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Mendes Ribeiro SM, Aragón MLSDC, Espinosa DDSG, Shibasaki WMM, Normando D. Orthodontic aligners: between passion and science. Dental Press J Orthod 2024; 28:e23spe6. [PMID: 38198351 PMCID: PMC10768648 DOI: 10.1590/2177-6709.28.6.e23spe6] [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: 10/02/2023] [Accepted: 11/10/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION The benefits and safety of using orthodontic aligners have been reported more by clinical experience and expert opinion than by scientific evidence. Another important aspect is that aligners are constantly evolving. It is important to obtain evidence that allows for new updates in manufacturing technology, in the development of new movement planning protocols, in the incorporation and design of attachments, and in the aid of skeletal anchorage. METHODS Evidence retrieved from six electronic databases (CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and the Joanna Briggs Library) is presented by means of questions and answers. CONCLUSIONS There is evidence that the aligners presented different levels of difficulty in performing each type of movement, with rotational and vertical movements being the most difficult to perform. Regarding perception of pain due to tooth movement, it seems to have less impact at the beginning of treatment; but dealing with more phonoarticulatory changes seems to require more treatment time in more complex cases. Aligners do not prevent the occurrence of root resorption, although the incidence and severity of resorption may be reduced, making oral hygiene easier and accepting the risk of white spots, caries and periodontal disease. Given the conflicting evidence, the release of bisphenol-A from the aligner cannot be denied. Solutions must be found to reduce the environmental impact of aligners disposal. There is an urgent need for well-designed randomized controlled trials.
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Affiliation(s)
| | | | | | | | - David Normando
- Universidade Federal do Pará (UFPA), Departamento de Ortodontia (Belém/PA, Brazil)
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Koletsi D, Panayi N, Laspos C, Athanasiou AE, Zinelis S, Eliades T. In vivo aging-induced surface roughness alterations of Invisalign ® and 3D-printed aligners. J Orthod 2023; 50:352-360. [PMID: 36573484 PMCID: PMC10693732 DOI: 10.1177/14653125221145948] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To assess the surface roughness of in-house 3D-printed orthodontic aligners compared with Invisalign® appliances, both retrieved as well as in the 'as-received' control status. DESIGN An in vitro study following intra-oral material aging. SETTING AND PARTICIPANTS Twelve clinically used Invisalign® appliances and the same number of 3D-printed aligners, without involvement of attachments, were obtained from a respective number of patients. A similar number of 'as-received' aligners, of each material, were used as control (CON) groups. METHOD Four groups of materials were examined: A = Invisalign® CON; B = Invisalign® used; C = 3D-printed CON; and D = 3D-printed used. Optical profilometry was employed to examine the following surface roughness parameters: amplitude parameters Sa, Sq and Sz and functional parameters Sc and Sv. Descriptive statistics and quantile regression modeling were conducted, and the level of statistical significance was set at α = 0.05. RESULTS Intra-oral exposure of 3D-printed aligners was significantly associated with increase in all tested parameters (P < 0.001 at all occasions). Significant differences were detected in the retrieved 3D-printed aligners compared with Invisalign® retrieved, with the exception of Sz. The respective effect sizes (median differences) were as follows: Sa: 169 nm, 95% confidence interval [CI] = 89-248, P < 0.001; Sq: 315 nm, 95% CI = 152-477, P < 0.001; Sc: 233 nm3/nm2, 95% CI = 131-335, P < 0.001; and Sv: 43 nm3/nm2, 95% CI = 17-68, P = 0.002. CONCLUSION Within the limitations of this study, we concluded that surface roughness differences existed between 3D-printed aligners and Invisalign® in the retrieved status, as well as between the control and retrieved 3D-printed groups.
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Affiliation(s)
- Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nearchos Panayi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Dentistry, School of Medicine, European University Cyprus, Nicosia, Cyprus
- Private practice, Limassol, Cyprus
| | - Christodoulos Laspos
- Department of Dentistry, School of Medicine, European University Cyprus, Nicosia, Cyprus
- Private practice, Limassol, Cyprus
| | | | - Spiros Zinelis
- Department of 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
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Peña-Corona SI, Chávez-Corona JI, Pérez-Caltzontzin LE, Vargas-Estrada D, Mendoza-Rodríguez CA, Ramos-Martínez E, Cerbón-Gutiérrez JL, Herrera-Barragán JA, Quintanar-Guerrero D, Leyva-Gómez G. Melatonin and Vitamins as Protectors against the Reproductive Toxicity of Bisphenols: Which Is the Most Effective? A Systematic Review and Meta-Analysis. Int J Mol Sci 2023; 24:14930. [PMID: 37834378 PMCID: PMC10573514 DOI: 10.3390/ijms241914930] [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: 08/28/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Bisphenols such as bisphenol A (BPA), S (BPS), C (BPC), F (BPF), AF (BPAF), tetrabromobisphenol, nonylphenol, and octylphenol are plasticizers used worldwide to manufacture daily-use articles. Exposure to these compounds is related to many pathologies of public health importance, such as infertility. Using a protector compound against the reproductive toxicological effects of bisphenols is of scientific interest. Melatonin and vitamins have been tested, but the results are not conclusive. To this end, this systematic review and meta-analysis compared the response of reproductive variables to melatonin and vitamin administration as protectors against damage caused by bisphenols. We search for controlled studies of male rats exposed to bisphenols to induce alterations in reproduction, with at least one intervention group receiving melatonin or vitamins (B, C, or E). Also, molecular docking simulations were performed between the androgen (AR) and estrogen receptors (ER), melatonin, and vitamins. About 1234 records were initially found; finally, 13 studies were qualified for review and meta-analysis. Melatonin plus bisphenol improves sperm concentration and viability of sperm and increases testosterone serum levels compared with control groups; however, groups receiving vitamins plus bisphenols had lower sperm concentration, total testis weight, and testosterone serum levels than the control. In the docking analysis, vitamin E had the highest negative MolDock score, representing the best binding affinity with AR and ER, compared with other vitamins and melatonin in the docking. Our findings suggest that vitamins could act as an endocrine disruptor, and melatonin is most effective in protecting against the toxic effects of bisphenols.
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Affiliation(s)
- Sheila I. Peña-Corona
- Departamento de Farmacia, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (S.I.P.-C.); (L.E.P.-C.)
| | - Juan I. Chávez-Corona
- Laboratorio de Investigación y Posgrado en Tecnología Farmacéutica, Universidad Nacional Autónoma de México-FESC, Campus 1, Cuautitlán Izcalli 54714, Mexico; (J.I.C.-C.); (D.Q.-G.)
| | - Luis E. Pérez-Caltzontzin
- Departamento de Farmacia, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (S.I.P.-C.); (L.E.P.-C.)
| | - Dinorah Vargas-Estrada
- Departamento de Fisiología y Farmacología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico;
| | - C. Adriana Mendoza-Rodríguez
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (C.A.M.-R.); (E.R.-M.)
| | - Edgar Ramos-Martínez
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (C.A.M.-R.); (E.R.-M.)
- Escuela de Ciencias, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca 04510, Mexico
| | - Jose L. Cerbón-Gutiérrez
- Departamento de Reproducción, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico;
| | - José A. Herrera-Barragán
- Departamento de Producción Agricola y Animal, Universidad Autónoma Metropolitana Unidad Xochimilco, Ciudad de México 04960, Mexico;
| | - David Quintanar-Guerrero
- Laboratorio de Investigación y Posgrado en Tecnología Farmacéutica, Universidad Nacional Autónoma de México-FESC, Campus 1, Cuautitlán Izcalli 54714, Mexico; (J.I.C.-C.); (D.Q.-G.)
| | - Gerardo Leyva-Gómez
- Departamento de Farmacia, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (S.I.P.-C.); (L.E.P.-C.)
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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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Mandurino M, Di Domenico GL, Baldani S, Collivasone G, Gherlone EF, Cantatore G, Paolone G. Dental Restorations. Bioengineering (Basel) 2023; 10:820. [PMID: 37508847 PMCID: PMC10376857 DOI: 10.3390/bioengineering10070820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Fulfilling a patient's request for a healthy, functional and esthetic smile represents a daily challenge for dental practitioners [...].
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Affiliation(s)
- Mauro Mandurino
- Dental School, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy
| | | | - Sofia Baldani
- Dental School, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy
| | - Giacomo Collivasone
- Dental School, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy
| | | | - Giuseppe Cantatore
- Dental School, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy
| | - Gaetano Paolone
- Dental School, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy
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Bonafé ACF, Oliveira DFLM, Fernandes EE, Garcia MT, Bressane A, de Oliveira W, de Mello Rode S. Microbiological evaluation in invisible aligner chemical cleaning methods against Candida albicans and Streptococcus mutans. Am J Orthod Dentofacial Orthop 2023:S0889-5406(23)00272-X. [PMID: 37294233 DOI: 10.1016/j.ajodo.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION This study aimed to assess the efficacy of chemical agents in removing Candida albicans and Streptococcus mutans biofilm from invisible aligners. METHODS The samples were made of EX30 Invisalign trays, biofilm was cultured by standardized suspensions of C. albicans ATCC strain and S. mutans clinical strain on the sample. The treatments used were 0.5% sodium hypochlorite (NaClO) (20 minutes), 1% NaClO (10 minutes), chlorhexidine (5 minutes), peroxide (15 minutes), and orthophosphoric acid (15 seconds). The control group received phosphate-buffered saline for 10 minutes. The colony-forming units per milliliter of each microorganism were determined by serial dilutions seeded in plates with selective culture mediums for each one. Data were analyzed by the Kruskal-Wallis and Conover-Iman tests at an α of 0.05. RESULTS For the C. albicans biofilm group, the control group had 9.7 Log10 of microorganism growth, and all treatment groups had statistically significant biofilm reduction, in which chlorhexidine presented the highest inhibition of 3 Log10, followed by alkaline peroxide and orthophosphoric acid both with 2.6 Log10, 1% NaClO (2.5 Log10), and 0.5% NaClO (2 Log10). As for S. mutans, the control group had 8.9 Log10 of growth, and a total microorganism inhibition was reached by chlorhexidine, 1% NaClO, and orthophosphoric acid, whereas alkaline peroxide inhibited growth to 7.9 Log10 and 0.5% NaClO 5.1 Log10. CONCLUSIONS Within the limitations, chlorhexidine and orthophosphoric acid had greater efficacy in both biofilms. In addition, 1% NaClO and alkaline peroxide also had significant effects; therefore, their incorporation aligners disinfection protocols are valid.
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Affiliation(s)
- Ana Carolina Ferreira Bonafé
- Department of Diagnosis and Surgery, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil.
| | | | - Ellen Eduarda Fernandes
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil
| | - Maíra Terra Garcia
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil
| | - Adriano Bressane
- Department of Environment Engineering, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil
| | - Wagner de Oliveira
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil
| | - Sigmar de Mello Rode
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil
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Degree of conversion of 3D printing resins used for splints and orthodontic appliances under different postpolymerization conditions. Clin Oral Investig 2023:10.1007/s00784-023-04893-8. [PMID: 36757463 DOI: 10.1007/s00784-023-04893-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To measure the degree of conversion (DC) of different 3D printing resins used for splints or orthodontic appliances under different postpolymerization conditions. MATERIALS AND METHODS Five 3D-printed photopolymer resins were studied. Each resin was analyzed in liquid form (n = 15), and then cylindrical specimens (n = 135) were additively manufactured and postcured with Form Cure (Formlabs) at different times (10, 60, and 90 min) and temperatures (20 °C, 60 °C, and 80 °C). The DC of each specimen was measured with Fourier transform infrared spectroscopy (FTIR). The data were statistically analyzed using a 3-way ANOVA followed by Tukey's post hoc test. RESULTS The time and temperature of postpolymerization significantly influenced the DC of each resin: when time and/or temperature increased, the DC increased. For all resins tested, the lowest DC was obtained with a postcuring protocol at 10 min and 20 °C, and the highest DC was obtained at 90 min and 80 °C. However, at 80 °C, the samples showed a yellowish color. CONCLUSIONS With the Form Cure device, the time and temperature of postcuring could have an impact on the DC of the 3D printing resins studied. The DC of the 3D printing resins could be optimized by adjusting the postpolymerization protocol. CLINICAL RELEVANCE Regardless of the resin used, when using the Form Cure device, postcuring at 60 min and 60 °C would be the minimal time and temperature conditions for achieving proper polymerization. Beyond that, it would be preferable to increase the postcuring time to boost the DC.
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Advances in orthodontic clear aligner materials. Bioact Mater 2022; 22:384-403. [PMID: 36311049 PMCID: PMC9588987 DOI: 10.1016/j.bioactmat.2022.10.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022] Open
Abstract
Rapid technological improvements in biomaterials, computer-aided design (CAD) and manufacturing (CAM) have endorsed clear aligner therapy (CAT) as a mainstay of orthodontic treatment, and the materials employed for aligner fabrication play an all-important role in determining the clinical performance of clear aligners. This narrative review has attempted to comprehensively encompass the entire gamut of materials currently used for the fabrication of clear aligners and elucidate their characteristics that are crucial in determining their performance in an oral environment. Historical developments and current protocols in aligner fabrication, features of contemporary bioactive materials, and emerging trends related to CAT are discussed. Advances in aligner material chemistry and engineering possess the potential to bring about radical transformations in the therapeutic applications of CAT; in the absence of which, clear aligners would continue to underperform clinically, due to their inherent biomechanical constraints. Finally, while innovations in aligner materials such as shape memory polymers, direct three-dimensional (3D) printed clear aligners and bioactive materials combined with clear aligner materials are essential to further advance the applications of CAT; increased awareness of environmental responsibilities among aligner manufacturers, aligner prescribing clinicians and aligner users is essential for better alignment of our climate change goals towards a sustainable planet.
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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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Alhendi A, Khounganian R, Almudhi A. Cytotoxicity assessment of different clear aligner systems: An in vitro study. Angle Orthod 2022; 92:482482. [PMID: 35666210 PMCID: PMC9374349 DOI: 10.2319/121621-919.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate and compare the cytotoxicity of multiple clear aligner systems (Invisalign, Eon, SureSmile, and Clarity). MATERIALS AND METHODS A cytotoxicity assessment was carried out by immersing three sets of aligners from the included four systems in normal saline for 1 month at 37°C. The solutions were then diluted to three different concentrations (5%, 10%, and 20% volume/volume). Gingival fibroblasts were exposed to the solution after being seeded to 96-well microplates for 48 hours, and the medium was substituted with an MTT solution (MTT: 3-[4,5-dime- thylthiazol-2-yl]-2,5-diphenyltetrazolium bromide). Optical density was then measured to determine cell viability and evaluate cytotoxicity subsequently. RESULTS Cytotoxicity comparison showed no statistically significant difference among the four included systems. However, when cell viability of each system was compared with the control, a significant difference was reported at the 10% and 20% solution concentrations. The Clarity system had the lowest toxicity across all solution concentrations. CONCLUSIONS The thermoplastic materials used by all tested systems (Invisalign, Eon, SureSmile, and Clarity) presented some degree of toxicity (slight to moderate), with statistically significant mean differences compared with the control.
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Alhendi A, Khounganian R, Ali R, Syed SA, Almudhi A. Structural Conformation Comparison of Different Clear Aligner Systems: An In Vitro Study. Dent J (Basel) 2022; 10:dj10050073. [PMID: 35621526 PMCID: PMC9139589 DOI: 10.3390/dj10050073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 12/10/2022] Open
Abstract
The aim of this study was to evaluate the structural conformations of three clear aligner systems, Eon®, SureSmile®, and Clarity®, and compare them with the most commonly used system, Invisalign®. Clear aligner samples from Invisalign®, Eon®, SureSmile®, and Clarity® were cut into 5 × 5 mm squares and exposed to artificial saliva for 2 weeks. The specimens were then subjected to a Vickers hardness test by applying three separate indentations with a 25 gf load for 15 s. Hardness was calculated using the following formula: Vickers hardness number = 1.854 (F/D2). Fourier transform infrared spectroscopy (FTIR) analysis was performed, with a diamond hemisphere and infrared beam being allowed to pass through each specimen. A mid-infrared range from 4000 to 375 cm−1 was recorded. The samples were also evaluated using scanning electron microscopy (SEM) combined with energy-dispersive X-ray microanalysis spectroscopy at different magnifications. No statistically significant differences were observed between the included systems with regard to hardness. All systems showed a polyurethane-based material, as illustrated by the FTIR analysis. Some structural variations were noted in the Invisalign® system, which had a more homogeneous architecture. Statistically significant differences in the carbon weights were found among the systems. The four systems presented comparable hardness levels. Mild molecular composition differences were found, but all systems had the similarity of being composed of a polyurethane-based material. Carbon and oxygen were the main elements, as they were located in all studied clear aligners. The SEM analysis revealed that Invisalign® had a smoother surface than the other three systems. All included clear aligners had similar characteristics with minimal differences, providing a wide variety of options for clinical orthodontic treatment according to patients’ demands.
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Affiliation(s)
- Aseel Alhendi
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia;
- Correspondence: ; Tel.: +966-541-419-097
| | - Rita Khounganian
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia;
| | - Raisuddin Ali
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Saeed Ali Syed
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Abdullazez Almudhi
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh 11545, 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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Sartori M, Borsari V, Maglio M, Brogini S, Bragonzoni L, Zaffagnini S, Fini M. Skin adhesion to the percutaneous component of direct bone anchored systems: systematic review on preclinical approaches and biomaterials. Biomater Sci 2021; 9:7008-7023. [PMID: 34549759 DOI: 10.1039/d1bm00707f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Nowadays, direct bone anchored systems are an increasingly adopted approach in the therapeutic landscape for amputee patients. However, the percutaneous nature of these devices poses a major challenge to obtain a stable and lasting proper adhesion between the implant surface and the skin. A systematic review was carried out in three databases (PubMed, Scopus, Web of Science) to provide an overview of the innovative strategies tested with preclinical models (in vitro and in vivo) in the last ten years to improve the skin adhesion of direct bone anchored systems. Fifty five articles were selected after screening, also employing PECO question and inclusion criteria. A modified Cochrane RoB 2.0 tool for the in vitro studies and the SYRCLE tool for in in vivo studies were used to assess the risk of bias. The evidence collected suggests that the implementation of porous percutaneous structures could be one of the most favorable approach to improve proper skin adhesion, especially in association with bioactive coatings, as hydroxyapatite, and exploiting the field of nanostructure. Some issues still remain open as (a) the identification and characterization of the best material/coating association able to limit the shear stresses at the interface and (b) the role of keratinocyte turnover on the skin/biomaterial adhesion and integration processes.
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Affiliation(s)
- Maria Sartori
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Veronica Borsari
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Melania Maglio
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Silvia Brogini
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Laura Bragonzoni
- University of Bologna - Department for Life Quality Studies, Bologna, Italy
| | - Stefano Zaffagnini
- IRCCS - Istituto Ortopedico Rizzoli, II Orthopaedic and Traumatologic Clinic, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Milena Fini
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
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Koletsi D, Iliadi A, Eliades T. Predictability of rotational tooth movement with orthodontic aligners comparing software-based and achieved data: A systematic review and meta-analysis of observational studies. J Orthod 2021; 48:277-287. [PMID: 34176358 PMCID: PMC8385585 DOI: 10.1177/14653125211027266] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate all available evidence on the prediction of rotational tooth movements with aligners. DATA SOURCES Seven databases of published and unpublished literature were searched up to 4 August 2020 for eligible studies. DATA SELECTION Studies were deemed eligible if they included evaluation of rotational tooth movement with any type of aligner, through the comparison of software-based and actually achieved data after patient treatment. DATA EXTRACTION AND DATA SYNTHESIS Data extraction was done independently and in duplicate and risk of bias assessment was performed with the use of the QUADAS-2 tool. Random effects meta-analyses with effect sizes and their 95% confidence intervals (CIs) were performed and the quality of the evidence was assessed through GRADE. RESULTS Seven articles were included in the qualitative synthesis, of which three contributed to meta-analyses. Overall results revealed a non-accurate prediction of the outcome for the software-based data, irrespective of the use of attachments or interproximal enamel reduction (IPR). Maxillary canines demonstrated the lowest percentage accuracy for rotational tooth movement (three studies: effect size = 47.9%; 95% CI = 27.2-69.5; P < 0.001), although high levels of heterogeneity were identified (I2: 86.9%; P < 0.001). Contrary, mandibular incisors presented the highest percentage accuracy for predicted rotational movement (two studies: effect size = 70.7%; 95% CI = 58.9-82.5; P < 0.001; I2: 0.0%; P = 0.48). Risk of bias was unclear to low overall, while quality of the evidence ranged from low to moderate. CONCLUSION Allowing for all identified caveats, prediction of rotational tooth movements with aligner treatment does not appear accurate, especially for canines. Careful selection of patients and malocclusions for aligner treatment decisions remain challenging.
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Affiliation(s)
- Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Anna Iliadi
- Department of Dental Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, Attica, Greece
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Eliades T, Zinelis S. Three-dimensional printing and in-house appliance fabrication: Between innovation and stepping into the unknown. Am J Orthod Dentofacial Orthop 2021; 159:1-3. [DOI: 10.1016/j.ajodo.2020.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/20/2020] [Indexed: 10/22/2022]
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Behaviour of Human Oral Epithelial Cells Grown on Invisalign ® SmartTrack ® Material. MATERIALS 2020; 13:ma13235311. [PMID: 33255259 PMCID: PMC7727678 DOI: 10.3390/ma13235311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/18/2022]
Abstract
Invisalign aligners have been widely used to correct malocclusions, but their effect on oral cells is poorly known. Previous research evaluated the impact of aligners’ eluates on various cells, but the cell behavior in direct contact with aligners is not yet studied. In the present study, we seeded oral epithelial cells (cell line Ca9-22) directly on Invisalign SmartTrack material. This material is composed of polyurethane and co-polyester and exhibit better mechanical characteristics compared to the predecessor. Cell morphology and behavior were investigated by scanning electron microscopy and an optical cell moves analyzer. The effect of aligners on cell proliferation/viability was assessed by cell-counting kit (CCK)-8 and 3,4,5-dimethylthiazol-2-yl-2,5-diphenyl tetrazolium bromide (MTT) assay and live/dead staining. The expression of inflammatory markers and proteins involved in epithelial barrier function was measured by qPCR. Cells formed cluster-like structures on aligners. The proliferation/viability of cells growing on aligners was significantly lower (p < 0.05) compared to those growing on tissue culture plastic (TCP). Live/dead staining revealed a rare occurrence of dead cells on aligners. The gene expression level of all inflammatory markers in cells grown on aligners’ surfaces was significantly increased (p < 0.05) compared to cells grown on TCP after two days. Gene expression levels of the proteins involved in barrier function significantly increased (p < 0.05) on aligners’ surfaces after two and seven days of culture. Aligners’ material exhibits no cytotoxic effect on oral epithelial cells, but alters their behavior and the expression of proteins involved in the inflammatory response, and barrier function. The clinical relevance of these effects has still to be established.
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Eliades T, Koletsi D. Minimizing the aerosol-generating procedures in orthodontics in the era of a pandemic: Current evidence on the reduction of hazardous effects for the treatment team and patients. Am J Orthod Dentofacial Orthop 2020; 158:330-342. [PMID: 32682661 PMCID: PMC7364170 DOI: 10.1016/j.ajodo.2020.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 02/06/2023]
Abstract
The purpose of this critical review is to list the sources of aerosol production during orthodontic standard procedure, analyze the constituent components of aerosol and their dependency on modes of grinding, the presence of water and type of bur, and suggest a method to minimize the quantity and detrimental characteristics of the particles comprising the solid matter of aerosol. Minimization of water-spray syringe utilization for rinsing is suggested on bonding related procedures, while temporal conditions as represented by seasonal epidemics should be considered for the decision of intervention scheme provided as a preprocedural mouth rinse, in an attempt to reduce the load of aerosolized pathogens. In normal conditions, chlorhexidine 0.2%, preferably under elevated temperature state should be prioritized for reducing bacterial counts. In the presence of oxidation vulnerable viruses within the community, substitute strategies might be represented by the use of povidone iodine 0.2%-1%, or hydrogen peroxide 1%. After debonding, extensive material grinding, as well as aligner related attachment clean-up, should involve the use of carbide tungsten burs under water cooling conditions for cutting efficiency enhancement, duration restriction of the procedure, as well as reduction of aerosolized nanoparticles. In this respect, selection strategies of malocclusions eligible for aligner treatment should be reconsidered and future perspectives may entail careful and more restricted utilization of attachment grips. For more limited clean-up procedures, such as grinding of minimal amounts of adhesive remnants, or individualized bracket debonding in the course of treatment, hand-instruments for remnant removal might well represent an effective strategy. Efforts to minimize the use of rotary instrumentation in orthodontic settings might also lead the way for future solutions. Measures of self-protection for the treatment team should never be neglected. Dressing gowns and facemasks with filter protection layers, appropriate ventilation and fresh air flow within the operating room comprise significant links to the overall picture of practice management. Risk management considerations should be constant, but also updated as new material applications come into play, while being grounded on the best available evidence.
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Affiliation(s)
- Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
| | - Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Koletsi D, Belibasakis GN, Eliades T. Interventions to Reduce Aerosolized Microbes in Dental Practice: A Systematic Review with Network Meta-analysis of Randomized Controlled Trials. J Dent Res 2020; 99:1228-1238. [PMID: 32660314 DOI: 10.1177/0022034520943574] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of this systematic review and network meta-analysis was to identify and rank the effectiveness of different interventions used in dental practice to reduce microbial load in aerosolized compounds. Seven electronic databases were searched to April 6, 2020, for randomized controlled trials (RCTs) or nonrandomized prospective studies in the field. Study selection, data extraction, and risk-of-bias assessment were performed for all included studies, while the outcome of interest pertained to differences in bacterial load quantification through the use of different interventions prior to aerosol-generating procedures in dental practices. Random effects frequentist network meta-analysis was performed, with mean difference (MD) and 95% CI as the effect measure. Confidence in the documented evidence was assessed through the newly fueled CINeMA framework (Confidence in Network Meta-analysis) based on the GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation). Twenty-nine clinical trials were deemed eligible, 21 RCTs and 8 nonrandomized studies, while 11 RCTs contributed to the network meta-analysis, comprising 10 competing interventions. Tempered chlorhexidine (CHX) 0.2% as compared with nonactive control mouth rinse, prior to routine ultrasonic scaling, was most effective toward reduced postprocedural bacterial load with an MD of -0.92 (95% CI, -1.54 to -0.29) in log10 bacterial CFUs (colony-forming units). For CHX 0.2%, an MD of -0.74 (95% CI, -1.07 to -0.40) was observed as compared with control. Tempered CHX 0.2% presented the highest probabilities of being ranked the most effective treatment (31.2%). Level of confidence varied from very low to moderate across all formulated comparisons. These findings summarize the current state of research evidence in the field of aerosolized bacteria in dentistry. Instigated by the era of SARS-CoV-2 pandemic, the stipulation of a broader evaluation of the aerosolized microbes, including viruses, potentially coupled with disinfectant-based prevention schemes should be prioritized.
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Affiliation(s)
- D Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - G N Belibasakis
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - T Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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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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