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Medical Hypotheses 73 (2009) 340341

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Medical Hypotheses
journal homepage: www.elsevier.com/locate/mehy

Microfabricated biocatalytic fuel cells: A new approach to accelerating the orthodontic tooth movement
Jafar Kolahi a,*, Mohamadreza Abrishami b, Zev Davidovitch c
a

Torabinejad Research Center, Isfahan University of Medical Sciences, No. 10, Sayt 180, Shahin Shahr, Isfahan Co 83188-65161, Iran Department of Periodontology, Shahid Beheshti University of Medical Sciences, Tehran, Iran c Department of Orthodontics, Case Western Reserve University, Cleveland, OH, USA
b

a r t i c l e

i n f o

s u m m a r y
Direct electric current is a potent biologic mean to accelerate periodontal tissue turnover and orthodontic tooth movement. The main problem associated with this approach is the source of electricity. A noninvasive, removable enzymatic micro-battery, will administer minute electric currents to the alveolar bone and oral soft tissues, utilizing glucose as a fuel, becoming a possible source of the electrical power required for accelerating the velocity of orthodontic tooth movement. 2009 Elsevier Ltd. All rights reserved.

Article history: Received 13 March 2009 Accepted 18 March 2009

Introduction Orthodontic patients frequently complain about the long duration of their treatment (2.53.0 years). Increasing the speed of tooth movement can solve this dilemma. Many chemical and physical agents are useful as adjuncts to the mechanical forces in accelerating orthodontic tooth movement. Evidence exists, showing that orthodontic tooth movement can be enhanced by supplementing the mechanical forces with other agents capable of affecting bone cells, such as vitamin C [1] and heat [2]. Another potent tool that could accelerate orthodontic tooth movement is electricity. Animal experiments indicate that when 1520 microamperes of low direct current (dc) is applied to the alveolar bone, modifying the bioelectric potential, osteoblasts and periodontal ligament cells demonstrate increased concentrations of the second messengers cAMP and cGMP. This nding suggests that electric stimulation enhances cellular enzymatic phosphorylation activities, leading to synthetic and secretory processes associated with accelerated bone remodeling [3]. The rate of tooth movement was studied in cats treated by mechanical forces that tipped their maxillary canines distally and in cats receiving electric stimulation to tissues surrounding orthodontically treated canines for up to 14 days. Teeth treated by force and electricity moved signicantly faster than those treated by force alone. The degree of new bone formation at electrically treated tension sites was higher than at the corresponding sites of teeth treated by force alone. These results suggest that orthodontic tooth movement might be accelerated by the use of force in conjunction with electrical currents, specically in range of 1020 microamperes [4].

The main clinical problem with this concept is the source of electricity for intraoral use. Patients do not tolerate easily usual power sources, such as miniature mercury cells. Therefore, the purpose of this hypothesis is to introduce a novel electrical power source for accelerating orthodontic tooth movement. Biocatalytic fuel cells (enzyme batteries) We propose the idea of fabricating a system with an enzyme immobilized on an electrode surface using external substrates (formate or glucose) as the fuel to produce electricity. Organic compounds are not oxidized efciently on electrode surface. However, when biocatalysts such as glucose oxidase or formate dehydrogenase are used, the enzymes substrate is reduced and electrons are transferred to the anode [5]. Thus, an enzyme battery could be fabricated with the combination of two enzyme electrodes (Fig. 1). For crafting an integrated enzyme battery, two or more cells can be connected in series. All these individual cells are fabricated on a single silicon wafer and glucose solution is introduced into the cell by the capillary effect. Electrical-power output of this enzyme battery will be several Watts [5]. In 2007, SONY announced the development of a bio-battery that generates electricity from carbohydrates (sugar) utilizing enzymes as its catalyst, through the application of power generation principles found in living organisms [6]. The hypothesis: Application of microfabricated biocatalytic fuel cells in orthodontics This hypothesis tries to promote biotechnology to clinical dentistry [7]. In recent years, there has been remarkable progress in research on implantable devices. An enzymatic micro-battery, which is placed on the gingiva near the alveolar bone, might be a

* Corresponding author. Tel.: +98 913 1081322. E-mail address: jafar.kolahi@gmail.com (J. Kolahi). 0306-9877/$ - see front matter 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.mehy.2009.03.041

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J. Kolahi et al. / Medical Hypotheses 73 (2009) 340341

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Fig. 1. A schematic diagram of an oral biocatalytic fuel cell. In this system, the reaction occurring is: Glucose + O2 ? Gluconolactone + H2O/H2O2.

possible electrical power source for accelerating orthodontic tooth movement. These devices use organic compounds (glucose) as the fuel, are noninvasive, and are not osseointegrated (Fig. 1). After application of dc in this fashion, the electric device can be easily removed. Due to the very small size of these devices, the procedure can be done with no tissue injury. A microfabricated enzyme battery has recently been constructed, designed to function as a power supply for microsurgery robots or articial organs [5]. Furthermore, a subcutaneously implantable system has been recently described for continuous glucose monitoring, which uses a miniaturized all-in-one glucose enzyme fuel cell [8]. Also, thermostable enzyme biofuel cells utilizing glucose dehydrogenase as an anode enzyme were constructed as a compartment-less biofuel cell [9]. We believe that these microfabricared biocatalytic fuel cells can be used in clinical dentistry. A combined forceelectric treatment may provide a powerful and practical technique for enhancing the velocity of orthodontic tooth movement, regardless the type of the orthodontic appliance. Evaluation of the hypothesis In a critical point of view, there are several questions regarding this hypothesis. Is a microfabricated enzyme battery tolerated by the oral tissues? Is there a risk of tissue damage? What is the effect of foods with different range of temperatures and pH on the output

of the enzyme battery? These questions can be addressed in animal studies similar to those reported by Davidovitch et al. [3,4], using a microfabricated enzyme battery as a source of electricity. There are two other issues to be addressed: short lifetime and poor power density. Both of these issues are related to enzyme stability, electron transfer rate, and enzyme loading. Recent progress in nanobiocatalysis increases the likelihood of improving these aspects of the system. Many nanostructured materials, such as mesoporous media, nanoparticles, nanobers, and nanotubes, have been demonstrated as efcient hosts of enzyme immobilization. It is evident that, when nanostructure of conductive materials is used, the large surface area of these nanomaterials can increase the enzyme loading and facilitate reaction kinetics, and thus improve the power density of the biofuel cells. In addition, research efforts have also been made to improve the activity and stability of immobilized enzymes by using nanostructures. It thus appears reasonable to expect that progress in nanostructured biocatalysts will play a critical role in overcoming the major obstacles in the development of powerful biofuel cells [10]. Finally, we hope to be able, eventually to extrapolate this hypothesis to the clinical environment, where millions of patients worldwide are subjected annually to applications of mechanical forces to their teeth for long periods of time. References
[1] Litton SF. Orthodontic tooth movement during an ascorbic acid deciency. Am J Orthod 1974;65(3):290302. [2] Tweedle JA. The effect of local heat on tooth movement. Angle Orthod 1965;35:21825. [3] Davidovitch Z, Finkelson MD, Steigman S, Shanfeld JL, Montgomery PC, Korostoff E. Electric currents, bone remodeling, and orthodontic tooth movement. I. The effect of electric currents on periodontal cyclic nucleotides. Am J Orthod 1980;77(1):1432. [4] Davidovitch Z, Finkelson MD, Steigman S, Shanfeld JL, Montgomery PC, Korostoff E. Electric currents, bone remodeling, and orthodontic tooth movement. II. Increase in rate of tooth movement and periodontal cyclic nucleotide levels by combined force and electric current. Am J Orthod 1980;77(1):3347. [5] Sasaki S, Karube I. The development of microfabricated biocatalytic fuel cells. Trends Biotechnol 1999;17(2):502. [6] Yeang K. Recharging your bio-batteries with a can of coke. Archit Design 2008;78(2):1345. [7] Raucher F. Biodontics in diagnosis and treatment planning. NY J Dent 1986;56(2):545. [8] Kakehi N, Yamazaki T, Tsugawa W, Sode K. A novel wireless glucose sensor employing direct electron transfer principle based enzyme fuel cell. Biosens Bioelectron 2007;22(910):22505. [9] Okuda-Shimazaki J, Kakehi N, Yamazaki T, Tomiyama M, Sode K. Biofuel cell system employing thermostable glucose dehydrogenase. Biotechnol Lett 2008;30(10):17538. [10] Kim J, Jia H, Wang P. Challenges in biocatalysis for enzyme-based biofuel cells. Biotechnol Adv 2006;24(3):296308.