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Stocker L, Zervou SK, Papageorgiou SN, Karakousoglou S, Triantis T, Hiskia A, Eliades G, Eliades T. Salivary levels of eluents during Invisalign™ treatment with attachments: an in vivo investigation. Prog Orthod 2024; 25:22. [PMID: 38825612 PMCID: PMC11144685 DOI: 10.1186/s40510-024-00522-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 06/04/2024] Open
Abstract
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.
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Affiliation(s)
- Larissa Stocker
- Clinic of Orthodontics and Pediatric Dentistry, Center for Dental Medicine, University of Zurich, Plattenstrasse 11, Zurich, 8032, Switzerland
| | - Sevasti-Kiriaki Zervou
- Laboratory for Photo-Catalytic Processes and Environmental Chemistry, Institute of Nanoscience and Nanotechology, National Center for Scientific Research "Demokritos", Agia Paraskevi, Greece
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center for Dental Medicine, University of Zurich, Plattenstrasse 11, Zurich, 8032, Switzerland
| | | | - Theodoros Triantis
- Laboratory for Photo-Catalytic Processes and Environmental Chemistry, Institute of Nanoscience and Nanotechology, National Center for Scientific Research "Demokritos", Agia Paraskevi, Greece
| | - Anastasia Hiskia
- Laboratory for Photo-Catalytic Processes and Environmental Chemistry, Institute of Nanoscience and Nanotechology, National Center for Scientific Research "Demokritos", Agia Paraskevi, Greece
| | - George Eliades
- Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center for Dental Medicine, University of Zurich, Plattenstrasse 11, Zurich, 8032, Switzerland.
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Çifçi Özkan E, Dumanlı Gök G. Evaluation of bisphenol release of different clear aligner materials using the liquid chromatography-mass spectrometry/mass spectrometry method. Angle Orthod 2023; 93:721-726. [PMID: 37539687 PMCID: PMC10633800 DOI: 10.2319/010923-17.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 06/01/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES To evaluate the bisphenol release of different brands of clear aligner materials. MATERIALS AND METHODS Six different clear aligner materials were used in this study: Duran (Scheu-Dental GmbH, Iserlohn, Germany), Zendura Flx (Bay Materials LLC, Fremont, CA, USA), Zendura A (Bay Materials), Essix (Raintree Essix Inc., Metairie, LA, USA), Taglus Premium (Laxmi Dental Export Pvt. Ltd, Mumbai, India), and Smart Track (Align Technology, San Jose, CA, USA). The samples were kept in saline solution for 8 weeks in airtight test tubes at 37°C. The ratio between the weights of the samples and the volumes of the dilutions was prepared as 0.1 g/mL as suggested by International Standards Organization parameters. To evaluate the bisphenol release of materials, liquid chromatography-mass spectrometry/mass spectrometry analysis was performed. Data were analyzed with the Kruskal-Wallis test (α = 0.05). RESULTS Bisphenol A (BPA) values in Smart Track were found to be significantly higher than the Zendura A and Zendura Flx groups (P = .02, P = .03, respectively). There was no statistically significant difference among the samples in terms of Bisphenol F (BPF) values (P = .108). In terms of Bisphenol S (BPS) values, a statistically significant difference was found (P = .002) indicating that Smart Track released significantly more BPS than Zendura A (P = .001). CONCLUSIONS Under the test conditions, the amounts of leached BPA, BPF, and BPS were less than the reference dose for daily intake. However, the cumulative effect of these appliances should not be underestimated.
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Affiliation(s)
- Esra Çifçi Özkan
- Corresponding author: Dr Esra Çifçi Özkan, Department of Orthodontics, Biruni University Faculty of Dentistry, Kazlıçeşme, Cinoğlu Çk. No:2, 34020 Zeytinburnu/İstanbul, Turkey (e-mail: )
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Peter E, J M, George SA. Bisphenol-A release from thermoplastic clear aligner materials: A systematic review. J Orthod 2023; 50:276-286. [PMID: 36922722 DOI: 10.1177/14653125231160570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
AIM The aim of the present study was to undertake a systematic review of the available evidence on the release of bisphenol-A (BPA) from thermoplastic materials used in the fabrication of clear aligners (CA). METHODS Electronic databases, such as MEDLINE (via PubMed), Google Scholar, Scopus, Cochrane Library, Web of Science, OpenGrey, and the U.S. National Institute of Heath-Clinical Trials, were searched up to 27 October 2022. In vivo/in vitro studies that assessed the release of BPA from different thermoplastic CA materials, with or without a control group, were selected. The risk of bias (RoB) in the randomised controlled trials (RCT) and in vitro studies was assessed using the Cochrane RoB tool and the guidelines for the reporting of pre-clinical studies, respectively. The quality of evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Pro tool. RESULTS Six studies were considered for review from a total of 1926 records. This included one RCT and five in vitro studies. Only two studies found leaching of BPA, while four did not report any traces. The RoB was found to be moderate to high. The GRADE evidence level ranged from low to very low. Five of the included studies were conducted in vitro. Significant heterogeneity among the included studies prevented a quantitative synthesis. CONCLUSION In light of the available conflicting evidence, BPA release from CAs can neither be confirmed nor denied. Safety remains questionable until high-quality in vivo trials prove otherwise. REGISTRATION PROSPERO CRD42022310434.
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Affiliation(s)
- Elbe Peter
- Department of Orthodontics & Dentofacial Orthopedics, Government Dental College, Kottayam, Kerala, India
| | - Monisha J
- Department of Orthodontics & Dentofacial Orthopedics, Annoor Dental College, Kerala, India
| | - Suja Ani George
- Department of Orthodontics & Dentofacial Orthopedics, Government Dental College, Kottayam, Kerala, India
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Yazdi M, Daryanavard H, Ashtiani AH, Moradinejad M, Rakhshan V. 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. Dent Res J (Isfahan) 2023; 20:41. [PMID: 37180685 PMCID: PMC10166753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/18/2022] [Accepted: 10/09/2022] [Indexed: 05/16/2023] Open
Abstract
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.
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Affiliation(s)
- Marzie Yazdi
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hanie Daryanavard
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Hashemi Ashtiani
- Department of Prosthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrnaz Moradinejad
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Vahid Rakhshan
- Department of Anatomy, Dental School, Azad University of Medical Sciences, Tehran, Iran
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Seifi S, Mirzakouchaki B, Rafighi A, Aghanejad A, Hamidi AA, Shahrbaf S. 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. Am J Orthod Dentofacial Orthop 2023; 163:148-153. [PMID: 36396531 DOI: 10.1016/j.ajodo.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Sara Seifi
- Department of Orthodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behnam Mirzakouchaki
- Department of Orthodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Rafighi
- Department of Orthodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ayuob Aghanejad
- Research Centre for Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Asghar Hamidi
- Research Centre for Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shirin Shahrbaf
- Academic Unit of Restorative Dentistry, the University of Sheffield, Sheffield, United Kingdom
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Moradinejad M, Yazdi M, Daryanavard H, Ashtiani A, Rakhshan V. 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. Dent Res J (Isfahan) 2023. [DOI: 10.4103/1735-3327.372658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Panayi N, Cha JY, Kim KB. 3D Printed Aligners : Material science, Workflow and Clinical applications. Semin Orthod 2023. [DOI: 10.1053/j.sodo.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Willi A, Patcas R, Zervou SK, Panayi N, Schätzle M, Eliades G, Hiskia A, Eliades T. Leaching from a 3D-printed aligner resin. Eur J Orthod 2022; 45:244-249. [PMID: 36130120 DOI: 10.1093/ejo/cjac056] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIM To quantitatively assess the degree of conversion and the water-leaching targeted compound from 3D-printed aligners. MATERIALS AND METHODS 3D-printed aligners were made of photopolymerized resin (Tera Harz TC85A). The molecular structure and degree of conversion of the set resin were investigated by ATR-FTIR spectroscopy (n = 5). The aligners (n = 10) were immersed in double distilled water for 1 week at 37°C and the eluents were analysed using liquid chromatography/mass spectrometry methods (LC-ESI-MS/MS for urethane dimethacrylate [UDMA] and LC-APCI-MS/MS for bispenol-A [BPA]). RESULTS The resin was composed of aliphatic vinyl ester-urethane monomers, with acrylate and/or methacrylate functionalization. The degree of conversion was estimated as to 83%. There was no detection of BPA in any of the assessed samples (0.25 µg/l). Quantifiable amounts of UDMA were detected in all the exposed samples, ranging from 29 to 96 µg/l. CONCLUSIONS Although efficiently polymerized and BPA free, the great variability in the amount of UDMA monomer leached from the examined samples may raise concerns on potential health hazards after repeated intraoral exposure, which is indicated for this class of materials.
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Affiliation(s)
- Andreas Willi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - Raphael Patcas
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - Sevasti-Kiriaki Zervou
- Photo-Catalytic Processes and Environmental Chemistry, Institute of Nanoscience and Nanotechnology, National Centre for Scientific Research Demokritos, Athens, Greece
| | - Nearchos Panayi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland.,Department of Dentistry, European University Cyrpus, Nicosia, Cyprus
| | - Marc Schätzle
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - George Eliades
- Photo-Catalytic Processes and Environmental Chemistry, Institute of Nanoscience and Nanotechnology, National Centre for Scientific Research Demokritos, Athens, Greece.,Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Anastasia Hiskia
- Photo-Catalytic Processes and Environmental Chemistry, Institute of Nanoscience and Nanotechnology, National Centre for Scientific Research Demokritos, Athens, Greece
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
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Thurzo A, Šufliarsky B, Urbanová W, Čverha M, Strunga M, Varga I. Pierre Robin Sequence and 3D Printed Personalized Composite Appliances in Interdisciplinary Approach. Polymers (Basel) 2022; 14:polym14183858. [PMID: 36146014 PMCID: PMC9500754 DOI: 10.3390/polym14183858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
This paper introduces a complex novel concept and methodology for the creation of personalized biomedical appliances 3D-printed from certified biocompatible photopolymer resin Dental LT Clear (V2). The explained workflow includes intraoral and CT scanning, patient virtualization, digital appliance design, additive manufacturing, and clinical application with evaluation of the appliance intended for patients with cranio-facial syndromes. The presented concept defines virtual 3D fusion of intraoral optical scan and segmented CT as sufficient and accurate data defining the 3D surface of the face, intraoral and airway morphology necessary for the 3D design of complex personalized intraoral and extraoral parts of the orthopedic appliance. A central aspect of the concept is a feasible utilization of composite resin for biomedical prototyping of the sequence of marginally different appliances necessary to keep the pace with the patient rapid growth. Affordability, noninvasiveness, and practicality of the appliance update process shall be highlighted. The methodology is demonstrated on a particular case of two-year-old infant with Pierre Robin sequence. Materialization by additive manufacturing of this photopolymer provides a highly durable and resistant-to-fracture two-part appliance similar to a Tübingen palatal plate, for example. The paper concludes with the viability of the described method and material upon interdisciplinary clinical evaluation of experts from departments of orthodontics and cleft anomalies, pediatric pneumology and phthisiology, and pediatric otorhinolaryngology.
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Affiliation(s)
- Andrej Thurzo
- Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava, 81250 Bratislava, Slovakia
- Correspondence: ; Tel.: +421-903-110-107
| | - Barbora Šufliarsky
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava and University Hospital, 81372 Bratislava, Slovakia
| | - Wanda Urbanová
- Department of Orthodontics and Cleft Anomalies, Faculty Hospital Kralovske Vinohrady, Dental Clinic 3rd Medical Faculty Charles University, 10034 Prague, Czech Republic
| | - Martin Čverha
- Clinic of Pediatric Otorhinolaryngology of the Medical Faculty Comenius University in Bratislava, 83340 Bratislava, Slovakia
| | - Martin Strunga
- Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava, 81250 Bratislava, Slovakia
| | - Ivan Varga
- Department of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, 81372 Bratislava, Slovakia
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Pratsinis H, Papageorgiou SN, Panayi N, Iliadi A, Eliades T, Kletsas D. Cytotoxicity and estrogenicity of a novel 3-dimensional printed orthodontic aligner. Am J Orthod Dentofacial Orthop 2022; 162:e116-e122. [PMID: 35842359 DOI: 10.1016/j.ajodo.2022.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Orthodontic aligners printed with in-office 3-dimensional (3D) procedures have been described, but no data on their biocompatibility exist. This study investigates the cytotoxicity and estrogenicity of a 3D-printed orthodontic aligner by assessing its biological and behavioral effects. METHODS Ten sets of 1 type of aligner were immersed in sterile deionized water for 14 days, and the cytotoxicity and estrogenicity of released factors were assessed via MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assays on human gingival fibroblasts and the estrogen-sensitive MCF-7 and the estrogen-insensitive MDA-MB-231 breast cancer cell lines. 17β-Estradiol and bisphenol-A were used as positive controls. The statistical analysis of data was performed with generalized linear models at a 0.05 level of significance. RESULTS No signs of cytotoxicity were seen for the aligner samples for concentrations (v/v) of 20% (P = 0.32), 10% (P = 0.79), or 5% (P = 0.76). The antioxidant activity expressed as the capacity to reduce intracellular levels of reactive oxygen species was not affected in the aligner samples (P = 0.08). No significant estrogenicity was induced by the aligner samples compared with eluents from the negative control for both MCF-7 (P = 0.65) and MDA-MB-231 (P = 0.78). As expected, 17β-Estradiol and bisphenol-A stimulated MCF-7 cell proliferation, whereas no effect was observed on MDA-MB-231 cells. CONCLUSIONS In conclusion, if any factors were released during the 14-day aging of 3D-printed aligners in water, these were not found to be cytotoxic for human gingival fibroblasts and did not affect their intracellular reactive oxygen species levels. Moreover, no estrogenic effects of these putative eluates were observed based on an E-screen assay.
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Affiliation(s)
- Harris Pratsinis
- Laboratory of Cell Proliferation and Ageing, Institute of Biosciences and Applications, National Center for Scientific Research "Demokritos," Athens, Greece
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nearchos Panayi
- Department of Dentistry, European University Cyprus, Nicosia, Cyprus; Private practice, Limassol, Cyprus
| | - Anna Iliadi
- Department of Dental Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
| | - Dimitris Kletsas
- Laboratory of Cell Proliferation and Ageing, Institute of Biosciences and Applications, National Center for Scientific Research "Demokritos," Athens, Greece
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Alhendi A, Khounganian R, Almudhi A, Ahamad SR. Leaching of Different Clear Aligner Systems: An In Vitro Study. Dent J (Basel) 2022; 10:dj10020027. [PMID: 35200252 PMCID: PMC8871144 DOI: 10.3390/dj10020027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate and compare the leaching of four different clear aligner systems (Invisalign®, Eon®, SureSmile®, and Clarity®). Three sets of aligners as obtained from the four manufacturers were cut and immersed in glass vials containing ethanol with different solutions. The first was 100% ethanol, the second was 75% ethanol to 25% water, the third was 50% ethanol to water, the fourth was 25% ethanol to 75% water, and the last was 100% water. The samples were incubated for two weeks at 37 °C. Leached substances were detected by the gas chromatography–mass spectrometry (GC-MS). Eleven different chemical compounds were detected and confirmed. Benzene1,3-bis(1,1-dimethylethyl) was the only compound detected in all four systems at levels of 100% and 75% ethanol. Statistically, insignificant differences were detected among the different systems where leaching was confirmed. Eon® system was the only material to show statistically significant differences when comparing the number of leached substances among the immersion solution concentrations. The four included systems showed variable degrees of leaching. The lowest amount of leached chemicals was observed in relation to the Invisalign® system, while the highest number was found in the Eon® system. None of the included clear aligner systems leached detectable amounts of bisphenol-A (BPA).
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Affiliation(s)
- Aseel Alhendi
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia;
- Correspondence: ; Tel.: +96-654-141-9097
| | - Rita Khounganian
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia;
| | - Abdullazez Almudhi
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia;
| | - Syed Rizwan Ahamad
- Central Laboratory, Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
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Francisco I, Paula AB, Ribeiro M, Marques F, Travassos R, Nunes C, Pereira F, Marto CM, Carrilho E, Vale F. The Biological Effects of 3D Resins Used in Orthodontics: A Systematic Review. Bioengineering (Basel) 2022; 9:bioengineering9010015. [PMID: 35049724 PMCID: PMC8773237 DOI: 10.3390/bioengineering9010015] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Three-dimensional (3D) resin medical-dental devices have been increasingly used in recent years after the emergence of digital technologies. In Orthodontics, therapies with aligners have gained popularity, mainly due to the aggressive promotion policies developed by the industry. However, their systemic effects are largely unknown, with few studies evaluating the systemic toxicity of these materials. The release of bisphenol A and other residual monomers have cytotoxic, genotoxic, and estrogenic effects. This systematic review aims to analyze the release of toxic substances from 3D resins used in Orthodontics and their toxic systemic effects systematically. The PICO question asked was, "Does the use of 3D resins in orthodontic devices induce cytotoxic effects or changes in estrogen levels?". The search was carried out in several databases and according to PRISMA guidelines. In vitro, in vivo, and clinical studies were included. The in vitro studies' risk of bias was assessed using the guidelines for the reporting of pre-clinical studies on dental materials by Faggion Jr. For the in vivo studies, the SYRCLE risk of bias tool was used, and for the clinical studies, the Cochrane tool. A total of 400 articles retrieved from the databases were initially scrutinized. Fourteen articles were included for qualitative analysis. The risk of bias was considered medium to high. Cytotoxic effects or estrogen levels cannot be confirmed based on the limited preliminary evidence given by in vitro studies. Evidence of the release of bisphenol A and other monomers from 3D resin devices, either in vitro or clinical studies, remains ambiguous. The few robust results in the current literature demonstrate the absolute need for further studies, especially given the possible implications for the young patient's fertility, which constitutes one of the largest groups of patients using these orthodontic devices.
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Affiliation(s)
- Inês Francisco
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3004-531 Coimbra, Portugal; (A.B.P.); (M.R.); (F.M.); (R.T.); (C.N.); (F.P.); (F.V.)
- Correspondence:
| | - Anabela Baptista Paula
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3004-531 Coimbra, Portugal; (A.B.P.); (M.R.); (F.M.); (R.T.); (C.N.); (F.P.); (F.V.)
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3004-531 Coimbra, Portugal; (C.M.M.); (E.C.)
- Faculty of Medicine, Area of Environment Genetics and Oncobiology (CIMAGO), Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, 3004-531 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-531 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3004-531 Coimbra, Portugal
| | - Madalena Ribeiro
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3004-531 Coimbra, Portugal; (A.B.P.); (M.R.); (F.M.); (R.T.); (C.N.); (F.P.); (F.V.)
| | - Filipa Marques
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3004-531 Coimbra, Portugal; (A.B.P.); (M.R.); (F.M.); (R.T.); (C.N.); (F.P.); (F.V.)
| | - Raquel Travassos
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3004-531 Coimbra, Portugal; (A.B.P.); (M.R.); (F.M.); (R.T.); (C.N.); (F.P.); (F.V.)
| | - Catarina Nunes
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3004-531 Coimbra, Portugal; (A.B.P.); (M.R.); (F.M.); (R.T.); (C.N.); (F.P.); (F.V.)
| | - Flávia Pereira
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3004-531 Coimbra, Portugal; (A.B.P.); (M.R.); (F.M.); (R.T.); (C.N.); (F.P.); (F.V.)
| | - Carlos Miguel Marto
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3004-531 Coimbra, Portugal; (C.M.M.); (E.C.)
- Faculty of Medicine, Area of Environment Genetics and Oncobiology (CIMAGO), Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, 3004-531 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-531 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3004-531 Coimbra, Portugal
- Faculty of Medicine, Institute of Experimental Pathology, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Eunice Carrilho
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3004-531 Coimbra, Portugal; (C.M.M.); (E.C.)
- Faculty of Medicine, Area of Environment Genetics and Oncobiology (CIMAGO), Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, 3004-531 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-531 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3004-531 Coimbra, Portugal
| | - Francisco Vale
- Faculty of Medicine, Institute of Orthodontics, University of Coimbra, 3004-531 Coimbra, Portugal; (A.B.P.); (M.R.); (F.M.); (R.T.); (C.N.); (F.P.); (F.V.)
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Tang SF, Hou X. Probing the toxic interactions between bisphenol A and glutathione S-transferase Phi8 from Arabidopsis thaliana. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 213:112029. [PMID: 33578103 DOI: 10.1016/j.ecoenv.2021.112029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
As primary polymer material in industrial products, bisphenol A (BPA) has become one of the most productive chemicals. Excluding its endocrine-disrupting property, BPA can also produce excessive reactive oxygen species (ROS). Nevertheless, the underlying toxic mechanisms of BPA-induced oxidative damages to plants are still unknown. In this work, glutathione S-transferase Phi8 was used as biomarker to evaluate the hazardous oxidative effects of BPA at the molecular level. Firstly, the intrinsic fluorescence of AtGSTF8 was statically quenched along with complex formation and structural and conformational changes, which led to the loosening and unfolding of the framework of AtGSTF8 as well as the increase of hydrophilicity around Trp residues. Then a single binding site was predicted for AtGSTF8 towards BPA and the complex formation was predominantly driven by hydrophobic interactions owing to the positive ΔH and ΔS. Besides, the predicted binding site of BPA was close to the H-site of AtGSTF8 which was surrounded by several hydrophobic amino acids based on the molecular docking results. The activity of glutathione S-transferase was declined and the plant growth was destroyed upon complex formation. The investigation of the binding mechanism of BPA with AtGSTF8 at molecular level would provide experimental assessments on toxicological effects of BPA on plants.
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Affiliation(s)
- Si-Fu Tang
- College of Chemistry and Pharmaceutical Sciences, Qingdao Agricultural University, Qingdao 266109, China
| | - Xiaomin Hou
- Shandong Province Key Laboratory of Applied Mycology, College of Life Sciences, Qingdao Agricultural University, Qingdao 266109, China.
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Elution study of acrylic monomers from orthodontic materials using high performance liquid chromatography (HPLC). J Orofac Orthop 2021; 83:34-47. [PMID: 33852039 PMCID: PMC8766367 DOI: 10.1007/s00056-021-00292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/06/2021] [Indexed: 11/17/2022]
Abstract
Purpose Main goal of the study was the identification and quantitative analysis of monomer elution from materials commonly used in fixed orthodontic therapy. Studies have shown severe health effects of monomers including cytotoxic, allergenic or mutagenic potential and endocrine changes. This in vitro study focusses primarily on five resins which are usually processed intraorally and remain in the oral cavity long-term. Methods We tested the elution of monomers from specimens (7.5 mm × 1.5 mm) immersed in artificial saliva at body temperature (37 °C) for 30 min to 5 weeks. The used method is in accordance with DIN EN ISO 10993-13. The five tested materials were BrackFix® (Voco GmbH, Cuxhaven, Germany), Triad®Gel (DeguDent GmbH, Hanau, Germany), and Transbond™ XT, LR and Plus (3M Unitek, Monrovia, CA, USA). All aliquots were analyzed using high performance liquid chromatography (HPLC). Data were statistically analyzed. Results All five analyzed materials eluted substances over a period of 5 weeks. Identified substances included bisphenol A (BPA), triethylene glycol dimethacrylate (TEGDMA) and urethane dimethacrylate (UDMA). BPA eluted from Transbond™ Plus, XT, LR and BrackFix®. The cumulated mean values after 35 days ranged from 16.04 to 64.83 ppm, depending on the material. TEGDMA eluted with a mean of 688.61 ppm from Transbond™ LR. UDMA with a mean of 1682.00 ppm from Triad®Gel. For each material the highest concentrations of all these substances were found in the first elution period. Other substances that were not equivocally identified or of low concentration also eluted. Conclusion Using the described method, it is possible to qualitatively and quantitatively determine the in vitro elution of monomers from orthodontic materials. The concentrations of the substances identified were below the current maximum recommended intake. However, a cumulative effect and low-dose effects should be considered for both patients and dental professionals, especially for young patients. Measures to reduce exposure patients and practitioners are suggested.
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Sabour A, El Helou M, Roger-Leroi V, Bauer C. Release and toxicity of bisphenol-A (BPA) contained in orthodontic adhesives: A systematic review. Int Orthod 2020; 19:1-14. [PMID: 33308954 DOI: 10.1016/j.ortho.2020.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/26/2020] [Accepted: 11/07/2020] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Anas Sabour
- Université Clermont - Auvergne, UFR d'Odontologie, 2, rue de Braga, 63100 Clermont-Ferrand, France.
| | - Marwan El Helou
- Université Clermont - Auvergne, UFR d'Odontologie, 2, rue de Braga, 63100 Clermont-Ferrand, France
| | - Valérie Roger-Leroi
- Université Clermont - Auvergne, UFR d'Odontologie, 2, rue de Braga, 63100 Clermont-Ferrand, France
| | - Cynthia Bauer
- Université Clermont - Auvergne, UFR d'Odontologie, 2, rue de Braga, 63100 Clermont-Ferrand, France
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The use of attachments in aligner treatment: Analyzing the “innovation” of expanding the use of acid etching–mediated bonding of composites to enamel and its consequences. Am J Orthod Dentofacial Orthop 2020; 158:166-174. [DOI: 10.1016/j.ajodo.2020.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/22/2020] [Indexed: 11/23/2022]
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Iliadi A, Koletsi D, Papageorgiou SN, Eliades T. Safety Considerations for Thermoplastic-Type Appliances Used as Orthodontic Aligners or Retainers. A Systematic Review and Meta-Analysis of Clinical and In-Vitro Research. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E1843. [PMID: 32295303 PMCID: PMC7215465 DOI: 10.3390/ma13081843] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Anna Iliadi
- Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (D.K.); (S.N.P.)
| | - Spyridon N. Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (D.K.); (S.N.P.)
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (D.K.); (S.N.P.)
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Piao X, Liu Z, Li Y, Yao D, Sun L, Wang B, Ma Y, Wang L, Zhang Y. Investigation of the effect for bisphenol A on oxidative stress in human hepatocytes and its interaction with catalase. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2019; 221:117149. [PMID: 31153119 DOI: 10.1016/j.saa.2019.117149] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 06/09/2023]
Abstract
Bisphenol A (BPA) as a chemical raw material, is widely used in the manufacturing process of daily necessities. It was reported that BPA could induce oxidative stress, and catalase (CAT) can protect the body from oxidative stress. In this paper, the effect of BPA on CAT was carried out in vitro and in vivo. Firstly, we studied the effects of BPA on oxidative stress, cell viability and CAT activity in human hepatocytes, and the results of vitro experiments show that the survival rate of hepatocytes significant decreased along with the increase of BPA concentration. And when the BPA concentration was 100 μM, the hepatocyte survival decreased by 13.2%, ROS levels in the cells increased by 85%. However, the activity of intracellular CAT increased with the increasing concentration of BPA in 24 h. The results of vivo experiments showed that the activity of CAT in the high-dose group decreased by 29.1% compared with the control group. The long-term effects of BPA on rats reduced the CAT activity in liver, which reduced the resistance to oxidative stress. Meanwhile, the interaction mechanism between BPA and CAT at the molecule level was performed via multiple spectra methods and molecular docking, and the results illustrated that the structural change of CAT is mainly due to the strong combination of BPA with the residues of Trp185. In addition, the interaction mechanism between BPA and CAT were hydrophobic and electrostatic effect. This study provided experimental evidence for better understanding the toxicity of BPA.
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Affiliation(s)
- Xianmei Piao
- Department of Pharmacology, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education, College of Pharmacy, Harbin Medical University, Baojian Road 157, Nangang District, Harbin 150081, PR China
| | - Zhongrui Liu
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Baojian Road 157, Nangang District, Harbin 150081, PR China
| | - Yangyang Li
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Baojian Road 157, Nangang District, Harbin 150081, PR China
| | - Dahong Yao
- Department of Medicinal Chemistry, College of Pharmacy, Shenzhen University, Nanhai Road 3688, Nanshan District, Shenzhen, Guangdong 518060, PR China
| | - Liwen Sun
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Baojian Road 157, Nangang District, Harbin 150081, PR China
| | - Baihui Wang
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Baojian Road 157, Nangang District, Harbin 150081, PR China
| | - Yan Ma
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Baojian Road 157, Nangang District, Harbin 150081, PR China
| | - Libo Wang
- Department of Medicinal Chemistry and Natural Medicine Chemistry, College of Pharmacy, Harbin Medical University, Baojian Road 157, Nangang District, Harbin 150081, PR China.
| | - Yan Zhang
- Department of Pharmacology, State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education, College of Pharmacy, Harbin Medical University, Baojian Road 157, Nangang District, Harbin 150081, PR China.
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Manoj MK, Ramakrishnan R, Babjee S, Nasim R. High-performance liquid chromatography analysis of salivary bisphenol A levels from light-cured and chemically cured orthodontic adhesives. Am J Orthod Dentofacial Orthop 2018; 154:803-808. [PMID: 30477778 DOI: 10.1016/j.ajodo.2018.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Madhav K Manoj
- Department of Orthodontics and Dento-facial Orthopedics, PMS College of Dental Science and Research, Trivandrum, Kerala, India.
| | - Roopesh Ramakrishnan
- Department of Orthodontics and Dento-facial Orthopedics, PMS College of Dental Science and Research, Trivandrum, Kerala, India
| | - Sujith Babjee
- Department of Orthodontics and Dento-facial Orthopedics, PMS College of Dental Science and Research, Trivandrum, Kerala, India
| | - Rasha Nasim
- Department of Orthodontics and Dento-facial Orthopedics, PMS College of Dental Science and Research, Trivandrum, Kerala, India
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Bisphenol A and orthodontics: An update of evidence-based measures to minimize exposure for the orthodontic team and patients. Am J Orthod Dentofacial Orthop 2018; 152:435-441. [PMID: 28962717 DOI: 10.1016/j.ajodo.2017.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 08/14/2017] [Accepted: 08/14/2017] [Indexed: 12/24/2022]
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Association between polymorphisms in genes encoding estrogen receptors (ESR1 and ESR2) and excreted bisphenol A levels after orthodontic bracket bonding: a preliminary study. Prog Orthod 2018; 19:19. [PMID: 29961922 PMCID: PMC6026583 DOI: 10.1186/s40510-018-0219-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/29/2018] [Indexed: 11/10/2022] Open
Abstract
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.
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Pelourde C, Bationo R, Boileau MJ, Colat-Parros J, Jordana F. Monomer release from orthodontic retentions: An in vitro study. Am J Orthod Dentofacial Orthop 2018; 153:248-254. [PMID: 29407502 DOI: 10.1016/j.ajodo.2017.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The adhesives used to bond orthodontic retentions are low-loaded composite resins with a resinous matrix containing bisphenol A diglycidyl ether dimethacrylate synthesized from bisphenol A (BPA), fluidizers such as triethylene glycol dimethacrylate (TEGDMA) and hydrophilic polymers such as hydroxyethylmethacrylate. BPA disrupts the endocrine balance, and TEGDMA has high risks for human health: eg, allergies and cytotoxicity. The aim of this study was to evaluate in vitro the release of monomers from orthodontic bonded retentions. METHODS A reproducible model of bonded retentions was carried out using calibrated molds. We analyzed the release of monomers by gas phase chromatography coupled with mass spectrometry. RESULTS This model allowed us to qualitatively and quantitatively evaluate the in-vitro release of monomers from orthodontic adhesives. The quantitative and qualitative analyses showed no BPA release above the 0.02 ppm detection limit. A greater release of TEGDMA was observed with Transbond LR (31.7 μg/mL) than with Transbond XT (13.12 μg/mL) (both, 3M Unitek, Monrovia, Calif). Other toxic components (iodobenzene, iodobiphenyl, triphenyl stibine, and so on) were also identified. CONCLUSIONS Toxic and carcinogenic molecules not mentioned in the material safety data sheets were identified.
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Affiliation(s)
- Chloé Pelourde
- Pôle d'Odontologie et de Santé buccale, Hôpital Pellegrin, Bordeaux, France; UFR d'Odontologie, Université de Bordeaux, Bordeaux, France
| | - Raoul Bationo
- Clinique Bucco-dentaire, Centre Médical des Armées, Ouagadougou, Burkina Faso
| | - Marie-José Boileau
- Pôle d'Odontologie et de Santé buccale, Hôpital Pellegrin, Bordeaux, France; UFR d'Odontologie, Université de Bordeaux, Bordeaux, France
| | - Jacques Colat-Parros
- Pôle d'Odontologie et de Santé buccale, Hôpital Pellegrin, Bordeaux, France; UFR d'Odontologie, Université de Bordeaux, Bordeaux, France
| | - Fabienne Jordana
- Faculty of Dentistry Nantes, France; Service d'Odontologie, Nantes, France.
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Deviot M, Lachaise I, Högg C, Durner J, Reichl FX, Attal JP, Dursun E. Bisphenol A release from an orthodontic resin composite: A GC/MS and LC/MS study. Dent Mater 2017; 34:341-354. [PMID: 29183672 DOI: 10.1016/j.dental.2017.11.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 10/21/2017] [Accepted: 11/13/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES First, to analyse the in vitro release of BPA and Bis-GMA from an orthodontic resin composite (Transbond XT, 3M Unitek), stored in various conditions, by gas chromatography/mass spectrometry (GC/MS) and liquid chromatography/mass spectrometry (LC/MS); then to extrapolate the data to the clinical situation. Secondly, to explore the thermal stability of Bis-GMA. METHODS Cylinders of resin composite were prepared and stored according to 3 different protocols: (1) they were light-cured 20s, then placed in artificial saliva; (2) they were light-cured 2s, then placed in acetonitrile; (3) they were light-cured 2s, then placed in methanol. For each group, BPA and Bis-GMA release were determined with GC/MS and/or LC/MS at least after one week. Besides, 120 brackets (10 of each type) were bonded over metal teeth, then debonded, and the weight and the surface of resin composite residues were measured. BPA and Bis-GMA release of adhesive residues were extrapolated from the data obtained with the cylinders. Besides, BPA release from a heated Bis-GMA solution was measured. RESULTS With GC/MC, BPA was detected in all samples. With LC/MS, BPA was detected only from samples immersed in MeOH; Bis-GMA was detected, in varying amount according to the extraction media and the light-curing time. BPA was found after heating of the Bis-GMA solution. SIGNIFICANCE Contamination risk and the heat applied in GC/MS may overestimate the BPA release from resin composite. Based on the LC/MS results, the risk of BPA release after orthodontic bonding would be more than 42000 times lower than the TDI for a 30-kg child.
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Affiliation(s)
- Marc Deviot
- Research Unit in Innovative Dental Materials and Interfaces, EA4462, Faculty of Dental Surgery, Paris Descartes University, 1 rue Maurice Arnoux, 92120 Montrouge, France; Bretonneau Hospital, 23 rue Joseph de Maistre, 75018 Paris, France
| | - Isabelle Lachaise
- Université Paris Est, ICMPE (UMR 7182), CNRS, UPEC, 2 rue Henri Dunant, 94320 Thiais, France
| | - Christof Högg
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilians-University, Nussbaumstrasse 26, 80336 Munich, Germany; Department of Operative Restorative Dentistry, Periodontology and Pedodontics, Ludwig-Maximilians-University, Goethestrasse 70, 80336 Munich, Germany
| | - Jürgen Durner
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilians-University, Nussbaumstrasse 26, 80336 Munich, Germany; Department of Operative Restorative Dentistry, Periodontology and Pedodontics, Ludwig-Maximilians-University, Goethestrasse 70, 80336 Munich, Germany
| | - Franz-Xaver Reichl
- Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilians-University, Nussbaumstrasse 26, 80336 Munich, Germany; Department of Operative Restorative Dentistry, Periodontology and Pedodontics, Ludwig-Maximilians-University, Goethestrasse 70, 80336 Munich, Germany
| | - Jean-Pierre Attal
- Research Unit in Innovative Dental Materials and Interfaces, EA4462, Faculty of Dental Surgery, Paris Descartes University, 1 rue Maurice Arnoux, 92120 Montrouge, France; Charles Foix Hospital, 7 avenue de la République, 94200 Ivry-sur-Seine, France
| | - Elisabeth Dursun
- Research Unit in Innovative Dental Materials and Interfaces, EA4462, Faculty of Dental Surgery, Paris Descartes University, 1 rue Maurice Arnoux, 92120 Montrouge, France; Albert Chenevier Hospital, 40 rue de Mesly, 94000 Créteil, France.
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Bisphenol A release from orthodontic adhesives measured in vitro and in vivo with gas chromatography. Am J Orthod Dentofacial Orthop 2017; 151:477-483. [PMID: 28257732 DOI: 10.1016/j.ajodo.2016.07.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/23/2022]
Abstract
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.
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Bationo R, Jordana F, Boileau MJ, Colat-Parros J. Release of monomers from orthodontic adhesives. Am J Orthod Dentofacial Orthop 2017; 150:491-8. [PMID: 27585778 DOI: 10.1016/j.ajodo.2016.02.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Raoul Bationo
- Postgraduate student, Oral and Dental Health Polyclinic, Faculty of Dentistry, Army Medical Center, Ouagadougou, Burkina Faso
| | - Fabienne Jordana
- Associate professor, Department of Odontology, Faculty of Dental Surgery, University of Nantes, Nantes, France.
| | - Marie-José Boileau
- Professor, Dentistry and Oral Health Center, Pellegrin Hospital, Faculty of Dentistry, University of Bordeaux, Bordeaux, France
| | - Jacques Colat-Parros
- Associate professor, Dentistry and Oral Health Center, Pellegrin Hospital, Faculty of Dentistry, University of Bordeaux, Bordeaux, France
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Comparative evaluation of salivary bisphenol A levels in patients wearing vacuum-formed and Hawley retainers: An in-vivo study. Am J Orthod Dentofacial Orthop 2017; 151:471-476. [DOI: 10.1016/j.ajodo.2016.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/20/2022]
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Halimi A, Benyahia H, Bahije L, Adli H, Azeroual MF, Zaoui F. Étude systématique de la libération du bisphénol A par les matériaux orthodontiques et ses effets biologiques. Int Orthod 2016; 14:399-417. [DOI: 10.1016/j.ortho.2016.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Halimi A, Benyahia H, Bahije L, Adli H, Azeroual MF, Zaoui F. A systematic study of the release of bisphenol A by orthodontic materials and its biological effects. Int Orthod 2016; 14:399-417. [PMID: 27856373 DOI: 10.1016/j.ortho.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Abdelali Halimi
- Équipe de recherche en biotechnologie et biomatériaux en milieu buccal, faculté de médecine dentaire, Mohammed V university in Rabat, centre hospitalier Ibn-Sina, Rabat-Instituts, BP 6212, Madinat Al Irfane, Rabat, Morocco.
| | - Hicham Benyahia
- Équipe de recherche en biotechnologie et biomatériaux en milieu buccal, faculté de médecine dentaire, Mohammed V university in Rabat, centre hospitalier Ibn-Sina, Rabat-Instituts, BP 6212, Madinat Al Irfane, Rabat, Morocco
| | - Loubna Bahije
- Équipe de recherche en biotechnologie et biomatériaux en milieu buccal, faculté de médecine dentaire, Mohammed V university in Rabat, centre hospitalier Ibn-Sina, Rabat-Instituts, BP 6212, Madinat Al Irfane, Rabat, Morocco
| | - Hanane Adli
- Équipe de recherche en biotechnologie et biomatériaux en milieu buccal, faculté de médecine dentaire, Mohammed V university in Rabat, centre hospitalier Ibn-Sina, Rabat-Instituts, BP 6212, Madinat Al Irfane, Rabat, Morocco
| | - Mohamed-Faouzi Azeroual
- Équipe de recherche en biotechnologie et biomatériaux en milieu buccal, faculté de médecine dentaire, Mohammed V university in Rabat, centre hospitalier Ibn-Sina, Rabat-Instituts, BP 6212, Madinat Al Irfane, Rabat, Morocco
| | - Fatima Zaoui
- Équipe de recherche en biotechnologie et biomatériaux en milieu buccal, faculté de médecine dentaire, Mohammed V university in Rabat, centre hospitalier Ibn-Sina, Rabat-Instituts, BP 6212, Madinat Al Irfane, Rabat, Morocco
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Sharma R, Kotyk MW, Wiltshire WA. An investigation into bisphenol A leaching from materials used intraorally. J Am Dent Assoc 2016; 147:545-50. [DOI: 10.1016/j.adaj.2016.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 02/07/2023]
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Moffitt AH, Raina J. Long-term bonded retention after closure of maxillary midline diastema. Am J Orthod Dentofacial Orthop 2015; 148:238-44. [PMID: 26232832 DOI: 10.1016/j.ajodo.2015.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The objectives of this study were to evaluate fixed bonded palatal surface retainers between the maxillary central incisors that were placed to maintain midline diastema closure and record their longevity, proclivity for damage, and periodontal health of the central incisors in patients 5 or more years after treatment. METHODS Twenty-nine subjects were contacted and interviewed by phone concerning the status of their bonded retainer and midline diastema. Eleven subjects with intact retainers came for a periodontal health evaluation of the maxillary central incisors. The measures used were the plaque index, the periodontal screening and recording score, and the gingival index. A split-mouth design was used. Statistical analyses of retainer duration, damage probability, and gingival health were performed. RESULTS Of the 29 subjects, 52% of the initial retainers were in place for an average of 23 years. For the total of 34 bonded retainers, the mean longevity was 17 years. The risk of breakage for any particular year the retainer was in place was 2%. The mean differences in scores between the maxillary central incisors and the control teeth were -0.06 for the plaque index, -0.14 for the periodontal screening and recording score, and -0.11 for the gingival index. Statistical tests on the differences indicated no evidence that the long-term presence of the bonded palatal surface retainer adversely affected the periodontal health of the maxillary central incisors. CONCLUSIONS The study's sample demonstrated that a bonded retainer for maintaining closure of a maxillary midline diastema can last an average of 17 years or more, with a yearly 2% chance of breakage and with no expected adverse effects on the periodontal health of the maxillary central incisors.
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Affiliation(s)
- Allen H Moffitt
- Assistant clinical professor, Division of Orthodontics, Department of Oral & Maxillofacial Surgery, Medical Center, Vanderbilt University, Nashville, Tenn.
| | - Jasleen Raina
- Resident, Division of Orthodontics, Department of Oral & Maxillofacial Surgery, Medical Center, Vanderbilt University, Nashville, Tenn
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