligand/ osteoprotegerin (RANKL/OPG) ratio. In contrast, levels of anti-resorptive mediators (IL-1RA, IL-4) was significantly decreased. Differences in force levels (150 g and 100 g) showed no difference in resorption, but a significant rise in biomarkers (aspartate transaminase [AST] and alkaline phosphatase [ALP]) for 150 g force. Moderate to severe resorption in young patients showed a rise in specific salivary proteins, requiring further validation. Limitations of the studies were heterogeneity in study design, biomarker collection, sample selection, and confounding inflammatory conditions. Conclusions: Various biomarkers in biofluids indicate active resorption, while resorption severity was associated with DSP and GM-CSF in GCF, and a few salivary proteins. However, a robust study design in the future is mandated.

Metabolomic signatures distinguish extracellular vesicles from osteoclasts and odontoclasts

“…Currently, no approaches have emerged that allow detection of pathological root resorption from gingival crevicular fluid or saliva in the clinic. 39 Our long-term approach seeks to utilize EVs as a source of biomarkers for root resorption, metabolites as biomarkers, and the use of A.I. and multiomics to identify signatures of pathological root resorption.…”

Clinical and radiographic characterization of external root resorption

“…Tiene un uso prometedor y puede tener un impacto significativo en el sistema de atención médica. Kapoor P, 2022 [18] Revisión bibliográfica Aumento de proteínas dentinarias, enzimas y metabolitos proteicos.…”

“…Mohd [36] detectó seis proteínas (S100A9, IGJ, HSPA1A, IGHV4-34, TYMP y VTN) que mostraron aumentos significativos durante la fase temprana de los tratamientos de ortodoncia, lo que los convierte en candidatos como biomarcadores potenciales que pueden explotarse para la detección de la reabsorción radicular. Estudios recientes indican qué biomarcadores encontrados en la saliva muestran un aumento significativo de interleucina-7, interleucina-10, interleucina-12p70, interferón γ, proteínas y metabolitos, y un descenso significativo de interleucina-4 cuando existe una reabsorción radicular externa inflamatoria [18,36]. A pesar de encontrar una relación entre los biomarcadores en el fluido crevicular gingival y el desarrollo de reabsorción radicular, es necesaria más evidencia acerca del uso clínico de estos biomarcadores [18].…”

“…Estudios recientes indican qué biomarcadores encontrados en la saliva muestran un aumento significativo de interleucina-7, interleucina-10, interleucina-12p70, interferón γ, proteínas y metabolitos, y un descenso significativo de interleucina-4 cuando existe una reabsorción radicular externa inflamatoria [18,36]. A pesar de encontrar una relación entre los biomarcadores en el fluido crevicular gingival y el desarrollo de reabsorción radicular, es necesaria más evidencia acerca del uso clínico de estos biomarcadores [18].…”