The periodontal status of removable appliances vs fixed appliances: A comparative meta-analysis

Progress in Biomaterials and Technologies in Dentistry

The field of dental biomedicine continues to evolve with significant advancements that are aimed at improving oral health outcomes [...].

The Influence of Orthodontic Treatment on Periodontal Health between Challenge and Synergy: A Narrative Review

By correctly repositioning teeth, orthodontic therapy improves both the function and appearance of an occlusion. The relationship between teeth and the tissues that surround and support them significantly influences these alterations. With ever more adults seeking orthodontic care, orthodontists are increasingly seeing patients with periodontal issues. Concerns about the patient's appearance, such as uneven gingival margins or functional issues caused by inflammatory periodontal diseases, should be accounted for when designing orthodontic treatment plans. Furthermore, orthodontics may increase the chances of saving and recovering a degraded dentition in cases of severe periodontitis. Today, general dentists, dontists, and orthodontists play integrative roles that enable them to achieve the best possible results for their patients. This review will improve the results of interdisciplinary treatments and increase cooperation between dental specialists by drawing attention to the essential connection between orthodontics and periodontics in regular clinical practice.

Impact of Clear Aligners on Oral Health and Oral Microbiome During Orthodontic Treatment

The demand for clear aligners has risen over the past decade because they satisfy patients' desire for less noticeable and more comfortable orthodontic appliances. Because clear aligners are increasingly used in orthodontics, there is a big push to learn more about the physiologic and microbial changes that occur during treatment. The present work highlighted further links between clear aligners and changes in oral health and the oral microbiome and provided plaque control methods for clear aligner trays. Existing literature revealed that clear aligners have no significant influence on the structure of the oral microbiome during orthodontic therapy. Clear aligner treatment demonstrated promising results in terms of controlling plaque index, gingival health, and the prevalence of white spot lesions. Nevertheless, grooves, ridges, microcracks, and abrasions on the aligner surface would provide a prime environment for bacterial adherence and the development of plaque biofilms. A combination of mechanical and chemical methods seems to be a successful approach for removing plaque biofilm from aligners whilst also preventing pigment adsorption.

Impact of Clear Aligners versus Fixed Appliances on Periodontal Status of Patients Undergoing Orthodontic Treatment: A Systematic Review of Systematic Reviews

The present umbrella review of four systematic reviews with meta-analysis aimed to assess whether clear aligners are associated with better periodontal conditions compared with fixed appliances in patients undergoing orthodontic treatment. The present study protocol was developed in accordance with the PRISMA statement before the literature search, data extraction, and analysis and was registered on PROSPERO (CRD42023401808). The question formulation, search, and study selection strategies were developed according to the PICO model. Systematic reviews with a meta-analysis published in English without date restriction were electronically searched across the Cochrane Library, Web of Science (Core Collection), Scopus, EMBASE, and MEDLINE/PubMed databases until 10 February 2023. An assessment of study quality was performed using the AMSTAR 2 tool. Differences in the PI, GI, and BOP in the short- and medium-term follow-ups, in the PPD in long-term follow-up, and the gingival recessions in the short-term follow-up were found between subjects with clear aligners and fixed appliances, revealing a slight tendency for clear aligners to be associated with healthier periodontal conditions. However, even if statistically significant, such differences would be negligible in a clinical environment. Therefore, the impact of orthodontic treatment with clear aligners and fixed appliances on periodontal health status should be considered comparable.

Functional Surface Coatings on Orthodontic Appliances: Reviews of Friction Reduction, Antibacterial Properties, and Corrosion Resistance

Surface coating technology is an important way to improve the properties of orthodontic appliances, allowing for reduced friction, antibacterial properties, and enhanced corrosion resistance. It improves treatment efficiency, reduces side effects, and increases the safety and durability of orthodontic appliances. Existing functional coatings are prepared with suitable additional layers on the surface of the substrate to achieve the abovementioned modifications, and commonly used materials mainly include metal and metallic compound materials, carbon-based materials, polymers, and bioactive materials. In addition to single-use materials, metal-metal or metal-nonmetal materials can be combined. Methods of coating preparation include, but are not limited to, physical vapor deposition (PVD), chemical deposition, sol-gel dip coating, etc., with a variety of different conditions for preparing the coatings. In the reviewed studies, a wide variety of surface coatings were found to be effective. However, the present coating materials have not yet achieved a perfect combination of these three functions, and their safety and durability need further verification. This paper reviews and summarizes the effectiveness, advantages and disadvantages, and clinical perspectives of different coating materials for orthodontic appliances in terms of friction reduction, antibacterial properties, and enhanced corrosion resistance, and discusses more possibilities for follow-up studies as well as for clinical applications in detail.

A systematic review of biocompatibility and safety of orthodontic clear aligners and transparent vacuum-formed thermoplastic retainers: Bisphenol-A release, adverse effects, cytotoxicity, and estrogenic effects

Background

An ever-increasing demand is seen for clear aligners and transparent vacuum-formed retainers. They are esthetic and convenient. However, the biomaterials used in these appliances might pose biological safety and biocompatibility threats in terms of their bisphenol-A (BPA) release, cytotoxicity, adverse effects, and estrogenic effects. Due to the controversial results and the lack of any systematic reviews in this regard, we conducted this systematic review.

Materials and Methods

Web of Science, PubMed, Cochrane, Scopus, and Google Scholar as well as references of the found articles were searched (independently by 3 researchers) up to December 22, 2021, to find studies relevant to the biocompatibility of clear aligners and thermoplastic retainers. The search keywords were a combination of the following (and more): Essix, vacuum-formed aligner, thermoplastic aligner, clear aligner, Invisalign, vacuum-formed retainer, BPA release, monomer release, cytotoxicity, estrogenicity, biocompatibility, chemical properties, and oral epithelial cell. As eligibility criteria, articles in all languages would be included as long as their text could be translated clearly using online translators or by professional translators; all types of publications (article, book, and thesis) would be included if containing relevant studies and information; they should have been on clear liners or thermoplastic retainers; and they should have been on biocompatibility, safety, cytotoxicity, or estrogenicity of clear aligners or thermoplastic retainers. There were no restrictions on the type of study (randomized clinical trials, experimental in vitro studies). Studies focusing merely on the mechanical properties of clear aligners or thermoplastic retainers (without examining their chemical properties) would be excluded. The risk of bias was assessed.

Results

The risk of bias was rather low. However, the methodologies of the studies were quite different. Overall, 16 articles (1 randomized clinical trial and 15 in vitro studies) were identified. The data for BPA release were reported in four articles (1 clinical trial and 3 in vitro studies). Quantitatively speaking, the amount of released BPA reported by in vitro studies was very low, if not zero. However, the BPA level was very high in the only randomized clinical trial. Many adverse effects were linked to using clear aligners or transparent retainers, including pain and soft-tissue issues such as burning, tingling, sore tongue, lip swelling, blisters, ulceration, dry mouth, periodontal problems, and even systemic problems such as difficulty in breathing. Besides these biological adverse effects, oral dysfunctions and speech difficulties and tooth damage may be associated with clear aligners and should as well be taken into consideration.

Conclusion

Given the very high levels of BPA leach observed in the only clinical trial and considering other possible dangers of small traces of BPA (even at low doses) and also given the numerous adverse events linked to clear aligners or transparent retainers, it seems that safety of these appliances might be questionable and more clinical studies of biocompatibility are needed in this regard.

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.

Self-perceived halitosis among young adults undergoing orthodontic treatment

INTRODUCTION

Halitosis is a common oral health problem that significantly impacts the quality of life of the affected individuals. In most cases, poor oral hygiene is responsible for the problem. Orthodontic therapy aims to correct malocclusion using different devices. It has been suggested that orthodontic treatment can promote gingival health by facilitating daily oral hygiene measures. However, the treatment may harm gingival health as these appliances may lead to a more significant accumulation of plaque, increasing the microbial load in the subgingival environment leading to halitosis.

OBJECTIVE

The primary goal of this survey is to assess the prevalence of self-perceived halitosis in patients undergoing orthodontic treatment.

MATERIALS AND METHODS

An online questionnaire was randomly distributed to patients undergoing orthodontic treatment. A total of 289 subjects completed the questionnaire. It included questions about: demographic data, medical history, social habits, past dental treatment and oral hygiene habits. Descriptive statistics as frequency distributions and percentages were calculated for the study variables.

RESULTS

The prevalence of self-perceived halitosis was 41.5%. The majority of the participants started to notice this problem during and after orthodontic treatment (62.5%). A statistically significant correlation was found between the regular dental visits and halitosis in patients with fixed orthodontic appliances (p-value = 0.010). Also, those patients had a substantial increase in tongue coating formation (p- value = 0.010).

CONCLUSION

Self-perceived halitosis is a common problem in patients receiving orthodontic treatment.

The Oral Microbiota Changes in Orthodontic Patients and Effects on Oral Health: An Overview

Nowadays, there is a considerable interest to study the biological and microbiological changes that accompany orthodontic treatment. Growing knowledge on oral microbiota allows, day after day, to identify and characterize the microbial arrangements specifically associated with oral and extra-oral conditions. The aim of the present work is to highlight any further correlations between orthodontic appliances and the qualitative and quantitative modifications of the oral microbiota, such as predisposing factors for the onset of caries, periodontal diseases, and other infections, which can impact the oral and systemic health of the orthodontic patients. When compared with subjects without orthodontic appliances, orthodontic patients reported significant qualitative and quantitative differences in supra- and subgingival plaque during the entire treatment period. Certain components of fixed appliances (mainly bonded molar brackets, ceramic brackets, and elastomeric ligatures) showed high risks of periodontal disease and tooth decay for patients. An unclear prevalence of Candida spp. and the paucity of studies on viruses and protozoas in the oral microbiota of orthodontic patients need to be further investigated. The evidence emerging from this study could guide clinicians in modulating the timing of controls and enhance patient motivation to prevent the formation of mature plaque, thus reducing the risks of oral-plaque-related diseases.