***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The study was conducted to compare the performance of three interdental products to dental floss in the control and removal of plaque , and in the reduction of gingivitis . METHODOLOGY One-hundred and twenty subjects were screened for the presence of interproximal sites of a size suitable for a GUMO Go-Betweens cleaner , and for being in compliance with inclusion and exclusion criteria . They were then assessed with the Plaque , Gingivitis , and Eastman Interdental Bleeding Indices ( EIBI ) at baseline , given a prophylaxis , r and omly assigned to one of four products ( Glide dental floss , Butler flossers , GUM Go-Betweens cleaners , and GUM Soft-Picks cleaners ) , and given product use instructions . Subjects returned at three weeks for a compliance review and at six weeks for a final visit . Plaque was assessed at the final visit before and after using the assigned products . Plaque , gingivitis , and bleeding scores were evaluated by analysis of covariance using the baseline measurements as the covariate . RESULTS All four interdental products significantly reduced interdental plaque from baseline to before-use at the final visit ( after six weeks ) employing baseline plaque as a covariate . Reductions were 16 % to 24 % . Similarly , use of the products at the final visit result ed in 26 % to 31 % reductions in plaque with the before-use plaque as a covariate . Interdental gingivitis scores showed a reduction both lingually and buccally , with reductions ranging from 27 % to 36 % for the former and 34 % to 53 % for the latter ( baseline was the covariate ) . No statistical differences were found between the products on the lingual interdental sites . The Go-Betweens cleaners showed a statistically greater reduction in the Gingival Index score buccally than the other three products . No differences were noted among the products for the EIBI . CONCLUSION In this study , dental floss , the recognized " gold st and ard " for gingivitis reduction , was matched in performance by flossers and an interdental cleaner with small elastomeric fingers , and surpassed by an interdental brush . All products performed comparably for plaque reduction and removal INTRODUCTION There exist a number of factors that affect the outcome of orthodontic treatment . These factors can be assessed by various gingival markers . One such maker is myeloperoxidase ( MPO ) . Hence , we planned the present study to assess and compare the MPO activity in the gingival crevicular fluid ( GCF ) of subjects undergoing orthodontic treatment by different aligning arch wires .  MATERIAL S AND METHODS The present study included assessment of patients who underwent orthodontic treatment for crowding of anterior teeth . Diagnostic cast models of all the subjects were made for recording the irregularity index . All the subjects were r and omly divided into three study groups with 15 patients in each group based on the type of nickel-titanium ( NiTi ) arch wires used . A collection of GCF sample s was done in all the patients at various time intervals and it was sent to the laboratory for assessment of MPO activity . Activity of the MPO enzyme was expressed in terms of number of units per 100 μL. All the results obtained were compiled and analyzed by Statistical Package for the Social Sciences ( SPSS ) software . RESULTS We observed that nonsignificant results were obtained while comparing the mean age and mean gingival score in all the study groups . However , significant results were obtained on comparing the mean MPO enzymatic activity in all the study groups at different time intervals . CONCLUSION Both superelastic NiTi and heat-activated NiTi generate optimal forces , which are necessary for higher metabolic response of the periodontal ligament . CLINICAL SIGNIFICANCE In the intimal stages of orthodontic treatment , both superelastic NiTi and heat-activated NiTi wires are superior in leveling and aligning the crowded teeth INTRODUCTION The aim of this study was to monitor the alveolar bone formation at the tension sites of teeth supporting the appliances for rapid maxillary expansion ( RME ) during the retention phase according to the local gingival crevicular fluid ( GCF ) alkaline phosphatase ( ALP ) activity . METHODS This split-mouth prospect i ve study included 23 prepubertal subjects ( 15 girls , 8 boys ; mean age , 9.0 ± 1.4 years ) who had a constricted maxillary arch and were undergoing RME .  Periodontal parameters , including probing depth  , were recorded at 3 and 6 months after RME . Furthermore , the GCF ALP activity was measured at the tension sites of the supporting test teeth ( TT ) and at the antagonist control teeth ( CT ) sites . RESULTS Periodontal parameters were generally similar between the TT and CT sites during the study , with the exception that probing depth underwent a slight increase at the TT sites . At baseline , the GCF ALP activity was similar between the TT and CT sites ; however , at both 3 and 6 months , significantly greater enzymatic activity was seen at the TT sites . The overall probing depth changes were not significantly correlated with the corresponding GCF ALP activity changes for either the TT or the CT sites . CONCLUSIONS Alveolar bone formation at the tension sites would last up to 6 months of retention after RME . These results warrant more comprehensive studies to assess whether the GCF ALP activity has potential as a diagnostic tool for bone formation during the retention phase of RME BACKGROUND During orthodontic tooth movement , the early response of periodontal tissues to mechanical stress is an acute inflammatory one . This study uses a longitudinal design to examine lactate dehydrogenase ( LDH ) activity in gingival crevicular fluid ( GCF ) to determine if GCF LDH can be used as a diagnostic aid in monitoring tooth movement and tissue response during orthodontic treatment . METHODS Seventeen patients ( mean age : 16.1 years ) participated in the study . Each patient was undergoing treatment for distal movement , and an upper first molar served as the test tooth ( TT ) , while the contralateral ( CT ) and antagonist ( AT ) teeth were used as controls . The CT was included in the orthodontic appliance , but was not subjected to the distal movement ; the AT was free from any orthodontic appliance . The GCF around the experimental teeth was harvested from both mesial and distal tooth sites immediately before appliance activation , and on days 7 , 14 , and 21 . Clinical gingival conditions were also recorded . RESULTS Gingival crevicular fluid LDH activity was significantly elevated in all sites of the TT and CT , as compared to the AT , where LDH activity remained at the baseline level throughout the study . Enzyme activity levels were also greater in the TT than in the CT , and in the compression sites . CONCLUSIONS Our results suggest that GCF LDH levels reflect the biological activity that takes place in the periodontium during orthodontic movement , and therefore they can be used as a diagnostic tool for monitoring for correct orthodontic tooth movement in clinical practice OBJECTIVES The aim of the study was to investigate alkaline phosphatase activity in the gingival crevicular fluid ( GCF ) during orthodontic tooth movement in humans . SETTING AND SAMPLE POPULATION Postgraduate orthodontic clinic . Ten female patients requiring all first premolar extraction s were selected and treated with st and ard edgewise mechanotherapy . EXPERIMENTAL VARIABLE Canine retraction was done using 100 g sentalloy springs . Maxillary canine on one side acted as experimental site while the contralateral canine acted as control . OUTCOME MEASURE Gingival crevicular fluid was collected from mesial and distal of canines before initiation of canine retraction ( baseline ) , immediately after initiation of retraction , and on 1st , 7th , 14th and 21st day and the alkaline phosphatase activity was estimated . RESULTS The results show significant ( p < 0.05 ) changes in alkaline phosphatase activity on the 7th , 14th and 21st day on both mesial and distal aspects of the compared experimental and control sides . The peak in enzyme activity occurred on the 14th day of initiation of retraction followed by a significant fall in activity especially on the mesial aspect . CONCLUSIONS The study showed that alkaline phosphatase activity could be successfully estimated in the GCF using calorimetric estimation assay kits . The enzyme activity showed variation according to the amount of tooth movement During orthodontic treatment , the early response of periodontal tissues to mechanical stress involves several metabolic changes that allow tooth movement . Many studies have evaluated such modifications by analysis of various host metabolites released into the gingival crevicular fluid ( GCF ) . This study used a cross-sectional design to examine the lactate dehydrogenase ( LDH ) activity in GCF to assess whether GCF LDH can be proposed as a sensitive marker for periodontal tissue modifications during orthodontic tooth movement . Thirty-seven subjects , 16 males and 21 females ( mean age 18.7 years , range 14.0 to 26.7 years ) , participated in this study . Each subject underwent a session of professional oral hygiene and received oral hygiene instructions ; 2 weeks later , a fixed orthodontic appliance was placed on the maxillary arch . A r and omly selected maxillary canine was considered as the test tooth , and its antagonist , which had no appliance , was used as the control tooth . From 2 to 12 weeks after orthodontic appliance placement , GCF was harvested from both experimental teeth at the mesiobuccal angle , for GCF volume and LDH activity determinations . Clinical monitoring consisted of recording supragingival plaque presence , bleeding on probing , and probing depth at the same collection sites . The results showed that no differences in clinical conditions and GCF volume occurred between the experimental teeth . On the contrary , GCF LDH activity in the test teeth was significantly greater than that of the control teeth ( P < .01 ) . Moreover , no differences were found in the enzymatic activity between the sexes by experimental tooth , and no significant correlation was present between GCF LDH activity and patients ' ages within experimental teeth . Our enzymatic results initially indicated a possible role of GCF LDH during the early phases of orthodontic treatment and therefore warrant further study as a possible diagnostic tool for tissue response during orthodontic treatment Obesity is a widespread chronic inflammatory disorder characterized by an increased overall disease burden and significant association with periodontitis . The aim of this prospect i ve clinical cohort study was to investigate the effect of obesity on orthodontic tooth movement . Fifty-five adolescent patients ( 27 males , 28 females ) with a mean ( SD ) age of 15.1 ( 1.7 ) years and mean ( SD ) body mass index ( BMI ) of 30.2 ( 3.5 ) kg/m2 in obese and 19.4 ( 2.2 ) kg/m2 in normal-weight groups were followed from start of treatment to completion of tooth alignment with fixed orthodontic appliances . Primary outcome was time taken to complete tooth alignment , while secondary outcomes included rate of tooth movement and change in clinical parameters ( plaque/gingival indices , unstimulated whole-mouth salivary flow rate , gingival crevicular fluid biomarkers ) . Data collection took place at baseline ( start of treatment : appliance placement ) , 1 h and 1 wk following appliance placement , and completion of alignment . Results were analyzed by descriptive statistics followed by generalized estimating equation regression modeling . There were no significant differences between groups in time taken to achieve tooth alignment ( mean [ SD ] 158.7 [ 75.3 ] d ; P = 0.486 ) . However , at 1 wk , initial tooth displacement was significantly increased in the obese group ( P < 0.001 ) , and after adjusting for confounders , obese patients had a significantly higher rate of tooth movement compared with normal-weight patients ( + 0.017 mm/d ; 95 % confidence interval , 0.008–0.025 ; P < 0.001 ) over the period of alignment . Explorative analyses indicated that levels of the adipokines leptin and resistin , the inflammatory marker myeloperoxidase ( MPO ) , and the cytokine receptor for nuclear factor kappa-B lig and ( RANKL ) were significantly different between obese- and normal-weight patients and associated with observed rates of tooth movement . This represents the first prospect i ve data demonstrating a different response in obese patients compared with normal-weight patients during early orthodontic treatment . These differences in the response of periodontal tissues to orthodontic force in the presence of obesity have potential short- and long-term clinical implication 
    Output:
    
Primary outcomes are significant upregulation in GCF levels of enzymes-aspartate aminotransferase ( AST ) , alkaline phosphatase ( ALP ) , matrix metalloproteinases ( MMPs ) , lactate dehydrogenase ( LDH ) , β-glucuronidase ( βG ) , tartrate resistant acid phosphatase ( TRAP ) , acid phosphatase ( ACP ) and down regulation in cathepsin B ( Cb ) .
Site specificity is shown by ALP , TRAP , AST , LDH , MMP9 with levels at compression site increasing earlier and in higher quantities compared with tension site .
ALP levels are higher at tension site only in retention .
A positive correlation of LDH , ALP and AST is also observed with increasing orthodontic force magnitude .
Conclusions : A strong evidence of variation in enzymes ( ALP , AST , ACP TRAP , LDH , MMPs , Cb ) in GCF is found in association with different magnitude , stages and sites of orthodontic force application