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Progress in Orthodontics Jun 2024Metallic and elastomeric ligatures are widely used in orthodontics to secure the archwire within the bracket slots, but elastomeric ligatures have traditionally been... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Metallic and elastomeric ligatures are widely used in orthodontics to secure the archwire within the bracket slots, but elastomeric ligatures have traditionally been associated with increased microbial colonization, which could adversely affect periodontal health.
AIM
This systematic review compares the periodontal effects of elastomeric and steel ligatures used for orthodontic fixed appliances.
METHODS
Unrestricted literature search of 7 databases (MEDLINE, Scopus, Web of Science, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Virtual Health Library) up to July 2023 were performed for randomized / non-randomized clinical studies on humans comparing the two ligation methods during fixed-appliance therapy. After duplicate study selection, data extraction, and risk-of-bias assessment with the Risk of Bias (RoB) 2 or the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool, random-effects meta-analyses of Mean Differences (MD) or Standardized Mean Differences (SMD) and their 95% confidence intervals (CIs) were carried out, followed by assessment of certainty of existing evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.
RESULTS
A total of 11 studies (3 randomized / 8 non-randomized) with 354 patients (mean age 14.7 years and 42% male) were included. No statistically significant differences were seen for plaque index (5 studies; SMD = 0.48; 95% CI = -0.03 to 1.00; P = 0.07), gingival index (2 studies; MD = 0.01; 95% CI = -0.14 to 0.16; P = 0.89), probing pocket depth (2 studies; MD = 0; 95% CI = -0.17 to 0.16; P = 0.97), or Streptococcus mutans counts (4 studies; SMD = 0.40; 95% CI=-0.41 to 1.20; P = 0.21). Elastomeric ligatures were associated with moderately increased total bacterial load (3 studies; SMD = 0.43; 95% CI = 0.10 to 0.76; P = 0.03). Confidence in these estimates was low in all instances due to the inclusion of non-randomized studies with high risk of bias.
CONCLUSIONS
Existing low quality evidence indicates that ligature method does not seem to influence the periodontal health during fixed treatment, even if elastomeric ligatures are associated with a moderate increase of bacterial load.
REGISTRATION
PROSPERO (CRD42023444383).
Topics: Humans; Elastomers; Orthodontic Appliances, Fixed; Steel; Periodontal Index; Orthodontic Brackets; Ligation
PubMed: 38880839
DOI: 10.1186/s40510-024-00520-8 -
Medical Science Monitor : International... Jun 2024Orthodontic treatments, while essential for achieving optimal oral health, present challenges in infection control due to the propensity for bacterial adhesion and...
Orthodontic treatments, while essential for achieving optimal oral health, present challenges in infection control due to the propensity for bacterial adhesion and biofilm formation on orthodontic appliances. Silver-coated orthodontic materials have emerged as a promising solution, leveraging the potent antimicrobial properties of silver nanoparticles (AgNPs). Antibacterial coatings are used in orthodontics to prevent the formation of bacterial biofilms. This systematic review evaluated the literature on antimicrobial silver coatings on fixed orthodontic appliances, including archwires, brackets, and microimplants. Two evaluators, working independently, rigorously conducted a comprehensive search of various databases, including PubMed, PubMed Central, Embase, Scopus and Web of Science. This systematic review comprehensively examined in vitro studies investigating the antimicrobial efficacy of silver-coated orthodontic archwires, brackets, and microimplants. The review registered in PROSPERO CRD42024509189 synthesized findings from 18 diverse studies, revealing consistent and significant reductions in bacterial adhesion, biofilm formation, and colony counts with the incorporation of AgNPs. Key studies demonstrated the effectiveness of silver-coated archwires and brackets against common oral bacteria, such as Streptococcus mutans and Staphylococcus aureus. Microimplants coated with AgNPs also exhibited notable antimicrobial activity against a range of microorganisms. The systematic review revealed potential mechanisms underlying these antimicrobial effects, highlighted implications for infection prevention in orthodontic practice, and suggested future research avenues. Despite some study heterogeneity and limitations, the collective evidence supports the potential of silver-coated orthodontic materials in mitigating bacterial complications, emphasizing their relevance in advancing infection control measures in orthodontics.
Topics: Silver; Humans; Biofilms; Orthodontic Brackets; Metal Nanoparticles; Orthodontic Wires; Orthodontic Appliances, Fixed; Anti-Infective Agents; Coated Materials, Biocompatible; Anti-Bacterial Agents; Streptococcus mutans; Bacterial Adhesion; Staphylococcus aureus
PubMed: 38843112
DOI: 10.12659/MSM.944255 -
Journal of Functional Biomaterials May 2024The objective of this study was to explore the effects of fixed orthodontic appliances on enamel structure by assessing microfractures, surface roughness, and... (Review)
Review
AIM
The objective of this study was to explore the effects of fixed orthodontic appliances on enamel structure by assessing microfractures, surface roughness, and alterations in color.
METHODS
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of online databases was conducted using the keywords 'enamel' AND 'orthodontic debonding'. Eligibility criteria included both in vivo and ex vivo clinical trials conducted on human teeth.
RESULTS AND DISCUSSION
A total of 14 relevant papers were analyzed. Various instruments and techniques were utilized across different studies to assess surface roughness, color change, and surface fractures.
CONCLUSIONS
The findings of this study suggest that ceramic brackets may lead to an increase in enamel fractures, particularly during bracket removal. The surface roughness of enamel exhibits variability depending on the adhesive substance and polishing methods used post-removal. Fixed orthodontic appliances could induce changes in enamel color, which may be alleviated by the use of nano-hydroxyapatite or specific polishing techniques. Further research is necessary to identify effective strategies for managing these color changes and improving the overall outcomes of fixed orthodontic treatment.
PubMed: 38786634
DOI: 10.3390/jfb15050123 -
Journal of Orthodontic Science 2024Enamel demineralization is a very common occurrence around bonded brackets in an orthodontic practice. Fluoride (FLR) applications have been used to prevent... (Review)
Review
Enamel demineralization is a very common occurrence around bonded brackets in an orthodontic practice. Fluoride (FLR) applications have been used to prevent decalcification and further progression of white spot lesions. The purpose of this systematic review and meta-analysis was to systematically appraise available literature on the effectiveness of fluoride mouthrinse in the prevention of demineralization around fixed orthodontic appliances. A search was conducted for randomized controlled clinical trials among four electronic databases (MEDLINE, Google Scholar, PubMed, and Cochrane Review) through MeSH terms and keywords. Studies were excluded if random allocation was not conducted, or if they were animal or studies. About 146 articles were screened and 5 studies were selected for the present review. Only two studies were selected for MA due to variations in the measurement of outcomes among studies. This review concluded that rinsing with FLR in the course of the fixed orthodontic treatment lessens demineralization around the bracket. Using FLR mouthrinse to inhibit the formation of white spot lesions or dental caries in patients with multiple cavities or restoration can be considered in clinical practice.
PubMed: 38784077
DOI: 10.4103/jos.jos_116_23 -
Polymers May 2024Polyetheretherketone (PEEK), an organic thermoplastic polymer, has gained interest in dentistry due to its excellent mechanical strength, flexibility, and... (Review)
Review
Polyetheretherketone (PEEK), an organic thermoplastic polymer, has gained interest in dentistry due to its excellent mechanical strength, flexibility, and biocompatibility. Furthermore, the ability to utilize CAD/CAM in the fabrication of PEEK enhances accuracy, reliability, and efficiency while also saving time. Hence, several orthodontic studies have explored the utilization of PEEK in various applications, such as archwires, brackets, fixed lingual retainers, palatal expansion devices, transpalatal arches, Tübingen palatal plates, different types of space maintainers, mini-implant insertion guides, and more. However, a complete systematic review of the available data comparing the performance of PEEK with traditional orthodontic materials has not yet been conducted. Therefore, this systematic review seeks to assess if PEEK material meets the required mechanical criteria to serve as an alternative to conventional orthodontic appliances. To ensure clarity and precision, this review will specifically concentrate on fixed appliances. This systemic review followed the PRISMA guidelines and utilized databases including PubMed/MEDLINE, Embase, Springer, Web of Science, and Wiley. Searches were restricted to English language articles from January 2013 to February 2024. Keywords such as "Polyetheretherketone" or "PEEK" and "Orthodontic" or "Orthodontic device" or "Orthodontic materials" were employed across all databases. Nine studies were incorporated, covering orthodontic archwires, brackets, and fixed lingual retainers. Based on the reviewed literature, PEEK demonstrates promising potential in orthodontic fixed appliances, offering advantages in force delivery, friction reduction, and aesthetic appeal. Further research is needed to fully explore its capabilities and optimize its application in clinical practice.
PubMed: 38732740
DOI: 10.3390/polym16091271 -
Lasers in Medical Science Apr 2024To investigate the in vivo and in situ effect of different types of lasers in prevention of enamel demineralization in high caries risk cases (around orthodontic... (Meta-Analysis)
Meta-Analysis Review
To investigate the in vivo and in situ effect of different types of lasers in prevention of enamel demineralization in high caries risk cases (around orthodontic brackets, around restoration and in caries susceptible pits and fissures). PubMed was searched using the following keyword sequence; (Laser therapy OR laser irradiation OR laser application) AND (enamel caries prevention OR enamel demineralization OR enamel remineralization OR early enamel caries OR early-enamel caries OR enamel resistance OR enamel decalcification OR white spot lesions WSLs OR incipient lesion OR enamel decay OR enamel Dissolution OR enamel microhardness) AND (clinical trial OR Randomized clinical trial OR In situ study). The latest literature search was ended by "30 January 2023". PubMed was used as a primary data base for study selection. Scopus, EBSCO, and Google scholar are checked in our study after results of systematic search on PubMed. Only duplicates were found. Two meta-analyses were carried out. The first, clinical meta-analysis on incidence of white spot lesions (WSLs) following CO2 laser irradiation of enamel. The second meta-analysis on ex-vivo/in situ effect of CO2 laser on microhardness of enamel. In each meta-analysis three studies were included. Risk of bias was assessed. The search identified eight studies (four ex-vivo and four clinical trials). Regarding the clinical meta-analysis, the overall standardized mean difference was 0.21 [ 95% confidence interval (CI): 0.15-0.30, p < 0.00001]. This indicates that the incidence of new WSLs in patients who received low power CO laser treatment was highly significantly lower than placebo groups. The heterogeneity was considerable (I = 71%). In the second meta-analysis, the overall standardized mean difference was 49.55 [ 95% confidence interval (CI): 37.74, 61.37, p < 0.00001]. This indicates that microhardness of enamel receiving low power (0.4-5 W) CO laser irradiation is highly significantly lower than control untreated enamel. The heterogeneity was substantial (I = 48%). Within the limitations of this study, Low level laser therapy concept with CO2 laser seems to be effective in preventing enamel caries.Prospero registration number: CRD42023437379.
Topics: Humans; Carbon Dioxide; Dental Caries Susceptibility; Lasers; Dental Caries; Low-Level Light Therapy; Randomized Controlled Trials as Topic
PubMed: 38635085
DOI: 10.1007/s10103-024-04049-4 -
Journal of Clinical and Experimental... Mar 2024To compare the effect of conventional brackets and self-ligating brackets on periodontal health. (Review)
Review
BACKGROUND
To compare the effect of conventional brackets and self-ligating brackets on periodontal health.
MATERIAL AND METHODS
A search of information up to October 2022 was carried out in the following electronic databases: PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science (WoS), EMBASE, SciELO and Google Scholar. We included studies that were randomised clinical trials, dealing with conventional brackets and self-ligating brackets and their effect on periodontal health, with no language restriction and no time limit. The Risk of Bias 2 (Rob 2.0) tool was used to determine the risk of bias of the included studies. The information selected from the studies was entered and analysed with RevMan 5.3, using the mean and standard deviation with a 95% confidence interval as a measure. Finally, an analysis was performed using the GRADE system to classify the quality of the evidence and grade the strength of the recommendation.
RESULTS
The preliminary search yielded a total of 399 articles, discarding those that did not meet the selection criteria, leaving only 13 articles. The effect of conventional and self-ligating brackets on periodontal health was determined using periodontal probing depth (PPD), plaque index (PI), gingival index (GI) and bleeding index (BI), showing advantages of self-ligating brackets in PI and BI, and no differences compared to self-ligating brackets in PPD and GI.
CONCLUSIONS
Self-ligating brackets probably better preserve periodontal health compared to conventional brackets regarding plaque accumulation and bleeding on probing. Conventional brackets, self-ligating brackets, periodontal health, orthodontic treatment, systematic review, meta-analysis.
PubMed: 38600930
DOI: 10.4317/jced.61378 -
International Journal of Clinical... Jan 2024The present review was conducted to test whether the addition of titanium dioxide (TiO) nanoparticles (NPs) within orthodontic bracket adhesives would alter their... (Review)
Review
OBJECTIVE
The present review was conducted to test whether the addition of titanium dioxide (TiO) nanoparticles (NPs) within orthodontic bracket adhesives would alter their properties and assess their antimicrobial activity against cariogenic microorganisms in addition to noteworthy mechanical properties.
MATERIALS AND METHODS
Using predetermined inclusion criteria, an electronic search was conducted using Dissertations and Thesis Global, the Web of Science, Cochrane, Scopus, and Medline/PubMed. Specific terms were utilized while searching the database.
RESULTS
Only seven of the 10 included studies assessed shear bond strength (SBS). The mean SBS among the control group varied from 9.43 ± 3.03 MPa to 34.4 ± 6.7 MPa in the included studies, while in the experimental group, it varied from 6.33 ± 1.51 MPa to 25.05 ± 0.5 MPa. Antibacterial activity was assessed in five of the 10 included studies using TiO NPs, which could easily diffuse through bacterial media to form the growth inhibition zone.
CONCLUSION
Antibacterial NPs added to orthodontic adhesives at a concentration of 1-5 wt% inhibit bacterial growth and have no effect on bond strength.
HOW TO CITE THIS ARTICLE
D Tivanani MVD, Mulakala V, Keerthi VS. Antibacterial Properties and Shear Bond Strength of Titanium Dioxide Nanoparticles Incorporated into an Orthodontic Adhesive: A Systematic Review. Int J Clin Pediatr Dent 2024;17(1):102-108.
PubMed: 38559855
DOI: 10.5005/jp-journals-10005-2729 -
European Journal of Orthodontics Apr 2024Initial caries lesion (ICLs) adjacent to orthodontic brackets are the most common side effect of orthodontic treatment with fixed appliances. The reported prevalence is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Initial caries lesion (ICLs) adjacent to orthodontic brackets are the most common side effect of orthodontic treatment with fixed appliances. The reported prevalence is uncertain and varies considerably across studies, from 27% to 97%.
OBJECTIVES
This paper was designed to evaluate and synthesize the available evidence on the prevalence and incidence rates of ICLs in relation to orthodontic treatment. Selection criteria: The review (Prospero protocol CRD42023412952) included randomized and non-randomized clinical trials of interventions, cohort studies, and cross-sectional studies, published after 1990 on the prevalence or incidence of ICLs during or after orthodontic treatment with fixed appliances. Search methods: Pubmed, Scopus, and Embase databases were searched from 1990 until 01 May 2023. The risk of bias assessment was performed with RoB 2 and ROBINS-I tool and the Joanna Briggs Institute Critical Appraisal Checklist. Data collection and analysis: The proportion of individuals with ICLs, reported as the number/percentage of individuals/teeth with ICLs or mean number of ICLs per subject, were used to synthesize results.
RESULTS
The search yielded a total of 468 papers; 21 studies were included in the systematic review, 2 of which were not included in the meta-analysis. The prevalence rate [95%CI] of ICLs was 0.57% [0.48; 0.65] in 1448 patients, 0.22% [0.14; 0.33] in 11583 teeth, with a mean number of lesions equal to 2.24 [1.79; 2.70] in 484 patients evaluated. The incidence rate of new carious lesions developed during orthodontic treatment was 0.48% [0.33; 0.63] in 533 patients, 0.15% [0.08; 0.26] in 1890 teeth with a mean number of ICLs equal to 2.29 [1.12; 3.46] in 208 patients evaluated.
LIMITATIONS
Although the high number of included studies and the overall good quality, there was a significant heterogeneity in the collected data.
CONCLUSION
The prevalence and incidence rates of ICLs in subjects undergoing orthodontic treatment are quite high and raise some concerns in terms of risk assessment of orthodontic treatment. ICLs represent an alarming challenge for both patients and professionals. Effective caries prevention strategies during treatment need to be considered and implemented where appropriate.
Topics: Humans; Cross-Sectional Studies; Dental Caries Susceptibility; Dental Caries; Dental Care
PubMed: 38387465
DOI: 10.1093/ejo/cjae008 -
Orthodontics & Craniofacial Research Feb 2024To evaluate the efficacy of microchips and 3D microsensors in the measurement of orthodontic forces. (Review)
Review
OBJECTIVE
To evaluate the efficacy of microchips and 3D microsensors in the measurement of orthodontic forces.
METHODS
Through September 2023, comprehensive searches were conducted on PubMed/MEDLINE, SCOPUS and SCIELO without restrictions.
RESULTS
After removing duplicate entries and applying the eligibility criteria, 23 studies were included for analysis. All the studies were conducted in vitro, and slightly more than half of them were centred on evaluating orthodontic forces exerted by aligners. Eight utilized microchips as measurement tools, while the remaining studies made use of 3D microsensors for their assessments. In the context of fixed appliances, key findings included a high level of agreement in 3-dimensional orthodontic force detection between simulation results and actual applied forces. Incorporating critical force-moment combinations during smart bracket calibration reduced measurement errors for most components. Translational tooth movement revealed a moment-to-force ratio, aligning with the bracket's centre of resistance. The primary findings in relation to aligners revealed several significant factors affecting the forces exerted by them. Notably, the foil thickness and staging were found to have a considerable impact on these forces, with optimal force transmission occurring at a layer height of 150 μm. Furthermore, the type of material used in 3D-printing aligners influenced the force levels, with attachments proving effective in generating extrusive forces. Deliberate adjustments in aligner thickness were observed to alter the forces and moments generated.
CONCLUSIONS
Microchips and 3D sensors provide precise and quantitative measurements of orthodontic forces in in vitro studies, enabling accurate monitoring and control of tooth movement.
PubMed: 38372469
DOI: 10.1111/ocr.12768