Distribution of white spot lesions among orthodontic patients attending teaching institutes in Khartoum

Understanding the spatial and topographic characteristics of enamel white spot lesions for targeted remineralization

Introduction

White spot lesions are opaque, chalky white or yellowish discolorations on the surface of teeth that result from the demineralization of the tooth structure. Many methods, including SEM, XRD, and FTIR spectroscopy, are crucial for identifying and evaluating enamel white spot lesions. It is imperative to have a thorough grasp of the morphology, crystallographic structure, mineral composition, and chemical changes associated with enamel white spot lesions.

Method

In vitro lesions were meticulously obtained by immersing extracted teeth in hydrochloric acid for a week and drying them using artificial caries. Characterization investigations were conducted with utmost precision and thoroughness using FTIR, XRD, and SEM, ensuring the reliability and validity of the results.

Results

FTIR analysis revealed the existence of calcium oxide and hydroxyapatite, and SEM examination assisted in identifying differences in surface shape. The enamel's crystalline nature was revealed via XRD investigation.

Conclusion

White spot lesions are associated with the development of deep caries. Advanced imaging strategies are needed for additional validation.

Orthodontic adhesive loaded with different proportions of ZrO2 silver-doped nanoparticles: An in vitro μTBS, SEM, EDX, FTIR, and antimicrobial analysis

Zirconium dioxide silver-doped nanoparticles (ZrO2AgDNPs) impacts the adhesive material in terms of its physical characteristics, antimicrobial properties, degree of conversion (DC), and micro-tensile bond strength (μTBS) of orthodontic brackets to the enamel surface. A comprehensive methodological analysis utilizing a range of analytical techniques, including scanning electron microscopy coupled with energy-dispersive x-ray spectroscopy (EDX), Fourier-transform infrared (FTIR) spectroscopy, DC analysis, and μTBS testing. A light-curable orthodontic adhesive, specifically Transbond XT, was combined with ZrO2AgDNPs at 2.5% and 5%. As a control, an adhesive with no incorporation of ZrO2AgDNPs was also prepared. The tooth samples were divided into three groups based on the weightage of NPs: group 1: 0% ZrO2AgDNPs (control), group 2: 2.5 wt% ZrO2AgDNPs, and group 3: 5 wt% ZrO2AgDNPs. EDX graph demonstrated silver (Ag), Zirconium (Zr), and Oxygen (O2), The antibacterial efficacy of adhesives with different concentrations of NPs (0%, 2.5%, and 5%) was assessed using the pour plate method. The FTIR spectra were analyzed to identify peaks at 1607 cm-1 corresponding to aromatic CC bonds and the peaks at 1638 cm-1 indicating the presence of aliphatic CC bonds. The μTBS was assessed using universal testing machine (UTM) and bond failure of orthodontic brackets was seen using adhesive remanent index (ARI) analysis. Kruskal-Wallis test assessed the disparities in survival rates of Streptococcus mutans. Analysis of variance (ANOVA) and post hoc Tukey multiple comparisons test calculated μTBS values. The lowest μTBS was observed in group 1 adhesive loaded with 0% ZrO2AgDNPs (21.25 ± 1.22 MPa). Whereas, the highest μTBS was found in group 3 (26.19 ± 1.07 MPa) adhesive loaded with 5% ZrO2AgDNPs. ZrO2AgDNPs in orthodontic adhesive improved μTBS and has acceptable antibacterial activity against S mutans. ZrO2AgDNPs at 5% by weight can be used in orthodontic adhesive alternative to the conventional method of orthodontic adhesive for bracket bonding. RESEARCH HIGHLIGHTS: The highest μTBS was found in orthodontic adhesive loaded with 5% ZrO2AgDNPs. ARI analysis indicates that the majority of the failures fell between 0 and 1 among all investigated groups. The colony-forming unit count of S. mutans was significantly less in orthodontic adhesive loaded with nanoparticles compared with control. The 0% ZrO2AgDNPs adhesive showed the highest DC.

Visible light-activated curcumin-doped zinc oxide nanoparticles integrated into orthodontic adhesive on Micro-tensile bond strength, degree of conversion, and antibacterial effectiveness against Staphylococcus Aureus. An investigation using scanning electron microscopy and energy-dispersive X-ray spectroscopy

AIM

To acquire a thorough comprehension of the photoactivated Cur-doped ZnONPs at different concentrations 0%, 2.5%, and 5% on the physical qualities, antibacterial efficacy, degree of conversion, and μshear bond strength between orthodontic brackets and the enamel surface.

MATERIAL AND METHODS

An extensive investigation was carried out utilizing a range of analytical methods, scanning electron microscopy (SEM) combined with energy-dispersive X-ray spectroscopy (EDX), Fourier-transform infrared (FTIR) spectroscopy, micro tensile bond strength (μTBS) testing, and evaluation of antibacterial effectiveness. Cur-doped ZnONPs at concentrations of 2.5% and 5% were blended with Transbond XT, a light-curable orthodontic adhesive. A control group without the addition of Cur-doped ZnONPs was also prepared. The tooth samples were categorized into three groups based on the weight percentage of NPs: Group 1 (control) with 0% Cur-doped ZnONPs, Group 2 with 2.5 wt% Cur-doped ZnONPs, and Group 3 with 5 wt% Cur-doped ZnONPs. The SEM technique was employed to analyze the morphological characteristics of Cur-doped ZnONPs and ZnONPs. The composition and elemental distribution of the modified Cur-doped ZnONPs were assessed using energy-dispersive X-ray spectroscopy. The effectiveness of NPs at various concentrations against S.Mutans was gauged through the pour plate method. DC of Cur-doped ZnONPs at a region of 1608 cm-1 to 1636 cm-1 for the cured area, whereas the uncured area spanned the same range of 1608 cm-1 to 1636 cm-1 was assessed. The Adhesive Remnant Index (ARI) approach was utilized to investigate the bond failure of orthodontic brackets, while a Universal Testing Machine (UTM) was utilized to test μTBS. The Kruskal-Wallis test was employed to investigate variations in S.mutans survival rates. To determine the μTBS values, analysis of variance (ANOVA) and the post hoc Tukey multiple comparisons test were used.

RESULTS

The maximum μTBS was given and documented in group 3: 5 wt% Cur-doped ZnONPs (21.21 ± 1.53 MPa). The lowest μTBS was given in group 2: 2.5 wt% Cur-doped ZnONPs (19.58 ± 1.27 MPa). The highest efficacy against S.mutans was documented in group 3 in which 5 wt% Cur-doped ZnONPs (0.39 ± 0.15). The lowest efficacy was seen in group 1 in which no Cur-doped ZnONPs were used (6.47 ± 1.23). The ARI analysis indicated that the predominant failure was between scores 0 and 1 among all experimental groups. Control group 1 which was not modified showed the highest DC (73.11 ± 4.19).

CONCLUSION

Orthodontic adhesive, containing 5% Cur-doped ZnONPs photoactivated with visible light exhibited a favorable impact on μTBS and indicated enhanced antibacterial efficacy against S.mutans. Nevertheless, it was observed that the addition of Cur-doped ZnONPs at different concentrations (2.5%,5%) resulted in a decrease in the monomer-to-polymer ratio compromising DC.

[Characteristics of white spot lesions associated with orthodontic treatment: a review]

Introduction

The purpose of this literature review is to provide scientific evidence on the characteristics of white spot lesions (WSL) during orthodontic treatment, their incidence, prevalence, risk factors related to their development, progression, and regression, as well as explain the most used diagnostic methods.

Materials and methods

An exhaustive search was carried out in the databases of Pubmed, Scopus, Science Direct and Embase up to the date of November 30, 2022. Cross-sectional studies that evaluated white spot lesions before and after orthodontic treatments were included. Two researchers carefully selected the articles evaluated and analyzed different key topics on the subject.

Results

It was found that the prevalence and incidence of white spots during orthodontic treatment varies widely depending on the diagnostic method used, the type of orthodontic technique used and the time of orthodontic treatment. The incidence of white spot lesions is highest in patients treated with conventional braces, followed by those who used self-ligating braces, and was lowest in patients who used aligners. The most affected teeth are the upper lateral incisors and upper maxillary canines at the level of the gingival third.

Conclusions

The incidence of white spots is associated with orthodontic treatment, being closely related to the treatment technique used and the treatment time. There is a regression of the LMB during the first year after removal of the appliance.

Quantifying the Release of Titanium From the Titanium Dioxide-Impregnated Composites Used in Orthodontic Bonding

BACKGROUND

Previous literature data has extensively assessed the biocompatibility of various orthodontic adhesives and their components, where the results of most of the studies showed cytotoxic effects of different degrees owing to the unbound molecules released structurally from the cured components.

AIM

The present in-vitro study was aimed to assess the release of titanium dioxide nanoparticles in the artificial saliva from the orthodontic composites impregnated with titanium dioxide nanoparticles of 5% w/w (weight/weight) and 1% w/w used for metal brackets bonding.

METHODS

The study assessed 160 teeth extracted freshly during orthodontic treatment and divided into two groups of 80 samples, each that bonded to orthodontic brackets having 5% w/w and 1% w/w composites with titanium dioxide nanoparticles kept in the artificial saliva. Quantification was done for 5% w/w and 1% w/w composites having titanium nanoparticles with inductively coupled plasma mass spectroscopy at 24 hours, two, four, and six months.

RESULTS

It was seen that in teeth with 1% titanium dioxide, the greatest titanium release was seen at two months, with non-significant release after two months. In teeth with 5% w/w titanium dioxide nanoparticles showed significant titanium release all the time. A significantly greater titanium dioxide release on increasing concentration from 1% to 5% was seen for the 5% w/w group at all the assessment times.

CONCLUSION

The present study concludes that a higher release of titanium is seen in 5% w/w composite containing titanium dioxide nanoparticles, and the concentrations of 1% and 5% can be safely used and are considered to be within permissible limits.

A Novel Coating of Orthodontic Archwires with Chlorhexidine Hexametaphosphate Nanoparticles

Materials and Methods

A solution of CHX-HMP nanoparticles with an overall concentration of 5 mM for both CHX and HMP was prepared, characterized (using atomic force microscope and Fourier transformation infrared spectroscopy), and used to coat orthodontic stainless steel (SSW) and NiTi archwires (NiTiW). The coated segments were characterized (using scanning electron microscopy SEM with energy dispersive X-ray spectrometry and field emission SEM) and subjected to the elusion assessment.

Results

After having their composition validated, the average size of the CHX-HMP NPs was assessed to be 51.21 nm, and the analysis revealed that the particles had both chlorine and phosphorus. After 30 minutes in the coating solution, NPs deposited on the surface of the SSW and NiTiW. A continuous release of soluble CHX in artificial saliva was detected from both SSW and NiTiW as long as the experiment lasted for 28 days without reaching a plateau. However, the release from coated NiTiW was significantly more than coated SSW at 7, 14, and 28 days. While at day 21, the release from coated SSW was slightly greater than that from the coated NiTiW.

Conclusion

Orthodontic stainless steel and NiTi archwires can be successfully coated with CHX-HMP NPs and give sustained release of CHX along the examined period.

Caries-preventive effectiveness of two different fluoride varnishes: A randomised clinical trial in patients with multi-bracketed fixed orthodontic appliances

BACKGROUND

Patients with multi-bracketed fixed orthodontic appliances are at a higher risk of developing enamel demineralisation.

AIM

To compare the efficacy of the quarterly application of two varnishes in preventing white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment.

DESIGN

Ninety-nine patients were randomly allocated into three intervention groups: Group A-standard oral hygiene instructions (OHI); Group B-5% sodium fluoride (NaF) varnish with standard OHI; and Group C-NaF plus tricalcium phosphate varnish with standard OHI. The outcome was assessed at 6-monthly intervals using a quantitative laser fluorescence device, clinical evaluation and photographic evaluation on six maxillary anterior teeth. A logistic regression model using generalised estimating equations with the intervention group, time and their interaction was used to compare the occurrence of WSLs, whereas the independent-samples Kruskal-Wallis test was used to compare the means of fluorescent values among different groups at p = .05.

RESULTS

Generalised estimating equations (with intervention and time as predictors) showed that only the effect of time was found to be significant (p < .001), whereas there was no significant difference among the three intervention groups (p = .305) using clinical assessment or photographic assessment (p = .599). At the 18-month follow-up, sodium fluoride (NaF) varnish with standard OHI was shown to reduce the odds of WSLs by 55% (p = .200), and NaF plus tricalcium phosphate varnish with standard OHI by 42% (p = .327).

CONCLUSION

The study failed to demonstrate that the quarterly application of both the study varnishes with OHI provided additional benefits compared with standard OHI alone in preventing WSLs, taking the effect of time of follow-up into consideration. There were higher odds of developing WSLs with an increased duration of orthodontic treatment.

Effects of Laser Therapy on Periodontal Status in Adult Patients Undergoing Orthodontic Treatment

Orthodontic treatment with fixed devices should only be indicated in case of a stable, non-active periodontal disease status. Throughout orthodontic treatment, a careful assessment of the periodontal status is advised. Due to its anti-inflammatory and antimicrobial effects, laser therapy is frequently used as an adjunct to classic periodontal therapy. The aim of this study was to evaluate the advantages and limitations of the use of laser therapy on periodontal status during orthodontic treatment. Throughout the 9 months during which this placebo-controlled, single-blind clinical trial was conducted, 32 patients were included in the study, divided into two groups: microscope “+” (patients who observed the bacteria within the dental plaque-sample examination on the screen of a dark-field microscope in real time) and microscope “−” (patients who did not see the oral pathogens using a dark-field microscope). For all patients, using the split-mouth study design, laser therapy was applied to one hemiarch (HL), whereas the other hemiarch received treatment without active light (HC). After one month, by analyzing the main indicators of periodontal health status, we found that the plaque index (PI) and bleeding on probing (BOP) values were significantly decreased after receiving treatment (for PI: HL-p = 0.0005, HC-p = 0.0297; for BOP: HL-p = 0.0121, HC-p = 0.0236), whereas the probing-depth (PD) values remained almost the same as before treatment (HL-p = 1.5143; HC-p = 1.4762). Conclusions: The use of the dark-field microscope proved to be beneficial in sensitizing patients to the presence of bacteria in the oral cavity and motivated them to strictly follow the rules of oral hygiene. Laser treatment can be a valuable aid in periodontal therapy, but only in adjunction with mechanical therapy.

Patient Satisfaction with Resin Infiltration Treatment for Masking Noncavitated White Spot Lesions on Anterior Maxillary Teeth: Two Case Reports

Aim

We assessed patient satisfaction with resin infiltration treatment outcomes for masking postorthodontic treatment noncavitated white spot lesions on anterior maxillary teeth.

Background

White spot lesions (WSLs) are opaque white areas of demineralization. The lesion may remineralize over time, but the opaque color usually remains, retaining the undesirable tooth color. Case Description: Resin infiltration (RI) was administered to two patients with a total of 10 anterior maxillary teeth diagnosed with noncavitated WSLs. Immediately after treatment, patients were asked about their comfort during the RI treatment and their level of satisfaction with treatment outcomes. Two weeks post-treatment, the two patients were asked again about their level of treatment outcome satisfaction and if they thought they needed a second treatment. Both reported that they were comfortable during the treatment and were extremely satisfied with the achieved treatment outcomes immediately and two weeks after the treatment and did not feel that they would need to seek further treatment to reach the desired outcome.

Conclusion

Resin infiltration is a comfortable, conservative treatment option providing satisfactory outcomes in masking noncavitated WSLs on anterior maxillary teeth after orthodontic treatment. Clinical Significance. Resin infiltration is a conservative treatment option to mask noncavitated WSLs after orthodontic treatment.

Motivation of Adult Patients with Orthodontic Treatment in Maintaining Oral Hygiene

Background: In the last decades, adult patients require orthodontic treatment as a therapeutic method in an increasing percentage. This treatment has a lot of benefits, but unfortunately it also presents a number of complications and risks, among which favoring the accumulation of bacterial plaque is the most concerning.

Aim of the study: In this study we aimed to evaluate the effectiveness of using the dark-field microscope as a method of motivating adult patients with orthodontic treatment in maintaining a proper oral hygiene.

Material and methods: Thirty-six patients were selected based on the inclusion and exclusion criteria. At time T0, patients were divided into two groups: Group 1–microscope and Group 2 – control, in such a way that the groups were as homogeneous as possible. Dental plaque samples were collected and analyzed under a dark field microscope in the presence of the patient for subjects from Group 1 but not Group 2. All patients were then instructed on oral hygiene techniques. The following periodontal indices were recorded of each patient: plaque index (PI), index of bleeding on probing (BOP), probing depth (PD) – at T0 and T1 (after one month).

Results: Comparing the PI and BOP values before (T0) and after treatment (T1), statistically significant results were detected (PI: p = 0.0020, BOP: p = 0.0297), which denotes that patients who observed the bacterial load of their dental plaque in real time using the dark-field microscope had a better oral hygiene and lower values of periodontal health indices. Regarding the PD index, the difference between time T0 and T1 was not statistically significant (p = 1.4762).

Conclusions: During the orthodontic treatment, adult patients often present gingival inflammation caused by improper hygiene. The use of the dark-field microscope is effective in motivating patients regarding the rules of maintenance of a proper oral hygiene.

White Spot Lesions: A Serious but Often Ignored Complication of Orthodontic Treatment

Objective:

The objective of this narrative review is to present an overview of the prevalence, clinical manifestation, diagnosis, and latest advances on white spot lesions.

Background:

White spot lesions have been defined as the earliest stage of demineralization on enamel surfaces that are easily discernible to the human eye.

Methods:

Relevant articles on white spot lesions were searched and reviewed from March 1975 till May 2021 in Pubmed, Scopus, Google Scholar, and ScienceDirect and were included in this review.

Results:

Even though the orthodontic field has seen several advances over the last few years, this is one complication that persists. White spot lesions are very commonly seen after completion of fixed orthodontic therapy when brackets are debonded. Previously conducted research has shown that there is a high prevalence rate of white spot lesions, which ranges from 50 to 90%. On intra-oral examination, a white spot can be seen as a matte-textured, opaque white lesion. Since the demineralization process takes place below the enamel surface, the outer layer only demonstrates pores that affect the natural light refractory properties of a tooth. This is what leads to the characteristic appearance of these lesions. One of the goals of modern dentistry is to treat non-cavitated lesions by promoting remineralization without the involvement of any invasive procedures.

Conclusion:

Fixed orthodontic therapy is usually a lengthy process and requires active cooperation between the orthodontist and the patient. However, it is the responsibility of the treating orthodontist to examine the tooth surfaces at each appointment to diagnose a developing white spot lesion as early as possible. With recent advances in diagnostic techniques, it has become much easier to identify these initial lesions and prevent their progression to cavitated lesions.

Quantification of Titanium Release From Titanium Dioxide Impregnated Composites in Orthodontic Bonding—An In Vitro Study

Objective

To evaluate the quantity of titanium dioxide nanoparticles released into the artificial salivary medium from orthodontic composite impregnated with 1% weight/weight (w/w) and 5% w/w titanium dioxide nanoparticles (TiO2 NPs) used for bonding metal brackets, thereby eventually comprehending the permissible levels.

Materials and Method

Eighty freshly extracted teeth for orthodontic treatment were divided into 2 groups of 40 teeth each and were bonded with brackets containing 1% w/w and 5% w/w composite containing titanium dioxide nanoparticles and placed in an artificial salivary medium. Quantification of 1% w/w and 5% w/w composite containing titanium nanoparticles was done using inductively coupled plasma mass spectroscopy for 4 timely periods 24 h, 2 months, 4 months, and 6 months.

Results

In the teeth that received 1% TiO2, the amount of titanium released was greatest in 2 months with no significant release at later intervals. In the second group that received 5%, there was a significant release of titanium at all intervals, with highest release at second month. On comparing the 2 concentrations at 4 different time intervals, the quantities were significantly greater in the 5% group at all time frames, thus implying a significant increase in titanium released with an increase in concentration from 1% to 5%.

Conclusion

Titanium release was higher in 5% w/w composite containing nanoparticles than 1% w/w composite containing nanoparticles, and 1% and 5% concentrations can be used safely and are within the permissible limits.

Efficacy of herbal versus chlorhexidine-based mouthwashes towards oral hygiene maintenance in patients undergoing fixed orthodontic therapy: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

The review aims to fill the gap in literature by comparing the efficacy of herbal and chlorhexidine-based mouthwashes towards oral hygiene maintenance (OHM) in patients undergoing fixed orthodontic treatment (OT).

METHODS

Indexed databases were searched electronically to include randomized controlled trials (RCTs) for data gathering. The protocol was registered in PROSPERO (CRD42020182497). Risk of bias assessment, quality of evidence investigation, and meta-analysis were performed to evaluate reported OHM related parameters at time points before and after the use of chlorhexidine (control group) and herbal mouthwashes (intervention group). With 95% confidence intervals, mean difference (MD) or standardized mean difference (SMD) were used to estimate effect size.

RESULTS

Out of eight RCTs, results from one RCT favored chlorhexidine and the results from a second RCT favored herbal mouthwashes. Results from three RCTs showed comparable effects for the respective investigated OHM related parameters. Chlorhexidine demonstrated higher antimicrobial efficacy against Streptococcus mutans (S.mutans) in two studies, and one RCT found comparable antimicrobial efficacies. Risk of bias was low in 4 studies, and moderate and high in two studies each. Quality of evidence was very low to moderate for the respective investigated parameters. Sub-group analysis for parameters colony forming units (CFU) {SMD (0.40) [95% CI (-0.22, 1.03)], gingival index (GI) {MD (0.06) [95% CI (-0.08, 0.20)]}, plaque index (PI) {SMD 0.22 [95% CI (-0.23, 0.67)]} before the use of chlorhexidine and herbal mouthwashes remained inconclusive.

CONCLUSION

The comparison between efficacy of herbal and chlorhexidine towards OHM in patients undergoing fixed OT remains debatable.

The effects of bimodal action of photodynamic and photothermal therapy on antimicrobial and shear bond strength properties of orthodontic composite containing nano-graphene oxide

BACKGROUND

White spot lesions are a common adverse effect of fixed orthodontic treatment and represent the main challenge to achieving esthetic appearance. The purpose of the current study was to evaluate physico-mechanical and antimicrobial potency of orthodontic composite (OC; Transbond XT) containing nano-structured graphene oxide (nGO) (OC-nGO) as a novel composite following photodynamic therapy (PDT) and photothermal therapy (PTT) against Streptococcus mutans.

MATERIALS AND METHODS

Following preparation of OC-nGO, shear bond strength (SBS) and adhesive remnant index (ARI) of the test OC-nGO (containing 1, 2, 5, and 10% wt. nGO) were measured using a universal testing machine and stereomicroscope, respectively. The antimicrobial activities of test OC contained different concentrations of nGO were determined by disk agar diffusion (DAD), biofilm formation inhibition, and eluted components assays. After continuously rinsed in the aging process (up to 180 days), the antimicrobial activity of OC-nGO containing the highest concentration of nGO which had simultaneously the highest antimicrobial activity and SBS value were determined by DAD, biofilm formation, metabolic activity, and gtfB gene expression assays following photo-activation using diode laser irradiation against S. mutans. Data were analyzed using One-way Analysis of Variance (ANOVA). The Bonferroni post hoc test was used for comparison between the experimental groups. The significant difference was considered at P values < 0.05.

RESULTS

OC with 5% wt. nGO showed simultaneously the highest SBS value (10.64 ± 2.76 MPa, P < 0.05) an antimicrobial and anti-biofilm activities. The OC-nGO in all test concentrations of nGO had ARI scores as same as control group (Transbond XT without the nGO) (P < 0.05). In microbial biofilm formation and gene expression assays, the reduction of photothermal disinfection and anti-virulence activities of the 5% wt. OC-nGO against test bacterium was associated with the time of aging process, so they were reduced significantly up to day 150. Diode laser irradiated 5% wt. OC-nGO suppressed 15.6 and 8.1-fold gtfB mRNA expressions in the biofilm growth of the S. mutans at days 120 and 150 of rinsing (P < 0.05). Microbial biofilm formation and gtfB gene expression in S. mutans at day 180 following PAD had a high level of similarity with OOC as the control group. 5% wt. OC-nGO following photo-activation was not colonized by the S. mutans at day 90 and significant suppressed 91.98% and 76.37% of S. mutans biofilm formation at day 120 and 150, respectively (both P < 0.05). From day 120 onwards, metabolic activity was progressively increased on laser-irradiated 5% wt. OC-nGO discs compared to the control group (OC alone). Photo-activated OC-nGO containing 5% wt. nGO suppressed 86.94% and 46.82% metabolic activity of the S. mutans at days 120 and 150 of rinsing (both P < 0.05).

CONCLUSIONS

Our data support that the photo-activated 5% wt. OC-nGO can serve as an orthodontic composite/adhesive additive to control cariogenic bacterial biofilms.

Antibacterial and white spot lesions preventive effect of an orthodontic resin modified with silver-nanoparticles

Background

To evaluate the antibacterial property of a modified orthodontic resin with different concentrations of silver-nanoparticles (AgNPs), and quantify its preventive effect on the formation of white spot lesions (WSLs).

Material and Methods

An orthodontic resin (Transbond XT) was modified with four concentrations of AgNPs (1%, 0.5%, 0.1%, and 0.05%), the orthodontic resin without AgNPs was used as control. Polymerized resin discs (n=80) were submitted to Agar diffusion test on Petri dishes inoculated with Streptococcus mutans and Lactobacillus acidophilus. In addition, resin discs of each group (n=40) were placed in 96-well plates with bacterial suspensions to evaluate the colony-forming-units (CFU). For the WSLs prevention test, brackets were bonded with the experimental orthodontic resins on 45 premolars (n=5), and were subjected to a microbiological caries induction method for 9 days. Photographs were taken before and after the test, and the images were evaluated with the Image J software to calculate the area of WSLs. The data were analyzed using ANOVA and Tukey-HSD test, Student´s t-test and Kruskal-Wallis test (α=0.05).

Results

The 0.5% and 1% AgNPs modified resin inhibit the growth of S. mutans and L. acidophilus. All the modified resins showed significantly less CFU, when compared to the control (p<0.05). 1% AgNPs resin promote the higher prevention of WSLs formation. There was no significant difference between the control group and the 0.1% and 0.05% groups.

Conclusions

0.5% and 1% of AgNPs modified orthodontic resin exhibit an important antibacterial activity against S. mutans and L. acidophilus, and prevent the formation of WSLs.

Key words:White spot lesions, antibacterial, orthodontics, adhesive, Silver-nanoparticles.

Estimation and correlation of salivary calcium, phosphorous, alkaline phosphatase, pH, white spot lesions, and oral hygiene status among orthodontic patients

Introduction:

The initial carious lesions are the so-called “white spot” lesions (WSLs), which implies that there is a subsurface area with most of the mineral loss beneath a relatively intact enamel surface. It is common in patients who are taking orthodontic treatment. Salivary reservoir of calcium and phosphorous counteracts the demineralization and encourages re-mineralization providing protection against caries challenge. This study was aimed to estimate and correlate the oral hygiene status, WSLs and salivary calcium, phosphorus, alkaline phosphatase (ALP), and pH in patients undergoing fixed orthodontic therapy.

Materials and Methods:

All clinical and biochemical parameters were recorded in 27 patients before starting orthodontic treatment and at 6 months of orthodontic treatment. The salivary calcium, phosphorous, ALP, and pH were determined by Arsenazo III method, Molybdate – UV and the International Federation of Clinical Chemistry method, respectively. International caries detection and assessment system index for WSL, orthodontic plaque index, bleeding on probing, and gingival index were recorded. Shapiro–Wilk's test and Wilcoxon test were applied to the data collected for statistical analysis.

Results:

There was a statistically significant increase with ALP levels, orthodontic plaque index score, gingival index score, and bleeding on probing index score. A statistically significant reduction was seen with respect to levels of calcium and pH.

Conclusion:

Maxillary canines and lateral incisors were the most affected teeth with WSLs (78.84%). There is a need for more stringent prevention programs and oral hygiene practices prior to initiation of orthodontic treatment and also during orthodontic treatment.

Scope of antimicrobial photodynamic therapy in Orthodontics and related research: A review

BACKGROUND

The aim of the present study was to comprehensively review indexed literature regarding the potential role of antimicrobial photodynamic therapy (aPDT) in Orthodontics.

METHODS

Indexed databases were searched up to and including January 2019 using the following key words: (a) antimicrobial photodynamic therapy; (b) antimicrobial photodynamic chemotherapy; (c) orthodontic; and (d) orthodontics. Original (clinical and experimental) studies, case-reports, and case-series were included. Letters to the Editor, commentaries and review articles were excluded.

RESULTS

Out of the 29 studies identified in the initial search, 4 studies were processed for data extraction. Three studies were randomized clinical trials performed in humans and 1 study was experimental. Results from 2 studies showed that aPDT is effective in the treatment of gingival inflammation in patients undergoing orthodontic therapy (OT). One study showed that oral decontamination can be successfully performed using aPDT among patients undergoing OT. Results of the experimental study showed that aPDT helps in surface decontamination of orthodontic instruments.

CONCLUSION

There is insufficient evidence in indexed literature to justify the potential role of aPDT in OT. Hence, further studies are required in this regard.

Influence of reminder therapy for controlling bacterial plaque in patients undergoing orthodontic treatment: A systematic review and meta-analysis

OBJECTIVE

To assess the scientific evidence regarding the influence of reminder therapy on plaque index, gingival index, and white spots in patients subjected to orthodontic treatment.

MATERIALS AND METHODS

Randomized clinical trials were searched in the electronic databases LILACS, PubMed, SciELO, Scopus, Web of Science, Embase, LIVIVO, and Cochrane Library. The databases OpenThesis and OpenGrey were used to capture the "gray literature," preventing selection and publication biases. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials tool. The software Review Manager was used for the meta-analysis. The heterogeneity among studies was assessed through the I ² statistic. A summary of the overall strength of evidence available was assessed using the Grades of Recommendations Assessment, Development, and Evaluation tool.

RESULTS

A total of 332 records were found, from which only 7 articles met the inclusion criteria and were subjected to analysis. Reminder therapy showed improved scores for the plaque index (standardized mean difference = -1.22; 95% confidence interval = -2.03 to -0.42; P = .003) and the gingival index (standardized mean difference = 1.49; 95% confidence interval = -2.61 to 0.37; P = .009). Moreover, there was lower occurrence of white spots (relative risk = 0.53; 95% confidence interval = 0.38 to 0.74; P < .001) when reminder therapy was implemented.

CONCLUSIONS

According to the existing high-quality evidence, reminder therapy is a valuable strategy and may contribute to the reduction of plaque and gingival indices as well as to the lower occurrence of white spots in patients subjected to orthodontic treatment.