Comparative Analysis of Periodontal Pain Using Two Different Orthodontic Techniques, Fixed Multibrackets and Removable Aligners: A Longitudinal Clinical Study with Monthly Follow-Ups for 12 Months

The aim of this study was to evaluate the perception of periodontal pain in patients treated with either fixed multibrackets or removable alignment systems with a monthly follow-up over a period of twelve months. Materials and Methods: This longitudinal clinical study comprised a sample of 140 patients (72 women; 68 men) divided into two groups of 70 patients each: the bracket group (BG) with conventional fixed brackets using the MBT technique with a 0.022″ slot and the Invisalign group (IG) with aligners (Invisalign). The visual analog scale (VAS) was used to quantify patient-reported pain. Pain analysis was conducted monthly at 4 (T1), 8 (T2), and 24 h (T3) post-follow-up as well as at 2 (T4), 3 (T5), 4 (T6), 5 (T7), 6 (T8), and 7 days (T9) post-follow-up during the first twelve months after starting orthodontic treatment. Results: Statistically significant differences (p < 0.05) were observed between both study groups in the mean pain scores on the visual analog scale (VAS) during the twelve-month follow-up period, except for during the eighth month of treatment. In the first month, the group with conventional brackets reported higher pain scores. From the second month onwards, we observed that patients with aligners described a higher level of pain compared to the group of patients with conventional brackets. In both experimental groups, though at different evaluation periods, we found that the peak of maximum pain occurred between 24 and 48 h (T3–T4) after monthly follow-up appointments; from this point, the pain decreased until reaching minimum values from the fifth day onwards (T7). Conclusions: In the first month of treatment, the patients with conventional fixed multibrackets reported the highest levels of pain compared to those with removable aligners. From the second month on, this trend changed. The patients with removable aligners reported the highest levels of pain. Therefore, the orthodontic system used influenced the perception of pain in patients.

The verisimilitude of damon brackets versus damon archwires– The real hero

: The Damon passive self-ligating system introduced broad archwires and a passive clip with posterior expansion and with minimal tipping of the teeth. To evaluate and compare the effectiveness of Damon brackets and Damon arch wires in maxillary arch dimensional changes with that of conventional brackets and conventional archwires. A total of 20 patients were selected for the study and randomly divided into 4 Groups with 5 patients in each group. Records (Study models) were taken before starting the treatment (T0) and at the end of leveling and alignment (T1) for all the 20 subjects. Pre-treatment (T0) and at the end of leveling and alignment (T1) study models were assessed for inter canine width, inter first premolar width and inter first molar width. There was statistically significant increase in maxillary arch width in Damon system and conventional bracket with Damon archwires when compared to conventional bracket system and Damon brackets with conventional archwires. The use of conventional or self-ligating brackets does not seem to be an important predictor of change in maxillary arch width in non-extraction patients. The amount of increase in arch width was due to Damon archwires and not because of Damon brackets.

Compliance with the ISO 27020:2019 norm of a sample of currently available preadjusted Orthodontic bracket systems. Are the actual dimensions as expected?

Background Determine the exact slot dimension of a sample of a MBT prescription stainless steel conventional brackets from different manufacturers to compare the actual values with the nominal ones declared by the manufacturers and to verify the compliance with tolerance limits given by the ISO 27020:2019. Different batches from each manufacturer were evaluated to determine whether or not they are different in size. In addition, the geometry of the slot walls was assessed. Methods 360 stainless steel preadjusted orthodontic brackets of 12 different manufacturers were assessed. All brackets had a nominal slot size of 0.022 by 0.028 inches, belonged to the right upper central incisor, and were fabricated with the metal injection molding technique (MIM). For each manufacturer, three different manufacturing batches were evaluated. Brackets were coded using a single-blind design. Results All bracket systems in the study group except one displayed a statistically significant difference with the nominal declared value, although only four of the systems did not comply with the tolerance limits established by the ISO 27020:2019. In most of the systems, the slot height was oversized when compared to the nominal one. A significant interbatch variability was found in most of the evaluated systems. Most of the brackets walls were divergent. Conclusions The dimensional accuracy of commercially available metal brackets is not guaranteed. The respect for the norm should be enforced as well as the quality controls along the manufacturing process since orthodontic brackets are a precision medical device.

STATISTICAL STUDY CONCERNING THE ORTHODONTISTS’ PERCEPTION OF THE CONVENTIONAL AND SELF-LIGATING BRACKET SYSTEMS

Objective. To compare the conventional and self-ligating brackets systems from the point of view of the clinician. Material and methods. A survey was delivered to orthodontists from the international community (n = 130) in order to evaluate and compare different proprieties of the two systems. Results. Conventional brackets are preferred when it comes to bonding technique, final results from an aesthetic and functional point of view and quality-price ratio, while self-ligating brackets are elected for improved patient hygiene, less chairside time and reduced friction and global treatment time. Conclusions. Orthodontists currently use both systems in their practice and each of them has certain features which makes them superior in comparison to the other.

Salivary pH changes under the effect of stainless steel versus elastomeric ligatures in fixed orthodontic patients: A single-center, randomized controlled clinical trial

BackgroundFluctuations in pH of saliva during a prolonged treatment course influences the enamel demineralization progress, which is one of the complications of fixed orthodontic treatment. This randomized clinical trial aimed to evaluate and compare the short-term effect of stainless steel (SS) versus elastomeric (EM) ligatures on salivary pH in patients scheduled for fixed orthodontic treatment.MethodsSeventy participants were enrolled in the study (54 females, 16 males) aged 19–36 who met specific inclusion criteria. They were randomly selected and allocated into two equal groups through a computer-generated randomization. All patients received fixed orthodontic treatment using conventional brackets. Two commonly used archwire ligature methods were used: stainless steel and elastomeric modules. An unstimulated (resting) salivary sample was collected before tying of the ligatures at T0 (baseline), 2 weeks, 6 weeks and 12 weeks. Salivary pH was measured using a digital pH meter. The level of significance was set at p value < 0.05.ResultsThe salivary pH level was stable between T0 and T1 (6.72 ± 0.14), then significantly and progressively increased from T1 to T2 (6.78 ± 0.13) and from T2 to T3 (6.81 ± 0.14) with (P < 0.05) in the SS group. In the EM group, the salivary pH level was significantly decreased in all follow-up periods; T0 (6.77 ± 0.16), T1 (6.72 ± 0.14), T2 (6.67 ± 0.13) and T3 (6.64 ± 0.13).ConclusionEM ligature showed a significant decrease in salivary pH to an unfavorable level, which increased the risk of enamel demineralization. Therefore, EM as ligature material is not recommended in patients with high caries index or inadequate oral hygiene.Trial RegistrationANZCTR.org. (ACTRN12618001647224). Registration Date: 5/10/2018, “Retrospectively registered”

Photobiostimulatory Effect of a Single Dose of Low-Level Laser on Orthodontic Tooth Movement and Pain

Objective. To assess the effect of low-level laser applied at 3 weeks intervals on orthodontic tooth movement (OTM) and pain using conventional brackets (CB). Materials and Methods. Twenty patients with Angle’s class II div 1 (10 males and 10 females; aged 20.25 ± 3.88 years) needing bilateral extractions of maxillary first bicuspids were recruited. Conventional brackets MBT of 0.022 in slot (McLaughlin Bennett Trevisi) prescription braces (Ortho Organizers, Carlsbad, Calif) were bonded. After alignment and levelling phase, cuspid retraction began with nitinol closed coil spring on 19 × 25 stainless steel archwire, wielding 150 gram force. 7.5 J/cm2 energy was applied on 10 points (5 buccal and 5 palatal) on the canine roots on the investigational side using gallium-aluminum-arsenic diode laser (940 nm wavelength, iLase™ Biolase, Irvine, USA) in a continuous mode. Target tissues were irradiated once in three weeks for 9 weeks at a stretch (T0, T1, and T2). Patients were given a feedback form based on the numeric rating scale (NRS) to record the pain intensity for a week. Silicon impressions preceded the coil activation at each visit (T0, T1, T2, and T3), and the casts obtained were scanned with the Planmeca CAD/CAM™ (Helsinki, Finland) scanner. Results. The regimen effectively accelerated (1.55 ± 0.25 mm) tooth movement with a significant reduction in distress on the investigational side as compared to the placebo side (94 ± 0.25 mm) ( p < 0.05 ). Conclusions. This study reveals that the thrice-weekly LLLT application can accelerate OTM and reduce the associated pain.

Streptococcus mutans adherence to conventional and self-ligating brackets: an in vitro study

ABSTRACT Introduction: Although self-ligating brackets presumably provide better hygiene conditions, no consensus has been reached so far. Objective: Therefore, the objective of this study was to evaluate, in an in vitro experimental design, the adherence of Streptococcus mutans (SM) in self-ligating and conventional brackets of different manufacturers and ligature types. Methods: Four commercial brands of maxillary premolar metal brackets were tested (Abzil®; Morelli®; 3M Unitek®; and GAC®). Each one was subdivided into three groups, which varied according to the type of ligature and bracket model (metallic, elastic, and self-ligating), totalizing twelve groups, composed of six brackets each. Previously sterilized brackets were initially immersed in saliva for one hour, and subsequently washed and added in a bacterial suspension, maintained in aerobiosis for 72 hours. The adhered bacteria were then separated and quantified by colony forming units (CFU/mL) counting after 48 hours of growth. The groups were compared by Kruskal-Wallis and Dunn post-hoc tests (p< 0.05). Results: Regardless of the commercial brand, self-ligating brackets had significantly less CFU/mL. However, according to comparisons performed within each commercial brand, only Abzil® self-ligating brackets had significantly lower biofilm adhesion. Among all of the self-ligating models, GAC® brackets presented the highest bacterial adhesion rate. Conclusions: Self-ligating brackets are likely to present lower rates of biofilm adhesion. Particularly, Abzil® and GAC® self-ligating brackets are less likely to accumulate biofilm. Although such results are derived from an in vitro study, practitioners might acknowledge findings concerning bacterial adhesion as one of the relevant features to be considered during bracket selection.

Effects of debonding a conventional & customized lingual appliance on enamel structure- An invitro study

Introduction: To evaluate the surface changes on enamel structure after debonding of customized and conventional lingual brackets bonded using restorative dual cure bonding material and a chemically cured bonding material with and without sandblasting. Materials and Method: The sample consisted of 40 premolar teeth extracted for the purpose of orthodontic treatment. Enamel surface changes, prior to bonding, were studied using a stereomicroscope (Olympus SZX7) and an optical microscope. 20 extracted premolars were arranged in 2 arch forms with 5 teeth in each quadrant, after which impression of the arches with rubber base impression material was made. These impressions were then sent to the laboratory for the fabrication of a customized lingual appliance. The remaining 20 premolars were divided into 2 arches, each arch having 10 extracted premolars divided into 4 sets, 1st to test customized brackets bonded with chemical cure resin without sandblasting, 2nd to test customized brackets with dual cure resin without sandblasting, 3rd to test conventional brackets with chemical sure resin with and without sandblasting and 4th to test conventional brackets bonded with dual cure resin with and without sandblasting. The post debonding photographs were analyzed using a standardized grid and Surface Roughness Index. Result: Thus, enamel defects are likely to be caused post debonding despite of using any combination. However, the surface roughness index has been shown to be highest post debonding in cases where customized brackets have been bonded using dual cure resin along with sandblasting. Conclusion: While a clinician may opt for a material like Rely X U200 to bond lingual appliances in order to have a better clinical management of the appliance, but he would have to keep the possibility of irreversible damage to enamel post debonding.