Release of bisphenol A from resin composite used to bond orthodontic lingual retainers

Toxicological Impact of Bisphenol A on Females' Reproductive System: Review Based on Experimental and Epidemiological Studies

The study encompassing research papers documented in the last two decades pertaining to the possible influence of bisphenol A (BPA) on the fertility of females are appraised with emphasis on the influence of BPA in reproductive organs (uterus and ovaries) and pregnancy outcomes including discussion on the reproductive process (implantation, estrous cycle, hormone secretion); outcomes reveal a connection amongst BPA and female infertility. Ovary, uterus, and its shape as well as function can alter a person's ability to become pregnant by influencing the hypothalamus-pituitary axis in the ovarian model. Additionally, implantation and the estrous cycle may be affected by BPA. However, more research is warranted to comprehend the underlying action mechanisms and to promptly identify any imminent reproductive harm.

Salivary levels of eluents during Invisalign™ treatment with attachments: an in vivo investigation

BACKGROUND

The aim of the present study was to investigate qualitatively and quantitatively the elution of substances from polyester-urethane (Invisalign™) aligners and resin composite attachments (Tetric EvoFlow) in vivo.

METHODS

Patients (n = 11) treated with the aligners and attachments (16 per patient, without other composite restorations) for an average of 20 months, who were planned for attachment removed were enrolled in the study. Patients were instructed to rinse with 50 mL of distilled water upon entry and the rinsing solution was collected (before removal). Then, the attachments were removed with low-speed tungsten carbide burs for adhesive residue removal, a thorough water rinsing was performed immediately after the grinding process to discard grinding particle residues, and subsequently, after a second water-rinsing the solution was collected for analysis (after removal). The rinsing solutions were analyzed for targeted (LC-MS/MS: Bis-GMA, DCDMA, UDMA, BPA) and untargeted (LC-HRMS: screening of leached species and their degradation products) compounds.

RESULTS

Targeted analysis revealed a significant reduction in BPA after attachment removal (4 times lower). Bis-GMA, DCDMA, UDMA were below the detection limit before removal but were all detectable after removal with Bis-GMA and UDMA at quantifiable levels. Untargeted analysis reviled the presence of mono-methacrylate transformation products of Bis-GMA (Bis-GMA-M1) and UDMA (UDMA-M1), UDMA without methacrylate moieties (UDMA-M2), and 4-(dimethylamino) benzoic acid (DMAB), the degradation product of the photo-initiator ethyl-4-(dimethylamino) benzoate (EDMAB), all after attachment removal. Several amino acids and endogenous metabolites were also found both before and after removal.

CONCLUSIONS

Elevated levels of BPA were traced instantaneously in patients treated with Invisalign™ and flowable resin composite attachments for the testing period. BPA was reduced after attachment removal, but residual monomers and resin degradation products were found after removal. Alternative resin formulations and attachment materials may be utilized to reduce eluents.

Tooth loss as a result of a bonded retainer: a case report

To reduce the risk of unwanted post-treatment changes following orthodontic treatment, use of bonded retainers is gaining popularity. Despite their efficacy and popularity with patients, it has been widely reported that there are significant risks with bonded retainers if they are not maintained and monitored. This case report demonstrates how unwanted tooth movement caused by a bonded retainer can lead to catastrophic failure and ultimately, tooth loss. The importance of active and regular monitoring of bonded retainers is highlighted and recommendations are made to the wider dental community on how to monitor such retainers in clinical practice.

Evaluation of the bisphenol released in the saliva after residual adhesive removal in orthodontic patients by using ultrasonic scaling and rotary system: A single-center randomized clinical trial

INTRODUCTION

Bisphenol A (BPA) is a substance commonly used in dental materials with noxious properties. Monomers of this substance may be dissolved in the saliva and cause adverse effects. This study aimed to evaluate the amount of BPA released in the saliva after residual adhesive removal in orthodontic patients using an ultrasonic scaler (US) and tungsten carbide bur (TCB).

METHODS

This single-center randomized clinical trial was conducted on 40 subjects whose stainless-steel brackets were bonded directly with light-cured bonding and composite. The subjects were randomly divided into 2 equal groups (n = 20) of TCB or US according to the adhesive removal method. The salivary BPA level was determined using high-performance liquid chromatography-mass spectrometry. And adhesive cleaning time was measured by a stopwatch. Data were analyzed by SPSS using an independent t test and paired-samples t test (P <0.05).

RESULTS

The mean salivary BPA level was significantly lower in the TCB method than in the US method. (1.008 ± 0.061 μg/mL and 2.83 ± 0.24 μg/mL, respectively) (P <0.001). The mean adhesive cleanup time was significantly shorter in the TCB method than in the US method (8.86 ± 0.83 minutes and 13.20±1.02 minutes, respectively) (P <0.001).

CONCLUSIONS

According to the results, residual adhesive removal with TCB released less BPA in saliva and shortened the adhesive cleaning time than the US method.

TRIAL REGISTRATION

The trial was registered at the Iranian Registry of Clinical Trials (IRCT20200702047988N1).

PROTOCOL

The protocol was not published before trial commencement.

Analytical Methods for Determination of BPA Released from Dental Resin Composites and Related Materials: A Systematic Review

Knowing the impacts of bisphenol A (BPA) on human health, this systematic review aimed to gather the analytical methods for the quantification of BPA release of BPA in dental materials in in vitro and in vivo (biological fluids) studies. A brief critical discussion of the impacts of BPA on human health and the possible association with BPA in dental materials was also presented. The research was carried out by three independent researchers, (according to PRISMA guidelines) in PUBMED and SCOPUS databases, by searching for specific keywords and articles published between January 2011 and February 2022. Seventeen articles met the eligibility criteria and were included in this systematic review: 10 in vitro and 7 in vivo. In in vitro studies, the highest amounts of BPA released were from flowable to conventional resins, followed by resin-modified glass ionomer. In contrast, the smallest amount was released from "BPA-free" composites and CAD-CAM blocks. Regarding in vivo studies, a higher concentration of BPA were found in saliva than urine or blood. The best analytical method for trace quantifying BPA is LC-MS/MS (Liquid Chromatography with Tandem Mass Spectrometry) due to its selectivity, low quantification limits, and the unequivocal identification. However, further studies are required to develop faster and more sensitive methods, in order to obtain more reliable results.

Monomer release from dental restorative materials containing dimethacrylate resin after bleaching

OBJECTIVE

The aim of this study is to determine the type and amount of monomer released over time after bleaching was applied to dental restorative materials containing dimethacrylate resin.

MATERIALS AND METHODS

Thirteen different restorative materials containing dimethacrylate resin were used in this study. Twenty samples were prepared from each material and the samples were randomly divided into 4 subgroups, namely, office bleaching, home bleaching, and separate control group for each of the bleaching methods. After bleaching, the samples were stored in 75% ethanol solution for 1, 14, and 28 days. Analysis of the samples collected to determine the type and amount of residual monomer released from the materials was performed using a liquid chromatography-tandem mass/mass spectrometer (LC-MS/MS). Data were analyzed using Friedman and Kruskal-Wallis tests. Statistical significance level was taken as p < 0.05.

RESULTS

In terms of bleaching groups, mostly no significant difference was found between the groups in each time period in restorative materials (p > 0.05). In terms of time periods, it was determined that the amount of release of all monomers was decreased over time. In terms of restorative materials, the highest monomer release was detected in composite resin groups and the least monomer release was detected in CAD/CAM blocks.

CONCLUSION

Although monomers were released from all materials, bleaching did not affect the amount of released monomer. Amounts of released monomers were generally below toxic limits.

CLINICAL RELEVANCE

Within the limits of this study, bleaching does not significantly affect monomer release in restorative materials containing dimethacrylate resin.

Monomer Release from Dental Resins: The Current Status on Study Setup, Detection and Quantification for In Vitro Testing

Improvements in mechanical properties and a shift of focus towards esthetic dentistry led to the application of dental resins in various areas of dentistry. However, dental resins are not inert in the oral environment and may release monomers and other substances such as Bisphenol-A (BPA) due to incomplete polymerization and intraoral degradation. Current research shows that various monomers present cytotoxic, genotoxic, proinflammatory, and even mutagenic effects. Of these eluting substances, the elution of BPA in the oral environment is of particular interest due to its role as an endocrine disruptor. For this reason, the release of residual monomers and especially BPA from dental resins has been a cause for public concern. The assessment of patient exposure and potential health risks of dental monomers require a reliable experimental and analytical setup. However, the heterogeneous study design applied in current research hinders biocompatibility testing by impeding comparative analysis of different studies and transfer to the clinical situation. Therefore, this review aims to provide information on each step of a robust experimental and analytical in vitro setup that allows the collection of clinically relevant data and future meta-analytical evaluations.

Bisphenol A release from short-term degraded resin-based dental materials

OBJECTIVES

There is still much debate about the release of bisphenol A (BPA) from resin-based dental materials. Therefore, this study aimed to quantify BPA present as an impurity and to evaluate whether their degradation by salivary, bacterial, and chemical challenges could increase its release.

METHODS

BPA was determined in three different amounts (300, 400, and 500 µg) of eight unpolymerized resin-based materials (four composites, one fissure sealant, two adhesives and one root canal sealer). Next, polymerized samples (n = 5) of each material were immersed in 1 mL of whole human pooled saliva collected from adults, Streptococcus mutans (2 × 10⁷ CFU/mL), and acidic (0.1 M HCl), alkaline (0.1 M NaOH), and control media, respectively. The amount of BPA was quantified using an UPLC-MS/MS method including derivatization of BPA by pyridine-3-sulfonyl chloride.

RESULTS

Only the composites contained trace amounts of BPA above the limit of quantification (ranging from 301±32 pg PBA/mg to 1534±62 pg BPA/mg), most likely as impurity from the synthesis of the monomers. The amounts of BPA released from polymerized materials upon salivary and bacterial degradation were too low for accurate quantification, but in water, quantifiable amounts of BPA were released from all materials. In alkaline media, the BPA release from two composites was significantly decreased, while the release from one adhesive was significantly increased, compared to water.

CONCLUSIONS

BPA already present in unpolymerized resin-based materials may account for the release of BPA after polymerization. There was no clear indication that short-term material degradation leads to increased release of BPA.

Investigation of the Impact of Dental Care via Composite Resin Restoration among Children with Attention Deficit Hyperactivity Disorder: A Registry-Based Nested Case-Control Study

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric conditions. Many studies have shown that exposure to low-dose bisphenol-A (BPA) can contribute to ADHD. The relationship between ADHD and composite resin is still unclear. We designed a nested case-control study to investigate the relationship between ADHD and composite resin restorations among children from the Taiwan's National Health Insurance Research Database. We included 85,503 people whose birth years were between 1998 and 2005 and who received resin restoration from January 2000 to December 2008. A 1:2 matched control sample without ADHD was randomly selected from the database by propensity score matching based on birth year and sex. We identified 4984 individuals as ADHD patients. The average diagnostic age of ADHD was 7.45 years old. The patients who received composite resin restorations had higher risk of ADHD than those who had never received them (aOR (adjusted odds ratio) = 1.25; 95% CI (confidence interval) = 1.13-1.38). Males had a higher risk of ADHD (aOR = 1.29; 95% CI = 1.14-1.43). Taken together, this nested case-control study demonstrated a positive association between ADHD and dental care via composite resin restoration in Taiwanese children. Prospective clinical studies of the relationship between ADHD and composite resin are warranted.

Fixed retention: pitfalls and complications

Long-term stability of orthodontic treatment results is problematic. Long-term or even lifelong retention with bonded retainers is being increasingly used among clinicians. Bonded retainers can provide an efficient and attractive method of retention, particularly because they require minimal compliance from patients. However, the use of bonded retainers is associated with relatively frequent complications, such as detachments of the adhesive layer or wire fractures, as well as unexpected complications with potentially severe consequences with associated periodontal and general health risks. It is imperative that the whole dental team are aware of these pitfalls and complications, and appreciate how to minimise and address these.

An integrative review on the toxicity of Bisphenol A (BPA) released from resin composites used in dentistry

The main aim of this study was to perform an integrative review on the release of bisphenol A (BPA) from resin-matrix composites and potential toxic effects. A bibliographic search was performed on the PubMed platform using the following keywords: "Bisphenol A" OR "BPA" AND "resin composite" OR "composite resin" AND "toxicity" OR "cytotoxicity" OR "release". Inclusion criteria involved in vitro and in vivo studies on the release and toxicity of BPA. Results highlighted the release of BPA from resin-matrix composites due to insufficient polymerization and/or degradation of the polymeric matrix. BPA is part of the organic matrix of resin-matrix composites and may be hydrolysed in human saliva, although studies report that low doses might not be detected by traditional chemical analysis. Studies exposing zebrafish embryos to different concentrations of Bis-GMA, showed 55% mortality at 10 μM Bis-GMA while 30% mortality was recorded at 1 μM Bis-GMA. In patients, a BPA concentration of around 2.09 × 10^-2 μg/ml was found in the saliva after placement of lingual orthodontic retainers with resin-matrix composites. Also, the BPA molecule can be swallowed and absorbed by the oral/gastrointestinal mucosa, which might result in systemic toxicity. The degradation of resin-matrix composites and release of BPA in oral environment are dependent on the organic matrix content and on the polymerization method. A increased release of BPA can lead to the absorption into oral and gastrointestinal mucosa with high risks of local and systemic toxicity.

Effects of Bisphenol A Released From Composite Fillings on Reproductive Hormone Levels in Men

Objectives

Composite resins are the most preferred filling material because of their excellent aesthetic qualities. However, a filling material should also be biocompatible as well as aesthetic. The aim of this study was to determine the serum and saliva bisphenol-A (BPA) levels and to examine the effects of serum BPA on reproductive hormone levels after healthy men were treated with composite fillings.

Methods

Eighteen healthy males each received 2 composite restorations. Saliva and blood samples of subjects were collected before resin application and 1 day and 1, 3, and 5 weeks after the resin was applied. BPA amounts in samples were detected using high-performance liquid chromatography (HPLC). Serum gonadotropins, testosterone, sex hormone binding globulin, free androgen index, and oestrogen levels were measured with radioimmunological assay kits. Statistical analysis of data was made using Friedman, Wilcoxon signed ranks and Mann-Whitney U tests (α = 0.05).

Results

The amount of BPA released from composite resins over time was not significantly elevated in either saliva or serum (P > 0.5). In addition, serum BPA levels were significantly higher than saliva BPA levels for both composites (P < .05), but saliva and serum BPA levels were not statistically different when comparing the 2 composites (P > .05).

Conclusions

BPA from composite resins used in this study did not significantly alter serum hormone levels.

Release and toxicity of bisphenol-A (BPA) contained in orthodontic adhesives: A systematic review

OBJECTIVE

The objectives of this systematic review of the literature are to search for BPA release from biomaterials used in orthodontics and to highlight their possible impact on human health.

MATERIALS AND METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model, digital and manual searches were conducted in February 2020 in the database of CENTRAL, MEDLINE and EMBASE. Thirteen parameters relating to the release and biological effects of BPA were identified and analysed.

RESULTS

Thirty-one non-randomized clinical trials were included. In general, the level of evidence was low, and the risk of bias ranged from moderate to high. Furthermore, although at different concentrations, most of in vitro and in vivo studies found BPA release from orthodontic adhesives. The lack of standardized protocols and the clinical and methodological heterogeneity of the studies prevented a valid interpretation of the actual results. Concerning the possible toxicity of BPA, no conclusive scientific evidence could be drawn, but it seems that orthodontic biomaterials containing BPA have potential adverse biological effects in humans.

DISCUSSION AND CONCLUSION

Until we have solid evidence from clinical trials, clinicians should consider that orthodontic adhesives containing BPA have potential short- and long-term adverse biological effects in humans. Careful consideration should therefore be given to bonding, polymerization and debonding protocols in orthodontics.

Risk assessment of predicted serum concentrations of bisphenol A in children and adults following treatment with dental composite restoratives, dental sealants, or orthodontic adhesives using physiologically based pharmacokinetic modeling

Bisphenol A (BPA) is a chemical used to manufacture bisphenol A glycidyl methacrylate (BisGMA). BisGMA has been used for decades in dental composite restoratives, sealants, and adhesives. Based on published studies, exposure to low concentrations of BPA are possible from dental and orthodontic devices. The serum BPA concentrations arising from such devices and oral doses were predicted using a PBPK model in children and adult females based on 1) published extraction data for cured and uncured 3M ESPE Filtek Supreme Ultra Flowable, 3M ESPE Filtek Bulk Fill Restorative, and 3M ESPE Clinpro Sealant and 2) published 20% ethanol/water and water rinsate data following orthodontic application with 3M ESPE Transbond MIP Primer and 3M ESPE Transbond XT Adhesive. Predicted oral exposure to BPA arising from these dental and orthodontic devices is low (median <10 ng/treatment) and predicted serum BPA concentrations were also low (<10^-4 nM). Even the maximum predicted exposure in this study (533.2 ng/treatment) yields a margin of exposure of 7.5 relative to the EFSA t-TDI (4 μg/kg-day) and is only 2.8% of the daily BPA exposure for the US population in a 58-kg woman (15,660 ng/day). Therefore, the exposure to BPA arising from the 3M ESPE dental and orthodontic devices evaluated in this study is negligible relative to daily BPA exposure in the general population and these potential BPA sources do not constitute a risk to patients.

Safety Considerations for Thermoplastic-Type Appliances Used as Orthodontic Aligners or Retainers. A Systematic Review and Meta-Analysis of Clinical and In-Vitro Research

Use of thermoplastic material in orthodontics, either as aligner or as retainer appliances, is common practice and is likely to increase in the years to come. However, no systematic assessment on safety considerations of these adjuncts has been implemented up to date. The aim of this systematic review was to collectively appraise the existing evidence from both clinical and laboratory studies, on whether these appliances are associated with any estrogenic/cytotoxic effects or bisphenol-A (BPA) and monomer leaching. Eight electronic databases were searched with no limits in December 22, 2019, for published and unpublished research. Eligibility criteria comprised of studies of any design, describing use of any type of thermoplastic aligner. Study selection, data extraction and risk of bias (RoB) assessment was done independently, either in duplicate or confirmed by a second reviewer. Random effects meta-analyses of weighted mean differences (WMD) with associated 95% Confidence Intervals (CIs) were planned. Quality of the evidence was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 58 articles were initially identified, while 5 were included in qualitative synthesis and 2 of those contributed to the quantitative syntheses. Four studies were in-vitro, while one was a randomized controlled trial; all assessed some type of orthodontic aligner or retainer, either as-received or retrieved. Risk of bias recordings ranged between unclear and high for all studies. Proliferation induction capacity of thermoplastic appliances' eluents on MCF-7 cells failed to be confirmed compared to beta-estradiol (2 studies: 5% v/v, WMD: -182.08; 95% CI: -198.83, -165.33; p-value < 0.001; and 20% v/v, WMD: -184.53; 95% CI: -206.17, -162.88; p-value < 0.001). No cytotoxic activity was detected as well. In addition, although evidence from in-vitro studies was indicative of no traceable detection of BPA or other monomers, the findings from a single clinical trial were allied to increased levels of BPA in whole stimulated saliva, after up to 30 days of thermoplastic retainer usage, compared to standard Hawley retainer. The quality of the evidence overall was low to medium. Current data from in-vitro research are indicative of an absence of an estrogenic or cytotoxic effect of thermoplastic aligners or retainers. Regarding BPA or monomer release, evidence from clinical and laboratory studies appear inconsistent.

Bisphenol A in human saliva and urine before and after treatment with dental polymer-based restorative materials

The aim of this study was to quantify bisphenol A (BPA) concentrations in saliva and urine before and after treatment with dental polymer-based restorative materials to assess if placement of this material is associated with increased BPA levels in saliva and urine. Twenty individuals in need of at least one dental restoration with polymer-based restorative material were included in this study. The participants were instructed to abstain from eating, drinking, and brushing their teeth for at least 10 h prior to sampling. Saliva and urine were collected before and 10 min (saliva only), 1 h, 24 h, and 1 wk after treatment. Samples were stored at -80°C before analyses. BPA in saliva and urine was determined with liquid chromatography/mass spectrometry. Linear mixed effects regression models were used for statistical analyses. There was a statistically significant increase of salivary BPA concentration directly after placement of the dental polymer-based restorations. Following placement, the concentration of BPA decreased exponentially with time. One week after treatment the BPA level in saliva was only marginally higher than before treatment. In urine, no statistically significant change of the BPA concentration was detected after treatment.

Once Resin Composites and Dental Sealants Release Bisphenol-A, How Might This Affect Our Clinical Management?-A Systematic Review

(1) Background: Bisphenol A (BPA) based dental resins are commonly used in preventive and reparative dentistry. Since some monomers may remain unpolymerized in the application of dental resin, they dissolve in the saliva. (2) Methods: The literature search was carried out in Pubmed, Cochrane and Embase databases. Randomized controlled trials, cohort studies and case-control studies that evaluated BPA levels in human urine, saliva and/or blood were included. (3) Results: The initial search had 5111 results. A total of 20 studies were included in the systematic review. Most studies showed an increase of the levels of bisphenol A 1 h after treatments with composite resins and dental sealants. One week after treatments the levels were decreased. (4) Conclusions: Some clinical precautions should be taken to decrease the release of BPA, namely the use of rubber dam, the immediate polishing of all resins used, or the use of glycerin gel to avoid non-polymerization of the last resin layer, and mouthwash after treatment. Another preventive measure in addition to the above-mentioned is the use of the smallest possible number of restorations or sealants, a maximum of four per appointment. These measures are even more important in children, adolescents and pregnant women.

A Systematic Review of Exposure to Bisphenol A from Dental Treatment

INTRODUCTION

Dental composite restorations and dental sealants containing bisphenol A glycidyl methacrylate (BisGMA) are commonly used materials in dentistry. Bisphenol A (BPA) is used to manufacture BisGMA and can be a by-product in BisGMA-based dental materials. BPA is an endocrine-disrupting chemical that may affect reproductive, psychological, cognitive, and endocrine-related health. We conducted a systematic review of clinical studies that measured urinary BPA (uBPA) concentrations before and after dental treatment to evaluate the extent to which individuals are exposed to BPA from dental treatment.

METHODS

Eligibility included studies that measured uBPA concentrations before and after dental treatment with any type of resin-based dental material. We searched PubMed, Cochrane, Web of Science, Virtual Health Library, Science Direct, ProQuest, and Clinical Trials with no date or language restrictions to identify published studies. We summarized eligible studies across participant characteristics, amount of treatment, and time of follow-up measures. Because methods of measuring uBPA varied, our primary outcome was the direction and percentage change between baseline and 24 h posttreatment and at later time points as available.

RESULTS

We identified 1,190 abstracts and 7 eligible studies: 4 in children and 3 in adults. In all studies, BPA concentrations increased 24 h after treatment. The 2 studies with the largest sample sizes found statistically significant increases >40% in uBPA concentrations at 24 h posttreatment (both P values <0.01). The 1 study to examine uBPA concentrations beyond 1 mo posttreatment found that concentrations returned to baseline by 14 d after treatment and remained at baseline 6 mo after treatment.

CONCLUSIONS

Our findings suggest that uBPA concentrations increase 24 h after dental treatment. One study showed that uBPA concentrations return to baseline by 14 d. Additional research is needed to determine the magnitude of change from pre- to post-dental treatment and the trajectory of uBPA concentrations posttreatment.

KNOWLEDGE TRANSFER STATEMENT

BPA is an endocrine-disrupting chemical that may have negative human health effects. Our findings suggest that urinary BPA concentrations increase in the short term after dental treatment. The extent to which such an increase may affect the health of patients remains an open question, particularly since there are no established thresholds for safety or harm related to BPA exposure.

High-performance liquid chromatography analysis of salivary bisphenol A levels from light-cured and chemically cured orthodontic adhesives

INTRODUCTION

Our objective was to assess the levels of bisphenol A (BPA) released from light-cured and chemically cured resins used for orthodontic bracket bonding in 1 month.

METHODS

Saliva specimens were obtained at 5 time periods from 40 healthy patients treated with orthodontic mechanotherapeutics. The periods of collections were just before bonding orthodontic brackets, followed by 30 minutes, 1 day, 1 week, and 1 month after orthodontic bonding. The specimens were analyzed with the high-performance liquid chromatography/mass spectrometry method for quantitative evaluation of BPA levels.

RESULTS

We observed a large increase in BPA levels 30 minutes after orthodontic bonding in the 2 groups. Thereafter, there was sudden decline in BPA levels as time passed, and the levels reached a statistically significant level at 1 month after orthodontic bonding. Interestingly, the amount of BPA released from chemically cured resin was much higher; this was also significant statistically compared with light-cured resins.

CONCLUSIONS

The results of this in-vivo approach with high-performance liquid chromatography on salivary specimens confirmed continued release of BPA after bonding brackets for 1 month, although in smaller quantities. The release during the initial 30 minutes is high, making it essential to introduce measures to dilute it for better patient safety.

Mechanical and hydrolytic degradation of an Ormocer®-based Bis-GMA-free resin composite

OBJECTIVES

The aim of the study was to evaluate the mechanical stability of bisphenol A-glycidyl methacrylate (Bis-GMA) and Ormocer-based resin composites before and after water absorption and to examine water saturation.

MATERIAL AND METHODS

Disc-shaped specimens of the Bis-GMA (Grandio SO, Voco) and the Ormocer-based (Admira Fusion, Voco) dental resin composites were produced, stored in water, and weighed after pre-determined times to measure the absorbed water. Bend bars were produced and stored for 24 h in dry conditions as well as in distilled water for 14 days or 60 days at 37 °C. The initial flexural strength (FS) under quasi-static loading and flexural fatigue strength (FFS) under cyclic loading were determined under 4-point bending. Fracture toughness (K_Ic) of both composites was measured using the single-edge-V-notch-beam (SEVNB) technique after the same storage conditions under 3-point bending.

RESULTS

Within the first 14 days, storage conditions did not affect the initial FS of Grandio SO, while a significant drop in initial FS was observed for Admira Fusion after 2 weeks in water and most of the water was absorbed within this time. FFS for the Bis-GMA composite was not reduced before 2 months in water, whereas for the Ormocer®-based composite, there has been a significant decrease in strength after cyclic fatigue already at 2 weeks of water storage. K_Ic of Admira Fusion decreased significantly after both storage periods, while K_Ic of Grandio SO decreased only significantly after 2 weeks of water storage.

CONCLUSION

All mechanical properties of the Bis-GMA composite were superior to those of the Ormocer®-based material, except water sorption.

CLINICAL SIGNIFICANCE

Water storage seems to have a much more pronounced effect on the mechanical properties of Ormocer®-based dental composites in comparison to Bis-GMA-based composites.

Association between polymorphisms in genes encoding estrogen receptors (ESR1 and ESR2) and excreted bisphenol A levels after orthodontic bracket bonding: a preliminary study

Background

Bisphenol A (BPA) is released from orthodontic composites used for bracket bonding. Genetic variations could modify the metabolism of this chemical within the organism. Considering that free BPA binds to estrogen receptors causing harmful effects to health, the present in vivo study aimed to evaluate the association between genetic polymorphisms in genes encoding estrogen receptors (ESR1 and ESR2) and excreted BPA levels in orthodontic patients.

Methods

Quantification of BPA levels in the urine of 16 patients was performed in a gas chromatograph mass spectrometer before (T0), at 24 h (T1), and 1 week (T2) after bracket bonding. DNA was extracted from saliva, and one genetic polymorphism in ESR1 (rs2234693) and two in ESR2 (rs4986938 and rs1256049) were analyzed by real-time PCR. Increases in BPA levels in the urine at T1 and T2 were grouped according to the genotype, and mean differences were compared by unpaired T test or Mann-Whitney test according to the normality of the data. The established alpha was 5%.

Results

BPA levels increased significantly at T1 and T2. There were no statistically significant differences in the increases in BPA levels according to the genotype for any genetic polymorphism (P > 0.05), at neither 24 h nor 1 week after bracket bonding.

Conclusions

The results suggested that there are no association between excreted BPA levels after bracket bonding and the evaluated genetic polymorphisms in ESR1 and ESR2. Further research should be performed in order to confirm these results.

A novel high sensitivity UPLC-MS/MS method for the evaluation of bisphenol A leaching from dental materials

There is a growing necessity to acquire more profound knowledge on the quantity of eluates from resin-based dental materials, especially with regard to bisphenol A (BPA). The aim of the present study was to develop a highly sensitive method to characterize the short-term release of BPA in saliva with ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), using an extraction step and additional derivatization of BPA with pyridine-3-sulfonyl chloride. Light-cured resin-based composites were incubated at 37 °C in 1 mL artificial saliva, which was refreshed daily for one week. The final protocol allows accurate quantification of very low levels of BPA in samples of artificial saliva (i.e. 1.10 pmol BPA/mL or 250 pg/mL). The daily BPA-release from dental composites, ranging from 1.10 to 7.46 pmol BPA/mL, was characterized over a period of 7 days. The highest total amount of BPA was released from Solitaire 2 (24.72 ± 2.86 pmol), followed by G-ænial Posterior (15.51 ± 0.88 pmol) and Filtek Supreme XTE (12.00 ± 1.31 pmol). In contrast, only trace amounts of BPA were released from Ceram.x Universal. This UPLC-MS/MS method might be used for clinical research focusing on the evaluation of the clinical relevance of BPA release from dental materials.

Antibacterial and remineralization effects of orthodontic bonding agents containing bioactive glass

Objective

The aim of this study was to evaluate the mechanical and biological properties of orthodontic bonding agents containing silver- or zinc-doped bioactive glass (BAG) and determine the antibacterial and remineralization effects of these agents.

Methods

BAG was synthesized using the alkali-mediated solgel method. Orthodontic bonding agents containing BAG were prepared by mixing BAG with flowable resin. Transbond™ XT (TXT) and Charmfil™ Flow (CF) were used as controls. Ion release, cytotoxicity, antibacterial properties, the shear bond strength, and the adhesive remnant index were evaluated. To assess the remineralization properties of BAG, micro-computed tomography was performed after pH cycling.

Results

The BAG-containing bonding agents showed no noticeable cytotoxicity and suppressed bacterial growth. When these bonding agents were used, demineralization after pH cycling began approximately 200 to 300 µm away from the bracket. On the other hand, when CF and TXT were used, all surfaces that were not covered by the adhesive were demineralized after pH cycling.

Conclusions

Our findings suggest that orthodontic bonding agents containing silver- or zinc-doped BAG have stronger antibacterial and remineralization effects compared with conventional orthodontic adhesives; thus, they are suitable for use in orthodontic practice.

Bisphenol A release from orthodontic adhesives measured in vitro and in vivo with gas chromatography

INTRODUCTION

The objectives of this study were to quantify in vitro the Bisphenol A (BPA) release from 5 orthodontic composites and to assess in vivo the BPA level in patients' saliva and urine after bracket bonding with an orthodontic adhesive system.

METHODS

For the in-vitro portion of this study, 5 orthodontic composites were evaluated: Eagle Spectrum (American Orthodontics, Sheboygan, Wis), Enlight (Ormco, Orange, Calif), Light Bond (Reliance Orthodontic Products, Itasca, Ill), Mono Lok II (Rocky Mountain Orthodontics, Denver, Colo), and Transbond XT (3M Unitek, Monrovia, Calif). Simulating intraoral conditions, the specimens were immersed in a water/ethanol solution, and the BPA (ng.g^-1) liberation was measured after 30 minutes, 24 hours, 1 day, 1 week, and 1 month by the gas chromatography system coupled with mass spectrometry. Twenty patients indicated for fixed orthodontic treatment participated in the in-vivo study. Saliva samples were collected before bracket bonding and then 30 minutes, 24 hours, 1 day, 1 week, and 1 month after bonding the brackets. Urine samples were collected before bonding and then at 1 day, 1 week, and 1 month after bonding. The results were analyzed statistically using analysis of variance and Tukey posttest, with a significance level of 5%.

RESULTS

All composites evaluated in vitro released small amounts of BPA. Enlight composite showed the greatest release, at 1 month. Regarding the in-vivo study, the mean BPA level in saliva increased significantly only at 30 minutes after bonding in comparison with measurements recorded before bonding.

CONCLUSIONS

All orthodontic composites released BPA in vitro. Enlight and Light Bond had, respectively, the highest and lowest BPA releases in vitro. The in-vivo experiment showed that bracket bonding with the Transbond XT orthodontic adhesive system resulted in increased BPA levels in saliva and urine. The levels were significant but still lower than the reference dose for daily ingestion.

Salivary bisphenol A levels and their association with composite resin restoration

Composite resin has been increasingly used in an effort to remove minimal amount of tooth structure and are used for restoring not just carious cavities but also cervical abrasion. To synthesize composite resin, bisphenol A (BPA) is used. The aim of the study was to measure the changes in salivary BPA level related with composite resin restoration. ELISA was used to examine the BPA levels in the saliva collected from 30 volunteers whose teeth were filled with composite resin. Salivary samples were collected immediately before filling and 5 min and 7 d after filling. Wilcoxon signed-ranks test and linear regression were performed to test the significant differences of the changes in BPA levels in saliva. Before a new composite resin filling, there was no significant difference between with and without existing filling of composite resin and BPA level in the saliva was not correlated to the number of filled surfaces with composite resin. However, BPA level in the saliva increased to average 3.64 μg/L from average 0.15 μg/L after filling 5 min. BPA level increased in proportion with the number of filled surfaces. BPA level decreased to average 0.59 after filling 7 d. However it was higher than the BPA level before a new composite resin filling. Considering 50 μg/kg/day as the Tolerable Daily Intake of BPA suggested by European Food Safety Authority, the amount of BPA eluted in saliva after the composite resin filling is considered a safe level that is not a hazard to health at all.

Release of monomers from orthodontic adhesives

INTRODUCTION

Most composite resins release both bisphenol A (BPA), which disrupts the endocrine balance, and triethylene glycol dimethacrylate (TEGDMA), which has high risks for human health: eg, allergies and cytotoxicity. The aim of this study was to characterize monomers released from orthodontic adhesives.

METHODS

We studied samples of orthodontic adhesives by associating 2 techniques: gas phase chromatography and mass spectrometry.

RESULTS

The in-vitro analysis detected significant quantities of BPA, TEGDMA, and other monomers in orthodontic adhesives used in daily practice: Transbond XT, Transbond Supreme LV (both, 3M Unitek, Monrovia, Calif), Blugloo (Ormco, Orange, Calif), and MonoLok 2 (Rocky Mountain Orthodontics, Denver, Colo).

CONCLUSIONS

Clinicians should consider that orthodontic adhesives contain BPA, an endocrine disruptor; TEGDMA, an allergic and a cytotoxic compound; and carcinogenic genotoxic compounds. These molecules are not mentioned in the material safety data sheets. Manufacturers should declare all components of dental composites to identify these substances that may result in allergic or undesirable side effects for patients and dental staff.

Including non-dietary sources into an exposure assessment of the European Food Safety Authority: The challenge of multi-sector chemicals such as Bisphenol A

In the most recent risk assessment for Bisphenol A for the first time a multi-route aggregate exposure assessment was conducted by the European Food Safety Authority. This assessment includes exposure via dietary sources, and also contributions of the most important non-dietary sources. Both average and high aggregate exposure were calculated by source-to-dose modeling (forward calculation) for different age groups and compared with estimates based on urinary biomonitoring data (backward calculation). The aggregate exposure estimates obtained by forward and backward modeling are in the same order of magnitude, with forward modeling yielding higher estimates associated with larger uncertainty. Yet, only forward modeling can indicate the relative contribution of different sources. Dietary exposure, especially via canned food, appears to be the most important exposure source and, based on the central aggregate exposure estimates, contributes around 90% to internal exposure to total (conjugated plus unconjugated) BPA. Dermal exposure via thermal paper and to a lesser extent via cosmetic products may contribute around 10% for some age groups. The uncertainty around these estimates is considerable, but since after dermal absorption a first-pass metabolism of BPA by conjugation is lacking, dermal sources may be of equal or even higher toxicological relevance than dietary sources.

A systematic study of the release of bisphenol A by orthodontic materials and its biological effects

INTRODUCTION

Bisphenol A (BPA) is a synthetic chemical substance used as a starting ingredient in the manufacturing process of a number or orthodontic materials. It is a well-known endocrine disruptor with low estrogenic properties. The aim of this investigation is to present a systematic review regarding the issue of bisphenol A release by orthodontic materials and its impact in orthodontics.

MATERIALS AND METHODS

A systematic analysis was performed by electronic search (between 1936 and 2015) on several data bases. The search was limited by using several specific key-words in two languages, English and French. Two investigators selected the responses, which met the selection criteria.

RESULTS AND DISCUSSION

Of the 376 studies found, only 21 met our selection criteria: 11 of these dealt with the release of bisphenol by orthodontic materials and 10 in vitro studies described the effects of BPA leaching from orthodontic materials on human and murine cells. The rate of BPA release was well below the daily tolerable intake (DTI) (50mg/kg/day in 2006, then 50μg/kg/day in 2015) according to the European Food Safety Authority (EFSA). Theoretical exposure to BPA was 11,000 times lower than recommendations. However, other studies have shown the presence of BPA and of monomers released in large quantities at very low doses. The effects of observed BPA varied significantly (toxic and carcinogenic potential) while some studies found no effects at all. The relatively small number of studies dealing with the release of Bisphenol A by orthodontic materials, apart from orthodontic materials and their significant biological effects, has led to the absence of standard protocols and has hindered precise determination of released BPA. Moreover, the lack of coherence between the various methodological approaches and variations in the experimental protocols have resulted in a low level of proof regarding the impact of BPA by orthodontic materials.

RECOMMENDATIONS

Through this study, the authors encourage clinicians to observe the following recommendations designed to reduce the amount of BPA released by materials used in orthodontics: keep the tip of the light-curing lamp as close as possible to the composite and perform indirect rather than direct light-curing; Pumice-polish the composite after bonding so as to reduce the potential amount of BPA released; reduce exposure by brushing or rinsing with a mouthwash during the first hour after bonding; follow a standardized, reproducible and expert-validated research protocol aimed at better understanding of BPA release.

Viscoelastic properties of orthodontic adhesives used for lingual fixed retainer bonding

OBJECTIVE

To evaluate the viscoelastic properties of two experimental BPA-free and one BisGMA-based orthodontic resin composite adhesives for bonding fixed retainers.

METHODS

A commercially available BisGMA-based (TXA: Transbond LR) and two bisphenol A-free experimental adhesives (EXA and EXB) were included in the study. The viscoelastic behavior of the adhesives was evaluated under static and dynamic conditions at dry and wet states and at various temperatures (21, 37, 50°C). The parameters determined were shear modulus (G), Young's modulus (E) under static testing and storage modulus (G₁), loss tangent (tanδ) and dynamic viscosity (n*) under dynamic testing. Statistical analysis was performed by 2-way ANOVA and Bonferroni post-hoc tests (α=0.05).

RESULTS

For static testing, a significant difference was found within material and storage condition variables and a significant interaction between the two independent variables (p<0.001 for G and E). EXA demonstrated the highest G and E values at 21°C/dry group. Dry specimens showed the highest G and E values, but with no significant difference from 21°C/wet specimens, except EXA in G. Wet storage at higher temperatures (37°C and 50°C) adversely affected all the materials to a degree ranging from 40 to 60% (p<0.001). For dynamic testing, a significant difference was also found in material and testing condition groups, with a significant interaction between the two independent variables (p<0.001 for G₁ and n*, p<0.01 for tanδ). Reduction in G₁, and n* values, and increase in tanδ values were encountered at increased water temperatures.

SIGNIFICANCE

The apparent detrimental effect of high temperature on the reduction of properties of adhesives may contribute to the loss of stiffness of the fixed retainer configuration under ordinary clinical conditions with unfavorable effects on tooth position and stability of the orthodontic treatment result.

Development and testing of novel bisphenol A-free adhesives for lingual fixed retainer bonding

AIM

To comparatively evaluate the properties of two BPA-free experimental adhesives (EXA, EXB) for lingual fixed retainer bonding versus a commercially available reference material (Transbond LR-TLR) based on BPA-compound.

MATERIALS AND METHODS

The experimental materials were a flowable 60 per cent glass filler-filled UEDMA/TEGDMA flowable composite (EXB) and a 70 per cent glass filler-filled paste composite with PCDMA/UEDMA/TEGDMA co-monomers. The properties tested were degree of conversion (DC%), mechanical properties (Martens hardness-MH, elastic modulus-E_IT, elastic index-n_IT), effect of prolonged (6 months) water storage (changes in Vickers microhardness-VHN) and pull-out strength employing a multi-stranded wire.

RESULTS

EXB showed the highest DC% (63.6 per cent), followed by EXA (50.5 per cent) and TRL (44.1 per cent), with all means differences being statistically significant (P < 0.05). The statistical rankings of MH (MPa) and E_IT (GPa) means were TLR (76.1MPa; 17.3GPa) > EXA (53MPa; 12.9GPa) > EXB (12.9MPa; 6.7GPa), whereas for n_IT, EXB (40 per cent) > EXA (34.9 per cent), TLR (33.6 per cent). All materials were affected by prolonged water storage with significant differences among them in VHN. TLR was the most affected material (ΔVHN = -11 per cent), followed by EXA (ΔVHN = -6.8 per cent) and EXB (ΔVHN = -4.2 per cent). No statistically significant differences were found in the pull-out strength testing (24-24.2 N range) and failure mode (70-77 per cent mixed).

CONCLUSION

Considering the differences between the two experimental materials, it may be concluded that the material containing the PCDMA/UEDMA/TEGDMA co-monomers may be used as an alternative to the control.

BPA qualtitative and quantitative assessment associated with orthodontic bonding in vivo

OBJECTIVE

To assess the in vivo amount of BPA released from a visible light-cured orthodontic adhesive, immediately after bracket bonding.

METHODS

20 orthodontic patients were recruited after obtaining informed consent. All patients received 24 orthodontic brackets in both dental arches. In Group A (11 patients), 25 ml of tap water were used for mouth rinsing, whereas in Group B (9 patients) a simulated mouth rinse formulation was used: a mixture of 20 ml de-ionized water plus 5 ml absolute ethanol. Rinsing solutions were collected before, immediately after placing the orthodontic appliances and after washing out the oral cavity and were then stored in glass tubes. Rinsing was performed in a single phase for 60s with the entire volume of each liquid. The BPA analysis was performed by gas chromatography-mass spectrometry.

RESULTS

An increase in BPA concentration immediately after the 1st post-bonding rinse was observed, for both rinsing media, which was reduced after the 2nd post-bonding rinse. Water exhibited higher levels of BPA concentration than water/ethanol after 1st and 2nd post-bonding rinses. Two-way mixed Repeated Measures ANOVA showed that the primary null hypothesis declaring mean BPA concentration to be equal across rinsing medium and rinsing status was rejected (p-value <0.001). The main effects of the rinsing medium and status, as well as their interaction were found to be statistically significant (p-values 0.048, <0.001 and 0.011 respectively).

SIGNIFICANCE

A significant pattern of increase of BPA concentration, followed by a decrease that reached the initial values was observed. The amount of BPA was relatively low and far below the reference limits of tolerable daily intake.

Adverse effects of bisphenol A on male reproductive function

BPA is a ubiquitous environmental contaminant, resulting mainly from manufacturing,use or disposal of plastics of which it is a component, and the degradation of industrial plastic-related wastes. Growing evidence from research on laboratory animals, wildlife, and humans supports the view that BPA produces an endocrine disrupting effect and adversely affects male reproductive function. To better understand the adverse effects caused by exposure to BPA, we performed an up-to-date literature review on the topic, with particular emphasis on in utero exposure, and associated effects on spermatogenesis, steroidogenesis, and accessory organs.BPA studies on experimental animals show that effects are generally more detrimental during in utero exposure, a critical developmental stage for the embryo. BPA has been found to produce several defects in the embryo, such as feminization of male fetuses, atrophy of the testes and epididymides, increased prostate size, shortening of AGD, disruption of BTB, and alteration of adult sperm parameters (e.g.,sperm count, motility, and density). BPA also affects embryo thyroid development.During the postnatal and pubertal periods and adulthood, BPA affects the hypothalamic-pituitary-testicular axis by modulating hormone (e.g., LH and FSH,androgen and estrogen) synthesis, expression and function of respective receptors(ER, AR). These effects alter sperm parameters. BPA also induces oxidative stress in the testis and epididymis, by inhibiting antioxidant enzymes and stimulating lipid peroxidation. This suggests that employing antioxidants may be a promising strategy to relieve BPA-induced disturbances.Epidemiological studies have also provided data indicating that BPA alters male reproductive function in humans. These investigations revealed that men occupationally exposed to BPA had high blood/urinary BPA levels, and abnormal semen parameters. BPA-exposed men also showed reduced libido and erectile ejaculatory difficulties; moreover, the overall BPA effects on male reproduction appear to be more harmful if exposure occurs in utero. The regulation of BPA and BPA-related products should be reinforced, particularly where exposure during the fetal period can occur. The current TDI for BPA is proposed as 25 and 50 1-1g/kg bwt/day (European Food Safety Authority and Health Canada, respectively). Based on the evidence available, we believe that a TDI value of 5 1-1g/kg bwt/day is more appropriate (the endpoint is modulation of rat testicular function). Certain BPA derivatives are being considered as alternatives to BPA. However, certain of these related products display adverse effects that are similar to those of BPA. These effects should be carefully considered before using them as final alternatives to BPA in plastic production.