[Oral and periodontal hygiene in orthodontic patients]

Comparative analysis of individual oral hygiene during treatment with bracket systems and aligners

Relevance. Individual oral hygiene is the primary way to prevent major dental diseases. Fixed orthodontic appliances (braces) may become a barrier to good individual oral care. Aligners can provide an alternative to braces, allowing adequate toothbrushing when removed.Aim. To compare hygiene levels among patients undergoing orthodontic treatment with conventional bracket systems and aligners.Materials and methods. The study assessed oral hygiene levels at the baseline, two weeks and three months after the beginning of orthodontic treatment. The study used the PHP index to evaluate oral hygiene levels..Results. Three months later, the comparative analysis revealed that 10% of patients with braces had good oral hygiene, 30% had acceptable oral hygiene, and 60% had poor. Twenty per cent of patients with aligners had good oral hygiene, 60% had acceptable oral hygiene, and 20% had poor.Conclusions. Individual oral hygiene level in patients with fixed orthodontic appliances is significantly lower than in patients with removable appliances.

Influence of probiotics on the periodontium, the oral microbiota and the immune response during orthodontic treatment in adolescent and adult patients (ProMB Trial): study protocol for a prospective, double-blind, controlled, randomized clinical trial

Background

Orthodontic treatment with fixed appliances is often necessary to correct malocclusions in adolescence or adulthood. However, oral hygiene is complicated by appliances, and prior studies indicate that they may trigger oral inflammation and dysbiosis of the oral microbiota, especially during the first 3 months after insertion, and, thus, may present a risk for inflammatory oral diseases. In recent periodontal therapeutic studies, probiotics have been applied to improve clinical parameters and reduce local inflammation. However, limited knowledge exists concerning the effects of probiotics in orthodontics. Therefore, the aim of our study is to evaluate the impact of probiotics during orthodontic treatment.

Methods

This study is a monocentric, randomized, double blind, controlled clinical study to investigate the effectiveness of daily adjuvant use of Limosilactobacillus reuteri (Prodentis®-lozenges, DSM 17938, ATCC PTA 5289) versus control lozenges during the first three months of orthodontic treatment with fixed appliances. Following power analysis, a total of 34 adolescent patients (age 12–17) and 34 adult patients (18 years and older) undergoing orthodontic treatment at the University Hospital Erlangen will be assigned into 2 parallel groups using a randomization plan for each age group. The primary outcome measure is the change of the gingival index after 4 weeks. Secondary outcomes include the probing pocket depth, the modified plaque index, the composition of the oral microbiota, the local cytokine expression and—only for adults—serum cytokine levels and the frequencies of cells of the innate and adaptive immune system in peripheral blood.

Discussion

Preventive strategies in everyday orthodontic practice include oral hygiene instructions and regular dental cleaning. Innovative methods, like adjuvant use of oral probiotics, are missing. The aim of this study is to analyse, whether probiotics can improve clinical parameters, reduce inflammation and prevent dysbiosis of the oral microbiota during orthodontic treatment. If successful, this study will provide the basis for a new strategy of prophylaxis of oral dysbiosis-related diseases during treatment with fixed appliances.

Trial registration

This trial is registered at ClinicalTrials.gov in two parts under the number NCT04598633 (Adolescents, registration date 10/22/2020), and NCT04606186 (Adults, registration date 10/28/2020).