Qual o impacto dos antidepressivos na movimentação dentária ortodôntica? uma revisão sistemática e meta-análise em modelos experimentais

Abstract

Antidepressants (AD) are a class of medications used to treat depression, as well as anxiety disorders, neuropathic pain, and even sleep disorders. Orthodontists should assess whether ADs can interact with or interfere with the progress of orthodontic treatment. The use of ADs has increased globally in recent years, and speculation about a possible interaction of these medications with orthodontic tooth movement (OTM) has been growing in the scientific literature. To integrate clinical and histological data from the literature on the impact of ADs during OTM into a systematic review and meta-analysis (CRD42023477371). Searches were conducted by two independent reviewers, with no date or language restrictions, in the following databases: Embase, Scopus, Web of Science, PubMed, and LILACS. Google Scholar, LIVIVO, and Proquest were also checked. Inclusion criteria required controlled animal studies exposed to ADs, detailing dose, frequency, administration, and evaluating the same teeth, devices, and orthodontic forces. Qualitative and quantitative analyses were collected. Risk of bias was assessed using the SYRCLE’s RoB Tool, and the quality of available evidence was evaluated with GRADE. The meta-analysis was performed using the RevMan tool. Results are presented as mean and standard deviation. Among 287 records identified, 11 studies (669 rats and 15 dogs) published between 2014 and 2023 were included. Data from four studies were pooled into eight meta-analyses. Six ADs were identified. A closed Ni-Ti spring fixed with a steel ligature wire ranging from 0.010” to 0.015” was used in all included studies. In rats, the first upper molar was used, connecting the orthodontic device to the upper central incisors (25 to 60gF). In dogs, the second premolars and canines were selected (200gF). No significant differences were found between the AD and control groups at various time points and with different antidepressants (p>0.05). Meta-analyses showed no differences in OTM between the fluoxetine group and control at 3 days (k=2) (MD= -1.33mm; 95% CI [−4.18, 1.53]), at 7 days (MD= -1.41mm; 95% CI [−5.03, 2.22]), at 14 days (MD=1.44mm; 95% CI [−1.54, 4.43]), and amitriptyline with the control group at 60 days (k=2) (MD= -0.54mm; 95% CI [−1.72, 0.65]). Regarding the number of osteoclasts, no statistical differences were found between the fluoxetine and control groups at 3 days (k=2) (MD=0.11; 95% CI [−0.22, 0.43]), at 7 days (MD=0.07; 95% CI [−0.25, 0.40]), at 14 days (MD=0.91; 95% CI [0.56, 1.25]), as well as amitriptyline and the control group at 60 days (k=2) (MD=0.11; 95% CI [−1.04, 1.26]). The certainty of the evidence was very low. The impact of ADs on experimental models of OTM is not significantly different from that of models without ADs.