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Published in: Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie 3/2015

01-05-2015 | Original article

Orthodontic forces add to nicotine-induced loss of periodontal bone

An in vivo and in vitro study

Authors: Dr. C. Kirschneck, P. Proff, M. Maurer, C. Reicheneder, P. Römer

Published in: Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie | Issue 3/2015

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Abstract

Objectives

Nicotine is considered an etiologic factor for chronic inflammatory phenomena within the periodontal ligament that may result in loss of periodontal attachment. Considering that smokers account for 26 % of adult and 12 % of adolescent patients in orthodontic practice, we performed in vivo and in vitro studies as to whether orthodontic forces may add to the nicotine-induced loss of periodontal bone.

Methods

Fourteen male rats (Fischer 344 inbred) were used. Seven of these served as controls, while the other seven received daily subcutaneous injections of 1.89 mg L-nicotine per kg body weight. Both groups were exposed to orthodontic mesialization of the first two upper left molars using a NiTi closed-coil spring, the contralateral side serving as control. Periodontal bone loss was assessed by cone-beam computed tomography (CBCT). Human periodontal fibroblasts were stressed by compression (2 g/cm2) and/or nicotine (3/5/7.5 µmol), and the expression of cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE2), interleukin-6 (IL-6), osteoprotegerin (OPG), and receptor activator of nuclear factor κB ligand (RANKL) was determined at the transcriptional level by quantitative real-time polymerase chain reaction (qRT-PCR) and at the translational level by enzyme-linked immunosorbent assay (ELISA). In addition, differentiation of co-cultured murine RAW264.7 cells to osteoclast-like cells was quantified by tartrate-resistant acid phosphatase (TRAP) staining.

Results

Orthodontic force application in vivo led to a significant increase in nicotine-induced periodontal bone loss, and cell compression in vitro to increased COX-2, PGE2, IL-6, and RANKL expression, reduced OPG expression, and enhanced differentiation of RAW264.7 cells to osteoclast-like cells compared to nicotine alone.

Conclusion

Additional loss of periodontal bone must be expected during orthodontic treatment of smokers. Clinicians should inform their patients of this increased risk and refrain from performing tooth movements before cessation of smoking.
Literature
1.
go back to reference Barka T, Anderson PJ (1962) Histochemical methods for acid phosphatase using hexazonium pararosanilin as a coupler. J Histochem Cytochem 10:741–753CrossRef Barka T, Anderson PJ (1962) Histochemical methods for acid phosphatase using hexazonium pararosanilin as a coupler. J Histochem Cytochem 10:741–753CrossRef
2.
go back to reference Bartal M (2001) Health effects of tobacco use and exposure. Monaldi Arch Chest Dis 56:545–554PubMed Bartal M (2001) Health effects of tobacco use and exposure. Monaldi Arch Chest Dis 56:545–554PubMed
3.
go back to reference Bergström J (2004) Tobacco smoking and chronic destructive periodontal disease. Odontology 92:1–8CrossRefPubMed Bergström J (2004) Tobacco smoking and chronic destructive periodontal disease. Odontology 92:1–8CrossRefPubMed
4.
go back to reference Bosco AF, Bonfante S, Almeida JM de et al (2007) A histologic and histometric assessment of the influence of nicotine on alveolar bone loss in rats. J Periodontol 78:527–532CrossRefPubMed Bosco AF, Bonfante S, Almeida JM de et al (2007) A histologic and histometric assessment of the influence of nicotine on alveolar bone loss in rats. J Periodontol 78:527–532CrossRefPubMed
5.
go back to reference Breivik T, Gundersen Y, Gjermo P et al (2009) Nicotinic acetylcholine receptor activation mediates nicotine-induced enhancement of experimental periodontitis. J Periodontal Res 44:297–304CrossRefPubMed Breivik T, Gundersen Y, Gjermo P et al (2009) Nicotinic acetylcholine receptor activation mediates nicotine-induced enhancement of experimental periodontitis. J Periodontal Res 44:297–304CrossRefPubMed
6.
go back to reference Buttke TM, Proffit WR (1999) Referring adult patients for orthodontic treatment. J Am Dent Assoc 130:73–79CrossRefPubMed Buttke TM, Proffit WR (1999) Referring adult patients for orthodontic treatment. J Am Dent Assoc 130:73–79CrossRefPubMed
7.
go back to reference Cam GR, Bassett JR (1984) Effect of prolonged exposure to nicotine and stress on the pituitary-adrenocortical response; the possibility of cross-adaptation. Pharmacol Biochem Behav 20:221–226CrossRefPubMed Cam GR, Bassett JR (1984) Effect of prolonged exposure to nicotine and stress on the pituitary-adrenocortical response; the possibility of cross-adaptation. Pharmacol Biochem Behav 20:221–226CrossRefPubMed
8.
go back to reference Cattaneo PM, Dalstra M, Melsen B (2009) Strains in periodontal ligament and alveolar bone associated with orthodontic tooth movement analyzed by finite element. Orthod Craniofac Res 12:120–128CrossRefPubMed Cattaneo PM, Dalstra M, Melsen B (2009) Strains in periodontal ligament and alveolar bone associated with orthodontic tooth movement analyzed by finite element. Orthod Craniofac Res 12:120–128CrossRefPubMed
9.
go back to reference Chang Y, Tsai C, Yang S et al (2003) Induction of cyclooxygenase-2 mRNA and protein expression in human gingival fibroblasts stimulated with nicotine. J Periodontal Res 38:496–501CrossRefPubMed Chang Y, Tsai C, Yang S et al (2003) Induction of cyclooxygenase-2 mRNA and protein expression in human gingival fibroblasts stimulated with nicotine. J Periodontal Res 38:496–501CrossRefPubMed
10.
go back to reference Cuff MJ, McQuade MJ, Scheidt MJ et al (1989) The presence of nicotine on root surfaces of periodontally diseased teeth in smokers. J Periodontol 60:564–569CrossRefPubMed Cuff MJ, McQuade MJ, Scheidt MJ et al (1989) The presence of nicotine on root surfaces of periodontally diseased teeth in smokers. J Periodontol 60:564–569CrossRefPubMed
11.
go back to reference Dahlberg G (1940) Statistical methods for medical and biological students. G. Allen & Unwin ltd, London Dahlberg G (1940) Statistical methods for medical and biological students. G. Allen & Unwin ltd, London
12.
go back to reference Di Domenico M, D’Apuzzo F, Feola A et al (2012) Cytokines and VEGF induction in orthodontic movement in animal models. J Biomed Biotechnol 2012:201689 Di Domenico M, D’Apuzzo F, Feola A et al (2012) Cytokines and VEGF induction in orthodontic movement in animal models. J Biomed Biotechnol 2012:201689
13.
go back to reference ElAttar TM, Lin HS, Tira DE (1981) Effect of epinephrine on prostaglandin E2 and cyclic AMP levels in gingiva of patients with chronic periodontitis. Prostaglandins Med 6:601–612CrossRefPubMed ElAttar TM, Lin HS, Tira DE (1981) Effect of epinephrine on prostaglandin E2 and cyclic AMP levels in gingiva of patients with chronic periodontitis. Prostaglandins Med 6:601–612CrossRefPubMed
14.
go back to reference European Commission (2012) Attitudes of Europeans towards tobacco. EUROBAROMETER 77.1 Special Eurobarometer 385. http://ec.europa.eu/health/tobacco/docs/eurobaro_attitudes_towards_tobacco_2012_en.pdf. Accessed 17 Sept 2014 European Commission (2012) Attitudes of Europeans towards tobacco. EUROBAROMETER 77.1 Special Eurobarometer 385. http://​ec.​europa.​eu/​health/​tobacco/​docs/​eurobaro_​attitudes_​towards_​tobacco_​2012_​en.​pdf.​ Accessed 17 Sept 2014
15.
go back to reference Grudianov AI, Kemulariia IV (2010) Laser Doppler estimation of the influence of tobacco-smoking on the blood microcirculation in the periodont at the patients with the different stages of periodontal diseases. Stomatologiia (Mosk) 89:10–14 Grudianov AI, Kemulariia IV (2010) Laser Doppler estimation of the influence of tobacco-smoking on the blood microcirculation in the periodont at the patients with the different stages of periodontal diseases. Stomatologiia (Mosk) 89:10–14
16.
go back to reference Hanes PJ, Schuster GS, Lubas S (1991) Binding, uptake, and release of nicotine by human gingival fibroblasts. J Periodontol 62:147–152CrossRefPubMed Hanes PJ, Schuster GS, Lubas S (1991) Binding, uptake, and release of nicotine by human gingival fibroblasts. J Periodontol 62:147–152CrossRefPubMed
17.
go back to reference Henemyre CL, Scales DK, Hokett SD et al (2003) Nicotine stimulates osteoclast resorption in a porcine marrow cell model. J Periodontol 74:1440–1446CrossRefPubMed Henemyre CL, Scales DK, Hokett SD et al (2003) Nicotine stimulates osteoclast resorption in a porcine marrow cell model. J Periodontol 74:1440–1446CrossRefPubMed
18.
go back to reference Johnson GK, Hill M (2004) Cigarette smoking and the periodontal patient. J Periodontol 75:196–209CrossRefPubMed Johnson GK, Hill M (2004) Cigarette smoking and the periodontal patient. J Periodontol 75:196–209CrossRefPubMed
19.
go back to reference Kamer AR, El-Ghorab N, Marzec N et al (2006) Nicotine induced proliferation and cytokine release in osteoblastic cells. Int J Mol Med 17:121–127PubMed Kamer AR, El-Ghorab N, Marzec N et al (2006) Nicotine induced proliferation and cytokine release in osteoblastic cells. Int J Mol Med 17:121–127PubMed
20.
go back to reference Kanzaki H, Chiba M, Shimizu Y et al (2002) Periodontal ligament cells under mechanical stress induce osteoclastogenesis by receptor activator of nuclear factor kappaB ligand up-regulation via prostaglandin E2 synthesis. J Bone Miner Res 17:210–220CrossRefPubMed Kanzaki H, Chiba M, Shimizu Y et al (2002) Periodontal ligament cells under mechanical stress induce osteoclastogenesis by receptor activator of nuclear factor kappaB ligand up-regulation via prostaglandin E2 synthesis. J Bone Miner Res 17:210–220CrossRefPubMed
21.
go back to reference Kirschneck C, Proff P, Fanghaenel J et al (2013) Differentiated analysis of orthodontic tooth movement in rats with an improved rat model and three-dimensional imaging. Ann Anat 195:539–553CrossRefPubMed Kirschneck C, Proff P, Fanghaenel J et al (2013) Differentiated analysis of orthodontic tooth movement in rats with an improved rat model and three-dimensional imaging. Ann Anat 195:539–553CrossRefPubMed
22.
go back to reference Kirschneck C, Wolf M, Reicheneder C et al (2014) Strontium ranelate improved tooth anchorage and reduced root resorption in orthodontic treatment of rats. Eur J Pharmacol 744:67–75CrossRefPubMed Kirschneck C, Wolf M, Reicheneder C et al (2014) Strontium ranelate improved tooth anchorage and reduced root resorption in orthodontic treatment of rats. Eur J Pharmacol 744:67–75CrossRefPubMed
23.
go back to reference Krinke GJ (ed) (2000) The laboratory rat. The handbook of experimental animals. Academic Press, San Diego Krinke GJ (ed) (2000) The laboratory rat. The handbook of experimental animals. Academic Press, San Diego
24.
go back to reference Lacey DL, Timms E, Tan HL et al (1998) Osteoprotegerin ligand is a cytokine that regulates osteoclast differentiation and activation. Cell 93:165–176CrossRefPubMed Lacey DL, Timms E, Tan HL et al (1998) Osteoprotegerin ligand is a cytokine that regulates osteoclast differentiation and activation. Cell 93:165–176CrossRefPubMed
25.
go back to reference Lampert T, Kuntz B (2014) Tabak- und Alkoholkonsum bei 11- bis 17-jährigen Jugendlichen. Ergebnisse der KiGGS-Studie—Erste Folgebefragung (KiGGS Welle 1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 57:830–839CrossRefPubMed Lampert T, Kuntz B (2014) Tabak- und Alkoholkonsum bei 11- bis 17-jährigen Jugendlichen. Ergebnisse der KiGGS-Studie—Erste Folgebefragung (KiGGS Welle 1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 57:830–839CrossRefPubMed
26.
go back to reference Laue E (2010) Nichtraucher auf dem Vormarsch—Gesundheitsschutz hat Vorrang—Statistisches Bundesamt (Destatis). https://www.destatis.de/DE/Publikationen/STATmagazin/Gesundheit/2010_06/2010_06Nichtraucher.html. Accessed 7 Sept 2014 Laue E (2010) Nichtraucher auf dem Vormarsch—Gesundheitsschutz hat Vorrang—Statistisches Bundesamt (Destatis). https://​www.​destatis.​de/​DE/​Publikationen/​STATmagazin/​Gesundheit/​2010_​06/​2010_​06Nichtraucher.​html.​ Accessed 7 Sept 2014
27.
go back to reference Laxman VK, Annaji S (2008) Tobacco use and its effects on the periodontium and periodontal therapy. J Contemp Dent Pract 9:97–107PubMed Laxman VK, Annaji S (2008) Tobacco use and its effects on the periodontium and periodontal therapy. J Contemp Dent Pract 9:97–107PubMed
28.
go back to reference Lee H, Pi S, Kim Y et al (2009) Effects of nicotine on antioxidant defense enzymes and RANKL expression in human periodontal ligament cells. J Periodontol 80:1281–1288CrossRefPubMed Lee H, Pi S, Kim Y et al (2009) Effects of nicotine on antioxidant defense enzymes and RANKL expression in human periodontal ligament cells. J Periodontol 80:1281–1288CrossRefPubMed
29.
go back to reference Leone A, Landini L (2013) Vascular pathology from smoking: look at the microcirculation! Curr Vasc Pharmacol 11:524–530CrossRefPubMed Leone A, Landini L (2013) Vascular pathology from smoking: look at the microcirculation! Curr Vasc Pharmacol 11:524–530CrossRefPubMed
30.
go back to reference Liu Y, Wu L, Wang J et al (2010) Micro-computerized tomography analysis of alveolar bone loss in ligature- and nicotine-induced experimental periodontitis in rats. J Periodontal Res 45:714–719CrossRefPubMed Liu Y, Wu L, Wang J et al (2010) Micro-computerized tomography analysis of alveolar bone loss in ligature- and nicotine-induced experimental periodontitis in rats. J Periodontal Res 45:714–719CrossRefPubMed
31.
go back to reference Livak KJ, Schmittgen TD (2001) Analysis of relative gene expression data using real-time quantitative PCR and the 2(-Delta Delta C(T)) Method. Methods 25:402–408CrossRefPubMed Livak KJ, Schmittgen TD (2001) Analysis of relative gene expression data using real-time quantitative PCR and the 2(-Delta Delta C(T)) Method. Methods 25:402–408CrossRefPubMed
32.
go back to reference Makino A, Yamada S, Okuda K et al (2008) Nicotine involved in periodontal disease through influence on cytokine levels. FEMS Immunol Med Microbiol 52:282–286CrossRefPubMed Makino A, Yamada S, Okuda K et al (2008) Nicotine involved in periodontal disease through influence on cytokine levels. FEMS Immunol Med Microbiol 52:282–286CrossRefPubMed
34.
35.
go back to reference Meikle MC (2006) The tissue, cellular, and molecular regulation of orthodontic tooth movement: 100 years after Carl Sandstedt. Eur J Orthod 28:221–240CrossRefPubMed Meikle MC (2006) The tissue, cellular, and molecular regulation of orthodontic tooth movement: 100 years after Carl Sandstedt. Eur J Orthod 28:221–240CrossRefPubMed
36.
go back to reference Moore GE, Bross I, Shamberger R et al (1967) Tar and nicotine retrieval from fifty-six brands of cigarettes. Cancer 20:323–332CrossRefPubMed Moore GE, Bross I, Shamberger R et al (1967) Tar and nicotine retrieval from fifty-six brands of cigarettes. Cancer 20:323–332CrossRefPubMed
37.
go back to reference Nakajima R, Yamaguchi M, Kojima T et al (2008) Effects of compression force on fibroblast growth factor-2 and receptor activator of nuclear factor kappa B ligand production by periodontal ligament cells in vitro. J Periodontal Res 43:168–173CrossRefPubMed Nakajima R, Yamaguchi M, Kojima T et al (2008) Effects of compression force on fibroblast growth factor-2 and receptor activator of nuclear factor kappa B ligand production by periodontal ligament cells in vitro. J Periodontal Res 43:168–173CrossRefPubMed
38.
go back to reference Nociti FH Jr, Nogueira-Filho GR, Primo MT et al (2000) The influence of nicotine on the bone loss rate in ligature-induced periodontitis. A histometric study in rats. J Periodontol 71:1460–1464CrossRefPubMed Nociti FH Jr, Nogueira-Filho GR, Primo MT et al (2000) The influence of nicotine on the bone loss rate in ligature-induced periodontitis. A histometric study in rats. J Periodontol 71:1460–1464CrossRefPubMed
39.
go back to reference Nogueira-Filho, Gda R, Rosa BT, César-Neto JB et al (2007) Low- and high-yield cigarette smoke inhalation potentiates bone loss during ligature-induced periodontitis. J Periodontol 78:730–735CrossRef Nogueira-Filho, Gda R, Rosa BT, César-Neto JB et al (2007) Low- and high-yield cigarette smoke inhalation potentiates bone loss during ligature-induced periodontitis. J Periodontol 78:730–735CrossRef
40.
go back to reference Proff P, Reicheneder C, Faltermeier A et al (2014) Effects of mechanical and bacterial stressors on cytokine and growth-factor expression in periodontal ligament cells. J Orofac Orthop 75:191–202CrossRefPubMed Proff P, Reicheneder C, Faltermeier A et al (2014) Effects of mechanical and bacterial stressors on cytokine and growth-factor expression in periodontal ligament cells. J Orofac Orthop 75:191–202CrossRefPubMed
41.
go back to reference Proff P, Römer P (2009) The molecular mechanism behind bone remodelling: a review. Clin Oral Investig 13:355–362CrossRefPubMed Proff P, Römer P (2009) The molecular mechanism behind bone remodelling: a review. Clin Oral Investig 13:355–362CrossRefPubMed
42.
go back to reference Reagan-Shaw S, Nihal M, Ahmad N (2008) Dose translation from animal to human studies revisited. FASEB J 22:659–661CrossRefPubMed Reagan-Shaw S, Nihal M, Ahmad N (2008) Dose translation from animal to human studies revisited. FASEB J 22:659–661CrossRefPubMed
43.
go back to reference Ren Y, Maltha JC, Kuijpers-Jagtman AM (2004) The rat as a model for orthodontic tooth movement – a critical review and a proposed solution. Eur J Orthod 26:483–490CrossRefPubMed Ren Y, Maltha JC, Kuijpers-Jagtman AM (2004) The rat as a model for orthodontic tooth movement – a critical review and a proposed solution. Eur J Orthod 26:483–490CrossRefPubMed
44.
go back to reference Römer P, Köstler J, Koretsi V et al (2013) Endotoxins potentiate COX-2 and RANKL expression in compressed PDL cells. Clin Oral Investig 17:2041–2048CrossRefPubMed Römer P, Köstler J, Koretsi V et al (2013) Endotoxins potentiate COX-2 and RANKL expression in compressed PDL cells. Clin Oral Investig 17:2041–2048CrossRefPubMed
45.
go back to reference Römer P, Wolf M, Fanghänel J et al (2014) Cellular response to orthodontically-induced short-term hypoxia in dental pulp cells. Cell Tissue Res 355:173–180CrossRefPubMed Römer P, Wolf M, Fanghänel J et al (2014) Cellular response to orthodontically-induced short-term hypoxia in dental pulp cells. Cell Tissue Res 355:173–180CrossRefPubMed
46.
go back to reference Rose JE, Behm FM, Westman EC et al (1999) Arterial nicotine kinetics during cigarette smoking and intravenous nicotine administration: implications for addiction. Drug Alcohol Depend 56:99–107CrossRefPubMed Rose JE, Behm FM, Westman EC et al (1999) Arterial nicotine kinetics during cigarette smoking and intravenous nicotine administration: implications for addiction. Drug Alcohol Depend 56:99–107CrossRefPubMed
47.
go back to reference Schechter MD, Cook PG (1976) Nicotine-induced weight loss in rats without an effect on appetite. Eur J Pharmacol 38:63–69CrossRefPubMed Schechter MD, Cook PG (1976) Nicotine-induced weight loss in rats without an effect on appetite. Eur J Pharmacol 38:63–69CrossRefPubMed
48.
go back to reference Sodagar A, Donyavi Z, Arab S et al (2011) Effect of nicotine on orthodontic tooth movement in rats. Am J Orthod Dentofacial Orthop 139:261–265CrossRef Sodagar A, Donyavi Z, Arab S et al (2011) Effect of nicotine on orthodontic tooth movement in rats. Am J Orthod Dentofacial Orthop 139:261–265CrossRef
49.
go back to reference Takada T, Yoshinari N, Sugiishi S et al (2004) Effect of restraint stress on the progression of experimental periodontitis in rats. J Periodontol 75:306–315CrossRefPubMed Takada T, Yoshinari N, Sugiishi S et al (2004) Effect of restraint stress on the progression of experimental periodontitis in rats. J Periodontol 75:306–315CrossRefPubMed
50.
go back to reference Tanaka H, Tanabe N, Shoji M et al (2006) Nicotine and lipopolysaccharide stimulate the formation of osteoclast-like cells by increasing macrophage colony-stimulating factor and prostaglandin E2 production by osteoblasts. Life Sci 78:1733–1740CrossRefPubMed Tanaka H, Tanabe N, Shoji M et al (2006) Nicotine and lipopolysaccharide stimulate the formation of osteoclast-like cells by increasing macrophage colony-stimulating factor and prostaglandin E2 production by osteoblasts. Life Sci 78:1733–1740CrossRefPubMed
52.
go back to reference Wang X, Liu Y, Wang Q et al (2010) Functional expression of alpha 7 nicotinic acetylcholine receptors in human periodontal ligament fibroblasts and rat periodontal tissues. Cell Tissue Res 340:347–355CrossRefPubMed Wang X, Liu Y, Wang Q et al (2010) Functional expression of alpha 7 nicotinic acetylcholine receptors in human periodontal ligament fibroblasts and rat periodontal tissues. Cell Tissue Res 340:347–355CrossRefPubMed
53.
go back to reference Wolf M, Lossdörfer S, Craveiro R et al (2013) Regulation of macrophage migration and activity by high-mobility group box 1 protein released from periodontal ligament cells during orthodontically induced periodontal repair: an in vitro and in vivo experimental study. J Orofac Orthop 74:420–434CrossRefPubMed Wolf M, Lossdörfer S, Craveiro R et al (2013) Regulation of macrophage migration and activity by high-mobility group box 1 protein released from periodontal ligament cells during orthodontically induced periodontal repair: an in vitro and in vivo experimental study. J Orofac Orthop 74:420–434CrossRefPubMed
54.
go back to reference Wu L, Duan D, Liu Y et al (2013) Nicotine favors osteoclastogenesis in human periodontal ligament cells co-cultured with CD4(+) T cells by upregulating IL-1β. Int J Mol Med 31:938–942PubMed Wu L, Duan D, Liu Y et al (2013) Nicotine favors osteoclastogenesis in human periodontal ligament cells co-cultured with CD4(+) T cells by upregulating IL-1β. Int J Mol Med 31:938–942PubMed
55.
go back to reference Xie R, Kuijpers-Jagtman AM, Maltha JC (2011) Inflammatory responses in two commonly used rat models for experimental tooth movement: comparison with ligature-induced periodontitis. Arch Oral Biol 56:159–167CrossRefPubMed Xie R, Kuijpers-Jagtman AM, Maltha JC (2011) Inflammatory responses in two commonly used rat models for experimental tooth movement: comparison with ligature-induced periodontitis. Arch Oral Biol 56:159–167CrossRefPubMed
Metadata
Title
Orthodontic forces add to nicotine-induced loss of periodontal bone
An in vivo and in vitro study
Authors
Dr. C. Kirschneck
P. Proff
M. Maurer
C. Reicheneder
P. Römer
Publication date
01-05-2015
Publisher
Springer Berlin Heidelberg
Published in
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie / Issue 3/2015
Print ISSN: 1434-5293
Electronic ISSN: 1615-6714
DOI
https://doi.org/10.1007/s00056-015-0283-7

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