Effects of Vitamin D on Orthodontic Tooth Movement and Treatment Stability: A Literature Review

Objective: Vitamin D, a key regulator of phosphocalcic metabolism, plays a central role in bone remodeling—a fundamental process underlying orthodontic tooth movement and post-treatment stability. Its specific influence on orthodontic outcomes, and in particular on relapse prevention, remains insufficiently characterized. This review systematizes the recent evidence on the role of vitamin D in orthodontics, focusing on its biological mechanisms and its potential to enhance treatment stability. Materials andMethods:A literature search was conducted in PubMed, ScienceDirect, Springer, and Google Scholar for studies published between 2013 and 2024. Selection followed the PRISMA recommendations, with an initial screening of titles and abstracts followed by full-text analysis. Relevant data were then extracted and critically appraised. Results:Of 3792 references initially identified, 2223 were retained after removal of duplicates and date restriction. After full-text reading, 27 articles were included: 6 meta-analyses and systematic reviews, 2 narrative reviews, 4 randomized clinical trials, 2 prospective studies, 1 in vitro study, 10 in vivo studies, and 2 longitudinal studies. Discussion:The body of evidence converges on a decisive role of vitamin D in bone remodeling, through modulation of the RANKL/OPG ratio and of the osteoclast/osteoblast balance. At physiological doses, it accelerates tooth movement and promotes higher-quality bone regeneration, reducing the risk of relapse and supporting periodontal fiber reorganization. Inappropriate dosing may, however, produce paradoxical effects, notably excessive bone densification that hinders tooth mobility. Methodological heterogeneity and small sample sizes limit the strength of current conclusions. Conclusion:Vitamin D emerges as a promising therapeutic adjunct in orthodontics, with notable benefits for bone remodeling and post-treatment stability. An individualized approach accounting for each patient’s vitamin D status remains essential, as do large-scale clinical trials to establish reliable recommendations.

• Vitamin D
• Calcitriol
• Orthodontic Tooth Movement
• Orthodontic Stability
• Relapse
• Bone Remodeling
• RANKL/OPG

1. Introduction

Vitamin D is a steroid hormone essential to phosphocalcic balance and bone health. Although it can be synthesized in the skin under the effect of UVB radiation, a widespread deficiency is observed in many regions, including Morocco, where nearly 85% of men and 77% of women over 50 years of age show vitamin insufficiency [1]. This situation, paradoxical in a country with abundant sunshine, is explained by cultural, dietary, and behavioral factors [2]. Genetic variations affecting key genes, such as CYP27B1, which is involved in the conversion of vitamin D to its active form, may exacerbate this deficit, particularly in populations where consanguinity is common [3].

These often-underestimated deficiencies have important systemic implications and also consequences for specific disciplines such as orthodontics, where they may influence the biological response to treatment and post-therapeutic stability. In orthodontics, post-treatment stability is an essential yet difficult goal to achieve. Relapse—defined as the return of teeth toward their initial position after removal of active appliances—remains a major problem despite retention: some studies report that it affects 30% to 50% of patients [4]. This phenomenon is linked to the slow reorganization of periodontal fibers, soft-tissue pressure, and individual biological variations [5].

The mechanisms of orthodontic stability are directly governed by bone remodeling, in which resorption and formation must be finely balanced. In this context, vitamin D plays a crucial role by regulating osteoblastic and osteoclastic activity through the RANK/RANKL/OPG pathway, a system in which the balance between RANKL—which promotes osteoclastic activity—and osteoprotegerin (OPG)—its regulator—governs remodeling [6]. Available data on its specific influence in orthodontics nonetheless remain limited: some experimental studies show that optimal levels improve the bone response and limit relapse, whereas others find no significant effect, highlighting methodological limitations and interindividual variability [3][6].

Objective:This work aims to assess the impact of vitamin D on the stability of orthodontic outcomes, focusing on its role in bone regeneration, periodontal reorganization, and relapse prevention. Secondary objectives are to study its effect on the speed and efficiency of orthodontic tooth movement (OTM), to analyze the bone-remodeling mechanisms it modulates, to appraise the relationship between vitamin D status and stability, and to examine the effects of supplementation, with a view to identifying ways to integrate it into clinical protocols.

2. Materials and Methods

2.1. Search Strategy

This review, based on an electronic literature search, follows the PRISMA recommendations for handling references. The databases queried were PubMed (via MEDLINE), Springer, ScienceDirect, and Google Scholar, selected for their coverage and accessibility. Three concepts structured the search: 1) vitamin D, 2) orthodontic tooth movement, and 3) orthodontic treatment stability.

Keywords associated with each concept were combined using Boolean operators according to two equations: (Vitamin D OR Calciferol OR Calcitriol)AND(Deficiency OR Administration)AND(Orthodontic Treatment OR Tooth Movement OR Orthodontic Tooth Movement); and (Vitamin D OR Calciferol OR Calcitriol)AND(Deficiency OR Administration)AND(Orthodontic Stability OR Orthodontic Relapse). Reference management and duplicate removal were performed using Zotero.

2.2. Selection Criteria

InclusionCriteria:articles published between 2013 and 2024 addressing the effect of vitamin D on OTM and/or orthodontic stability; systematic reviews and meta-analyses, clinical trials, retrospective and prospective studies, literature reviews, and in vitro and in vivo (animal) experimental studies; publications in English or French.

ExclusionCriteria:sponsored articles or those with conflicts of interest, case series, editorials and expert opinions, viewpoints, duplicates, and publications prior to 2013.

3. Results

The initial search identified 3792 references from Springer, PubMed, ScienceDirect, and Google Scholar. After removing duplicates and applying the date restriction (2013-2024), 2223 references were retained. Screening of titles and abstracts yielded a preselection of 47 articles; after full-text review and application of the exclusion criteria, 27 articles were definitively included (Table 1).

Table 1. Distribution of the 27 included articles by study type.

Table 1

Study Type	Number of Articles
Meta-analyses and systematic reviews	6
Narrative reviews	2
Randomized clinical trials	4
Prospective clinical studies	2
In vitro studies	1
In vivo (animal) studies	10
Longitudinal studies	2
Total	27

4. Discussion

4.1. Vitamin D: Metabolism and Deficiency

Vitamin D, a fat-soluble prohormone, derives from the cutaneous synthesis of 7-dehydrocholesterol into cholecalciferol (D3) under UVB exposure, and from dietary intake or supplements. Its bioavailability depends on age, skin pigmentation, and photoprotection [7]-[10]. It then undergoes a double hydroxylation: hepatic, producing 25-hydroxyvitamin D (calcifediol), the reference circulating form of vitamin D status owing to its 2- to 3-week half-life [11]; then renal, under the action of 1α-hydroxylase, producing 1,25-dihydroxyvitamin D (calcitriol), the biologically active form, regulated by calcemia, phosphatemia, and PTH [7]. Calcitriol acts by binding to the vitamin D receptor (VDR), expressed in numerous tissues, and exerts effects that are not only mineral but also immunomodulatory and anti-inflammatory [9][12].

A serum 25(OH)D level between 30 and 60 ng/mL is considered optimal; a value below 20 ng/mL defines deficiency, and a value of 21 - 29 ng/mL insufficiency [8][13]. The Moroccan Society of Rheumatology recommends levels ≥ 30 ng/mL and, given a prevalence exceeding 85% among adult women, advocates strategies that combine screening of at-risk populations, targeted supplementation, and food fortification [1][14]. In severe deficiency (<10 ng/mL), a loading phase (e.g., 50,000 IU/week for 6 to 8 weeks) precedes a daily maintenance dose of 1000 to 2000 IU [8][13].

4.2. Vitamin D and Bone Metabolism

Bone metabolism continuously balances resorption of old bone and formation of new bone, ensuring skeletal strength and phosphocalcic homeostasis [12]. Experimental studies show that vitamin D deficiency disrupts this balance: Khalaf and Almudhi (2022) report, in the rat, a decreased RANKL/OPG ratio and reduced osteoclastic activity [15], while Gong et al. (2018) observe inhibition of osteoblastic formation and periodontal degeneration in the deficient mouse [16]. Conversely, calcitriol supply restores bone formation, particularly in the maxillary region [17], and supplementation increases bone mineral density (BMD) and bone volume while reducing porosity [6][12][18]. Several studies emphasize that vitamin D can also stimulate the controlled resorption required for tooth movement [19][20], and that it can counterbalance the inhibitory effect of bisphosphonates on remodeling [21] (Table 2).

Table 2. Effects of vitamin D on bone remodeling according to the included studies.

Table 2

Study	Type	Population	Observed Effect
Khalaf & Almudhi (2022)	Exp. (rats)	Induced deficiency	↓ RANKL/OPG ratio; ↓ osteoclastic activity
Narmada et al . (2019)	Exp. (rats)	Pregnant, supplemented	↑ RANKL; ↑ osteoclast number
Fügl et al . (2015)	Exp. (rats)	Vitamin D deficiency	↑ bone formation with local calcitriol
Gong et al . (2018)	Exp. (mice)	Vitamin D deficiency	↓ osteoblasts; periodontal degeneration
Gratton (2022)	Exp. (rats)	Systemic administration	↑ BMD and bone volume; ↓ porosity
Kazemian et al . (2023)	Meta-analysis	Osteoporotic patients	↑ BMD; improved bone formation
Sundar et al . (2023)	Syst. review	Bone regeneration (adjuvant)	Better bone formation and osseointegration

BiphasicEffect: The action of vitamin D depends closely on its concentration. At physiological levels, moderate doses reduce the RANKL/OPG ratio and support balanced remodeling [22]; in initially deficient subjects (<50 nmol/L), moderate supplementation (400 - 800 IU/day) slightly improves BMD, notably at the femoral neck [23]. Conversely, high doses (>1000 IU/day) may induce hypercalcemia without additional benefit, and supraphysiological local concentrations increase mineralization to the point of slowing tooth movement [23][24]. A targeted and individualized approach, therefore, appears necessary to maximize benefits while avoiding deleterious effects.

4.3. Vitamin D and Orthodontic Tooth Movement

Orthodontic tooth movement relies on remodeling of the alveolar bone: bone formation on the tension side and resorption on the compression side, under the control of the RANKL/OPG pathway [25]-[29]. Most studies report an accelerating effect of vitamin D. Al-Attar and Abid (2022) report a 23.5% reduction in the alignment time of the mandibular incisors, associated with a decrease in initial pain [5]; Varughese et al. (2019) an increase in canine distalization speed (0.38 → 0.49 mm/week) [30]; Nishitha et al. an acceleration of 33.6%, comparable to prostaglandin E1 [31]. Farzanegan et al. (2023) observe acceleration in the second month after restoration of serum levels and regulation of the RANKL/OPG ratio [32]. Meta-analyses confirm this trend, with standardized mean differences (SMD) of 1.63 (p < 0.05) in Al-Attar et al. (2021) [33] and 1.43 (p = 0.002) in Tini et al. (2024) [34].

Synergistic effects are described with prostaglandin E2, displacement increasing from 0.231 mm (control) to 0.702 mm in combination [20], along with a “rescue” effect on remodeling under alendronate, vitamin D restoring an accelerated OTM of 21% [21]. One paradoxical result is worth noting: Shetty et al. (2015) observe a slowdown (1.14 vs 1.86 mm/week) attributed to excessive bone densification under local administration [24], underscoring the importance of precise dosing (Table 3).

Table 3. Summary of the effects of vitamin D on orthodontic tooth movement (OTM). RCT: randomized clinical trial; PGE2: prostaglandin E2; PRP: platelet-rich plasma; SMD: standardized mean difference.

Table 3

Study	Type/Route	Main Result
Al-Attar & Abid (2022)	RCT—systemic	↓ 23.5% in mandibular incisor alignment time
Varughese et al . (2019)	RCT—local (intraligamentary)	Canine distalization: 0.38 → 0.49 mm/week
Nishitha et al . (2017)	Clinical—local	↑ 33.6% in displacement speed
Navya et al . (2022)	RCT—local	0.42 mm/week (vs 0.32 control; 0.46 PRP)
Farzanegan et al . (2023)	Clinical—oral	Acceleration at month 2 (RANKL/OPG regulation)
Shetty et al . (2015)	Clinical—local	Slowdown: 1.14 vs 1.86 mm/week (densification)
Gratton et al . (2022)	Exp. (rats)—syst./local	Systemic: ↑ bone strength, OTM slowed
Moradinejad et al . (2024)	Exp. (rats)—systemic	+21% OTM alone; restores OTM under alendronate
Seifi et al . (2013)	Exp. (rats)—systemic	0.231 → 0.702 mm with PGE2 (synergy)
Al-Attar et al . (2021)	Meta-analysis	Increased OTM—SMD 1.63 (p < 0.05)
Tini et al . (2024)	Meta-analysis	Increased OTM—SMD 1.43 (p = 0.002)

4.4. Vitamin D and Orthodontic Treatment Stability

Post-treatment stability depends on complete bone regeneration and on the reorganization of the collagen fibers of the periodontal ligament (PDL), a process that can extend over several months and justifies appropriate retention [5][12][35][36]. Before it is complete, residual forces tend to draw the tooth back toward its initial position; periodontal, occlusal, muscular, and anatomical factors, together with craniofacial growth, contribute to relapse [36]-[38].

Three complementary studies by Khamees et al. (2023) illuminate the role of vitamin D in stability. In a relapse model (0.5 N force for 14 days, 7-day retention, 7-day relapse), the deficient group (VDD) showed increased resorption, a decreased osteoblast count, and impaired regeneration, with more relapse; the supplemented group (VDS) showed greater bone deposition and reduced relapse [39]. At the root level, the cementum deposition/resorption ratio fell from 46% (control) to 31.6% in the deficiency group and rose to 68.4% under supplementation, reflecting improved cemental remodeling (Table 4). Finally, the PDL appeared irregular and fragmented in deficiency, hence increased mobility, but well-defined and close to normal under supplementation, confirming the action of vitamin D on hard tissues as well as soft tissues [40]-[42].

Table 4. Cementum deposition/resorption ratio according to vitamin D status (after Khamees et al., 2023). CR: cemental resorption; CD: cemental deposition.

Table 4

Group	n	Resorption (CR)	Deposition (CD)	CD/CR (%)
Control	10	15	6.1	46%
Deficient (VDD)	10	63	20	31.6%
Supplemented (VDS)	10	10.1	6.6	68.4%

These observations are consistent with earlier work showing that local 1,25-dihydroxyvitamin D balances resorption and deposition and stabilizes teeth after movement [43][44], and that vitamin D stimulates osteoblastic proliferation and matrix mineralization [45]. Gratton (2022) confirms the superiority of the systemic route: gavage of 2000 IU/kg/day for 47 days improves BMD and bone volume (BV/TV) and reduces porosity, with a significant decrease in late relapse, whereas local injection has no notable effect on these parameters [12]. Taken together, the evidence supports integrating screening of vitamin D status and, where appropriate, prior systemic supplementation, particularly in patients at risk of deficiency or with a history of relapse.

4.5. Clinical Implications

Vitamin D, administered systemically or locally, constitutes a promising approach to optimizing orthodontic treatment: acceleration of OTM, reduction of pain, and support of post-treatment stability. Systemic correction of an established deficiency before the active phase, followed by maintenance of optimal serum levels during retention, appears to be the most rational lever, provided that dosing is individualized to avoid the paradoxical effects of overdosing. In a Moroccan context marked by a high prevalence of hypovitaminosis D, targeted screening of orthodontic patients could represent a simple and cost-effective measure.

4.6. Limitations

Several limitations restrict the scope of these conclusions. Studies directly targeting post-treatment stability remain few, with most data concerning bone remodeling and OTM. A large proportion of the work relies on animal models, whose transposability to humans is uncertain. The heterogeneity of protocols—force magnitude and direction, retention duration, biomarkers (RANKL/OPG, BMD), route and dosage of supplementation—together with the diversity of populations, complicates comparisons. Finally, the absence of standardized supplementation protocols hampers the development of precise recommendations. Rigorous clinical trials, in diverse human cohorts and with longitudinal follow-up, are needed.

5. Conclusion

Vitamin D appears to be a key factor in bone remodeling, orthodontic tooth movement, and post-treatment stability. By modulating the RANKL/OPG ratio and the osteoblast/osteoclast balance, it promotes efficient tooth movement, high-quality bone regeneration, and reorganization of periodontal fibers, thereby reducing the risk of relapse—provided that dosing is appropriate, since an excess may instead densify the bone and limit tooth mobility. A promising therapeutic adjunct, it warrants an individualized approach based on the patient’s vitamin D status. Further standardized, large-scale research remains indispensable to confirm these observations and establish reliable clinical recommendations.

Author Contributions

Afaf Moussaid: Literature search, data analysis, and writing—original draft. Hajar Bouzid: Conceptualization, supervision, writing—review & editing, and corresponding author. Sanaa Alami: Methodology and validation. Amal ElAouame: Supervision and critical revision of intellectual content.

References

1.. El Khasmi, M., Farh, M., Iddar, A. and Tahri, E.H. (2021) La vitamine D: Activités biologiques, dosage, résultats et état des lieux au Maroc. RevueMarocainedeNéphrologie, 1, 104-110. Khasmi, M. Farh, M. Iddar, A. Tahri, E.H. 2021 La vitamine D: Activités biologiques, dosage, résultats et état des lieux au Maroc Revue Marocaine de Néphrologie 1

2.. El Maataoui, A., Biaz, A., El Machtani, S., Bouhsain, S., Dami, A., El Maghraoui, A., et al. (2016) Vitamin D Status in Healthy Moroccan Men and Women Aged 50 Years and Older: A Cross-Sectional Study. Archives of Osteoporosis, 11, Article No. 24. https://doi.org/10.1007/s11657-016-0279-y 10.1007/s11657-016-0279-y27378487https://doi.org/10.1007/s11657-016-0279-y Maataoui, A. Biaz, A. Machtani, S. Bouhsain, S. Dami, A. Maghraoui, A. 2016 Vitamin D Status in Healthy Moroccan Men and Women Aged 50 Years and Older: A Cross-Sectional Study Archives of Osteoporosis 11 No 10.1007/s11657-016-0279-y 27378487

3.. Demir, K., Kattan, W.E., Zou, M., Durmaz, E., BinEssa, H., Nalbantoğlu, Ö., et al. (2015) Novel CYP27B1 Gene Mutations in Patients with Vitamin D-Dependent Rickets Type 1A. PLOS ONE, 10, e0131376. https://doi.org/10.1371/journal.pone.0131376 10.1371/journal.pone.013137626132292https://doi.org/10.1371/journal.pone.0131376 Demir, K. Kattan, W.E. Zou, M. Durmaz, E. BinEssa, H. 2015 Novel CYP27B1 Gene Mutations in Patients with Vitamin D-Dependent Rickets Type 1A PLOS ONE 10 10.1371/journal.pone.0131376 26132292

4.. Inchingolo, F., Inchingolo, A.M., Ceci, S., Carpentiere, V., Garibaldi, M., Riccaldo, L., et al. (2023) Orthodontic Relapse after Fixed or Removable Retention Devices: A Systematic Review. Applied Sciences, 13, Article 11442. https://doi.org/10.3390/app132011442 10.3390/app132011442https://doi.org/10.3390/app132011442 Inchingolo, F. Inchingolo, A.M. Ceci, S. Carpentiere, V. Garibaldi, M. Riccaldo, L. 2023 Orthodontic Relapse after Fixed or Removable Retention Devices: A Systematic Review Applied Sciences 13 11442 10.3390/app132011442

5.. Al-Attar, A. and Abid, M. (2022) The Effect of Vitamin D ₃ on the Alignment of Mandibular Anterior Teeth: A Randomized Controlled Clinical Trial. International Journal of Dentistry, 2022, Article ID: 6555883. https://doi.org/10.1155/2022/6555883 10.1155/2022/655588335198025https://doi.org/10.1155/2022/6555883 Al-Attar, A. Abid, M. 2022 The Effect of Vitamin D3 on the Alignment of Mandibular Anterior Teeth: A Randomized Controlled Clinical Trial International Journal of Dentistry 2022 655588 ID 10.1155/2022/6555883 35198025

6.. Ferrillo, M., Calafiore, D., Lippi, L., Agostini, F., Migliario, M., Invernizzi, M., et al. (2023) Role of Vitamin D for Orthodontic Tooth Movement, External Apical Root Resorption, and Bone Biomarker Expression and Remodeling: A Systematic Review. Korean Journal of Orthodontics, 54, 26-47. https://doi.org/10.4041/kjod23.064 10.4041/kjod23.06438268460https://doi.org/10.4041/kjod23.064 Ferrillo, M. Calafiore, D. Lippi, L. Agostini, F. Migliario, M. Invernizzi, M. Movement, E 2023 Role of Vitamin D for Orthodontic Tooth Movement, External Apical Root Resorption, and Bone Biomarker Expression and Remodeling: A Systematic Review Korean Journal of Orthodontics 54 10.4041/kjod23.064 38268460

7.. Norman, A.W. (2008) From Vitamin D to Hormone D: Fundamentals of the Vitamin D Endocrine System Essential for Good Health. The American Journal of Clinical Nutrition, 88, 491S-499S. https://doi.org/10.1093/ajcn/88.2.491s 10.1093/ajcn/88.2.491s18689389https://doi.org/10.1093/ajcn/88.2.491s Norman, A.W. 2008 From Vitamin D to Hormone D: Fundamentals of the Vitamin D Endocrine System Essential for Good Health The American Journal of Clinical Nutrition 88 10.1093/ajcn/88.2.491s 18689389

8.. Holick, M.F. (2006) High Prevalence of Vitamin D Inadequacy and Implications for Health. Mayo Clinic Proceedings, 81, 353-373. https://doi.org/10.4065/81.3.353 10.4065/81.3.35316529140https://doi.org/10.4065/81.3.353 Holick, M.F. 2006 High Prevalence of Vitamin D Inadequacy and Implications for Health Mayo Clinic Proceedings 81 10.4065/81.3.353 16529140

9.. Girgis, E. and Reyad, A.A. (2019) Vitamin D: Pharmacology and Clinical Challenges in Oral Health Care. Journal of the International Academy of Periodontology, 21, 118-124. Girgis, E. Reyad, A.A. 2019 Vitamin D: Pharmacology and Clinical Challenges in Oral Health Care Journal of the International Academy of Periodontology 21

10.. Macdonald, H.M. (2012) Contributions of Sunlight and Diet to Vitamin D Status. Calcified Tissue International, 92, 163-176. https://doi.org/10.1007/s00223-012-9634-1 10.1007/s00223-012-9634-123001438https://doi.org/10.1007/s00223-012-9634-1 Macdonald, H.M. 2012 Contributions of Sunlight and Diet to Vitamin D Status Calcified Tissue International 92 10.1007/s00223-012-9634-1 23001438

11.. Tashkandi, N., Zhao, Y., Mitchell-Lee, G., Stephens, D., Patel, M., Motro, M., et al. (2021) Longitudinal Assessment of Salivary Vitamin D Binding Protein during Orthodontic Tooth Movement. BMC Oral Health, 21, Article No. 332. https://doi.org/10.1186/s12903-021-01689-8 10.1186/s12903-021-01689-834225707https://doi.org/10.1186/s12903-021-01689-8 Tashkandi, N. Zhao, Y. Mitchell-Lee, G. Stephens, D. Patel, M. Motro, M. 2021 Longitudinal Assessment of Salivary Vitamin D Binding Protein during Orthodontic Tooth Movement BMC Oral Health 21 No 10.1186/s12903-021-01689-8 34225707

12.. Gratton, M., Londono, I., Rompré, P., Villemure, I., Moldovan, F. and Nishio, C. (2022) Effect of Vitamin D on Bone Morphometry and Stability of Orthodontic Tooth Movement in Rats. American Journal of Orthodontics and Dentofacial Orthopedics, 162, e319-e327. https://doi.org/10.1016/j.ajodo.2022.08.019 10.1016/j.ajodo.2022.08.01936216621https://doi.org/10.1016/j.ajodo.2022.08.019 Gratton, M. Londono, I. Villemure, I. Moldovan, F. Nishio, C. 2022 Effect of Vitamin D on Bone Morphometry and Stability of Orthodontic Tooth Movement in Rats American Journal of Orthodontics and Dentofacial Orthopedics 162 10.1016/j.ajodo.2022.08.019 36216621

13.. Pludowski, P., Takacs, I., Boyanov, M., Belaya, Z., Diaconu, C.C., Mokhort, T., et al. (2022) Clinical Practice in the Prevention, Diagnosis and Treatment of Vitamin D Deficiency: A Central and Eastern European Expert Consensus Statement. Nutrients, 14, Article 1483. https://doi.org/10.3390/nu14071483 10.3390/nu1407148335406098https://doi.org/10.3390/nu14071483 Pludowski, P. Takacs, I. Boyanov, M. Belaya, Z. Diaconu, C.C. Mokhort, T. Prevention, D 2022 Clinical Practice in the Prevention, Diagnosis and Treatment of Vitamin D Deficiency: A Central and Eastern European Expert Consensus Statement Nutrients 14 1483 10.3390/nu14071483 35406098

14.. Abourazzak, F.E., Khazzani, H., Mansouri, S., Ali, S., Alla, O., Allali, F., et al. (2016) Recommandations de la société marocaine de rhumatologie sur la vitamine d chez l’adulte. RevueMarocainedeRhumatologie, 35, 3-15. Abourazzak, F.E. Khazzani, H. Mansouri, S. Ali, S. Alla, O. Allali, F. 2016 Recommandations de la société marocaine de rhumatologie sur la vitamine d chez l’adulte Revue Marocaine de Rhumatologie 35

15.. Khalaf, R.M. and Almudhi, A.A. (2022) Effects of Vitamin D Deficiency on the Rate of Orthodontic Tooth Movement: An Animal Study. The Saudi Dental Journal, 34, 129-135. https://doi.org/10.1016/j.sdentj.2021.12.008 10.1016/j.sdentj.2021.12.00835241902https://doi.org/10.1016/j.sdentj.2021.12.008 Khalaf, R.M. Almudhi, A.A. 2022 Effects of Vitamin D Deficiency on the Rate of Orthodontic Tooth Movement: An Animal Study The Saudi Dental Journal 34 10.1016/j.sdentj.2021.12.008 35241902

16.. Gong, A., Chen, J., Wu, J., Li, J., Wang, L., Goltzman, D., et al. (2018) 1,25‐Dihydroxyvitamin D Deficiency Accelerates Alveolar Bone Loss Independent of Aging and Extracellular Calcium and Phosphorus. Journal of Periodontology, 89, 983-994. https://doi.org/10.1002/jper.17-0542 10.1002/jper.17-054229637561https://doi.org/10.1002/jper.17-0542 Gong, A. Chen, J. Wu, J. Li, J. Wang, L. Goltzman, D. 2018 1,25‐Dihydroxyvitamin D Deficiency Accelerates Alveolar Bone Loss Independent of Aging and Extracellular Calcium and Phosphorus Journal of Periodontology 89 10.1002/jper.17-0542 29637561

17.. Fügl, A., Gruber, R., Agis, H., Lzicar, H., Keibl, C., Schwarze, U.Y., et al. (2015) Alveolar Bone Regeneration in Response to Local Application of Calcitriol in Vitamin D Deficient Rats. Journal of Clinical Periodontology, 42, 96-103. https://doi.org/10.1111/jcpe.12342 10.1111/jcpe.1234225469560https://doi.org/10.1111/jcpe.12342 Gruber, R. Agis, H. Lzicar, H. Keibl, C. Schwarze, U.Y. 2015 Alveolar Bone Regeneration in Response to Local Application of Calcitriol in Vitamin D Deficient Rats Journal of Clinical Periodontology 42 10.1111/jcpe.12342 25469560

18.. Kazemian, E., Pourali, A., Sedaghat, F., Karimi, M., Basirat, V., Sajadi Hezaveh, Z., et al. (2023) Effect of Supplemental Vitamin D ₃ on Bone Mineral Density: A Systematic Review and Meta-Analysis. Nutrition Reviews, 81, 511-530. https://doi.org/10.1093/nutrit/nuac068 10.1093/nutrit/nuac06836308775https://doi.org/10.1093/nutrit/nuac068 Kazemian, E. Pourali, A. Sedaghat, F. Karimi, M. Basirat, V. Hezaveh, Z. 2023 Effect of Supplemental Vitamin D3 on Bone Mineral Density: A Systematic Review and Meta-Analysis Nutrition Reviews 81 10.1093/nutrit/nuac068 36308775

19.. Narmada, I.B., Husodo, K.R.D., Nugraha, A.P. and Iskandar, R.P.D. (2019) Effect of Vitamin D during Orthodontic Tooth Movement on Rankl Expression and Osteoclast Number in Pregnant Wistar Rats ( Rattusnovergicus). Journal of Krishna Institute of Medical Sciences University, 8, 37-42. Narmada, I.B. Husodo, K.R.D. Nugraha, A.P. Iskandar, R.P.D. 2019 Effect of Vitamin D during Orthodontic Tooth Movement on Rankl Expression and Osteoclast Number in Pregnant Wistar Rats (Rattus novergicus) Journal of Krishna Institute of Medical Sciences University 8

20.. Seifi, M., Hamedi, R. and Nazirii, M. (2013) The Synergistic Effect of Vitamin D and Prostaglandin E2 on Orthodontic Tooth Movement in Rats. Iranian Journal of Orthodontics, 8, 1-5. Seifi, M. Hamedi, R. Nazirii, M. 2013 The Synergistic Effect of Vitamin D and Prostaglandin E2 on Orthodontic Tooth Movement in Rats Iranian Journal of Orthodontics 8

21.. Moradinejad, M., Yazdi, M., Mard, S.A., Razavi, S.M., Shamohammadi, M., Shahsanaei, F., et al. (2022) Efficacy of the Systemic Co-Administration of Vitamin D ₃ in Reversing the Inhibitory Effects of Sodium Alendronate on Orthodontic Tooth Movement: A Preliminary Experimental Animal Study. American Journal of Orthodontics and Dentofacial Orthopedics, 162, e17-e27. https://doi.org/10.1016/j.ajodo.2021.11.014 10.1016/j.ajodo.2021.11.01435501223https://doi.org/10.1016/j.ajodo.2021.11.014 Moradinejad, M. Yazdi, M. Mard, S.A. Razavi, S.M. Shamohammadi, M. Shahsanaei, F. 2022 Efficacy of the Systemic Co-Administration of Vitamin D3 in Reversing the Inhibitory Effects of Sodium Alendronate on Orthodontic Tooth Movement: A Preliminary Experimental Animal Study American Journal of Orthodontics and Dentofacial Orthopedics 162 10.1016/j.ajodo.2021.11.014 35501223

22.. Küchler, E.C., Schröder, A., Teodoro, V.B., Nazet, U., Scariot, R., Spanier, G., et al. (2021) The Role of 25-Hydroxyvitamin-D ₃ and Vitamin D Receptor Gene in Human Periodontal Ligament Fibroblasts as Response to Orthodontic Compressive Strain: An in Vitro Study. BMC Oral Health, 21, Article No. 386. https://doi.org/10.1186/s12903-021-01740-8 10.1186/s12903-021-01740-834362362https://doi.org/10.1186/s12903-021-01740-8 Teodoro, V.B. Nazet, U. Scariot, R. Spanier, G. 2021 The Role of 25-Hydroxyvitamin-D3 and Vitamin D Receptor Gene in Human Periodontal Ligament Fibroblasts as Response to Orthodontic Compressive Strain: An in Vitro Study BMC Oral Health 21 No 10.1186/s12903-021-01740-8 34362362

23.. Reid, I.R., Bolland, M.J. and Grey, A. (2014) Effects of Vitamin D Supplements on Bone Mineral Density: A Systematic Review and Meta-Analysis. The Lancet, 383, 146-155. https://doi.org/10.1016/s0140-6736(13)61647-5 10.1016/s0140-6736(13)61647-524119980https://doi.org/10.1016/s0140-6736(13)61647-5 Reid, I.R. Bolland, M.J. Grey, A. 2014 Effects of Vitamin D Supplements on Bone Mineral Density: A Systematic Review and Meta-Analysis The Lancet 6736 13 10.1016/s0140-6736(13)61647-5 24119980

24.. Shetty, A., Patil, A.K., Ameet R., and Sandhu, P.K. (2015) Local Infiltration of Vitamin D ₃does Not Accelerate Orthodontic Tooth Movement in Humans: A Preliminary Study. The Angle Orthodontist. https://api.semanticscholar.org/CorpusID:68742513 Shetty, A. Patil, A.K. Sandhu, P.K. 2015 Local Infiltration of Vitamin D3does Not Accelerate Orthodontic Tooth Movement in Humans: A Preliminary Study 687425

25.. Zamanian, M.Y., Golmohammadi, M., Vadiyan, F.V., Almulla, A.A., Vadiyan, D.E., Morozova, N.S., et al. (2024) A Narrative Review of the Effects of Vitamin D ₃ on Orthodontic Tooth Movement: Focus on Molecular and Cellular Mechanisms. Food Science & Nutrition, 12, 3164-3176. https://doi.org/10.1002/fsn3.4035 10.1002/fsn3.403538726436https://doi.org/10.1002/fsn3.4035 Zamanian, M.Y. Golmohammadi, M. Vadiyan, F.V. Almulla, A.A. Vadiyan, D.E. Morozova, N.S. 2024 A Narrative Review of the Effects of Vitamin D3 on Orthodontic Tooth Movement: Focus on Molecular and Cellular Mechanisms Food Science & Nutrition 12 10.1002/fsn3.4035 38726436

26.. Nimeri, G., Kau, C.H., Abou-Kheir, N.S. and Corona, R. (2013) Acceleration of Tooth Movement during Orthodontic Treatment—A Frontier in Orthodontics. Progress in Orthodontics, 14, Article No. 42. https://doi.org/10.1186/2196-1042-14-42 10.1186/2196-1042-14-4224326040https://doi.org/10.1186/2196-1042-14-42 Nimeri, G. Kau, C.H. Abou-Kheir, N.S. Corona, R. 2013 Acceleration of Tooth Movement during Orthodontic Treatment—A Frontier in Orthodontics Progress in Orthodontics 14 No 10.1186/2196-1042-14-42 24326040

27.. Zainal Ariffin, S.H., Yamamoto, Z., Zainol Abidin, L.Z., Megat Abdul Wahab, R. and Zainal Ariffin, Z. (2011) Cellular and Molecular Changes in Orthodontic Tooth Movement. The Scientific World Journal, 11, 1788-1803. https://doi.org/10.1100/2011/761768 10.1100/2011/76176822125437https://doi.org/10.1100/2011/761768 Ariffin, S.H. Yamamoto, Z. Abidin, L.Z. Wahab, R. Ariffin, Z. 2011 Cellular and Molecular Changes in Orthodontic Tooth Movement The Scientific World Journal 11 10.1100/2011/761768 22125437

28.. Lin, Y., Fu, M.L., Harb, I., Ma, L.X. and Tran, S.D. (2023) Functional Biomaterials for Local Control of Orthodontic Tooth Movement. Journal of Functional Biomaterials, 14, Article 294. https://doi.org/10.3390/jfb14060294 10.3390/jfb1406029437367258https://doi.org/10.3390/jfb14060294 Lin, Y. Fu, M.L. Harb, I. Ma, L.X. Tran, S.D. 2023 Functional Biomaterials for Local Control of Orthodontic Tooth Movement Journal of Functional Biomaterials 14 294 10.3390/jfb14060294 37367258

29.. Yasuda, H. (2021) Discovery of the RANKL/RANK/OPG System. Journal of Bone and Mineral Metabolism, 39, 2-11. https://doi.org/10.1007/s00774-020-01175-1 10.1007/s00774-020-01175-133389131https://doi.org/10.1007/s00774-020-01175-1 Yasuda, H. 2021 Discovery of the RANKL/RANK/OPG System Journal of Bone and Mineral Metabolism 39 10.1007/s00774-020-01175-1 33389131

30.. Pulikkottil, V.J., Lakshmanan, L., Varughese, S.T., Shamanna, P.U., Goyal, N., Thomas, B.S., et al. (2019) Effect of Vitamin D on Canine Distalization and Alveolar Bone Density Using Multi-Slice Spiral CT: A Randomized Controlled Trial. The Journal of Contemporary Dental Practice, 20, 1430-1435. https://doi.org/10.5005/jp-journals-10024-2698 10.5005/jp-journals-10024-2698https://doi.org/10.5005/jp-journals-10024-2698 Pulikkottil, V.J. Lakshmanan, L. Varughese, S.T. Shamanna, P.U. Goyal, N. Thomas, B.S. 2019 Effect of Vitamin D on Canine Distalization and Alveolar Bone Density Using Multi-Slice Spiral CT: A Randomized Controlled Trial The Journal of Contemporary Dental Practice 20 10.5005/jp-journals-10024-2698

31.. Gowda, N.C., Kumar, P. and Swasti, K.M. (2017) Vitamin D ₃ versus Prostaglandin E1: A Comparative Clinical Study on the Rate of Orthodontic Tooth Movement. International Journal of Scientific Research, 6, 98-100. https://www.worldwidejournals.com/international-journal-of-scientific-research-(IJSR)/fileview.php?val=July_2017_1498913865__37.pdf Gowda, N.C. Kumar, P. Swasti, K.M. 2017 Vitamin D3 versus Prostaglandin E1: A Comparative Clinical Study on the Rate of Orthodontic Tooth Movement International Journal of Scientific Research 6

32.. Farzanegan, F., Nour, G.G., Mobarhan, M.G. and Rangrazi, A. (2023) Evaluation of the Effect of Oral Vitamin D ₃ Supplement on Orthodontic Tooth Movement: A Randomized Clinical Trial Study. Journal of Advanced Oral Research, 14, 110-116. https://doi.org/10.1177/23202068231177239 10.1177/23202068231177239https://doi.org/10.1177/23202068231177239 Farzanegan, F. Nour, G.G. Mobarhan, M.G. Rangrazi, A. 2023 Evaluation of the Effect of Oral Vitamin D3 Supplement on Orthodontic Tooth Movement: A Randomized Clinical Trial Study Journal of Advanced Oral Research 14 10.1177/23202068231177239

33.. Al-Attar, A., Abid, M., Dziedzic, A., Al-Khatieeb, M.M., Seppala, M., Cobourne, M.T., et al. (2021) The Impact of Calcitriol on Orthodontic Tooth Movement: A Cumulative Systematic Review and Meta-Analysis. Applied Sciences, 11, Article 8882. https://doi.org/10.3390/app11198882 10.3390/app11198882https://doi.org/10.3390/app11198882 Al-Attar, A. Abid, M. Dziedzic, A. Al-Khatieeb, M.M. Seppala, M. Cobourne, M.T. 2021 The Impact of Calcitriol on Orthodontic Tooth Movement: A Cumulative Systematic Review and Meta-Analysis Applied Sciences 11 8882 10.3390/app11198882

34.. Tini, A., Subramanian, S.K., Anbarasu, P., Munusamy, N., Balamurugan, B. and Antony, A. (2024) Influence of Vitamin D in Orthodontic Tooth Movement—A Systematic Review and Meta-Analysis of Randomized Controlled Trials in Humans. European Journal of Orthodontics, 46, cjae043. https://doi.org/10.1093/ejo/cjae043 10.1093/ejo/cjae04339225083https://doi.org/10.1093/ejo/cjae043 Tini, A. Subramanian, S.K. Anbarasu, P. Munusamy, N. Balamurugan, B. Antony, A. 2024 Influence of Vitamin D in Orthodontic Tooth Movement—A Systematic Review and Meta-Analysis of Randomized Controlled Trials in Humans European Journal of Orthodontics 46 10.1093/ejo/cjae043 39225083

35.. Alnajar, H.A.A.M. and Al Groosh, D.H. (2021) The Effects of Calcitonin on Post‐orthodontic Relapse in Rats. Clinical and Experimental Dental Research, 7, 293-301. https://doi.org/10.1002/cre2.373 10.1002/cre2.37333300289https://doi.org/10.1002/cre2.373 Alnajar, H.A.A.M. Groosh, D.H. 2021 The Effects of Calcitonin on Post‐orthodontic Relapse in Rats Clinical and Experimental Dental Research 7 10.1002/cre2.373 33300289

36.. Littlewood, S., Kandasamy, S. and Huang, G. (2017) Retention and Relapse in Clinical Practice. Australian Dental Journal, 62, 51-57. https://doi.org/10.1111/adj.12475 10.1111/adj.1247528297088https://doi.org/10.1111/adj.12475 Littlewood, S. Kandasamy, S. Huang, G. 2017 Retention and Relapse in Clinical Practice Australian Dental Journal 62 10.1111/adj.12475 28297088

37.. Iosub Ciur, M.D., Zetu, I.N., Haba, D., Viennot, S., Bourgeois, D. and Andrian, S. (2016) Evaluation of the Influence of Local Administration of Vitamin D on the Rate of Orthodontic Tooth Movement. RevistaMedico- ChirurgicalăaSocietățiide MedicișiNaturaliștidinIași, 120, 694-699. Ciur, M.D. Zetu, I.N. Haba, D. Viennot, S. Bourgeois, D. Andrian, S. 2016 Evaluation of the Influence of Local Administration of Vitamin D on the Rate of Orthodontic Tooth Movement Revista Medico-Chirurgicală a Societății de Medici și Naturaliști din Iași 120

38.. Ben Mohimd, H., Bahije, L., Zaoui, F., Halimi, A. and Benyahia, H. (2018) Is Systematic Mandibular Retention Mandatory? A Systematic Review. International Orthodontics, 16, 114-132. https://doi.org/10.1016/j.ortho.2018.01.013 10.1016/j.ortho.2018.01.01329478925https://doi.org/10.1016/j.ortho.2018.01.013 Mohimd, H. Bahije, L. Zaoui, F. Halimi, A. Benyahia, H. 2018 Is Systematic Mandibular Retention Mandatory? A Systematic Review International Orthodontics 16 10.1016/j.ortho.2018.01.013 29478925

39.. Khamees, A.M. and Al Groosh, D.H. (2023) Effect of Vitamin D Deficiency on Postorthodontic Relapse: An Animal Study. Clinical and Experimental Dental Research, 9, 701-710. https://doi.org/10.1002/cre2.765 10.1002/cre2.76537448180https://doi.org/10.1002/cre2.765 Khamees, A.M. Groosh, D.H. 2023 Effect of Vitamin D Deficiency on Postorthodontic Relapse: An Animal Study Clinical and Experimental Dental Research 9 10.1002/cre2.765 37448180

40.. Zhang, D., Yang, Y.Q., Li, X.T. and Fu, M.K. (2004) The Expression of Osteoprotegerin and the Receptor Activator of Nuclear Factor Kappa B Ligand in Human Periodontal Ligament Cells Cultured with and without 1 α,25-Dihydroxyvitamin D ₃. Archives of Oral Biology, 49, 71-76. https://doi.org/10.1016/s0003-9969(03)00201-2 10.1016/s0003-9969(03)00201-214693199https://doi.org/10.1016/s0003-9969(03)00201-2 Zhang, D. Yang, Y.Q. Li, X.T. Fu, M.K. 2004 The Expression of Osteoprotegerin and the Receptor Activator of Nuclear Factor Kappa B Ligand in Human Periodontal Ligament Cells Cultured with and without 1α,25-Dihydroxyvitamin D3 Archives of Oral Biology 9969 03 10.1016/s0003-9969(03)00201-2 14693199

41.. Hosokawa, Y., Hosokawa, I., Shindo, S., Ozaki, K. and Matsuo, T. (2015) Calcitriol Suppressed Inflammatory Reactions in IL-1 β-Stimulated Human Periodontal Ligament Cells. Inflammation, 38, 2252-2258. https://doi.org/10.1007/s10753-015-0209-y 10.1007/s10753-015-0209-y26156812https://doi.org/10.1007/s10753-015-0209-y Hosokawa, Y. Hosokawa, I. Shindo, S. Ozaki, K. Matsuo, T. 2015 Calcitriol Suppressed Inflammatory Reactions in IL-1β-Stimulated Human Periodontal Ligament Cells Inflammation 38 10.1007/s10753-015-0209-y 26156812

42.. Cui, J., Li, J., Wang, W., Han, X., Du, J., Sun, J., et al. (2016) The Effect of Calcitriol on High Mobility Group Box 1 Expression in Periodontal Ligament Cells during Orthodontic Tooth Movement in Rats. Journal of Molecular Histology, 47, 221-228. https://doi.org/10.1007/s10735-016-9669-0 10.1007/s10735-016-9669-026956363https://doi.org/10.1007/s10735-016-9669-0 Cui, J. Li, J. Wang, W. Han, X. Du, J. Sun, J. 2016 The Effect of Calcitriol on High Mobility Group Box 1 Expression in Periodontal Ligament Cells during Orthodontic Tooth Movement in Rats Journal of Molecular Histology 47 10.1007/s10735-016-9669-0 26956363

43.. Kale, S., Kocadereli, İ., Atilla, P. and Aşan, E. (2004) Comparison of the Effects of 1,25 Dihydroxycholecalciferol and Prostaglandin E2 on Orthodontic Tooth Movement. American Journal of Orthodontics and Dentofacial Orthopedics, 125, 607-614. https://doi.org/10.1016/j.ajodo.2003.06.002 10.1016/j.ajodo.2003.06.00215127030https://doi.org/10.1016/j.ajodo.2003.06.002 Kale, S. Atilla, P. 2004 Comparison of the Effects of 1,25 Dihydroxycholecalciferol and Prostaglandin E2 on Orthodontic Tooth Movement American Journal of Orthodontics and Dentofacial Orthopedics 125 10.1016/j.ajodo.2003.06.002 15127030

44.. Kawakami, M. and Takano-Yamamoto, T. (2004) Local Injection of 1,25-Dihydroxyvitamin D ₃ Enhanced Bone Formation for Tooth Stabilization after Experimental Tooth Movement in Rats. Journal of Bone and Mineral Metabolism, 22, 541-546. https://doi.org/10.1007/s00774-004-0521-3 10.1007/s00774-004-0521-315490263https://doi.org/10.1007/s00774-004-0521-3 Kawakami, M. Takano-Yamamoto, T. 2004 Local Injection of 1,25-Dihydroxyvitamin D3 Enhanced Bone Formation for Tooth Stabilization after Experimental Tooth Movement in Rats Journal of Bone and Mineral Metabolism 22 10.1007/s00774-004-0521-3 15490263

45.. Shevde, N.K., Plum, L.A., Clagett-Dame, M., Yamamoto, H., Pike, J.W. and DeLuca, H.F. (2002) A Potent Analog of 1 α,25-Dihydroxyvitamin D ₃ Selectively Induces Bone Formation. Proceedings of the National Academy of Sciences, 99, 13487-13491. https://doi.org/10.1073/pnas.202471299 10.1073/pnas.20247129912374862https://doi.org/10.1073/pnas.202471299 Shevde, N.K. Plum, L.A. Clagett-Dame, M. Yamamoto, H. Pike, J.W. DeLuca, H.F. 2002 A Potent Analog of 1α,25-Dihydroxyvitamin D3 Selectively Induces Bone Formation Proceedings of the National Academy of Sciences 99 10.1073/pnas.202471299 12374862