The Histopathological analysis of Proton Pump Inhibitor & H2 receptor antagonist on bone cells in orthodontically induced tooth movement: A Randomised Control animal study

Abstract Objectives: The primary objective was to assess the effects of ranitidine and esomeprazole on OTM in an animal model via: a) Histopathology: H&E staining for osteoclasts and SATB2 immunostaining for osteoblasts. The secondary objective evaluated its impact on bone remodeling, correlating its effect with serum biochemistry: calcium, magnesium, phosphorus, and creatinine. Materials and Methods: Sixty-nine male Rattus norvegicus (200–250 g, 10 weeks old) were randomly assigned to three groups: control, ranitidine (Group 2), and esomeprazole (Group 3). A 50 g NiTi closed-coil spring was placed between the left central incisor and first molar. Groups 2 and 3 received (30 mg/kg/day) of the respective drug via oral gavage; controls received saline. Blood was collected on days 1 and 42 for serum analysis. On day 42, tooth movement was recorded, the animals were euthanized, and histological analysis was performed to evaluate osteoclasts and osteoblasts. Paired t-tests and one-way ANOVA were used for statistical analysis (P ≤ 0.05). Results: Esomeprazole (Group 3) produced the highest osteoclast count (84 ± 7.1) and greatest tooth movement (0.585 ± 0.021 mm). Control had the highest number of osteoblasts (SATB2), while Groups 2 and 3 showed inhibition. Serum phosphorus significantly decreased in Groups 2 (3.642 ± 1.449) and 3 (5.556 ± 1.595 mg/dL); calcium decreased in Group 3 (9.368 ± 0.328 mg/dL). Conclusion: Esomeprazole (PPI) induced a decrease in serum Ca levels, the highest osteoclastic activity, and OTM, followed by ranitidine (H₂RA), with the control group showing the least. Both PPI and H₂RA inhibit or reduce osteoblastic activity.