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Ronchi Lemos C, Ventura Fadel MA, Polmann H, Meller Dias de Oliveira J, Pauletto P, Miron Stefani C, Flores-Mir C, De Luca Canto G. Clear aligner's adverse effects: A systematic review protocol. PLoS One 2024; 19:e0302049. [PMID: 38696380 PMCID: PMC11065214 DOI: 10.1371/journal.pone.0302049] [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: 12/29/2023] [Accepted: 03/25/2024] [Indexed: 05/04/2024] Open
Abstract
With the growing popularity of clear aligners, more patients have chosen to use them instead of traditional orthodontic braces to correct their malocclusions. Clear aligners offer distinct advantages over conventional fixed braces, such as limited aesthetic impact, the convenience of easily removing them for meals, improved accessibility for brushing and flossing, and a treatment approach that avoids the use of metal, minimizing potential irritation to the cheeks and gums. Manufacturers point out a disadvantage that can be administered in this type of treatment. Still, to our knowledge, a comprehensive review of the published literature assessing the adverse/negative effects of clear aligners has not yet been conducted. A systematic review, with or without meta-analysis, will be performed. The inclusion criteria will be studies involving individuals using clear aligners and reporting potential adverse/negative effects during or after treatment. No restrictions about time or language will be applied. The studies screening will be conducted in two stages. Two independent reviewers will initially evaluate the title and abstract under the eligibility criteria. Subsequently, the same two reviewers will examine the articles' full text in-depth. The results will be synthesized in the form of a narrative description and incorporate a meta-analysis if justified. Furthermore, we will present details regarding the sample characteristics, intervention, study objectives, methodologies employed, and primary findings. This study aims to investigate the potential adverse effects and their frequency among orthodontic patients wearing clear aligners. Moreover, the outcomes of this review have the potential to illuminate specific inherent limitations of aligner therapy as a comprehensive orthodontic approach.
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Affiliation(s)
- Cintia Ronchi Lemos
- Brazilian Centre for Evidence-Based Research (COBE), Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Marianella Aguilar Ventura Fadel
- Brazilian Centre for Evidence-Based Research (COBE), Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Helena Polmann
- Brazilian Centre for Evidence-Based Research (COBE), Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Júlia Meller Dias de Oliveira
- Brazilian Centre for Evidence-Based Research (COBE), Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Patrícia Pauletto
- School of Dentistry, Universidad De Las Américas (UDLA), Quito, Ecuador
| | - Cristine Miron Stefani
- Brazilian Centre for Evidence-Based Research (COBE), University of Brasilia (UNB), Brasília, Brazil
| | | | - Graziela De Luca Canto
- Brazilian Centre for Evidence-Based Research (COBE), Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
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Nobrega C, Nunes GP, de Paiva Buischi Y, Kajimoto NDC, Delbem ACB. In vitro assessment of dental erosion caused by clear aligners. J Mech Behav Biomed Mater 2024; 152:106390. [PMID: 38277909 DOI: 10.1016/j.jmbbm.2024.106390] [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: 10/15/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/28/2024]
Abstract
The primary objective of this in vitro study was to investigate the erosive potential of enamel under the use of clear aligners (CA), by simulating in vivo conditions experienced by patients who do not remove their CA during the consumption of acidic beverages. In addition, the difference in erosion protection conferred by artificial and human saliva was also evaluated. Sound-extracted human premolars (n = 20) had half of their surfaces protected with acid-resistant nail polish and were randomly distributed into two experimental groups (n = 10): teeth immersed in human saliva or artificial saliva. All teeth had half of their lingual surfaces enclosed by a CA device. The erosive challenges consisted of individual immersion of each sample in citrus acid three times a day, intermediated by immersion in human saliva or artificial saliva for 2 h, during ten days of the erosive protocol. The enamel mineral content was analyzed by high-resolution microtomography. The differential mineral concentration profiles were obtained by subtracting the profile of the mineral concentration of the exposed area and enamel under the CA area from the respective sound area (control). In addition, enamel wear and enamel volume loss were measured. Scanning electron microscopy (SEM) was also performed to analyze the enamel surface. Data were analyzed by two-way ANOVA, followed by the Student-Newman-Keuls test. The enamel wear was higher in teeth immersed in artificial saliva, when compared to human saliva (p < 0.001). The volume loss of the exposed enamel area was lower for tooth immersed in human saliva than in artificial saliva (p < 0.001), during the acid challenge protocol. The use of CA during acid challenges promoted wear and mineral loss of dental enamel, being these changes more pronounced on the enamel surface under the CA. These results open a new path for the development of further studies adopting clinical protocols that promote more accurate responses in the clinical practice during orthodontic treatment.
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Affiliation(s)
- Celestino Nobrega
- Department of Orthodontics, Case Western Reserve University, Cleveland, OH, United States.
| | - Gabriel Pereira Nunes
- Department of Preventive and Restorative Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - Yvonne de Paiva Buischi
- Department of Periodontics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Natália de Campos Kajimoto
- Department of Periodontics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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Nagesh S, Kumaran K, Mani P. Iron and Magnesium Co-substituted Hydroxyapatite Nanoparticles in Orthodontic Composite: A Preliminary Assessment. Cureus 2024; 16:e56388. [PMID: 38633975 PMCID: PMC11022009 DOI: 10.7759/cureus.56388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Aim The study aims to characterize Fe and Mg co-substituted hydroxyapatite nanoparticles (FeMgHAPn) and assess the antimicrobial properties of FeMgHAPn-incorporated orthodontic composite. Materials and methods FeMgHAPn was synthesized using the sol-gel method, and the prepared nanoparticle powder was characterized using Fourier Transform Infrared Spectroscopy (FTIR), energy-dispersive X-ray analysis (EDX)) and scanning electron microscopic (SEM) analysis. The FeMgHAPn was incorporated into a commercially available orthodontic composite in two concentrations (40 and 20 μL), and the structure was examined using SEM. The FeMgHAPn-incorporated composite was tested for its antimicrobial efficacy against Streptococcus mutans, Staphylococcus aureus, and Escherichia coli using the agar-well diffusion method. The zones of inhibition (ZOI) were measured in millimeters (mm). Results The characterization of the FeMgHAPn indicated the successful formation of the nanoparticle without any impurities or byproducts. The high concentration (40 μL) of FeMgHAPn-incorporated orthodontic composite showed the maximum ZOI against all three microbes, followed by the low concentration (20 μL) and the control group. Conclusion The FeMgHAPn-incorporated orthodontic composite showed promising antimicrobial activity against caries-causing S. mutans, S. aureus, and E. coli.
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Affiliation(s)
- Shweta Nagesh
- Orthodontics and Dentofacial Orthopedics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Kirthick Kumaran
- Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Pugazh Mani
- Orthodontics and Dentofacial Orthopedics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Muro MP, Caracciolo ACA, Patel MP, Feres MFN, Roscoe MG. Effectiveness and predictability of treatment with clear orthodontic aligners: A scoping review. Int Orthod 2023; 21:100755. [PMID: 37086643 DOI: 10.1016/j.ortho.2023.100755] [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: 11/24/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION In an ideal clinical setting, orthodontic therapy with clear aligners (CA) should improve the patients' initial malocclusion and must guarantee equivalence between the results predicted and those obtained clinically to be considered an effective treatment. Therefore, this scoping review aimed to identify the orthodontic literature concerning the effectiveness and predictability of CA treatments. METHODS A systematic computerized search was performed in 3 databases: PubMed, Scopus, and Embase. Inclusion criteria selected observational and clinical studies performed in at least 10 adult orthodontic patients, whose results of CA treatment's effectiveness and/or predictability were assessed. RESULTS The 3 database computerized searches resulted in 1,553 articles, and 169 full texts were considered potentially relevant. After applying the eligibility criteria, 33 studies were included. Most studies (76%) were designed as cohort studies and have been published in the last 5 years (79%). The majority included only non-extraction treatments (73%), and 79% reported results achieved with the Invisalign® system. The most predictable movement was the buccolingual tipping, while the least predictable movements were rotation, intrusion, and extrusion. Aligner treatment was effective for mild to moderate crowding resolution, and the success of overbite correction still seems to be limited. CONCLUSIONS The studies have demonstrated improvement of initial malocclusion through CA treatments. Still, predictability degree is overestimated and does not accurately reflect the occlusion immediately at the end of treatment. In future studies, there should be an effort to broaden the utilization of alternative aligner systems beyond Invisalign® and broadly disseminate their outcomes to strengthen clear aligners evidence base.
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Affiliation(s)
| | | | - Mayara Paim Patel
- Dental Research Division, School of Dentistry, Guarulhos University, Guarulhos, São Paulo, Brazil
| | | | - Marina Guimarães Roscoe
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Song Z, Fang S, Guo T, Wen Y, Liu Q, Jin Z. Microbiome and metabolome associated with white spot lesions in patients treated with clear aligners. Front Cell Infect Microbiol 2023; 13:1119616. [PMID: 37082715 PMCID: PMC10111054 DOI: 10.3389/fcimb.2023.1119616] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/17/2023] [Indexed: 04/07/2023] Open
Abstract
White spot lesions (WSLs) have long been a noteworthy complication during orthodontic treatment. Recently, an increasing number of orthodontists have found that adolescents undergoing orthodontic treatment with clear aligners are at a higher risk of developing WSLs. The oral microbiota and metabolites are considered the etiologic and regulatory factors of WSLs, but the specific impact of clear aligners on the oral microbiota and metabolites is unknown. This study investigated the differences in the salivary microbiome and metabolome between adolescents with and without WSLs treated with clear aligners. Fifty-five adolescents (aged 11-18) with Invisalign appliances, 27 with and 28 without WSLs, were included. Saliva samples were analyzed using 16S rRNA gene sequencing and ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS); the data were further integrated for Spearman correlation analysis. The relative abundances of 14 taxa, including Actinobacteria, Actinomycetales, Rothia, Micrococcaceae, Subdoligranulum, Capnocytophaga, Azospira, Olsenella, Lachnoanaerobaculum, and Abiotrophia, were significantly higher in the WSL group than in the control group. Metabolomic analysis identified 27 potential biomarkers, and most were amino acids, including proline and glycine. The metabolites were implicated in 6 metabolic pathways, including alanine, aspartate and glutamate metabolism; glycine, serine and threonine metabolism; and aminoacyl-tRNA biosynthesis. There was a correlation between the salivary microbial and metabolomic datasets, reflecting the impact of clear aligners on the metabolic activity of the oral flora. A concordant increase in the levels of Lachnoanaerobaculum, Rothia, Subdoligranulum and some amino acids had predictive value for WSL development. In summary, when adolescents undergo long-term clear aligner therapy with poor oral hygiene habits, clear aligners can disrupt the balance of the oral microecosystem and lead to oral microbiota dysbiosis, thereby increasing the risk of developing WSLs. Our findings might contribute to the understanding of the pathogenesis of WSLs and provide candidate biomarkers for the diagnosis and treatment of WSLs associated with clear aligners.
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Affiliation(s)
- Zhixin Song
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, Air Force Medical University, Xi’an, China
| | - Shishu Fang
- Department of Stomatology, General Hospital of Southern Theater Command of the Chinese People’s Liberation Army, Guangzhou, China
| | - Tao Guo
- Department of Orthodontics, TaiKang Shanghai Bybo Dental Hospital, Shanghai, China
| | - Yi Wen
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, Air Force Medical University, Xi’an, China
| | - Qian Liu
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, Air Force Medical University, Xi’an, China
- *Correspondence: Qian Liu, ; Zuolin Jin,
| | - Zuolin Jin
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, Air Force Medical University, Xi’an, China
- *Correspondence: Qian Liu, ; Zuolin Jin,
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Adel SM, El-Harouni N, Vaid NR. White Spot Lesions: State of the Art Biomaterials and Workflows used in Prevention, Progression and Treatment. Semin Orthod 2023. [DOI: 10.1053/j.sodo.2023.01.002] [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: 01/20/2023]
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Occlusal Plane Modification in Clear Aligners Treatment: Three Dimensional Retrospective Longitudinal Study. Dent J (Basel) 2022; 11:dj11010008. [PMID: 36661545 PMCID: PMC9857834 DOI: 10.3390/dj11010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
The purpose of the present study was to evaluate: (i) maxillary occlusal plane changes after clear aligners therapy with a 3D measurement technique; and (ii) as a secondary outcome, if such changes were correlated to the patient’s 1axilla-mandibular divergence. 3D maxillary models of 32 patients (7 males and 25 females; mean age 22.3 +/− 3.4 year) treated with clear aligners were analyzed. The angle (α) between a reference palatine plane and a maxillary occlusal plane was measured. Five angular cephalometric measurements (NSL/MP; PP-OP; OP-MP; PP-MP; PFH/AFH%) were performed and related to Δα. The subjects were further divided into three groups according to facial divergence. After aligner treatment, Δα increased in hyperdivergent patients and decreased in hypodivergent patients (p < 0.05). Δα showed a significant positive correlation with NSL/MP (rho = 0.44) and negative correlation with PFH/AFH% (rho = −0.53). Aligners treatment produced a counterlockwise rotation of the maxillary occlusal plane, even if this rotation occurs differently depending on divergence.
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