Cleaning removable orthodontic appliances: a survey

Orthodontists' instructions for oral hygiene in patients with removable and fixed orthodontic appliances

INTRODUCTION

The aim of this questionnaire-based survey was to evaluate information on frequencies, instructions and products relating to oral hygiene (OH) in orthodontic practices.

METHODS

Using a computer-generated randomization list, 1000 orthodontists were selected and sent a questionnaire. The size and number of inhabitants of the federal states of Germany were considered. The federal states with the highest return rate (Baden-Wuerttemberg [BW], Bavaria [B], Hesse [H], Lower Saxony [LS], Nordrhein-Westphalia [NRW]) were considered and differences between the 16 federal states were divided into North, South, East and Central Germany.

RESULTS

The response rate of the questionnaires was 52.4%. The majority (53.8%) worked in one practice alone. Most (59.1%) have been orthodontists for 5-25 years. For vestibular multibracket appliances (MBA) in BW, B, H and LS over 90% recommended interdental brushes (IDB). In NRW 91.4% recommend fluoride gel. In B and H more than 80% chose electric toothbrush (ETB), in BW, LS and NRW more than 80% manual toothbrush (MTB). For lingual MBA (LMBA) in BW, H, LS and NRW with approximately 50% each fluoride gel, IDB and MTB were chosen. In B fluoride gel, IDB and ETB. For removable apparatus (RA), five federal states recommended MTB (>80%) and ETB (BW, B, H > 80%; NRW > 70%; LS > 60%).

CONCLUSION

Electric toothbrushes are recommended for the use with all appliances, only with removable appliances manual toothbrushes are favoured. For vestibular MBA it is strongly advised to use IDB additionally.

Effect of Different Cleaning Regimes on Biofilm Formation of Acrylic-Based Removable Orthodontic Appliance: A Randomized Clinical Trial

Objectives

This study aimed to evaluate the effects of different cleaning regimes of acrylic-based removable orthodontic appliances on bacterial biofilm formation and whether the surface modification, i.e., polished acrylic fitting surface, reduces biofilm formation.

Materials and Methods

This double-blind, parallel, randomized clinical trial involved thirty-nine orthodontic patients indicated for removable orthodontic appliances. The patients were allocated into three groups according to the cleaning method: brushing with a denture brush and chlorhexidine (CHX) toothpaste, Lacalut cleaning tablet, and a combination of both cleaning methods. Each patient wore an upper removable appliance containing eight wells fitted with eight detachable acrylic tiles (four polished and four unpolished) for seven days. Five types of oral microbiota were evaluated using selective growth media and biochemical tests. The biofilm cleaning efficacy was assessed using the colony-forming unit (CFU) and scanning electron microscopy (SEM). Statistical Analysis. Data from the CFU using different cleansing regimes were compared, following log transformation, using one-way analysis of variance (ANOVA). The polished and unpolished tiles were compared for biofilm formation on each cleansing method using an independent t-test.

Results

There was no significant difference among the three cleaning methods on the polished or unpolished tiles. However, in polished tiles, streptococci were significantly reduced in all cleaning methods, whereas staphylococci and Staphylococcus aureus were markedly decreased in brushing and combination cleaning methods. However, the total number of anaerobic bacteria was significantly reduced in polished tiles using the combination method only.

Conclusions

Polishing the fitting surface of an acrylic-based orthodontic appliance reduced the tested bacterial biofilm formation and may enhance cleaning efficiency. Brushing and combination methods showed superior cleaning effects compared to cleaning tablets. This trial is registered with NCT05707221.

Investigation of the cleaning performance of commercial orthodontic cleaning tablets regarding biofilm removal on PMMA test specimens : An ex vivo study

PURPOSE

The purpose of this ex vivo study was to compare the cleaning performance of three commercially available orthodontic cleaners on polymethyl methacrylate (PMMA) test specimens covered with biofilm.

METHODS

Twenty subjects wore an individually manufactured vacuum-formed maxillary splint with four integrated PMMA test specimens for 7 days. The four test specimens were located on the buccal surfaces of the maxillary molars. After a 7-day wearing period, the PMMA test specimens colonized by biofilm were divided into two halves. One half was placed in 150 ml of tap water or in 150 ml of cleaning solution of the cleaners Retainer Brite® (Dentsply International Raintree Essix, Sarasota, FL, USA), Kukis® Xpress (Reckitt Benckiser, Heidelberg, Germany) or Dontodent (Propack, Heidelberg, Germany) while the other half remained uncleaned. The modified o‑phthaldialdehyde (OPA) method was used to determine the amount of protein on both halves of the test specimens. The difference was tested for significance as a measure of the cleaning effect using a paired sample t‑test.

RESULTS

The cleaning performance of the three orthodontic cleaners was higher than the cleaning performance of tap water (mean 25.9 ± 6.5%). While Retainer Brite® (mean 54.5 ± 7.1%) removed significantly more biofilm than Dontodent (mean 41.5 ± 9.2%, p < 0.001) and Kukis® Xpress (mean 39.9 ± 11.5%, p < 0.001), there was no significant difference in the cleaning performance between Kukis® Xpress and Dontodent (p = 1).

CONCLUSION

Seven-day-old biofilm is only removed partially by the investigated orthodontic cleaners, so that they are not suitable as the only measure for removing established biofilms.

Resistance of PETG Materials on Thermocycling and Brushing

The aim was to assess the impact of thermocycling and brushing on the surface roughness and mass of PETG material-the most commonly used for orthodontic retainers. A total of 96 specimens were exposed to thermocycling and brushing with three different kinds of toothbrushes depending on the number and thickness of the bristles. Surface roughness and mass were evaluated three times: initially, after thermocycling, and after brushing. In all four brands, both thermocycling and brushing increased surface roughness significantly (p < 0.001), with Biolon having the lowest and Track A having the highest. In terms of brushing, only Biolon samples showed statistically significant increased roughness after brushing with all three types of brushes, in comparison to Erkodur A1, where differences were not statistically significant. Thermocycling increased the mass of all samples, but a statistically significant difference was found only in Biolon (p = 0.0203), while after brushing, decreased mass was found in all specimens, statistically significant only in Essix C+ (CS 1560: p = 0.016). PETG material showed instability when exposed to external influences- thermocycling produced an increase in roughness and mass, and brushing mostly caused an increase in roughness and decrease in mass. Erkodur A1 demonstrated the greatest stability, whereas Biolon demonstrated the lowest.

Comparative Evaluation of Bacterial Colonization Color Stability and Halitosis of Oral Appliances Fabricated Using Cold Cure Acrylics, Heat Cure Acrylics and Thermoforming Sheets: An In Vivo Study

Aim

Removable oral appliances form an integral part of interceptive orthodontic procedures. Bacterial colonization leading to halitosis and poor color stability are the major disadvantages of the same in spite of patient acceptability. The aim of the present study was to evaluate bacterial colonization, color stability, and halitosis from the oral appliances fabricated using cold cure, cold cure under pressure pot, heat cure acrylics, thermoforming sheet, Erkodur and antibacterial thermoforming sheet, Erkodur-bz.

Materials and methods

A group of 40 children was divided into five groups and the appliances were delivered. Bacterial colonization and halitosis were evaluated before giving the appliance to the patient after 1 and 2 months. Color stability was evaluated before giving the appliance to the patient and then after 2 months. This study was designed as a single-blinded randomized clinical trial.

Results

Results have shown that after 1 and 2 months, bacterial colonization was higher from the appliances fabricated with cold cure and was lower for the Erkodur group, which was statistically significant. Color stability was more from the appliances fabricated with Erkodur and was less for cold cure, which was statistically significant. Halitosis after 1 month was more from the appliances fabricated with cold cure and less from Erkodur group, which was statistically significant. After 2 months, halitosis was more from the cold cure group and less from Erkodur group, which was not statistically significant.

Conclusion

Thermoforming sheet, Erkodur showed better results than other groups in terms of bacterial colonization, color stability, and halitosis.

Clinical significance

When removable appliances are indicated for minor orthodontic tooth movement, Erkodur is preferable due to the advantages of easy fabrication and less bacterial colonization.

How to cite this article

Madhuri L, Puppala R, Kethineni B, et al. Comparative Evaluation of Bacterial Colonization Color Stability and Halitosis of Oral Appliances Fabricated Using Cold Cure Acrylics, Heat Cure Acrylics and Thermoforming Sheets: An In Vivo Study. Int J Clin Pediatr Dent 2022;15(5):499-503.

What Are the Cleaning and Disinfection Methods for Acrylic Orthodontic Removable Appliance? A Systematic Review

(1) Background: The use of removable orthodontic appliances, which is common in early ages, requires careful hygiene, as several different microorganisms are found on their surface during the orthodontic treatment. (2) Methods: Comprehensive electronic searches were conducted up to May 2021. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs), prospective or retrospective, evaluating the efficacy of cleaning and disinfection methods for acrylic removable orthodontic appliances, redacted in the English language, were included. Three independent blinding review authors were involved in study selection, data extraction, and bias assessment. (3) Results: A total of 2491 records were screened and eight studies (six RCTs and two CCTs) fulfilled the inclusion criteria. Among the overall cleaning and disinfection methods described in the included studies, four categories could be defined: liquid antimicrobial agents, commercial tablet cleansers, natural plant extracts and incorporation of quaternary ammonium methacryloxy silicate, all of which demonstrated superior efficacy compared to the placebo/negative control. However, the different methods were not compared with each other. (4) Conclusions: Biofilm control on acrylic orthodontic removable appliances can be performed using the different cleaning and disinfection methods considered in the included studies. Further studies are needed to define the most effective technique. Registration: PROSPERO CRD 42021269297.

Impact of household vinegar on calculus removal and mechanical properties of orthodontic resin

PURPOSE

This study evaluated calculus removal efficacy of household vinegar and its effect on autopolymerizing orthodontic resin following repeated immersion.

METHODS

A total of 72 sectioned specimens of orthodontic retainers with calculus deposits following cleaning with the help of immersion in vinegar of different dilutions between 12.5% and 100%, tap water, effervescent tablets, and mechanical debridement were digitally analyzed. Changes in Ca and Fe ions in vinegar were assessed by atomic emission spectroscopy (AES). For mechanical testing, autopolymerizing polymethyl methacrylate (PMMA) samples were similarly grouped and immersed for 78 cycles and their flexural strength and hardness measured. Fourier-transform infrared spectroscopy (FTIR) was performed to evaluate changes in their chemical composition. One-way analysis of variance (ANOVA) and Tukey's test were used to analyze the differences in the mean flexural strength and hardness between the groups (p ≤ 0.05).

RESULTS

A minimum immersion of 2 h in 25% vinegar solution combined with brushing attained efficiency of 74.13 ± 22% calculus removal. Whereas, tap water and effervescent tablets had 15% and 49% efficiency, respectively. AES results showed diffusion of Ca ions from calculus into the vinegar solution as a plausible mechanism for its structural weakening and removal. Results of mechanical testing showed that undiluted vinegar solution affected the flexural strength of PMMA and this effect was significantly different from that of the effervescent tablets and the remaining vinegar concentrations. There was no significant difference in hardness between the groups. The FTIR showed no changes in the chemical composition of PMMA samples following repeated immersions.

CONCLUSION

Vinegar can be useful in the removal of calculus from dental appliances but should be used in diluted forms to minimize side effects.

Microbial evaluation of the effectiveness of different methods for cleansing clear orthodontic retainers: A randomized clinical trial

OBJECTIVE

To compare effectiveness of brushing an Essix retainer with water only and brushing followed by soaking in one of three commercial cleansing tablets.

MATERIALS AND METHODS

A double-blind, parallel, randomized clinical trial with a split-mouth design was completed with 60 volunteers with specific eligibility criteria assigned to three groups to compare the cleansing effectiveness of brushing an Essix retainer with water only, followed by soaking in one of three alkaline peroxide-based commercial cleansing tablets (Retainer Brite®, Kukis®, and Corega®). Each participant wore an upper Essix retainer (with an electronic microsensor) on a full-time basis for 14 days and used one of the three products on one side of the retainer for 15 min/d. The effectiveness of the cleansing tablets was tested by the scanning electron microscopy, bacterial identification, bacterial quantification, and disk diffusion methods.

RESULTS

Bacterial quantification tests demonstrated nonsignificant statistical differences between the control and test sides of the three cleansing tablets: Retainer Brite®, Kukis®, and Corega® (Mann-Whitney test P-values were .6, .37, and .5, respectively). A Kruskal-Wallis test also showed nonstatistical difference in the bacterial counts between the three groups (P-value = .5). In vitro tests showed a minimal inhibition zone of Staphylococcus epidermidis only with Corega® tablets.

CONCLUSIONS

Using chemical cleansing tablets after mechanical cleansing did not significantly reduce the bacterial count in Essix retainers when compared to use of mechanical cleansing alone. However, the tablets seem to be effective against "cocci" bacterial species.

ATP Bioluminometers Analysis on the Surfaces of Removable Orthodontic Aligners after the Use of Different Cleaning Methods

Purpose. The aim was to quantify the bacteria concentration on the surface of orthodontic clear aligners using three different cleaning methods. Furthermore the objective was to validate the efficacy of the bioluminometer in assessing the bacteria concentration. Materials and Methods. Twenty subjects (six males and fourteen females) undergoing orthodontic therapy with clear aligners (Invisalign® Align Technology, Santa Clara, California) were enrolled in this study. The observation time was of six weeks. The patients were instructed to use different cleaning methods (water, brushing with toothpaste, and brushing with toothpaste and use of sodium carbonate and sulphate tablet). At the end of each phase a microbiological analysis was performed using the bioluminometer. Results. The highest bacteria concentration was found on aligners cleaned using only water (583 relative light units); a value of 189 relative light units was found on aligners cleaned with brushing and toothpaste. The lowest bacteria concentration was recorded on aligners cleaned with brushing and toothpaste and the use of sodium carbonate and sulfate tablet. Conclusions. The mechanical removal of the bacterial biofilm proved to be effective with brushing and toothpaste. The best results in terms of bacteria concentration were achieved adding the use of sodium carbonate and sulfate tablet.