Effect of Enamel Pretreatment with Pastes Presenting Different Relative Dentin Abrasivity (RDA) Values on Orthodontic Bracket Bonding Efficacy of Microfilled Composite Resin: In Vitro Investigation and Randomized Clinical Trial

Effect of Over-the-counter Whitening Toothpaste and Mouthwash in Orthodontics: A Literature Review

Aim

To summarize and analyze all the available literature on the use of over-the-counter toothpaste and mouthwashes with whitening agents and their possible effects on orthodontic treatment.

Background

Tooth color change frequently occurs during orthodontic treatment and represents a self-perceived need. According to the patient's perspective, there is a preference for the use of toothpaste and mouthwashes with some whitening effect.

Materials and methods

An electronic bibliographic search in English was carried out until June 2022, in PubMed, Scopus, and Web of Science databases. Randomized or nonrandomized clinical trials and experimental laboratory studies were included.

Review results

A total of 57 papers were obtained from an electronic search and 11 studies were included in the review. Outcomes such as strength force elastomeric, color stability, frictional resistance, ion release, shear bond strength (SBS), and adhesive remnant index (ARI) were evaluated.

Conclusion

Toothpaste and mouthwashes with whitening action did not have a favorable effect on most of the outcomes evaluated. In some cases regular toothpaste showed a better effect and in other cases, there were no differences with the control group. Only in the outcome release of ions from wires to whitening effect in teeth with or without attached brackets, they have a better performance.

Clinical significance

Due to the unfavorable effects of over-the-counter whitening toothpaste and mouthwashes on orthodontic materials and appliances, their use should be justified during treatment.

How to cite this article

Chinchay-Ruesta S, Ortiz-Pizarro M, Rodríguez-Díaz DR, et al. Effect of Over-the-counter Whitening Toothpaste and Mouthwash in Orthodontics: A Literature Review. Int J Clin Pediatr Dent 2023;16(S-3):S311-S316.

Effects of Acidic Environments on Dental Structures after Bracket Debonding

Brackets are metallic dental devices that are very often associated with acidic soft drinks such as cola and energy drinks. Acid erosion may affect the bonding between brackets and the enamel surface. The purpose of this study was to investigate the characteristics of brackets' adhesion, in the presence of two different commercially available drinks. Sixty human teeth were divided into six groups and bonded with either resin-modified glass ionomer (RMGIC) or resin composite (CR). A shared bond test (SBS) was evaluated by comparing two control groups with four other categories, in which teeth were immersed in either Coca-Cola^TM or Red Bull^TM energy drink. The debonding between the bracket and enamel was evaluated by SEM. The morphological aspect correlated with SBS results showed the best results for the samples exposed to artificial saliva. The best adhesion resistance to the acid erosion environment was observed in the group of teeth immersed in Red Bull^TM and with brackets bonded with RMGIC. The debonded structures were also exposed to Coca-Cola^TM and Red Bull^TM to assess, by atomic force microscopy investigation (AFM), the erosive effect on the enamel surface after debonding and after polishing restoration. The results showed a significant increase in surface roughness due to acid erosion. Polishing restoration of the enamel surface significantly reduced the surface roughness that resulted after debonding, and inhibited acid erosion. The roughness values obtained from polished samples after exposure to Coca-Cola^TM and Red Bull^TM were significantly lower in that case than for the debonded structures. Statistical results evaluating roughness showed that Red Bull^TM has a more erosive effect than Coca-Cola™. This result is supported by the large contact surface that resulted after debonding. In conclusion, the prolonged exposure of the brackets to acidic drinks affected the bonding strength due to erosion propagation into both the enamel-adhesive interface and the bonding layer. The best resistance to acid erosion was obtained by RMGIC.

Mechanical Properties of Orthodontic Cements and Their Behavior in Acidic Environments

The present research is focused on three different classes of orthodontic cements: resin composites (e.g., BracePaste); resin-modified glass ionomer RMGIC (e.g., Fuji Ortho) and resin cement (e.g., Transbond). Their mechanical properties such as compressive strength, diametral tensile strength and flexural strength were correlated with the samples' microstructures, liquid absorption, and solubility in liquid. The results show that the best compressive (100 MPa) and flexural strength (75 Mpa) was obtained by BracePaste and the best diametral tensile strength was obtained by Transbond (230 MPa). The lowestvalues were obtained by Fuji Ortho RMGIC. The elastic modulus is relatively high around 14 GPa for BracePaste, and Fuji Ortho and Transbond have only 7 GPa. The samples were also subjected to artificial saliva and tested in different acidic environments such as Coca-Cola and Red Bull. Their absorption and solubility were investigated at different times ranging from 1 day to 21 days. Fuji Ortho presents the highest liquid absorption followed by Transbond, the artificial saliva has the best absorption and Red Bull has the lowest absorption. The best resistance to the liquids was obtained by BracePaste in all environments. Coca-Cola presents values four times greater than the ones observed for artificial saliva. Solubility tests show that BracePaste is more soluble in artificial saliva, and Fuji Ortho and Transbond are more soluble in Red Bull and Coca-Cola. Scanning electron microscopy (SEM) images evidenced a compact structure for BracePaste in all environments sustaining the lower liquid absorption values. Fuji Ortho and Transbond present a fissure network allowing the liquid to carry out in-depth penetration of materials. SEM observations are in good agreement with the atomic force microscopy (AFM) results. The surface roughness decreases with the acidity increasing for BracePaste meanwhile it increases with the acidity for Fuji Ortho and Transbond. In conclusion: BracePaste is recommended for long-term orthodontic treatment for patients who regularly consume acidic beverages, Fuji Ortho is recommended for short-term orthodontic treatment for patients who regularly consume acidic beverages and Transbond is recommended for orthodontic treatment over an average time period for patients who do not regularly consume acidic beverages.

Effect of different enamel pretreating agents on bonding efficacy and survival rates of orthodontic brackets: In vitro study and split-mouth randomized clinical trial

INTRODUCTION

This double in vitro study and randomized clinical trial aimed to investigate the bonding failure rates of orthodontic brackets after enamel pretreatment with agents showing different particle sizes.

METHODS

For the in vitro study, 80 bovine teeth were randomly divided into 4 groups according to the pretreating method used and their particle sizes: erythritol (14 μm), glycine (18-22 μm), sodium bicarbonate (70 μm), and no pretreatment. Scanning electron microscopy microphotographs were performed after pretreatment. Then, brackets were bonded, and shear bond strength was calculated. For the clinical study, agents with low (erythritol) and high (sodium bicarbonate) particle sizes were chosen. Twenty consecutive patients willing to start fixed orthodontic treatment with vestibular stainless steel brackets were enrolled. Patients were randomly divided into 2 groups following a split-mouth design. Group A underwent a 5-second enamel pretreatment procedure with erythritol for teeth belonging to maxillary left and mandibular right quadrants, whereas the remaining quadrants were pretreated for 5 seconds with sodium bicarbonate powder. In group B, quadrants were inverted. Then, brackets were bonded on the vestibular surfaces of teeth, and patients were visited monthly for 12 months to assess bond failures. Periodontal evaluation of probing pocket depth, bleeding on probing, plaque index, and papilla bleeding index was conducted before bonding and after 1, 3, 6, and 12 months.

RESULTS

The in vitro study showed that erythritol and control presented significantly higher shear bond strength values for other agents. Bicarbonate showed the lowest values. In the clinical study, 20 patients (aged 16.4 ± 3.9 years) were enrolled, and all completed the study. Erythritol showed a significantly lower failure rate (3%) than sodium bicarbonate (7.5%). Kaplan-Meier survival plots showed statistically significant differences in risk of failure between the 2 groups during the 12-month follow-up.

CONCLUSIONS

Enamel pretreatment with erythritol can be a viable technique to reduce failure rates of orthodontic brackets.

REGISTRATION

The trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

No funding or grant was received for this research.

Bonding Failures of Lingual Orthodontic Brackets: A Retrospective Study Comparing Lingual Brackets with KommonBase Extensions, to Customized Lingual Brackets

The aim of the present study was to evaluate in a clinical setting the bracket survival of lingual brackets bonded with the KommonBase system, and to compare it to the survival of a customized lingual bracket system. Two convenience samples of 13 consecutive patients treated with lingual fixed appliances with KommonBase extensions (Group 1) and 14 consecutive patients treated with customized Incognito™ lingual fixed appliances were retrospectively enrolled (Group 2). First time debondings were recorded from the files. Data were submitted to statistical analysis and a Log-rank test was used to compare the Kaplan–Meier survival curves between the two groups. Statistical significance was set as p < 0.05. Lingual brackets bonded with the KommonBase system showed a failure rate of 8%, while Incognito brackets showed a failure rate of 7.1%. The Log-rank test comparing the Kaplan–Meier survival curves revealed no statistically significant difference between the two groups (p = 0.343). Most debondings occurred during the first 6 months. Upper incisors and canines were less prone to debond than premolars and molars. In conclusion, no difference in bracket survival was observed between the KommonBase system and a customized lingual appliance.

Utilization of a 3D Printed Orthodontic Distalizer for Tooth-Borne Hybrid Treatment in Class II Unilateral Malocclusions

This paper introduces a novel method of 3D designing and 3D printing of a hybrid orthodontic tooth-borne personalized distalizer for treatment of unilateral Class II malocclusion. Research objectives were to clinically utilize 3D printed distalizers, appraise feasibility of this technique and compare two different biocompatible photopolymers (white and transparent). Frequency of distalizers’ debonding and patients’ aesthetical perception was evaluated on the set of 12 complete orthodontic treatments. The mean duration of treatment period with a bonded distalizer was 6.4 months. All cases were adults with unilateral Class II malocclusion managed with a hybrid approach as a part of Invisalign® comprehensive treatment. Results showed that such perspective practice is feasible for 3D design and in-office 3D printing of a personalized distalizer. Results also showed no clinically significant differences between both studied biopolymers. The paper discusses an evaluation of such personalized distalizer functionality with regard to the current state of the art and compares to conventional prefabricated alternatives like a Carriere® Distalizer™ appliance. Research showed a preference of patients towards transparent biocompatible photopolymer instead of the white A2 shade. The paper concludes that additive manufacturing from dental resins is a viable method in personalization and in-office 3D printing of orthodontic auxiliaries, particularly distalizers. New materials for orthodontic 3D printing endow enhanced individualization, thus more efficient treatment.