Effect of Bleaching Mouthwash on Force Decay of Orthodontic Elastomeric Chains

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.

Effect of filament types and loops number on the force degradation of elastomeric chains used for orthodontic treatment: an in-vitro study

BACKGROUND

In orthodontic treatment, closing spaces, specifically the extraction and scattered spaces of the anterior teeth, requires some auxiliary bias, such as an elastomeric chain. Many factors affect the mechanical properties of elastic chains. In this study, we investigated the relationship of the filament type, the number of loops, and the force degradation of elastomeric chains under thermal cycling conditions.

METHODS

The orthogonal design included three filament types (i.e., close, medium, and long). Four, five, and six loops of each elastomeric chain were stretched to have an initial force of 250 g in an artificial saliva environment at 37 °C and thermocycling between 5 and 55 °C three times a day. The remaining force of the elastomeric chains was recorded at different time points (4 h, 24 h, 7 days, 14 days, 21 days, and 28 days), and the percentage of the remaining force was calculated.

RESULTS

The force decreased significantly in the initial 4 h and degraded mostly within the first 24 h. In addition, the percentage of force degradation increased slightly between 1 and 28 days.

CONCLUSIONS

Under the same initial force, the longer the connecting body is, the fewer the number of loops and the greater the force degradation of the elastomeric chain are.

The Effects of Zinc-Containing Mouthwashes on the Force Degradation of Orthodontic Elastomeric Chains: An In Vitro Study

Objective

This study aimed to evaluate and compare the force degradation of two types of elastomeric chains following different periods of immersion in zinc-containing mouthwashes.

Materials and Methods

Four hundred and forty pieces of Elasto-Force and Super Elasto-Force elastomeric chains were divided into two control and eight experimental groups. The pieces were stretched to 25 mm on pins mounted on an acrylic block and stored in distilled water at 37°C. The experimental groups were immersed in four different types of mouthwash for one minute twice a day throughout the test period. Ten continuous thermocycles per day between cold and hot water baths (5–55°C) were carried out. Forces were measured at six-time intervals (initial, 24 hours, 1, 3, 6, and 8 weeks). The mean force was calculated and compared among different elastomeric chains, mouthwashes, and times using the t-test and one-way ANOVA test followed by Tukey's HSD test. The level of significance was set at 0.05.

Results

Both types of elastomeric chains had significant force degradation over time (74–79% at 8 weeks). The Super Elasto-Force generated a higher force level than the Elasto-Force elastomeric chain at all time points. SmartMouth Clinical DDS mouthwash had a significantly lower effect on force degradation than other mouthwashes with no significant difference compared to control groups.

Conclusions

Depending on these results: there is no clinically significant difference between both types of elastomeric chains, although Super Elasto-Force delivered a higher force level. The pH of the mouthwashes could play a role in force degradation over time, rather than other ingredients including zinc. The SmartMouth mouthwash had the minimum effect on force degradation of elastomeric chains, followed by Halita, Listerine Total Care Zero, and Breath Rx, respectively.

Force Degradation of Elastomeric Chains after Storage Time and Mechanical Brushing

The purpose of this in vitro study was to evaluate the force decrease of different elastomeric chains after different times: initial, 10 minutes, 1 day, 28 days and after mechanical brushing. Twenty orthodontic elastomeric chains segments were utilized for each commercial brand. Initially, the elastomeric chain of 15mm long were immediate stretched up to 20 mm in an Instron and the force was measured in gf. After all specimens were placed stretched on rectangular acrylic jigs with distance of 20 mm, immersed in deionized water at 37oC for 10 minutes and the force (gf) was measured again. Five test measurements of remaining force were made at the following time intervals: initial, 10 minutes, 1 day, 28 days and mechanical brushing. After 28 days, the acrylic plates with the specimens were adapted in the mechanical brushing machines (MSCT 3) and the elastomeric chains were submitted to mechanical brushing and the force (gf) measure again. The force (gf) was submitted to mixed-model ANOVA and Sidak post-hoc test (α=0.05). A statistically significant reduction in the force was found for all orthodontic elastomeric chain types after 1 day, 28 days and mechanical brushing (p<0.05). Morelli and 3M Unitek elastomeric chains showed significantly higher force than Abzil and GAC (p<0.05) after 1 day, 28 days and mechanical brushing. In conclusion, the force delivered by all elastomeric chains decayed rapidly over time. Morelli and 3M Unitek elastomeric chains consistently had a significantly greater force after mechanic brushing, while GAC the lowest.

Comparison of in vivo and in vitro force decay of elastomeric chains/modules: a systematic review and meta analysis

BACKGROUND

The study evaluated and compared the force decay of orthodontic elastomeric chains/modules in both in vivo and in vitro settings.

METHODS

A protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was formulated and registered with the International Prospective Register of Systematic Reviews. A total of 53 articles (44 in vitro and 9 in vivo studies) found via search of the electronic databases of Cochrane and the National Library of Medicine (MEDLINE; PubMed), and manual search of the gray literature from institutional library resources, were selected. Data extraction, quality analysis, risk of bias assessment, and meta-analysis of the level of force decay of elastomeric chains/modules were conducted per standard protocol, and suitable statistical analyses were applied.

RESULTS

The mean force decay in the in vivo setting was 41.9% at 24 hours, 42.6% after 1 week, 46.8% after 2 weeks, and 55.0% after 3 weeks. Similarly, the force decay in the in vitro studies was 38.9% at 24 hours, 42.1% after 1 week, 44.6% after 2 weeks, and 51.1% after 3 weeks. However, at the 95% confidence interval, the force decay rates of in vivo and in vitro studies overlap, with a statistically insignificant difference in force decay observed in the in vivo and in vitro settings.

CONCLUSIONS

This systematic review and meta-analysis observed more force decay in the in vivo studies versus the in vitro studies (although this difference was statistically insignificant), with the maximum force decay occurring during the initial days, with a reduction to approximately 50% within 3 weeks. Hence, change of the elastomeric chains/module, at intervals of 3 weeks, is advised. (PROSPERO registration no. CRD42020209535).

Influence of Mouthwash Rinsing on the Mechanical Properties of Polymeric Ligature Ties Used for Dental Applications

Mouthwashes are used during dental treatments to mitigate the complications caused by poor oral hygiene. However, these solutions also affect the properties of dental appliances, including those used in orthodontics. This point has been investigated in this study focusing on the changes in mechanical properties of polymeric orthodontic ligature ties. Commercial ties from four brands were characterized in terms of their maximum forces and displacement, delivery forces, molecular structures, and microscopic morphology. These properties were compared against the ties, which were rinsed with commercial mouthwashes from three manufacturers. The results showed that mouthwash rinsing significantly reduced the maximum bearable forces of ligature ties by up to 73.1%, whereas the reduction in their maximum displacement was up to 74.5% across all tested brands. Significant changes in microscopic morphology of ligature ties were observed after mouthwash rinsing, but not their molecular structure. Furthermore, mouthwash rinsing also reduced the delivery forces from ligature ties by between 20.9 and 32.9% at their first deformation cycle. It can be concluded from this study that mouthwashes have significant impact on the mechanical properties of polymeric orthodontic ligature ties and could also potentially affect the overall efficacy of orthodontic and other dental treatments.

Comparison of the force decay over time of four different brands of elastomeric chains (elongated to 25mm grey/transparent and closed/open): An in-vitro study

Elastomeric chains are widely used by orthodontists for incisor retraction and space closure. However, force degradation and permanent deformation are expected to occur.

OBJECTIVES

The present study was designed to compare the force degradation of closed, open, grey and transparent power chains from four orthodontic companies (American orthodontics® (AO®), Dentsply®, Ormco® and Rocky Mountain Orthodontics® (RMO®)) over time.

MATERIALS AND METHODS

Universal testing machine was used to measure the force of the power chains elongated to 25mm at 0hours, and after storage in artificial saliva at 24hours, 1 week, 2 weeks, 3 weeks, and 4 weeks. A Tukey's honestly significant difference test was performed.

RESULTS

Most of the power chains showed less than 30% of force decay at 24hours of elongation. The AO® transparent open elastomeric chains presented the lowest percentage of force remaining at almost all times: 24hours (58.9%), 1 week (67.7%), 2 weeks (43.2%), 3 weeks (72.4%), and 4 weeks (63%). Most of the power chains had an increase of force measured after 2 weeks of storage in artificial saliva. Three of the sixteen groups (Ormco® grey open, RMO® grey and transparent closed) displayed an increase in the force at 4 weeks of elongation compared to the force registered at 0hours.

CONCLUSION

The results indicated that the force generated by elastomeric chains at 4 weeks remains optimal for a physiologic tooth movement.

Evaluation of degradation of force of esthetic elastomeric chains

Abstract Introduction Elastomers are considered important allies to orthodontic treatment and due to the aesthetic demand, aesthetic elastomers are increasingly used in adult patients. Objective The aim of this experimental in vitro study was to evaluate the degradation of force of esthetic elastomeric chains, of three different sizes: short, medium and long. Material and method For evaluating the degradation of force, 90 elastomeric chain segments were used, divided into 9 Groups (n=10), as follows: Morelli short elastomer, Morelli medium, Morelli long, Orthometric short, Orthometric medium, Orthometric long, American Orthodontic short, American Orthodontic medium and American Orthodontic long. Acrylic plates with pins were used to provide stretching of the elastomeric chains. The initial stretching force of the elastomeric chain was 150 grams, measured by a tensiometer. After this, they were prestretched to 50% of their original length, measured in an Instron 4411 Universal test machine, and placed on the seating pin on the plate. The plate was immersed in artificial saliva at 37 °C in a plastic receptacle, and removed for measurement after a time interval of 21 days. For statistical analysis, the methodology of mixed models for repeated measures in time and Tukey-Kramer test were used. Degradation of the forces was analyzed by 2-way analysis of variance (ANOVA) and the Tukey test. Result All the elastomeric chains showed statistically significant reduction in force (p<0.05). The American Orthodontic elastomeric chains showed higher reduction in force values, irrespective of the elastic size (p<0.05). Conclusion The three commercial brands studied underwent significant reduction in the quantity of force released; the American Orthodontic brand of elastomer showed the highest value of degradation in force.