Orthodontic brackets friction changes after clinical use: A systematic review

Quantitative and qualitative analysis of metallic ion release of orthodontic brackets in three different pH conditions - An invitro study

Background

Fluoridated mouth rinses improve anti-cariogenic environment but decrease oral pH below critical value, affecting orthodontic bracket surface topography and causing corrosive changes over prolonged use. This invitro study aimed to quantitatively and qualitatively assess the surface topography and metallic ion release of the stainless steel (SS) brackets at varying acidic and alkaline pH.

Materials and methods

Forty unused SS brackets were divided into four groups (Group A, B, C, D) and immersed for 48- hours in solutions of artificial saliva and sodium fluoride (0.2 %) mouth rinse at varying pH of 5.5,6.7,7 and 8. The surface morphologic changes were analyzed under scanning electron microscope (SEM) at 50×, 150×, and 500× magnification. The changes in slot area were scored using the customized scale. The Energy Dispersive Xray Spectroscopy Analysis (EDAX) was used to estimate the probed elements' atomic and weight percentage.

Results

The mean score of the scale was 3.4 for the brackets immersed in the acidic solution which was statistically significant (p = 0.00)and for alkaline and neutral solutions (p = 0.00). Chromium was found to be significantly higher in the alkaline solution (p = 0.016) followed by the neutral solution. Carbon was found excess in acidic solution than the neutral and alkaline solution.

Conclusion

Quantitative and qualitative analysis of the ion release in stainless steel brackets using SEM and EDAX revealed the corrosive effect of fluoride ion causing maximum surface changes in acidic medium and chromium release in alkaline pH.

Corrosion of Fixed Orthodontic Appliances: Causes, Concerns, and Mitigation Strategies

The orthodontic supply market is a prosperous billion-dollar industry, driven by an increasing demand for orthodontic appliances. The supremacy of metallic first-generation biomaterials is evident for manufacturing brackets, archwires, bands, and other components due to their well-recognized chemical inertness, spontaneous passivation, biocompatibility, and favorable mechanical properties combination. However, the oral cavity is the ultimate corrosion-promoting environment for any metallic material. In this work, the general picture of the intraoral degradation of fixed orthodontic appliances is first addressed, from the causes to the harmful effects and their oral clinical implications. Current mitigation strategies are also pointed out, including the alloys’ bulk composition adjustment combined with new and advanced manufacturing processes and/or their surface treatment or coating deposition. The versatile use of thin films and coatings stands out with different deposition technologies: Many in vivo and in vitro efforts have been devoted to oral aging, from monolithic to composite architectures and micro- to nano-scale materials, to meet the best and safest oral practice demands. Unfortunately, literature data suggest that even the existing commercially available protective coatings have drawbacks and are fallible. Further multidisciplinary research is still required to effectively mitigate the corrosion behavior of fixed orthodontic appliances.

Effect of oral environment on contemporary orthodontic materials and its clinical implications

Contemporary orthodontics entails using advanced materials and devices, simplifying the process of tooth movement. It is well documented that orthodontic materials are subjected to various fluctuations and stresses in the oral environment, such as salivary pH, dietary habits, temperature changes, and masticatory loads. These changes reduce bonding materials' longevity, plasticize resin polymers, and reduce elastic properties. In addition, the corrosion of orthodontic appliances in the oral environment has concerned clinicians for some time. This is focused on two principal issues: whether corrosion products are absorbed into the body and cause either localized or systemic effects, and the results of corrosion on the physical properties and the clinical performance of orthodontic appliances. Recently, another major concern is the potential release of bisphenol-A from materials containing polymers such as thermoplastic aligners and resins, which is known to induce xenoestrogenicity and cytotoxicity when the tissue level exceeds the daily recommended intake. However, most of these findings are based on in vitro studies that suffer from serious drawbacks such as failure to replicate the exact oral environment and process during orthodontic treatment. Therefore, developing clinically relevant methods should be the goal of future research related to the aging of orthodontic materials. The purpose of this review is to outline the impact of the oral environment on contemporary orthodontic materials.

Effect of Graphene Sheets Embedded Carbon Films on the Fretting Wear Behaviors of Orthodontic Archwire-Bracket Contacts

Carbon films were fabricated on the orthodontic stainless steel archwires by using a custom-designed electron cyclotron resonance (ECR) plasma sputtering deposition system under electron irradiation with the variation of substrate bias voltages from +5 V to +50 V. Graphene sheets embedded carbon (GSEC) films were fabricated at a higher substrate bias voltage. The fretting friction and wear behaviors of the carbon film-coated archwires running against stainless steel brackets were evaluated by a home-built reciprocating sliding tribometer in artificial saliva environment. Stable and low friction coefficients of less than 0.10 were obtained with the increase of the GSEC film thickness and the introduction of the parallel micro-groove texture on the bracket slot surfaces. Particularly, the GSEC film did not wear out on the archwire after sliding against three-row micro-groove textured bracket for 10,000 times fretting tests; not only low friction coefficient (0.05) but also low wear rate (0.11 × 10^-6 mm³/Nm) of the GSEC film were achieved. The synergistic effects of the GSEC films deposited on the archwires and the micro-groove textures fabricated on the brackets contribute to the exceptional friction and wear behaviors of the archwire-bracket sliding contacts, suggesting great potential for the clinical orthodontic treatment applications.

Friction Force Adjustment by an Innovative Covering System Applied with Superelastic NiTi Brackets and Wires-An In-Vitro Study

The aim of this study was the investigation of polymeric coverings to adjust frictional forces between V-shaped wires and brackets, both made of superelastic NiTi. Adjustment of frictional forces is relevant for certain stages during orthodontic therapy. Coverings able to generate frictional forces when assembled to such brackets are additively manufactured. Six different internal widths of coverings were examined in three different environments: dry condition at room temperature (RT) or body temperature (BT), or artificial saliva (AS) at RT. The different coverings significantly affected the frictional forces for all media (p < 0.001). A correlation between internal width of the covering and resulting frictional forces was found. BT and dry environment showed the lowest friction forces for all samples. The highest force was found for two covering types at RT in AS, while the remaining four covering types showed the highest values in dry environment (p < 0.001). Friction could, therefore, be adjusted by variation of bracket covering clipped onto brackets, which is useful for orthodontic therapy. Coverings delivering higher friction provide dental anchorage, while coverings with lower friction can be used for tooth movement or purely esthetic reasons. It was shown that the variation of covering width may be used for adjustment of frictional forces.

Metal Release and Surface Degradation of Fixed Orthodontic Appliances during the Dental Levelling and Aligning Phase: A 12-Week Study

The purpose of the present study is twofold: (i) to assess the salivary nickel, chromium, and iron concentrations and (ii) to characterize the surface microstructure of the typical commercially available Ni-containing metallic appliances during the first 12-week orthodontic treatment period. A total of 85 unstimulated saliva samples were collected from patients before treatment, after 2 days, and after 1, 4, and 12 weeks. Salivary ion concentrations were determined by inductively coupled plasma optical emission spectroscopy, and data were analyzed with the Statistical Package for Social Sciences (IBM SPSS) software. The recorded mean metal concentrations were in the ranges of 132–175 µg/L for Ni, 171–192 µg/L for Cr, and 826–1023 µg/L for Fe. No statistically significant variations were observed between the different study times, and the null hypothesis (the concentrations of metallic ions in patients’ saliva did not significantly change after the placement of the orthodontic appliances) was accepted (p > 0.05). Mean salivary metallic ions were below toxic levels, and no adverse clinical reactions were registered. The intraoral surface degradation of the fixed components was corroborated by optical microscopy, scanning electron microscopy, and energy dispersive spectrometry. Microstructural analysis after complete orthodontic procedure confirmed different corrosion types, from pitting to biocorrosion.

In vitro study of structural and mechanical properties of latex and non-latex intermaxillary orthodontic elastics

PURPOSE

We evaluated bacterial endotoxin adhesion, superficial micromorphology and mechanical properties of latex and non-latex intermaxillary orthodontic elastics.

METHODS

To quantify the adhered bacterial endotoxin, elastics were divided into 5 groups: experimental (n = 12) latex and non-latex elastics, previously contaminated by an endotoxin solution, negative control (n = 6) latex and non-latex elastics without contamination, and positive control (n = 6) stainless steel specimens (metallic replicas), contaminated by an endotoxin solution. In parallel, the structural micromorphology (n = 6) and surface roughness of latex and non-latex intermaxillary orthodontic elastics were assessed using confocal laser microscopy. Force degradation (g) and deformation of the internal diameter change (mm) were also evaluated. Structural micromorphology, surface roughness (µm), force degradation (g) and internal diameter (mm) change were evaluated at time 0 and after 24 and 72 h in a deformation test. Data were analyzed by the Shapiro-Wilk, Kruskal-Wallis, Dunn, ANOVA and Bonferroni tests (α = 5%).

RESULTS

Endotoxin adhered similarly to both types of elastics with scores of 3 (> 1.0 EU/mL). The surface microstructure of both types of elastics showed irregularities and porosities at all times. Initially, the latex elastics had a higher surface roughness (p < 0.001) than the non-latex ones. After 24 h loading, surface roughness of the latex elastics was significantly reduced (p < 0.001), while after 72 h, the values were similar for both types (p > 0.05). The non-latex elastics had significantly higher force generation values (p < 0.05) at 0, 24 and 72 h compared with the latex elastics, although there was a significant reduction (p < 0.001) in force over time for both elastics. Despite similar initial values, non-latex elastics had a significantly larger internal diameter (p < 0.001) after the loading periods of 24 and 72 h compared with the latex elastics.

CONCLUSION

Both elastics showed high affinity with endotoxin and microstructural irregularities of their surface. The non-latex elastics generated higher force values but demonstrated greater deformation of the internal diameter after loading.

Preparation of Zirconium Hydrogen Phosphate Coatings on Sandblasted/Acid-Etched Titanium for Enhancing Its Osteoinductivity and Friction/Corrosion Resistance

Background

Sandblasted/acid-etched titanium (SLA-Ti) implants are widely used for dental implant restoration in edentulous patients. However, the poor osteoinductivity and the large amount of Ti particles/ions released due to friction or corrosion will affect its long-term success rate.

Purpose

Various zirconium hydrogen phosphate (ZrP) coatings were prepared on SLA-Ti surface to enhance its friction/corrosion resistance and osteoinduction.

Methods

The mixture of ZrCl₄ and H₃PO₄ was first coated on SLA-Ti and then calcined at 450°C for 5 min to form ZrP coatings. In addition to a series of physiochemical characterization such as morphology, roughness, wettability, and chemical composition, their capability of anti-friction and anti-corrosion were further evaluated by friction-wear test and by potential scanning. The viability and osteogenic differentiation of MC3T3-E1 cells on different substrates were investigated via MTT, mineralization and PCR assays.

Results

The characterization results showed that there were no significant changes in the morphology, roughness and wettability of ZrP-modified samples (SLA-ZrP0.5 and SLA-ZrP0.7) compared with SLA group. The results of electrochemical corrosion displayed that both SLA-ZrP0.5 and SLA-ZrP0.7 (especially the latter) had better corrosion resistance than SLA in normal saline and serum-containing medium. SLA-ZrP0.7 also exhibited the best friction resistance and great potential to enhance the spreading, proliferation and osteogenic differentiation of MC3T3-E1 cells.

Conclusion

We determined that SLA-ZrP0.7 had excellent comprehensive properties including anti-corrosion, anti-friction and osteoinduction, which made it have a promising clinical application in dental implant restoration.

Assessment of frictional resistance and surface roughness in orthodontic wires coated with two different nanoparticles

Several mechanical and biological factors may change the orthodontic wire frictional resistance (FR). Titanium dioxide (TiO₂ ) and silica dioxide (SiO₂ ) nanoparticle (NP) coatings may be used to improve the characteristics of materials, reducing FR between archwire and bracket. This in vitro study aimed to evaluate the FR of orthodontic wires with and without coating in both dry and wet environments and measure the surface roughness (SR). One hundred and eighty segments of rectangular Cr-Ni orthodontic wires (Morelli Co, Brazil) were divided into three groups according to the NP coating applied: TiO₂ group; SiO₂ group; and control group. The SR parameters were measured in an optical profilometer, the surface morphology was analyzed with scanning electron microscopy (SEM), and FR was performed in a universal testing machine in dry and wet environments (n = 30). The statistical analysis was performed using the Generalized Estimated Equations model with a Bonferroni post-test (α = 0.05). It was observed that SiO₂ NP coating decreased FR significantly when compared to the TiO₂ and control groups, in both environments (p < .001). The SiO₂ and TiO₂ groups presented statistically lower SR than the control group and were similar to each other (p < .001). The SiO₂ group presented the lower depth of Valley parameter than the TiO₂ group (p < .001). The SEM showed that the TiO₂ coating had the most heterogeneous surface morphology than the SiO₂ and control groups. The orthodontic wires with NP coating modified the FR and morphology. The SiO₂ coating reduced FR in both dry and wet environments and decreased SR.

Friction evaluation of an elastic chain positioned under or over the wire in self-ligating brackets

Objectives:

This study aimed to evaluate the frictional resistance produced by active and passive self-ligating brackets on stainless steel archwires in the absence or presence of elastomeric chains under or over the wire.

Materials and Methods:

Four types of self-ligating brackets were used: Two active and two passive. For each commercial brand, five brackets were bonded to an acrylic plate and the frictional resistance was evaluated with 0.018” and 0.019” × 0.025” stainless steel wires in three situations: Without elastomeric chain, with elastomeric chain placed under and over the wire.

Results:

The bracket type, cross-section of the wire, and type of ligation had significant interactions with each other; the frictional resistance was significantly lower with the use of passive self-ligated brackets, while no difference was found when a 0.018” wire was tested. Moreover, the frictional resistance in the absence of an elastomeric chain, or when the chain was under the wire, was significantly lower in comparison with the values obtained when the chain was placed on the wire.

Conclusion:

Frictional resistance of passive and active self-ligated brackets is influenced by the ligation methods and the cross-sectioning of archwires.

The effect of school intervention programs on the body mass index of adolescents: a systematic review with meta-analysis

Effective obesity interventions in adolescent populations have been identified as an immediate priority action to stem the increasing prevalence of adult obesity. The purpose of this meta-analysis was to make a quantitative analysis of the impact of school-based interventions on body mass index during adolescence. Studies were retrieved from PubMed, Scopus, Science Direct and Web of Science databases. Results were pooled using a random-effects model with 95% confidence interval considered statistically significant. Of the 18 798 possible relevant articles identified, 12 articles were included in this meta-analysis. The global result showed a low magnitude effect, though it was statistically significant (N = 14 428), global e.s. = -0.055, P = 0.004 (95% CI = -0.092, -0.017). Heterogeneity was low among the studies (I2 = 9.017%). The funnel plot showed no evidence of publication bias. The rank-correlation test of Begg (P = 0.45641) and Egger's regression (P = 0.19459) confirmed the absence of bias. This meta-analysis reported a significant effect favoring the interventions; however, future research are needed since the reported the evidence was of low magnitude, with the studies following a substantial range of approaches and mostly had a modest methodological quality.