The effect of bisphosphonate risedronate emulgel on the inhibition of tooth movement relaps

Background: Orthodontic treatment is performed to correct the malocclusion, and after treatment is complete. The position of the teeth must be maintained because the teeth can move back to their original position, commonly known as relapse. Various attempts have been made, such as using retainers, and various studies have used pharmacological agents such as bisphosphonate risedronate to inhibit relapse, but these studies still used the injection method, which is inconvenient to apply and has a systemic effect. For this reason, changing the bisphosphonate preparation to an emulgel will facilitate its application and have a local effect, but it is necessary to test and determine its effectiveness in inhibiting the relapse. Method: An experimental laboratory study was conducted on 18 guinea pigs, which were divided into three groups: I (control), II (emulgel without risedronate), and III (emulgel with risedronate). The teeth were moved with open coil springs on both lower incisors for seven days, stabilized for seven days, and emulgel applied in groups II and III. The coil spring was removed, and the distance between the two incisors was measured on the third and seventh days. Result: Using One-Way ANOVA and Post Hoc LSD, the data analysis results showed significant differences between the control and the risedronate emulgel groups on the third and seventh days. The largest relapse occurred in the control group, while the smallest was in the emulgel group with risedronate. Conclusion: These results indicate that risedronate bisphosphonate in the form of emulgel influences inhibiting


INTRODUCTION
Orthodontics is one of the fields of dentistry, which studies facial growth, tooth development and occlusion, and the diagnosis, intercept, and treatment of occlusive anomalies.
Using orthodontic appliances, treatment is beneficial for improving dental health and quality of life related to oral health, aesthetics, and function. 1 Public awareness regarding orthodontic treatment is getting better as is the result of research by Aditya After treatment with orthodontic appliances is completed, the next stage is the retention phase.
The retention phase is the final stage in orthodontic treatment, which serves to maintain the teeth in position. In this case, the tooth tends to return to the initial malocclusion position, commonly known as relapse. 5  compared to a group of mice not given risedronate.
Risedronate also has the potential to have side effects such as lower osteonecrosis than other bisphosphonates. 13 Besides, intraperitoneal injection is widely used in research but has drawbacks, including passing through a high firstpass metabolism, requiring sterility, and causing damage to the abdominal organs if the procedure is inappropriate. 14 In this case, emulgel combines two formations, emulsion and gel, as a topical drug preparation to accelerate local drug absorption. 15 The advantages of emulgel preparations are good stability, ease of formulation and application, and patient comfort. 13 Hence, it is necessary to know the effect of risedronate bisphosphonate in the form of emulgel on the inhibition of tooth relapse movement to prevent relapse with an easy and convenient application.

RESEARCH METHOD
Emulgel preparations were made in the   After seven days of stabilization, the open coil spring was removed, and the distance between the two lower incisors was measured (initial distance).
Emulgel application was still carried out until distance measurements were made on the 3 rd and 7 th days (final distance).

RESULTS
The initial and final distance measurement results in the 3 rd and 7 th -day groups can be seen in Tables 1 and 2     The normality test obtained significant results for all groups above 0.05, so it can be said that the data were normally distributed. The homogeneity test showed 0.119 and 0.063, indicating that the data were homogeneous or had the same variance.
Furthermore, a one-way ANOVA test was performed, and the significant data on day 3 and day 7 was 0.038 and 0.043, signifying significant differences between groups I, II, and III (Table 3).
Next, the LSD Post Hoc test was conducted (Table   4). The significance of groups I and III on the 3rd and 7th days was 0.014 and 0.016, meaning there was a significant difference between groups I and III.

DISCUSSION
The results uncovered a significant  Thus, it has the potential to be easy and convenient to apply the preparation. Moreover, it is necessary to know its histological effect, i.e., the effect on osteoclasts and osteoblasts, which play an important role in tooth relapse movement.

ACKNOWLEDGEMENT
The authors would like to thank the Universitas Muhammadiyah Yogyakarta for supporting this research's funds, facilities, and infrastructure. In addition, no conflict of interest exists in this manuscript's research results and publication.