Orthodontic appliances did not increase risk of dental caries and periodontal disease under preventive protocol

Tongue microbiota in relation to the breathing preference in children undergoing orthodontic treatment

BACKGROUND

Mouth breathing (MB), a risk factor of oral dysbiosis and halitosis, is linked with craniofacial anomalies and pediatric obstructive sleep apnea. Here, we aimed to analyze tongue microbiota in children from the perspective of their breathing pattern before/during orthodontic treatment.

METHODS

This prospective case-control study included 30 children with orthodontic anomalies, 15 with MB and 15 with nasal breathing (NB), matched by age, sex, and body mass index. All underwent orthodontic examination and sleep apnea monitoring. Tongue swabs were collected before starting (timepoint M0) and approx. six months into the orthodontic therapy (timepoint M6). Oral candidas and bacteriome were analyzed using mass spectrometry technique and 16S rRNA sequencing, respectively.

RESULTS

MB was associated with higher apnea-hypopnea index. At M0, oral candidas were equally present in both groups. At M6, Candida sp. were found in six children with MB but in none with NB. No significant differences in bacterial diversity were observed between groups and timepoints. However, presence/relative abundance of genus Solobacterium was higher in children with MB than NB at M0.

CONCLUSIONS

Significant links between MB and the presence of genus Solobacterium (M0) as well as Candida sp. (M6) were found in children with orthodontic anomalies, highlighting the risk of halitosis in them.

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.

Evaluation of Antibacterial Effect of Hybrid Nano-coating of Stainless Steel Orthodontic Brackets on Streptococcus Mutans - An In vitro Study

Nano-coating of orthodontic brackets with a combination or hybrid of metals and metal oxides may reduce the streptococcus mutans count and incidence of enamel decalcification seen around brackets in patients undergoing fixed orthodontic treatment. In total, 255 orthodontic brackets (3M Unitek, Monrovia, California, USA) were divided into one control group (group I) of 60 and three experimental groups of 65 each (groups II, III, and IV). The experimental group brackets were coated with a combination of silver-zinc oxide, copper oxide -zinc oxide, and silver-copper oxide nanoparticles using physical vapour deposition method. The two nanoparticles used for each group were mixed in the ratio of 1:1 by weight for providing a uniform hybrid coating. Sixty brackets from each group were used for microbiological evaluation of antibacterial activity against Streptococcus mutans in blood agar medium, and the remaining five brackets from each experimental group were used for SEM analysis to check the uniformity of the coating. Nano-coated brackets demonstrated better antibacterial properties than uncoated brackets. Copper oxide-zinc oxide nanoparticles coated brackets demonstrated better antibacterial properties than the silver-zinc oxide and silver- copper oxide coated brackets.

Effect of chlorhexidine mouthwashes on periodontal parameters and extrinsic tooth staining in orthodontic patients

INTRODUCTION

Periodontal health and biofilm control are primordial to success in orthodontic treatment. This study aimed to evaluate the effect of chlorhexidine (CHX) mouthwashes on periodontal status and extrinsic tooth staining in orthodontic patients.

METHODS

Thirty-three patients of both sexes, aged 11-33 years, under orthodontic treatment with fixed appliances at <16 months, were randomly distributed into 2 groups. In the control group, patients received mechanical hygiene instruction, and in the experimental group, patients also used CHX wash twice a week for 60 days. The effectivity of the protocols was evaluated using the plaque, gingival, gingival bleeding, and discoloration indexes before the hygiene protocol was applied, 15, 30, and 60 days after protocol implementation.

RESULTS

In the experimental group, there was a decrease in the plaque, gingival, and gingival bleeding indexes at the different evaluation periods (P <0.05). In addition, there was a significant difference in the discoloration index at 60 days compared with initial time points after implementing hygiene protocols in the experimental group (P <0.05). In contrast, there were no significant differences in plaque, gingival, gingival bleeding, and discoloration indexes in the control group at any time (P >0.05).

CONCLUSIONS

CHX mouthwash administered 30 days, twice a week, significantly improved the periodontal status with mild brown staining. After this period, expressive extrinsic tooth staining was observed.

Sliding behaviour and surface quality after static air polishing of conventional and modern bracket materials : In vitro analysis

OBJECTIVES

As part of orthodontic treatment, air polishing is routinely used for professional tooth cleaning. Thus, we investigated the effects of static powder polishing on sliding behaviour and surface quality of three different bracket materials (polymer, ceramic, metal), including a 3D-printed bracket.

METHODS

Two bracket types of each material group were polished with an air-polishing device using sodium bicarbonate. Exposure times were set at 10, 20, and 60 s; the application distance was 5 mm. The force loss due to sliding resistance was tested with an orthodontic measurement and simulation system (OMSS) using a 0.016 inch × 0.022 inch stainless steel archwire. Untreated brackets served as control. Polishing effects and slot precision were evaluated using an optical digital and scanning electron microscope.

RESULTS

Sliding behaviour and slot precision differed significantly between and within the groups. Prior to polishing, polymer brackets showed the least force loss, ceramic brackets the highest. With progressive polishing time, the resistance increased significantly with titanium brackets (26 to 37%) and decreased significantly with steel brackets (36 to 25%). Polymer brackets showed the smallest changes in force loss with respect to polishing duration. Slot precision showed the largest differences between material groups and was primarily manufacturer-dependent with hardly any changes due to the polishing time.

CONCLUSION

Powder polishing can positively or negatively affect the sliding properties of the bracket-archwire complex but is more dependent on the bracket-archwire material combination (i.e., manufacture-dependent slot precision). For titanium brackets, resistance only increased after 60 s of polishing. For ceramic brackets, effective reduction was observed after 10 s of polishing. Polymer brackets, including the 3D-printed brackets, showed better sliding properties than ceramic or metal brackets even after polishing for 60 s. Removal of plaque and dental calculus should lead to a noticeable improvement of the sliding properties and outweighs structural defects that may develop.

Effect of fixed orthodontic appliances on gingival status and oral microbiota: a pilot study

Background

This pilot study aimed to investigate how fixed orthodontic appliances simultaneously applied on the upper and lower arches affect the oral environment in the medium term.

Methods

The oral status of 30 orthodontic patients was evaluated using the number of decay-missing-filled teeth (DMFT), plaque (PI), and gingival indices (GI) before bonding of fixed orthodontic appliances (T0) and during the therapy (T1). Besides, the gingival crevicular fluid (GCF) and a dental plaque were collected. Samples were analyzed for selected Candida sp. and for 10 selected oral bacteria using mass spectroscopy and multiplex polymerase chain reaction, respectively.

Results

In 60% of patients, deterioration of the oral status (demonstrated by the increase in PI) was recorded (p < 0.05). Moreover, the changes in PI correlated with those of GI (p < 0.001). At the T1 time point, the mean representation of Actinomyces sp. in the total prokaryotic DNA in GCF and dental plaque of individual patients increased compared to T0 (p < 0.05). The probability of finding any of the 7 selected periodontal bacteria combined with Candida sp. was 10 times higher in patients in whom PI deteriorated between T0 and T1 (p < 0.01).

Conclusions

Changes in the oral microbial diversity and an increase in PI were observed in the medium term after bonding of orthodontic appliance. Our study highlights the importance of a complex approach in this type of research as the association between clinical characteristics and combined microbial parameters is higher than when evaluated separately.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02511-9.

Association of periodontal therapy, with inflammatory biomarkers and complications in COVID-19 patients: a case control study

BACKGROUND

In previous studies, COVID-19 complications were reported to be associated with periodontitis. Accordingly, this study was designed to test the hypothesis that a history of periodontal therapy could be associated with lower risk of COVID-19 complications.

METHODS

A case-control study was performed using the medical health records of COVID-19 patients in the State of Qatar between March 2020 and February 2021 and dental records between January 2017 and December 2021. Cases were defined as COVID-19 patients who suffered complications (death, ICU admissions and/or mechanical ventilation); controls were COVID-19 patients who recovered without major complications. Associations between a history of periodontal therapy and COVID-19 complications were analysed using logistic regression models adjusted for demographic and medical factors. Blood parameters were compared using Kruskal-Wallis test.

RESULTS

In total, 1,325 patients were included. Adjusted odds ratio (AOR) analysis revealed that non-treated periodontitis was associated with significant risk of need for mechanical ventilation (AOR = 3.91, 95% CI 1.21-12.57, p = 0.022) compared to periodontally healthy patients, while treated periodontitis was not (AOR = 1.28, 95% CI 0.25-6.58, p = 0.768). Blood analyses revealed that periodontitis patients with a history of periodontal therapy had significantly lower levels of D-dimer and Ferritin than non-treated periodontitis patients.

CONCLUSION

Among COVID-19 patients with periodontal bone loss, only those that have not received periodontal therapy had higher risk of need for assisted ventilation. COVID-19 patients with a history of periodontal therapy were associated with significantly lower D-dimer levels than those without recent records of periodontal therapy.

CLINICAL RELEVANCE

The fact that patients with treated periodontitis were less likely to suffer COVID-19 complications than non-treated ones further strengthen the hypothesis linking periodontitis to COVID-19 complications and suggests that managing periodontitis could help reduce the risk for COVID-19 complications, although future research is needed to verify this.

Periodontal Health in Patients with Self-Ligating Brackets: A Systematic Review of Clinical Studies

BACKGROUND AND OBJECTIVES

The aim of this systematic review with meta-analysis is to assess the available evidence from human clinical studies of using self-ligating brackets compared to conventional brackets in maintaining periodontal health.

MATERIALS AND METHODS

The protocol details were registered in the PROSPERO database (CRD42022302689). This review was performed under the PRISMA guidelines. The electronic search was performed in PubMed, Scopus, Web of Science and grey literature databases, as well as manual searches to find relevant articles published until January 2022. The inclusion criteria consisted of human clinical studies which reported the use of fixed orthodontic treatment with self-ligating brackets (SLBs) or conventional brackets (CBs) in maintaining periodontal health.

RESULTS

A total of 453 studies were imported into the Covidence Platform from the databases. Of these, six articles met the inclusion criteria. For plaque index, statistical significance was achieved for SLBs compared to CBs (0.31 (95% CI (0.15 to 0.48), p = 0.0001). For gingival index, probing depth and bleeding on probing no statistical significance was achieved. None of the included studies assessed clinical attachment level.

CONCLUSIONS

The present systematic review with meta-analysis was considered to provide relevant data on periodontal health during orthodontic treatment in patients with SLBs in comparison with patients wearing CBs. Our findings indicated that SLBs are not superior to CBs in terms of periodontal health.

Influence Of Orthodontic Brackets Design And Surface Properties On The Cariogenic Streptococcus mutans Adhesion

Objective

To compare the surface properties of self-ligating metallic (SLM), ceramic esthetic, and conventional metallic (CM) brackets, and evaluate the adhesion of Streptococcus mutans biofilms to their surface, attempting to interpret the correlation between bracket type and enamel demineralization from a microbiological perspective.

Materials and methods

Twenty-two brackets of each group were used. The brackets’ surface roughness was defined and the bacterial adhesion was performed using the strain S. mutans ATCC25175 with 8 h or 24 h of incubation time. The total bacterial adhesion (TBA) of biofilms was assessed using optical density (OD) methodology. To quantify bacteria viability (BV), the colony forming units (CFU) were counted. A scanning electron microscopy (SEM) observation of biofilms was also performed. Results: Ceramic brackets exhibited significantly higher roughness (0.304) compared to CM (0.090) and SLM (0.067) ones (C > CM = SLM). The data obtained with the TBA and BV tests showed that S. mutans biofilm formed on bracket groups exhibited similar results for both incubation periods. From the SEM images it is possible to observe that biofilm structure formed for 24 h was denser than that for 8 h of incubation with significantly more aggregates and cells for three groups.

Conclusion

This in vitro study suggests that despite the higher surface roughness of ceramic brackets, this alone does not influence the adhesion of the S. mutans biofilms.

Clinical relevance

From a microbiological perspective, the bracket's design may be more relevant than its surface roughness with respect to the adhesion of cariogenic bacteria biofilm with potential risk to dental enamel integrity.

Self-ligating brackets exhibit accumulation of high levels of periodontopathogens in gingival crevicular fluid

Different types of brackets seem to influence the disruption of the oral microbial environment. Therefore, the aim of this study was to evaluate the influence of self-ligating brackets on the gingival crevicular fluid levels of the putative periodontal pathogens Aggregatibacter actinomycetemcomitans sorotype a (Aaa), Tannerella forsythia, Fusobacterium nucleatum, and Porphyromonas gingivalis. Sixty samples of crevicular fluid of twenty patients (11 boys and 9 girls) were analysed at baseline (T0) and after 30 (T1) and 60 (T2) days of bonding of the self-ligating (In-Ovation^®R, Dentsply, GAC or SmartClip™, 3 M Unitek, Monrovia, CA, USA) and of one conventional bracket (Gemini™, 3 M Unitek, Monrovia, CA, USA) used with elastomeric ligatures. Total DNA from samples was extracted using CTAB-DNA precipitation method and Real-time PCR was performed to analyse bacterial level. Non-parametric Friedman and Wilcoxon tests were used for data analysis (p value of < 0.05). F. nucleatum presented a different level among the different brackets at T1 (p = 0.025), the highest level in the Gemini™ bracket when compared to the SmartClip™ bracket (p = 0.043). P. ginigvalis levels increased in the In-Ovation^®R (p = 0.028) at T1. The subgingival levels of bacterial species associated with periodontal disease P. ginigvalis increased in the self-ligating brackets In-Ovation^®R.Clinical Relevance: Some kinds of brackets could provide more retentive sites than others, and it seems to modulate the subgingival microbiota, since, in this study, we could observe the increase of the species associated with periodontal disease. Preventive protocols should be adopted in the use of self-ligating brackets.

Salivary microbial changes during the first 6 months of orthodontic treatment

Background

Orthodontic treatment is widely used to treat malocclusion. However, the influence of treatment on the oral microbiome remains unclear. In this study, we investigated salivary microbial changes in patients undergoing orthodontic treatment.

Methods

In total, 19 orthodontic patients participated in this study. Saliva samples were collected at the following three timepoints: before (T0) and 3 months (T1) and 6 months (T2) after the placement of orthodontic appliances. High-throughput sequencing was performed based on the 16S rRNA gene V4 region.

Results

The phyla of Proteobacteria, Bacteroidetes, Firmicutes, Actinobacteria and Fusobacteria were predominant. Observed Species, Chao1 and ACE, which represent α diversity, were significantly decreased at T1 and subsequently increased at T2. In addition, the β diversity at T1 based on the Bray-Curtis distances differed from T0 and T2. The relative abundances of Prevotella, Porphyromonas and Peptostreptococcus were decreased with treatment, whereas those of Capnocytophaga and Neisseria exhibited the opposite results. In total, 385 of 410 operational taxonomic units were shared at T0, T1 and T2. The co-occurrence networks with hub nodes at T1 were the most complex.

Conclusion

Orthodontic treatment temporarily affected the saliva microbial community. This dynamic alteration in species did not induce deterioration in oral health. Oral hygiene instructions were necessary and should be emphasized during each visit. Further studies with longer observation periods and more participants are required.

Candida prevalence and oral hygiene due to orthodontic therapy with conventional brackets

BACKGROUND

Conventional brackets are often used during orthodontic therapy of patients with malocclusion. The complex construction of such brackets greatly inhibits oral hygiene, which predisposes to increased carriage of microbiota. Orthodontic brackets could act as reservoir of yeast and predispose to oral candidosis. The aim of this study was to assess Candida prevalence and the role of oral hygiene during fixed appliance therapy. A further aim was to characterize the isolated yeasts according to their ability to form biofilms.

METHODS

Seventeen participants (average age 17 ± 7 years) were monitored by taking oral rinses and elastomeric ligature samples, and by evaluating the approximal plaque index (API) and gingival bleeding index (GBI) before and after placement of the orthodontic conventional brackets for 12 weeks. Isolated yeasts were counted and biofilm formation was evaluated.

RESULTS

One hundred and sixteen samples (67 oral rinses and 49 orthodontic elastomers) were collected. Ten patients (58.8% subjects) were Candida-carriers (two were colonized after bracket placement) and C. albicans was the most common species. The average number of yeasts in the oral cavity showed some fluctuation during the study, but in general had an upward trend (adj. R2 = 0.7967, p = 0.07025). A correlation was found between median number of yeasts and the periodontal indices (API, GBI). The average API values decreased in the Candida-carriers (adj. R² = 0.95; p = 0.01709), while average GBI values increased in the noncarriers (adj. R² = 0.92; p = 0.0256).

CONCLUSIONS

Treatment with orthodontic appliances promotes Candida yeast colonization, which is variable over time in terms of strain and species, with dominance of C. albicans, and without increased biofilm-forming activity. The API value decreases over time in carriers, and the GBI value increases in uncolonized patients, which may have predictive significance for the development of oral candidiasis during orthodontic treatment.

Healing without Surgery: A Case of Supernumerary Tooth,

Background:

Supernumerary teeth are present in 0,2-3% of the population. Multiple supernumeraries are often associated with syndromes such as cleidocranial dysplasia and Gardner's syndrome. They often hinder the permanent eruption’s teeth, causing cavities, periodontal lesions, pulp necrosis, and in some cases follicular cysts. Reactive lesions such as fibroma, local fibrous hyperplasia, pyogenic granuloma, and peripheral ossifying fibroma are frequent gingival lesions.

Materials and Methods:

We reported a case of a 9 years old patient with the missed eruption of a permanent element caused by a supernumerary tooth, associated with an exophytic palatine lesion. The deciduous incisor was still present and the supernumerary included. It was decided to proceed with the extraction of the deciduous and to wait for scheduling checks every two months. After a few months, the conoid shape supernumerary tooth erupted in the maxillary arch, so a fixed orthodontic therapy was performed to create the space for the central incisor’s eruption.

Results:

After a few months, the tooth began to erupt in the arch thanks to orthodontic traction. The patient was instructed to correct and specific oral hygiene maneuvers to lower the plaque index and try to reduce gingival hypertrophy.

Conclusion:

Supernumerary teeth often hinder the eruption and development of the related permanent tooth causing localized periodontal problems. Corrective fixed orthodontics requires more strict oral hygiene to avoid periodontal complications.

Relationship between orthodontic treatment and dental caries: results from a national survey

OBJECTIVES

Orthodontic treatment has been suggested to increase the risk of dental caries. The aim of this study was to evaluate the association between orthodontic treatment and the likelihood of dental caries.

METHODS

The study included data for adults aged ≥ 19 years who participated in the Korea National Health and Nutrition Examination Survey in 2013-2015. The participants' demographic, socio-economic, and general and oral health-care data were collected by trained interviewers using a structured questionnaire. The number of decayed teeth (DT) and the decayed, missing and filled teeth (DMFT) index score on oral examinations performed by dentists were compared between subjects who underwent orthodontic treatment and those who did not, using the chi-squared test and logistic regression analysis.

RESULTS

All logistic regression analysis models showed a significant association between orthodontic treatment and untreated dental caries. The likelihood of having untreated dental caries was lower in subjects who had received orthodontic treatment than in those who had not, regardless of confounding factors (P < 0.001). After adjustment for confounding factors, the mean number of DT was lower in subjects who had received orthodontic treatment than in those who had not (0.66 vs. 0.94; P < 0.001). There was no statistically significant difference in the DMFT index score between the two groups.

CONCLUSIONS

Orthodontic treatment was associated with a decreased likelihood of untreated dental caries. Moreover, there was no evidence indicating a link between the DMFT index score and orthodontic treatment.