Evaluation of the genotoxic effects of fixed appliances on oral mucosal cells and the relationship to nickel and chromium concentrations: An in-vivo study

The use of micronucleus assay in exfoliated oral cells in patients undergoing fixed orthodontic therapy: a systematic review with meta-analysis

The aim of this systematic review was to evaluate published papers regarding the micronucleus assay in oral mucosal cells of patients undergoing orthodontic therapy (OT). A search of the scientific literature was made in the PubMed, Scopus, and Web of Science databases for all data published until November, 2021 using the combination of the following keywords: "fixed orthodontic therapy," "genetic damage", "DNA damage," "genotoxicity", "mutagenicity", "buccal cells", "oral mucosa cells," and "micronucleus assay". The systematic review was designed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Nine studies were retrieved. Some authors demonstrated that OT induces cytogenetic damage in oral mucosal cells. Out of the nine studies included, two were classified as strong, five as moderate, and two as weak, according to the quality assessment components of the Effective Public Health Practice Project (EPHPP). Meta-analysis data revealed no relationship between mutagenicity in oral cells and OT in different months of treatment. At one month, the SMD = 0.65 and p = 0.08; after three months of OT, the SMD = 1.21 and p = 0.07; and after six months of OT, the SMD = 0.56 and p = 0.11. In the analyzed months of OT, I2 values were >75%, indicating high heterogeneity. In summary, this review was not able to demonstrate that OT induces genetic damage in oral cells. The study is important for the protection of patients undergoing fixed OT, given that mutagenesis participates in the multi-step process of carcinogenesis.

Use of liquid-based cytology samples reveals genomic instability and cell death in patients undergoing orthodontic treatment

PURPOSE

To examine the use of liquid-based exfoliative cytology to determine the presence of genomic instability and cell death in the oral mucosa of patients with orthodontic appliances.

METHODS

Fifty-four oral mucosa samples were collected from 18 patients and divided into three stages: T0, before fixation of orthodontic appliances; T1, 25 days after appliance fixation; T2, 90 days after appliance fixation. All samples were Papanicolaou-stained and observed by microscopy (1,000 cells/sample) to ascertain the frequency of micronucleated cells (MN) and nuclear abnormalities (nuclear buds (NB), binucleated (BN), condensed chromatin (CC), karyorrhexis (KR), and karyolysis (KL)). Differences were analyzed statistically using the Mann-Whitney, Wilcoxon, Kruskal-Wallis and chi-squared tests.

RESULTS

After placement of orthodontic appliances, significant differences were observed for genomic instability biomarkers (MN and NB) and cell death (CC, KR and KL) (P < 0.05). Female patients and older patients exhibited a higher frequency of MN.

CONCLUSION

Liquid-based cytology has revealed that orthodontic appliances induce genomic instability and cell death in epithelial tissue of the oral mucosa, facilitating sample preservation and yielding more than one preparation per sample. Future studies should investigate whether such cell damage can be reversed through cell repair or whether cell alterations evolve and lead to disease.

Short tandem repeat (STR) instability in the oral mucosa of patients submitted to fixed orthodontic therapy: a limitation of STR profile quality for human identification

The purpose of this study was to evaluate changes in short tandem repeat (STR) profile quality before and after fixed orthodontic therapy. Samples of oral epithelial cells were obtained from 28 volunteers who had an indication for orthodontic treatment. The samples were collected before and three months after starting orthodontic treatment with fixed appliances. DNA extraction and integrity were evaluated by electrophoresis, and STR profiles were obtained by polymerase chain reaction amplification and STR typing via capillary electrophoresis. DNA electrophoresis showed a higher proportion (7/28, 25%) of DNA degradation in the samples collected after fixed orthodontic treatment compared to those obtained before starting orthodontic therapy (3/28, 11%), however, changes in DNA were not significant (p=0.289). In concordance all STR profiles showed complete genotyping; however, imbalances in the size of heterozygotes and in the signal were detected in 25% of STR profiles after orthodontic therapy. Moreover, STR instability was demonstrated by an increase in stutter bands detected in 60% of the DNA profiles after treatment and a spurious allele of the D195433 marker was found in one sample after treatment. The STR profiles of samples obtained from the oral cavity with orthodontic appliances should be interpreted with caution. STR instability increases the incidence of artifacts that could compromise the quality of the results of tests performed in forensic DNA laboratories.

Assessment of metal ion accumulation in oral mucosa cells of patients with fixed orthodontic treatment and cellular DNA damage: a systematic review

Intraoral fixed appliances remain in the potentially corrosive environment of the mouth for an average of two years. Over time, corrosion causes the release of metal ions, such as nickel and chromium. These metals can become allergenic and cytotoxic, causing different conditions in the human body. The aim of this study therefore is to carry out a systematic review of the available scientific evidence on the accumulation of metal ions, and the genotoxic and cytotoxic effects in oral mucosa cells deriving from short- and long-term exposure to them. The systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome (quantification of metal ion deposits and assessment of their genotoxic and/or cytotoxic effects) and secondary outcome (complementary analysis of cytotoxic and genotoxic effects) were examined. The Cochrane Collaboration tool and Toxicological data Reliability Assessment Tool (ToxRTool) were used for quality assessment. Once the search was performed, a total of seven articles met the inclusion criteria and were included in this study. Two main techniques were used to assess genotoxic effects: alkaline comet assay (6/7) and micronucleus method (1/7). Cytotoxicity was evaluated (4/7) using the trypan blue dye test. Accumulations of nickel (7/7), chromium (5/7), and other metals (zinc, cobalt, iron, manganese, molybdenum, titanium) were also quantified. The results allowed us to conclude that release of metal ions and acute cell and DNA damage in oral mucosa cells takes place in the early stages of treatment. However, more long-term studies are needed to evaluate chronic exposure to metals and DNA damage, as well as cellular capacity to recover DNA integrity.

New and Recovered Temporary Anchorage Devices, In Vitro Assessment of Structural and Surface Properties

The orthodontic miniscrew (TADs) is a device that is fixed into bone in the short term for the purpose of enhancing orthodontic anchorage. The aim of our study was to investigate the structural and surface properties of recovered TADs after orthodontic treatment, and compare them to new TADs. TADs (n = 15) from the same manufacturer (Absoanchor; Dentos, Daegu, Korea) were assessed; n = 10 were recovered from patients after orthodontic treatment and n = 5 were new. We performed electrochemical investigations, scanning electron microscopy (SEM) and microbiological analysis. Qualitative analysis on general electrochemical polarization revealed that the TADs retrieved from the patients provided much lower current densities in the passivity zone, and the oxidative processes taking place on their surface were of lower intensity. The surface morphologies of the tips of the retrieved mini-implants showed less sharp tips and smooth surfaces. Defects in the form of pores or cracks could be identified in both evaluated TAD groups. All retrieved TADs showed signs of biological materials (SEM analysis) and contamination on their surfaces. In conclusion, these results can assist orthodontists in comprehending the complexities of TAD behavior with respect to their design and structure.

Cytotoxicity, genotoxicity, and cellular metal accumulation caused by professionally applied fluoride products in patients with fixed orthodontic appliances: A randomized clinical trial

BACKGROUD

Corrosion of metal orthodontic appliances caused by professional fluoride products has been recently concerned. Therefore, the objective of this study was to evaluate the cytotoxic and genotoxic effect of these products on buccal mucosal cells from patients wearing fixed orthodontic appliances.

METHODS

A total of 44 patients, aged 12 to 35 years, who began orthodontic treatment with fixed appliances were included in this single-center, prospective, randomized clinical trial. Patients were randomly allocated into 4 parallel groups according to the type of professional fluoride treatment applied after placing the appliances: acidulated phosphate fluoride gel (APF); neutral fluoride gel (NGel); fluoride varnish (FVa); and without fluoride treatment (control). Buccal cells were collected before treatment (T1) and 3 months after appliance placement (T2). The cells were assayed for cell viability and underwent Papanicolaou staining. Cells with micronuclei and degenerative nuclear alterations were scored using a light microscope. Cell metal content was quantified by inductively coupled plasma-mass spectrometry. The data were analyzed with the Kruskal-Wallis test.

RESULTS

The intracellular nickel content in the APF group significantly increased (P < 0.05), whereas that of the control, NGel, and FVa groups did not. The changes in chromium concentration in all groups were not significantly different compared with control. Use of APF resulted in a significantly higher decrease in cell viability and increase in morphologic signs of cell death compared with control (P < 0.05). The change in frequency of micronucleated cells was not significantly different from that in the control group.

CONCLUSIONS

Applying APF gel on fixed orthodontic appliances increased the cell metal content and decreased cell viability; however, genotoxic effects were absent. FVa and NGel are suggested as the products of choice to use during orthodontic treatment.

Influence of Conventional or Invisalign Orthodontic Treatment on Mineral and Trace Element Salivary Levels: Longitudinal Study with Total Reflection X-ray Fluorescence

This work aimed to evaluate the salivary concentration of chemical elements in patients undergoing orthodontic treatment with fixed orthodontic appliances and removable aligners. Twelve Angle Class I and II orthodontic patients undergoing treatment with conventional fixed appliances and 15 patients treated with removable aligners provided unstimulated whole saliva samples before treatment (pre) and after 3 months of treatment (post). The concentration and secretion rate of chemical elements in saliva were determined by total reflection X-ray fluorescence. Differences from pre to post and between groups were determined with the paired T test or Wilcoxon test, and two-way ANOVA, considering P < 0.05. The concentrations of S, Cl, and K decreased, while Zn increased significantly (P < 0.05) between pre and post treatment with the fixed appliance treatment. The salivary secretion rate of S was decreased from pre to post in the fixed appliance group. No differences in the concentration and secretion rate of chemical elements were detected from pre to post in the Invisalign group. Fe secretion rate presented an interaction between time and treatment, with lower secretion at post (P = 0.02) in the Invisalign group. Increased Br secretion rate and decreased Rb, Fe, P, and K in Invisalign patients suggested a better salivary electrolyte profile regarding periodontal bone remodeling. No significant alterations in ions associated with metal corrosion and inflammatory reactions were detected in orthodontic patients under dental plaque control.

Biomonitoring of children and adolescents using orthodontic appliances made of acrylic resins through micronucleus testing of exfoliated buccal and palatal mucosa cells

INTRODUCTION

The present study aimed to investigate the occurrence of micronuclei and the degenerative nuclear alterations indicative of apoptosis and necrosis in the exfoliated buccal and palatal mucosa cells of children and adolescents using orthodontic appliances made of self-curing acrylic resins.

METHODS

The micronuclei and nuclear alterations were evaluated in a minimum of 2000 cells collected from the cheeks and palates of 30 patients of both sexes, aged between 6 and 12 years. The cell evaluations were performed before appliance installation and 15 to 21 days after installation. A conditional test was used. In all analyses, the significance level was 5%.

RESULTS

No differences in the occurrence of micronuclei or the nuclear degenerative changes indicative of apoptosis and necrosis were observed in the cheek cells between the 2 time points (P > 0.05). However, evaluation of the palate cells revealed a significant increase in the occurrence of micronuclei and the nuclear alterations indicative of apoptosis (P < 0.01) but not of karyolysis (P > 0.05).

CONCLUSIONS

Direct contact of orthodontic appliances made of acrylic resins with the oral mucosa increases the incidence of chromosomal damage and degenerative nuclear alterations.

Gene (HPRT) and chromosomal (MN) mutations of nickel metal powder in V79 Chinese hamster cells

Nickel metal is a naturally occurring element used in many industrial and consumer applications. Human epidemiological data and animal cancer bioassays indicate that nickel metal is not likely to be a human carcinogen. Yet, nickel metal is classified as a suspected human carcinogen (CLP) and possibly carcinogenic to humans (IARC). There are no reliable studies on the potential for nickel metal to induce gene and micronucleus (MN) mutations. To fill these datagaps and increase our understanding of the mechanisms underlying the lack of nickel metal carcinogenicity, gene and micronucleus mutation studies were conducted with nickel metal powder (N36F) in V79 Chinese Hamster cells following OECD 476 and 487 guidelines, respectively, under GLP. Gene mutation at the hprt locus was tested, with and without metabolic activation, after 4-h treatment with 0.05-2.5 mM nickel metal powder. Cytokinesis-block MN frequency following exposure to 0.25-1.5 mM nickel metal was tested after 4-h treatment, with and without metabolic activation, followed by a 24-h treatment without metabolic activation. In the gene mutation assay, there were modest increases in hprt mutants observed at some test concentrations, not exceeding 2.2-fold, which were either within the historical control values and/or showed no concentration-response trend. The positive controls showed increases of at least 7-fold. Likewise, no increases in the MN frequency exceeding 1.5-fold were observed with nickel metal, with no concentration-response trends. Taking these results together, it can be concluded that nickel metal is non-mutagenic and does not cause gene nor chromosomal mutations.

In vivo study on the release of nickel, chromium, and zinc in saliva and serum from patients treated with fixed orthodontic appliances

Background:

Fixed orthodontic appliances can release metal ions such as nickel, chromium, and zinc into saliva and blood, which can cause contact dermatitis, hypersensitivity, and cytotoxicity. This study was undertaken to assess the release of nickel, chromium, and zinc in saliva and serum of patients undergoing fixed orthodontic treatment.

Materials and Methods:

This in vivo study was conducted on 80 participants with an age range of 15–40 years. Thirty were included as controls and 50 participants were treated with fixed orthodontic appliances. Saliva and blood samples were collected at five different periods, before insertion of fixed orthodontic appliance and at 1 week, 3 months, 1 year, and 1.5 years after insertion of appliance, respectively. The metal ion content in the samples were analyzed by atomic absorption spectrophotometry. Mean levels of nickel, chromium, and zinc in saliva and serum were compared between groups using independent sample t-test and before and after results using paired t-test. P < 0.05 was considered as statistically significant.

Results:

At the end of 1.5 years, the mean salivary levels of nickel, chromium, and zinc in controls were 5.02 ppb, 1.27 ppb, and 10.24 ppb, respectively, as compared to 67 ppb, 30.8 ppb, and 164.7 ppb at the end of 1.5 years. This was statistically significant with P < 0.001. A significant increase in the metal ion levels were seen in participants with before and after insertion of appliance (P < 0.001).

Conclusion:

Orthodontic appliances do release considerable amounts of metal ions such as nickel, chromium, and zinc in saliva and serum. However, it was within permissible levels and did not reach toxic levels.

Concise Review of Nickel Human Health Toxicology and Ecotoxicology

Nickel (Ni) metal and Ni compounds are widely used in applications like stainless steel, alloys, and batteries. Nickel is a naturally occurring element in water, soil, air, and living organisms, and is essential to microorganisms and plants. Thus, human and environmental nickel exposures are ubiquitous. Production and use of nickel and its compounds can, however, result in additional exposures to humans and the environment. Notable human health toxicity effects identified from human and/or animal studies include respiratory cancer, non-cancer toxicity effects following inhalation, dermatitis, and reproductive effects. These effects have thresholds, with indirect genotoxic and epigenetic events underlying the threshold mode of action for nickel carcinogenicity. Differences in human toxicity potencies/potentials of different nickel chemical forms are correlated with the bioavailability of the Ni2+ ion at target sites. Likewise, Ni2+ has been demonstrated to be the toxic chemical species in the environment, and models have been developed that account for the influence of abiotic factors on the bioavailability and toxicity of Ni2+ in different habitats. Emerging issues regarding the toxicity of nickel nanoforms and metal mixtures are briefly discussed. This review is unique in its covering of both human and environmental nickel toxicity data.

Systemic Level of Oxidative Stress during Orthodontic Treatment with Fixed Appliances

The aim of the study was to assess the level of selected systemic oxidative stress parameters during the first week of orthodontic treatment with fixed appliances. Fifty-four males with malocclusion and having a similar lifestyle were randomized using a computer based procedure and allocated to either the treatment group (TG; n=27;24.6 ± 1.7 years) or control group (CG; n=27;24.7 ± 1.7 years). Capillary blood was collected at baseline and 6 hours, 24 hours, and 7 days after archwire insertion. At the same time points, capillary blood was retrieved in the CG. In order to determine the oxidative stress, both the reactive oxygen species (ROS) formation and the antioxidative defense (AD) potential were measured using the ROS testing and oxygen free radicals defense (equivalent to antioxidant defense) testing, respectively, by a blinded operator. The ratio between ROS and AD (ROS/AD) was calculated and data were analyzed using nonparametric tests. No drop-outs or harms were detected. At baseline, neither ROS (1.54 [1.22; 2.12] and 1.74 [1.40; 2.01] for the TG and CG, respectively), AD (1.19 [0.66; 1.50] and 1.19 [0.57; 1.42] for the TG and CG, respectively), nor ROS/AD levels were significantly different (p>0.05). After 24 hours, the ROS level significantly increased in the TG (2.05 [1.71; 2.26]) and was higher compared to the CG ROS level (1.67 [1.29; 1.95]; p=0.025), while for the AD level, no marked between and within group differences were detected. A notable change of ROS/AD ratio was observed over time only within the TG (p=0.026). Moreover, a significantly higher ROS/AD ratio was detected 24 hours after archwire insertion in the TG compared to the CG (2.69 [1.44; 3.89] and 1.79 [1.45; 2.35], respectively), followed by a decrease. Orthodontic treatment with fixed appliances might induce systemic oxidative stress in the short-term, since ROS levels and ROS/AD levels are normalized within 7 days after archwire insertion.

Genotoxic effects in oral mucosal cells caused by the use of orthodontic fixed appliances in patients after short and long periods of treatment

OBJECTIVE

This study aimed to evaluate the genotoxic effects in the oral epithelial cells of patients undergoing fixed orthodontic treatment and to compare these to a control group without treatment. The null hypothesis to be tested is that corrective orthodontic treatment at different periods does not cause genotoxic effects in patients.

MATERIAL AND METHODS

An observational cross-sectional study including 74 patients enrolled in corrective orthodontic treatment and 21 control patients, between 11 and 35 years of age, of both genders, participated in the research. Patients undergoing treatment were divided into four treatment groups differentiated by treatment periods: G1, n = 21 (1 month to 12 months); G2, n = 21 (13 to 24 months); G3, n = 23 (25 to 48 months); and G4, n = 9 (over 48 months). Cells were collected by scraping the internal side of the cheek and subsequently placed in tubes containing 0.9% sodium chloride solution. The sample underwent evaluation for genotoxic effects by means of the micronucleus test (MNT). Bivariate analyses were performed using parametric tests (t test or ANOVA) and nonparametric tests (Chi-square test, Kruskal-Wallis test, Dunn post-test). The adopted level of significance was 5%.

RESULTS

Statistically significant differences for any of the genotoxic abnormalities (binucleated, trinucleated, karyolysis, piknosis, nuclear buds) were not found except for karyolysis, which was higher in the control group than in G4 (p < 0.05).

CONCLUSIONS

This study did not demonstrate evidence of genotoxic effects even after long periods of corrective orthodontic treatment.

CLINICAL RELEVANCE

This study explores genotoxic effects in fixed orthodontic patients.

Effects of Restoring the Primary Dentition with Stainless-Steel Crowns on Children's Salivary Nickel and Chromium Levels, and the Associations with Saliva pH: a Preliminary Before-After Clinical Trial

Nickel and chromium existing in stainless-steel crowns (SSCs, used in pediatric dentistry) might be cytotoxic and allergenic. However, no in vivo studies have examined their salivary levels in children using SSCs, or in young children without SSCs. Also, the effect of acidity on metal ion release has not yet been evaluated in any previous in vivo studies in the whole literature. Therefore, this preliminary before-after clinical trial was conducted. Salivary nickel/chromium levels of 30 children before and after 2 months of placement of SSCs were measured using atomic absorption spectrophotometry. Salivary pH was measured with a digital pH meter. The effects of treatment, pH, number of SSCs, gender, and age on salivary ions were analyzed statistically (α = 0.05, β = 0.15). Salivary nickel concentrations increased from 4.9010 ± 4.7390 to 5.6320 ± 4.7210 μg/L (P = 0.000, paired t test). Chromium increased from 0.3273 ± 0.5214 to 0.4199 ± 0.6404 μg/L (P = 0.016). Saliva pH increased from 6.81 ± 0.52 to 7.04 ± 0.47 (P = 0.000). Ion levels were not correlated with pH (P > 0.14), except chromium in the follow-up (rho = - 0.435, P = 0.016). Nickel increase (but not chromium increase) was correlated with pH increase (rho = 0.367, P = 0.046). Age was only correlated with baseline chromium (rho = 0.373, P = 0.042). Being male was associated with baseline/follow-up nickel levels (P ≤ 0.030). SSC number was not correlated with ions or pH (P > 0.36). It was shown for the first time that SSCs might increase salivary nickel and chromium concentrations and reduce saliva acidity. Nickel increase might be in line with pH elevation. The raised pH might be associated with reduced chromium release. Boys might have higher nickel levels than might girls, with or without SSCs.

Effect of radiofrequency electromagnetic fields (RF-EMFS) from mobile phones on nickel release from orthodontic brackets: An in vitro study

BACKGROUND

The worldwide dramatic increase in the use of cell phones has generated great concerns about their potential adverse health effects.

OBJECTIVE

The aim of the present study was to evaluate the effects of radiofrequency electromagnetic fields (RF-EMFs) emitted from mobile phones on the level of nickel release from orthodontic brackets.

METHODS

Twenty stainless steel brackets were divided randomly into experimental and control groups (n=10). Brackets were immersed in artificial saliva at 37°C for 6 months. Experimental group were exposed to GSM 900MHz RF-EMFs emitted from a mobile phone stimulator for 4hours. The specific absorption rate (SAR) was 2.287W/kg. The concentration of nickel in the artificial saliva in both groups was evaluated by using the cold-vapour atomic absorption spectrometry. The Mann-Whitney test was used to assess significant differences in nickel release between the exposed and non-exposed groups.

RESULTS

The mean nickel levels in the exposed and non-exposed groups were 11.95 and 2.89μg/l, respectively. This difference between the concentrations of nickel in the artificial saliva of these groups was statistically significant (P=0.001).

CONCLUSION

Exposure to RF-EMFs emitted from mobile phones can lead to human exposure to higher levels of nickel in saliva in patients with orthodontic appliances. As nickel exposure can lead to allergic reaction in humans and considering this point that about 10-20% of the population can be hypersensitive to nickel, further studies are needed to evaluate the effects of radiofrequency electromagnetic fields (RF-EMFs) emitted from common devices such as mobile phones or Wi-Fi routers on the level of nickel release from orthodontic brackets.

Genotoxic and cytotoxic effects of Haas appliance in exfoliated buccal mucosa cells during orthodontic treatment

OBJECTIVES

To evaluate the genotoxic and cytotoxic effects of Haas appliances through micronuclei test and cytogenetic damage analysis in buccal mucosa epithelial cells of patients undergoing orthodontic treatment.

MATERIALS AND METHODS

Twenty-eight patients, 6-12 years of age and of both genders, who required a Haas appliance for the correction of a posterior crossbite were included. Epithelial cells from the mucosa were collected by gently scraping the inside of both the right and left cheeks. The cells were collected before the insertion of the appliance (T0), 1 month after the device was installed (T1), and again 3 months after the appliance was immobilized (T2). The cells were processed to obtain slides. Feulgen/Fast Green was used as the staining method, and the number of normal, karyolytic, pyknotic, nuclear buds, bi/trinucleated, and micronucleus cells were counted under light microscopy. Cellular abnormalities were evaluated with parametric and nonparametric tests for comparison of the means by analysis of variance testing, Tukey posttest, or the Kruskal-Wallis test and then by Dunn's posttest. The significance level was 5%.

RESULTS

There were no statistically significant changes in the micronuclei in the evaluated periods ( P > .05). Nuclear buds increased at T1 ( P < .05), returning to baseline levels at T2. Other abnormalities (cariolytic, pyknotic, and bi/trinucleated cells) showed a significant increase at T1 and T2 ( P < .0001).

CONCLUSIONS

The Haas appliance did not cause an increase in micronuclei in cells of the buccal mucosa. However, statistically significant increases in cariolytic, pyknotic, and bi/trinucleated cells were observed during treatment, suggesting possible DNA damage.

Role of dental hardware in oral cavity squamous cell carcinoma in the low-risk nonsmoker nondrinker population

BACKGROUND

Oral cavity squamous cell carcinoma (SCC) arising in nonsmokers and nondrinkers remains poorly characterized. We hypothesized that these patients had prior exposure to metallic dental hardware.

METHODS

We utilized a questionnaire querying the lifetime oral health status of 54 patients. Demographics and extensive oral health history were collected.

RESULTS

The majority of patients (74%) had prior exposure to metallic dental hardware. The younger population with almost exclusively oral tongue cancer had a high prevalence of metallic orthodontic braces (40%) within 15 years before diagnosis. In the 51+ year age group, 82% had crowns, dental implants, and/or dentures with metallic elements.

CONCLUSION

Exposure to metallic dental hardware has increased in the past few decades given the rise of orthodontic braces and older adults retaining more teeth. Although this study does not prove a causal relationship between oral cavity SCC and dental hardware, this is a step toward identifying and investigating their role.

Evaluation of scalp hair nickel and chromium level changes in patients with fixed orthodontic appliance: a one-year follow-up study

BACKGROUND AND OBJECTIVES

The release of metal ions from orthodontic appliances is part of the dissolution and biomechanical processes of alloys. Nickel (Ni) and chromium (Cr) are the elements commonly used in the manufacture of various components of fixed orthodontic appliances, including bands, brackets and wires. This study was aimed to measure the Ni and Cr ions levels in the scalp hair of patients treated with fixed orthodontic appliances in comparison of the control group.

MATERIALS AND METHODS

The patient group consisted of 24 patients treated with fixed orthodontic appliances for one year, while the control group included 28 healthy individuals without orthodontic appliances. Analysis of the Cr and Ni was performed using atomic absorption spectrophotometer by graphite furnace method. The data were analyzed via student and paired samples t-test and ANOVA repeated measurement test.

RESULTS

After one year, the levels of Ni and Cr in two groups showed significant differences (0.086 ± 0.007 and 0.258 ± 0.009 µg/g for control group and 0.149 ± 0.010 and 0.339 ± 0.013 µg/g for patient group, respectively for Ni and Cr, p < .001). ANCOVA test by removing the effects of age, gender and the baseline levels of Ni and Cr showed that changes in these ions in the scalp hair of both groups after one year were statistically significant.

CONCLUSION

Due to the slightly elevated levels of Ni and Cr ions in the scalp hair of patients treated with fixed orthodontic appliances and considering the cytotoxic and allergic effects of these ions, changing the ingredients in fixed orthodontic appliances is suggested for the future.

A CAD/CAM Zirconium Bar as a Bonded Mandibular Fixed Retainer: A Novel Approach with Two-Year Follow-Up

Stainless steel alloys containing 8% to 12% nickel and 17% to 22% chromium are generally used in orthodontic appliances. A major concern has been the performance of alloys in the environment in which they are intended to function in the oral cavity. Biodegradation and metal release increase the risk of hypersensitivity and cytotoxicity. This case report describes for the first time a CAD/CAM zirconium bar as a bonded mandibular fixed retainer with 2-year follow-up in a patient who is subjected to long-term treatment with fixed orthodontic appliance and suspected to have metal hypersensitivity as shown by the considerable increase of nickel and chromium concentrations in a sample of patient's unstimulated saliva. The CAD/CAM design included a 1.8 mm thickness bar on the lingual surface of lower teeth from canine to canine with occlusal rests on mesial side of first premolars. For better retention, a thin layer of feldspathic ceramic was added to the inner surface of the bar and cemented with two dual-cured cement types. The patient's complaint subsided 6 weeks after cementation. Clinical evaluation appeared to give good functional value where the marginal fit of digitized CAD/CAM design and glazed surface offered an enhanced approach of fixed retention.

Effects of fixed orthodontic treatment on nickel and chromium levels in gingival crevicular fluid as a novel systemic biomarker of trace elements: A longitudinal study

INTRODUCTION

Nickel and chromium might induce hypersensitivity. Therefore, they are of interest to orthodontists. Gingival crevicular fluid (GCF) is highly relevant to orthodontic treatments and might reflect systemic changes associated with the inflammatory response induced by orthodontic forces. Therefore, it might also be used to show metal ion changes. Nevertheless, baseline metal levels of GCF are unknown, and the effect of orthodontic treatment on GCF metal levels has not been investigated. The aim of this study was to assess the levels of nickel and chromium in GCF.

METHODS

Based on a pilot study, the sample size was predetermined as 24 × 3 measurements to obtain test powers above 90%. Nickel and chromium concentrations were measured before treatment and 1 month and 6 months later in 12 female and 12 male patients who had fixed orthodontic appliances using atomic absorption spectrophotometry. The gingival index was also evaluated in each session. The effects of treatment on GCF ions were analyzed using repeated-measures analysis of variance and Friedman tests (α = 0.05, β ≤0.01).

RESULTS

The gingival index worsened over time (chi-square test, P <0.001). The mean nickel levels were 3.894 ± 1.442, 5.913 ± 2.735, and 19.810 ± 8.452 μg per gram, respectively, at baseline, month 1, and month 6. Chromium concentrations were 1.978 ± 0.721, 4.135 ± 1.591, and 13.760 ± 3.555 μg per gram, respectively. Compared with the baseline, nickel increased by 150% and 510%, respectively, in the first and sixth months (Friedman, P <0.0001), and chromium increased by 200% and 700%, respectively (analysis of variance, P <0.0001).

CONCLUSIONS

Six months of fixed orthodontic treatment might intensify the levels of nickel and chromium in the GCF as well as gingival inflammation.

Orthodontic treatment modifies the oxidant-antioxidant balance in saliva of clinically healthy subjects

PURPOSE

The aim of our study was to analyse salivary markers of oxidative stress and an antioxidant response in clinically healthy subjects with fixed orthodontic appliances.

MATERIAL/METHODS

37 volunteers were included in the study. Unstimulated (UWS) and stimulated (SWS) whole saliva were analysed for oxidative and antioxidant status and nickel levels immediately before the insertion of the appliances, an one week after and twenty four weeks after the insertion of fixed appliances.

RESULTS

A significant increase in tiobarbituric acid reactive substance (TBARS) and total oxidant status (TOS) one week, and total protein concentration twenty four weeks after the attachment of orthodontic appliances was found in the saliva. The markers of antioxidant status: superoxide dismutase (SOD), catalase (CAT), uric acid (UA), peroxidase (Px), and total antioxidant status (TAS) were not changed in all periods in UWS. In SWS a significant decrease in SOD1 and CAT was found whereas Px was increased one week after treatment and UA twenty four weeks following treatment. TAS was decreased in UWS and SWS twenty four weeks after orthodontic treatment. Oxidative status index (OSI) was elevated both in UWS and SWS one week after orthodontic treatment in comparison to the results obtained before and twenty four weeks. One week after treatment an increased concentration of nickel was also observed.

CONCLUSIONS

Orthodontic treatment modifies the oxidative-antioxidative balance in the saliva of clinically healthy subjects. Increased nickel concentration in saliva, released from orthodontic appliances, seems to be responsible for changes in the oxidative status of the saliva.

Effects of Fixed Orthodontic Treatment Using Conventional, Copper-Included, and Epoxy-Coated Nickel-Titanium Archwires on Salivary Nickel Levels: A Double-Blind Randomized Clinical Trial

Orthodontic archwires, especially nickel-titanium (NiTi) ones, are a major source of nickel release. Despite their importance, no in vivo studies have assessed the ion release from conventional or new generations of NiTi archwires (copper-included and epoxy-coated). This double-blind parallel randomized clinical trial was done on 84 saliva specimens sampled at two time points from 42 orthodontic patients. The patients were randomly divided into three groups of NiTi, copper NiTi (NiTiCu), and epoxy NiTi archwires (n = 14 each). The effects of 2-month treatment, wire types, gender, and age on pretreatment, posttreatment, and time-dependent differences were analyzed statistically (α = 0.05). Salivary nickel concentrations were 10.4571 ± 0.77168 and 11.0779 ± 0.81232 μg/L, respectively, in the baseline and second month. This increase was significant (P = 0.0000, paired t test). The extents of nickel increase in different groups were 0.8279 ± 0.14 (NiTi), 0.6493 ± 0.10 (NiTiCu), and 0.385 ± 0.11 (epoxy-coated NiTi) μg/L (P = 0.0000, one-way analyses of variance (ANOVA)). Differences between each two archwire types were significant (P = 0.000, Tukey). Age and gender did not play a role. It can be concluded that NiTi archwires might increase nickel salivary levels. Epoxy-coated NiTi followed by copper NiTi archwires might release less nickel compared to conventional NiTi ones.

A comparative evaluation of ion release from different commercially-available orthodontic mini-implants – an in-vitro study

Background

Titanium alloy mini-implants have become popular in recent times and have been extensively used and studied. Although corrosion resistance of orthodontic materials has always been of concern, this property has been the least explored. The present study aimed to assess the composition, surface characterisation and corrosion resistance of five commercially available mini-implants by assaying ion release in artificial saliva.

Methods

Ten mini-implants each from five companies were obtained: Group 1 – AbsoAnchor (Dentos Inc, South Korea); Group 2 – Microimplant Anchorage System (MIA, Biomaterials Korea); Group 3 – The Orthodontic Mini Anchorage System (TOMAS, Dentaurum, Germany); Group 4 – mini-implants (Denticon, Maharashtra, India); Group 5 – orthodontic mini-implants (J.J.Orthodontics, Kerala, India). One mini-implant from each group was subjected to characterisation and surface microstructure analysis using Energy Dispersive Atomic Spectrometry (EDAX) and Scanning Electron Microscope (SEM), respectively. Ten miniimplants were immersed for 30 days in Fusayama-Meyer artificial saliva solution and the release of titanium, aluminium and vanadium ions was detected with Inductively Coupled Plasma - Optical Emission Spectrometry (ICP-OES). The Kruskal-Wallis test was used for multi-variate analysis. In order to determine the significant differences between the groups on independent samples, the Mann-Whitney U test (bi-variate analysis) was applied.

Results and conclusion

All groups showed machining defects but surface pitting after immersion was mostly evident in Group 4. Although the composition of all the implants was comparable, there was a statistically significant difference in the Ti, Al and V release between Group 4 – the group with maximum release – and Group 2, the group with least release.

Release of nickel and chromium ions in the saliva of patients with fixed orthodontic appliance: An in-vivo study

INTRODUCTION

Various components of fixed orthodontic appliances are continuously interacting with saliva and other fluids in the mouth releasing various metal ions including nickel and chromium that can cause damaging effects if their concentration exceeds above the toxic dose.

AIM

To determine and compare the level of nickel and chromium in the saliva of patients undergoing fixed orthodontic treatment at different time periods.

MATERIALS AND METHODS

The sample of saliva of 13 patients was taken at different time periods that is: Group 1 (before appliance placement), Group II, III, and IV (after 1-week, 1-month, and 3 months of appliance placement respectively). The fixed appliance comprised of brackets, bands, buccal tubes, lingual sheath, transpalatal arch and wires composed of Ni-Ti and stainless steel. The level of ions was determined using graphite furnace atomic absorption spectro-photometry. The data thus obtained were statistically analyzed using SPSS Statistical Analysis Software (Version 15.0).

RESULTS

Level of nickel and chromium in saliva was highest in Group II and lowest in Groups I for both the ions. On comparison among different Groups, it was statistically significant for all the groups (<0.001) except between Group III and Group IV.

CONCLUSION

The release of nickel and chromium was maximum at 1-week and then the level gradually declined. These values were well below the toxic dose of these ions. The results should be viewed with caution in subjects with Ni hypersensitivity.

In vivo determination of aluminum, cobalt, chromium, copper, nickel, titanium and vanadium in oral mucosa cells from orthodontic patients with mini-implants by Inductively coupled plasma-mass spectrometry (ICP-MS)

Miniscrews are used as orthodontic anchorage devices in the dentistry clinical practice but the in vivo metallic release from these structures has been not previously investigated. The aim of this study was to determine the content of Al, Co, Cr, Cu, Ni, Ti and V in oral mucosa cells of control subjects, patients under orthodontic treatment and with both, orthodontic treatment and miniscrew, in order to know the contribution of these mini-implants to the total metallic content. ICP-MS measurements revealed the following ascending order: Cr<Ni<Ti<Cu<Al, and Co and V were practically undetected. Significant differences in comparison to the control group were found for Cu in the orthodontic group, and for Ni in both, orthodontic and orthodontic+miniscrew groups. Potential correlations among metallic elements and with some clinical factors were also explored. These findings suggest that miniscrews do not increase significantly the metal release.

Genotoxic and cytotoxic effects and gene expression changes induced by fixed orthodontic appliances in oral mucosa cells of patients: a systematic review

CONTEXT

The accumulation of chronic or severe acute DNA and cellular damage in oral mucosa cells is one of the main factors that help initiate a wide range of malignant lesions in the oral cavity. There has been considerable controversy in the literature about the effect of such sustained genotoxic and cytotoxic damage to oral mucosa cells.

OBJECTIVE

The aim of this systematic review, reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, is to investigate the effects of such interventions.

METHODS

Electronic and manual searches were performed (15 May 2015) for Randomized Clinical Trials/quasi-Randomized Clinical Trials that analyzed the genotoxic/cytotoxic effects of these types of oral appliances in humans. A primary outcome (cell/DNA damage) and a number of secondary outcomes were examined. Two reviewers carried out the study selection and performed a "risk of bias" assessment [Cochrane Collaboration's tool]. Wherever possible the meta-analysis was conducted on homogenous groups.

RESULTS

From the electronic search (2797), 6 studies met the eligibility criteria. Most studies (5/6) observed significant differences in most comparisons at the short-term (1-3 months) and long-term (24-48 months) evaluations, with respect to critically acute genotoxic/cytotoxic effects. Some of the studies (2/3) concluded that the post-removable effects at DNA/cellular levels were not significant (p > 0.05) with respect to the controls.

CONCLUSIONS

Acute DNA/cellular damage in oral mucosa cells is induced by orthodontic appliances. Nevertheless, even though these effects were no longer detected after removing the appliances, more rigorous RCTs are needed to explore the extent to which acquired damage can be observed in the oral mucosa.

In vitro and in vivo evidence of the cytotoxic and genotoxic effects of metal ions released by orthodontic appliances: A review

Intraoral fixed orthodontic appliances are frequently used in the clinical practice of dentistry. They are made from alloys containing different metals at various percentages. The use of these appliances leads to the long-term exposure of patients to these materials, and the potential toxic effects of this exposure raises concerns about patient safety. Thus, the biocompatibility (corrosion behaviour and toxicity) of these materials has to be evaluated prior to clinical use. In the present report, the most recent studies in the scientific literature examining metal ion release from orthodontic appliances and the toxic effects of these ions have been reviewed with a special focus on cytotoxicity and genotoxicity. Previous studies suggest that a case-by-case safety evaluation is required to take into account the increasing variability of materials, their composition and the manufacturing processes. Moreover, in vivo toxicity studies in regard to metal release, cytotoxicity and genotoxicity are still scarce. Therefore, in vitro and in vivo monitoring studies are needed to establish cause-effect relationships between metal ion release and biomarkers of cytotoxicity and genotoxicity. Further investigations could be performed to elucidate the toxic mechanisms involved in the observed effects with a special emphasis on oxidative damage.

Preliminary study of genotoxicity evaluation of orthodontic miniscrews on mucosa oral cells by the alkaline comet assay

Miniscrew implants are widely used nowadays in orthodontic treatments due to their good results in clinical practice. However, data regarding the biocompatibility of commercially available orthodontic miniscrews and temporary devices are very scarce, and their role as genotoxicity inducers has been not previously evaluated with the alkaline comet assay. The aim of this study was to investigate the DNA damage in buccal cells of patients subjected to orthodontic treatments. The alkaline comet assay has been applied in oral mucosa cells from patients treated with conventional orthodontic treatment in comparison to patients treated additionally with miniscrews, non-treated volunteers (control) and smoking volunteers (positive control). The application of orthodontic appliances and miniscrews induced significant and similar (2-fold) increases of %DNA in tail in comparison to control group. Females experienced a significant increase in %DNA in all the treatments in comparison to the control group, whereas males showed significant damage only with the combined orthodontic and miniscrew treatment. In conclusion, conventional orthodontic appliances induced genotoxicity, and the incorporation of miniscrews assayed did not imply any additional increase of DNA damage.

Effects of fixed orthodontic treatment on hair nickel and chromium levels: a 6-month prospective preliminary study

Although nickel and chromium are known as allergen and cytotoxic orthodontic metals, very few and controversial studies have assessed the effect of orthodontic treatment on their systemic levels reflected by their best biomarker of exposure, hair. This prospective preliminary study was conducted to evaluate hair nickel and chromium levels in fixed orthodontic patients. Scalp hair nickel/chromium concentrations of 12 female and 12 male fixed orthodontic patients were measured before treatment and 6 months later, using atomic absorption spectrophotometry. The effects of treatment, gender, and age on hair ions were analyzed statistically (α = 0.05). The patients' mean age was 18.38 ± 3.98 years. The mean nickel levels were 0.1380 ± 0.0570 and 0.6715 ± 0.1785 μg/g dry hair mass, respectively, in the baseline and sixth month of treatment. Chromium concentrations were 0.1455 ± 0.0769 and 0.1683 ± 0.0707 μg/g dry hair mass, respectively. After 6 months, nickel increased for 387 % (paired t test P = 0.0000) and chromium increased for 16 % (P = 0.0002). No significant correlations were observed between any ion levels with age or gender (Spearman P > 0.2). Within the limitations of this preliminary study, it seems that 6 months of fixed orthodontic treatment might increase levels of hair nickel and chromium. Future larger studies are necessary to validate these results.

Effects of fixed orthodontic treatment using conventional versus metal-injection molding brackets on salivary nickel and chromium levels: a double-blind randomized clinical trial

INTRODUCTION

Despite the importance of nickel and chromium release from orthodontic brackets, there are no in vivo or in vitro studies on this issue in the case of metal-injection molding (MIM) brackets.

METHODS

Saliva samples were collected from 30 orthodontic patients divided randomly into two groups of conventional and MIM brackets, before treatment and 2 months later. Approved attendees with odd and even numbers were, respectively, assigned to the control and treatment groups. For blinding, the patients were not informed of their bracket types, and the saliva samples were coded. Nickel and chromium levels were determined using atomic absorption spectrophotometry. Data were analysed using repeated-measures two-way analysis of covariance, independent-samples t-test, chi-squared, Spearman and point-biserial correlation coefficients, Mann-Whitney, and Wilcoxon tests (α = 0.05).

RESULTS

Mean nickel level increased from 7.87±8.14 (pre-treatment) to 12.57±9.96 (2nd month) in the control group, and from 8.62±9.85 (pre-treatment) to 8.86±6.42 µg/l in the MIM group. Both of these increases were significant (Wilcoxon P < 0.03). Average chromium level changed from 0.25±0.56 (pre-treatment) to 0.35±0.62 and from 0.42±0.48 to 0.26±0.57 µg/l in the MIM group. Only the reduction observed in the MIM group was significant (Wilcoxon P = 0.0438). Age and gender had no significant influence on ion levels (P > 0.1). The differences between both ions' levels measured in the 60th day in both bracket groups were not significant (Mann-Whitney P > 0.05). The extents of changes over time were not significantly different between the bracket types (Mann-Whitney P > 0.05).

LIMITATIONS

The sample size was not predetermined based on power calculations. The spectrophotometer was limited to detecting chromium concentrations above 0.25 µg/l. Ion discharge from brackets might continuously change. The current in vivo methods are unable to take such fluctuations into account.

CONCLUSION

Nickel might increase in patients undergoing treatment with both bracket types, although the rate of increase might be greater in patients under treatment with conventional brackets. Using MIM brackets might reduce salivary chromium for a trivial but generalizable amount. Still, ion levels leached from conventional versus MIM brackets might not show a difference after 2 months. Age and gender might not affect the ion levels in normal people or orthodontic patients.

REGISTRATION

The protocol is registered offline at the university library.

PROTOCOL

The protocol was not published before the trail commencement.

FUNDING

Self-funded (S. H.).

CONFLICT OF INTEREST

None to declare.

Modelling of Cr and Ni ions release during orthodontic treatment: in vitro and in vivo methods

The kinetics of metal ions release from orthodontic appliances in in vitro, in in vivo on pigs, and in vivo trials on patients (where hair samples were taken) was discussed. We have evaluated (by means of ICP-OES and ISO 17025) and compared the mass of Cr and Ni ions released. Not all the metal ions released from the appliance were transferred to hair tissue. The transfer factor was expressed as coefficient ω and evaluated as: ωCr(patients) 33.0%, ωCr(pigs) 17.2%, ωNi(patients) 49.8%, ωNi(pigs) 0.553%. The kinetics was described by a power function. Coefficient ω was used to combine the models: the in vitro and in vivo on animals on the one hand and the in vitro and in vivo on human on the other, which enabled the extrapolation of in vitro and translation of the results into in vivo conditions. The dose of metal ions released during orthodontic treatment was estimated.

Possible implications of Ni(II) on oral IL-1β-induced inflammatory processes

OBJECTIVES

Nickel (Ni) is one of the main metal elements in orthodontic and prosthetic devices. Different effects of Ni are described ranging from an induction of local inflammation to allergy and cancerous/mutagenic properties. Inflammatory reactions are frequently observed in the oral cavity, but the interrelationship of Ni with those events is still unknown. Therefore, we focused on the impact of Ni on inflammation in vitro.

METHODS

In accordance to previous immersion tests of our lab, human gingival fibroblasts (HGFs) (n=6) were exposed to a pro-inflammatory environment using interleukin-1 beta (IL-1β) and additionally stimulated with different Ni(II) concentrations (400 and 4000ng/ml). At varying time points the expression of pro- and anti-inflammatory as well as matrix degeneration proteins, i.e. MMPs, were analyzed. Furthermore, proliferation assays, wound healing tests and the detection of NF-κB activation were conducted. Unstimulated HGFs served as control.

RESULTS

Our experiments showed that low clinical average Ni(II) levels did not alter pro-inflammatory cytokines significantly compared to control (p>0.05). Instead, a 10-fold higher dose up-regulated these mediators significantly in a time-dependent manner (p<0.01). This was even more pronounced combining both Ni(II) concentrations with an inflammatory condition (p<0.001), MMP expressions were in line with our findings (p<0.001). The mRNA data were supported by proliferation and wound closure assays (p<0.001). However, the combination of both stimuli induced contradictory results. Analyzing NF-κB activation revealed that our results may be in part attributed to NF-κB.

SIGNIFICANCE

Our in vitro study implicated that Ni(II) has various modifying effects on IL-1β-induced inflammatory processes depending on the concentration.

Biomonitorization of chromium, copper, iron, manganese and nickel in scalp hair from orthodontic patients by atomic absorption spectrometry

The study was aimed to assess Cu, Cr, Fe, Mn and Ni levels in human scalp hair from a broad population group treated with orthodontic appliances (n=70) to determine, whether the concentration of a given metal was significantly influenced by the orthodontic treatment in comparison to control group (n=56). Levels of metal compounds were determined by atomic absorption spectrometry. The mean, ranges, median and 5th and 95th percentiles of metals analyzed in hair that were hypothesized to be systemically absorbed from stainless steel, are provided. The influence of individual factors on metal concentrations was considered (gender, age), and inter-element interactions were studied by evaluation of correlation coefficients between elements, as well as by multiple regression analysis. Differences in the content of metals in hair were only significantly increased for Mn when compared to the control group, but their levels were of the same magnitude to other control populations, and consequently, no risks linked to the treatment have been found. The orthodontic treatment increased significantly Mn levels in young patients (<20 years old) when compared with control group. Scalp hair analysis is a good method to investigate the release of the elements from fixed orthodontic appliances.

The release of metal ions from orthodontic appliances animal tests

OBJECTIVE

To investigate the release of metal ions from an orthodontic appliance in tests on animals (pigs).

MATERIALS AND METHODS

An animal test was conducted on 24 pigs divided equally into an experimental and a control group. In total, 12 sets of experimental orthodontic plates were surgically inserted into pig snouts in the experimental group for 6 months. Noninvasive matrices (hair [0, 3, and 6 months]) and invasive matrices (kidneys, liver, lungs, aorta, and oral mucosa) were collected for multi-elemental analysis (inductively coupled plasma optical emission spectrometry) from the experimental and control groups.

RESULTS

The greatest differences in the content of toxic metals were found in the aorta (Ni level was 4.8 times higher in experimental than in the control group), in the cheek (Ni 3.5 times higher), and in the hair sampled after 3 months (Cr 3.4 times higher).

CONCLUSIONS

The obtained data indicate that the products of corrosion have passed into selected tissues of pigs; however, the doses of toxic metal ions released from the appliance did not reach toxic levels.

Release of metal ions from fixed orthodontic appliance: an in vitro study in continuous flow system

OBJECTIVE

To evaluate the release of metal ions from fixed orthodontic appliances.

MATERIALS AND METHODS

A new system for in vitro testing of dental materials was constructed and consisted of a thermostatic glass reactor that enabled immersion of the studied material. Experimental conditions reflected the human oral cavity, with a temperature of 37°C and a saliva flow rate of 0.5mL/min. The simulated fixed orthodontic appliance made of stainless steel was evaluated. Sampling was performed at several time points during the 28-day study, and the metal ion concentration was determined by inductively coupled plasma optical emission spectrometry.

RESULTS

The total mass of released metal ions from the appliance during 4 weeks of the experiment was as follows nickel 18.7 μg, chromium 5.47 μg, copper 31.3 μg.

CONCLUSIONS

The estimated doses of nickel, chromium, and copper determined by extrapolation of experimental data released during the treatment period were far below the toxic dose to humans. This shows that orthodontic treatment might not be a significant source of exposure to these metal ions.

Effects of long-term fixed orthodontic treatment on salivary nickel and chromium levels: a 1-year prospective cohort study

Effect of long-term orthodontic treatment on salivary nickel and chromium has not been quite assessed except in few retrospective studies with controversial results. The aim of this prospective study was to measure salivary levels of these ions during 1 year of orthodontic treatment. Saliva samples were collected from 20 orthodontic patients, before treatment (control) and 6 and 12 months later. Nickel and chromium concentrations were determined using atomic absorption spectrophotometry. Data were analyzed using one- and two-way repeated-measures ANOVA, Bonferroni, Friedman (α = 0.05), and Wilcoxon signed-ranks tests (α = 0.016). Average nickel level changed from 9.75 ± 5.02 to 10.37 ± 6.94 and then to 8.32 ± 4.36 μg/L in 1 year. Average chromium concentration changed from 3.86 ± 1.34 to 4.6 ± 6.11 and then to 2.04 ± 1.66 μg/L. Alterations in nickel values were not statistically significant [P = 0.468 (ANOVA)], but fluctuations in chromium levels were [P = 0.021 (Friedman)]. The decrease in chromium concentration after 12 months was significant compared to the control [P = 0.004 (Wilcoxon)]. Although slightly increased after 6 months, the concentration of both ions dropped to levels slightly lower than the control groups after 12 months.