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Yu J, Qin D, Guo F, Zhao T, He H, Hua F. THE EFFECTS OF PREVENTIVE INTERVENTIONS FOR ORTHODONTICALLY INDUCED WHITE SPOT LESIONS: AN UMBRELLA REVIEW AND EVIDENCE MAPPING. J Evid Based Dent Pract 2025; 25:102089. [PMID: 40335188 DOI: 10.1016/j.jebdp.2025.102089] [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: 11/06/2024] [Revised: 12/16/2024] [Accepted: 01/11/2025] [Indexed: 05/09/2025]
Abstract
OBJECTIVES To summarize and evaluate systematic reviews (SRs) regarding preventive interventions for orthodontically induced white spot lesions (WSLs) and map currently available evidence in this field. MATERIALS AND METHODS An electronic search was conducted up to 20 June 2024 in the following 7 databases with no restrictions: PubMed, Embase, Web of Science, Cochrane Reviews, Scopus, WanFang, and CNKI. Screening, data extraction, and quality assessment (using AMSTAR 2 and ROBIS) were performed by 2 authors independently and in duplicate. Results were summarized and analyzed qualitatively. Evidence mapping was applied to display current evidence and research gaps. RESULTS A total of 24 SRs were included. Only a few SRs were of 'low' risk of bias (n = 4) according to ROBIS, or of 'high' (n = 1) or 'moderate' overall confidence (n = 2) according to AMSTAR 2. The evidence mapping depicted the diversity of interventions, and 27 different comparisons in included SRs were identified. Remineralizing agents were the most frequently assessed types of interventions, while self-applied antibacterial agents and mechanical cleaning procedures were studied in few SRs. Topical fluoride applications, oral hygiene-related reminders and sealants were effective in preventing WSLs compared to control/placebo. No sufficient evidence supported the effectiveness of other interventions. CONCLUSION The number of high-quality SRs regarding the preventive intervention of WSLs is limited. Various preventive interventions for WSLs exist, but most current SRs focus on remineralizing agents. More high-quality randomized controlled trials are required to increase the certainty of evidence and to guide clinical practice. REGISTRATION PROSPERO (CRD42023428516).
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Affiliation(s)
- Jingjing Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Danchen Qin
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Dentofacial Deformities in Children, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Feiyang Guo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Dentofacial Deformities in Children, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Tingting Zhao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Dentofacial Deformities in Children, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hong He
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Dentofacial Deformities in Children, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Dentofacial Deformities in Children, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Orthodontics and Pediatric Dentistry at Optics Valley Branch, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
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Olawade DB, Leena N, Egbon E, Rai J, Mohammed APEK, Oladapo BI, Boussios S. AI-Driven Advancements in Orthodontics for Precision and Patient Outcomes. Dent J (Basel) 2025; 13:198. [PMID: 40422618 DOI: 10.3390/dj13050198] [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: 01/22/2025] [Revised: 03/12/2025] [Accepted: 04/24/2025] [Indexed: 05/28/2025] Open
Abstract
Artificial Intelligence (AI) is rapidly transforming orthodontic care by providing personalized treatment plans that enhance precision and efficiency. This narrative review explores the current applications of AI in orthodontics, particularly its role in predicting tooth movement, fabricating custom aligners, optimizing treatment times, and offering real-time patient monitoring. AI's ability to analyze large datasets of dental records, X-rays, and 3D scans allows for highly individualized treatment plans, improving both clinical outcomes and patient satisfaction. AI-driven aligners and braces are designed to apply optimal forces to teeth, reducing treatment time and discomfort. Additionally, AI-powered remote monitoring tools enable patients to check their progress from home, decreasing the need for in-person visits and making orthodontic care more accessible. The review also highlights future prospects, such as the integration of AI with robotics for performing orthodontic procedures, predictive orthodontics for early intervention, and the use of 3D printing technologies to fabricate orthodontic devices in real-time. While AI offers tremendous potential, challenges remain in areas such as data privacy, algorithmic bias, and the cost of adopting AI technologies. However, as AI continues to evolve, its capacity to revolutionize orthodontic care will likely lead to more streamlined, patient-centered, and effective treatments. This review underscores the transformative role of AI in modern orthodontics and its promising future in advancing dental care.
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Affiliation(s)
- David B Olawade
- Department of Allied and Public Health, School of Health, Sport and Bioscience, University of East London, London E16 2RD, UK
- Department of Research and Innovation, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK
- Department of Public Health, York St John University, London E14 2BA, UK
- School of Health and Care Management, Arden University, Arden House, Middlemarch Park, Coventry CV3 4FJ, UK
| | - Navami Leena
- Faculty of Public Health and Healthcare Management, Westford University College, Sharjah 50325, United Arab Emirates
| | - Eghosasere Egbon
- Department of Tissue Engineering and Regenerative Medicine, Faculty of Life Science Engineering, FH Technikum, 1200 Vienna, Austria
| | - Jeniya Rai
- Department of Public Health, York St John University, London E14 2BA, UK
| | - Aysha P E K Mohammed
- School of Health and Care Management, Arden University, Arden House, Middlemarch Park, Coventry CV3 4FJ, UK
| | - Bankole I Oladapo
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
| | - Stergios Boussios
- Department of Research and Innovation, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK
- Faculty of Medicine, Health, and Social Care, Canterbury Christ Church University, Canterbury CT1 1QU, UK
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King's College London, London WC2R 2LS, UK
- Kent Medway Medical School, University of Kent, Canterbury CT2 7NZ, UK
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK
- AELIA Organization, Thermi, 57001 Thessaloniki, Greece
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Hussain U, Wahab A, Kamran MA, Alnazeh AA, Almoammar S, Alshahrani SSM, Niazi FH, Alam S, Arif N, Campobasso A, Pandis N. Prevalence, Incidence and Risk Factors of White Spot Lesions Associated With Orthodontic Treatment - A Systematic Review and Meta-Analysis. Orthod Craniofac Res 2025; 28:379-399. [PMID: 39717964 DOI: 10.1111/ocr.12888] [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: 10/13/2024] [Revised: 11/18/2024] [Accepted: 12/12/2024] [Indexed: 12/25/2024]
Abstract
The primary objective was to systematically assess the prevalence, incidence and risk factors of WSLs with orthodontic treatment. The secondary objective was to compare the prevalence of WSLs between conventional fixed appliances (CFA) and other appliances, as well as with no treatment. PubMed, Scopus, Web of Science, LILACs, Virtual Health Library and Cochrane CENTRAL were searched. Risk of bias was assessed using RoB-2, ROBINS-I tool and the Joanna Briggs Institute Critical Appraisal Checklist. Random-effects meta-analyses of pooled proportions and odds ratios (OR) with 95% confidence intervals (CIs) were conducted, followed by meta-regressions, sensitivity analyses, and an assessment of the quality of evidence using GRADE. Trial Sequential Analysis (TSA) was performed to determine the conclusiveness of the evidence. Fifty-seven studies involving 9101 patients (mean age of 16.4 years, 33.5% male) were included. Among orthodontic patients, the pooled prevalence of WSLs was 55.06% (95% CI: 47.7%, 63.6%: 42 studies), incidence was 34.2% (95% CI: 27.6%, 40.6%: 44 studies) and surface prevalence was 26.9% (6 studies; 95% CI: 13.8%, 39.8%). Among non-treated patients, the pooled prevalence of WSLs was 29.1% (95% CI: 17.2%, 41.1%; 21 studies). The odds of WSLs were significantly higher, with CFA being 4.73 times greater compared to other appliances (OR = 4.7, 95% CI: 1, 19.2, p = 0.05) and seven times higher compared to no treatment (OR = 7, 95% CI: 2.6, 18.5, p = 0.001). Prevalence of WSLs increased with longer treatment duration (p < 0.001), varied with ethnicity, being highest in Africans and lowest in Americans (p < 0.05), and method of detection (p < 00.1). TSA confirmed that CFA leads to more WSLs than other appliances or no treatment, with future studies unlikely to alter the direction of the outcomes. Orthodontic treatment increases WSL prevalence, influenced by various factors. Clinicians should carefully consider the development of WSLs during orthodontic treatment and adjust treatment plans accordingly, choose appliances wisely and monitor with effective detection tools. Since one-third of untreated cases already have WSLs, proper documentation at treatment start is essential. Trail Registration: CRD42023478065.
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Affiliation(s)
- Umar Hussain
- Orthodontics, Saidu College of Dentistry, Swat, Pakistan
| | - Abdul Wahab
- Sardar Begum Dental College & Hospital, Peshawar, Pakistan
| | - Muhammad Abdullah Kamran
- Department of Pediatric Dentistry and Orthodontic, Sciences College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Abdullah Ali Alnazeh
- Orthodontics Division, Department of Pediatric Dentistry and Orthodontic Sciences College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Salem Almoammar
- Orthodontics Division, Department of Pediatric Dentistry and Orthodontic Sciences College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | | | - Fayez Hussain Niazi
- Department of Restorative and Prosthetic Dentistry, College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Shamsul Alam
- Health Department, Shangla, Khyber Pakhtunkhwa, Pakistan
| | - Nauman Arif
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Alessandra Campobasso
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Nikoloas Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Bern, Switzerland
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Xia L, Zhou C, Mei P, Jin Z, He H, Wang L, Bai Y, Chen L, Li W, Wang J, Hu M, Song J, Cao Y, Liu Y, Hou B, Wei X, Niu L, Lu H, Ma W, Wang P, Zhang G, Guo J, Li Z, Lu H, Ren L, Xu L, Wu X, Lu Y, Hu J, Yue L, Zhang X, Fang B. Expert consensus on the prevention and treatment of enamel demineralization in orthodontic treatment. Int J Oral Sci 2025; 17:13. [PMID: 40021614 PMCID: PMC11871012 DOI: 10.1038/s41368-024-00335-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 09/25/2024] [Accepted: 10/22/2024] [Indexed: 03/03/2025] Open
Abstract
Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
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Affiliation(s)
- Lunguo Xia
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chenchen Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Peng Mei
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zuolin Jin
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, Air Force Medical University, Xi'an, China
| | - Hong He
- Department of Orthodontics, Hubei-MOST KLOS and KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lin Wang
- Department of Orthodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Yuxing Bai
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing, China
| | - Lili Chen
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
| | - Weiran Li
- Department of Orthodontics, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Jun Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Min Hu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, China
| | - Jinlin Song
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yang Cao
- Department of Orthodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yuehua Liu
- Department of Orthodontics, Shanghai Stomatological Hospital, Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Benxiang Hou
- Center for Microscope Enhanced Dentistry, Capital Medical University School of Stomatology, Beijing, China
| | - Xi Wei
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Lina Niu
- Department of Prosthodontics, School of Stomatology, Air Force Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Xi'an, China
| | - Haixia Lu
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Wensheng Ma
- Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, China
| | - Peijun Wang
- Department of Orthodontics, School of Stomatology, Harbin Medical University, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guirong Zhang
- Department of Orthodontics, Shenyang Stomatological Hospital, Shenyang, China
| | - Jie Guo
- Department of Orthodontics, School and Hospital of Stomatology, Shandong University, Jinan, China
| | - Zhihua Li
- Department of Orthodontics, Affiliated Stomatological Hospital of Nanchang University, Jiangxi Provincial Key Laboratory of Oral Biomedicine, Nanchang, China
| | - Haiyan Lu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University, Hebei Provincial Key Laboratory of Stomatology, Hebei Provincial Clinical Research Center for Oral Diseases, Shijiazhuang, China
| | - Liling Ren
- School of Stomatology, Lanzhou University, Lanzhou, China
| | - Linyu Xu
- Department of Orthodontics, Fujian Key Laboratory of Oral Diseases, Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Xiuping Wu
- Department of Orthodontics, School and Hospital of Stomatology, Shanxi Medical University, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China
| | - Yanqin Lu
- Department of Orthodontics, Xiangya Stomatology Hospital, Central South University, Changsha, China
| | - Jiangtian Hu
- Department of Orthodontics, Affiliated Stomatological Hospital of Kunming Medical University, Kunming, China
| | - Lin Yue
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Beijing, China.
| | - Xu Zhang
- School and Hospital of Stomatology, Institute of Stomatology, Tianjin Medical University, Tianjin Key Laboratory of Oral Soft and Hard Tissues Restoration and Regeneration, Tianjin, China.
| | - Bing Fang
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China.
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Baneshi M, O'Malley L, El-Angbawi A, Thiruvenkatachari B. EFFECTIVENESS OF CLEAR ORTHODONTIC ALIGNERS IN CORRECTING MALOCCLUSIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2025; 25:102081. [PMID: 39947778 DOI: 10.1016/j.jebdp.2024.102081] [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: 02/22/2024] [Revised: 12/07/2024] [Accepted: 12/10/2024] [Indexed: 05/09/2025]
Abstract
OBJECTIVE The purpose of this research was to assess the effectiveness of clear aligners in treating various types of malocclusions when compared to fixed orthodontic appliances. METHODS AND QUALITY The following databases were searched: EMBASE (Ovid), Medline (Ovid), the Cochrane Library, Latin America and the Caribbean Literature on Health Sciences (Lilacs), Web of Science and EBMR review until October 2024. Additionally, Google scholar, PubMed were also searched for completion for including all relevant articles. No restrictions were placed on language or publication date, and only randomized controlled trials (RCTs) were included in this review. Evaluation of the potential for bias in randomized controlled trials (RCTs) was carried out with the use of the revised Cochrane Risk of Bias instrument (ROB tool 2). The primary outcome was the treatment accuracy of clear aligners vs fixed appliances and included orthodontic tooth movement in terms of anteroposterior discrepancy, transverse discrepancy, vertical discrepancy and overjet. The secondary outcomes included the effectiveness of treatment, such as duration of treatment, periodontal health, root resorption and patient satisfaction. Available data was meta-synthesized using Review Manager 5.4. RESULTS About 21 RCT studies were selected from a total of 600 records and involved 970 participants. All 21 studies included a comparison of the effectiveness of clear aligners vs fixed appliances. About 3 of the studies were assessed to be at high risk of bias, whilst 14 of the studies were assessed to be at unclear risk of bias, and only 1 study was found to be at low risk of bias. Based on the primary outcome, there was no significant difference in the ABO objective grading scores, Little Irregularity Index and PAR scores between the fixed appliances and clear aligner treatments. Meta-analysis was only possible for secondary outcomes. The scores for plaque index (MD = -0.76, 95% CI, -1.14 to - 0.38, P = .00001), gingival index (MD = -0.61, 95% CI, -0.78 to - 0.44, P = .00001) and bleeding index (MD = -0.71, 95% CI, -0.92 to - 0.49, P < .0001) were significantly lower in clear aligners when compared to the fixed appliances. The patients quality of life at 6 months was significantly better for clear aligners compared with fixed appliances (MD = -4.37, 95% CI, -6.93 to -1.80, P < .0001). Clear aligners also appeared to have a better outcome for chairside time, pain and root resorption. CONCLUSION The overall quality of evidence from the included studies was low. Both clear aligners and fixed appliances worked well in treating simple malocclusions treated on a nonextraction basis. There was no significant difference in the ABO Objective Grading System, Little Irregularity index and PAR scores between the clear aligner and fixed appliance groups. There was low quality evidence available in favor of clear aligners for periodontal health and moderate quality evidence in favor of clear aligners for quality of life. More high-quality studies evaluating clear aligner treatment for treating complex malocclusions are required.
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Affiliation(s)
- Maryam Baneshi
- Research Scholar, Division of Dentistry, University of Manchester, Manchester, UK
| | - Lucy O'Malley
- Division of Dentistry, University of Manchester, Manchester, UK
| | | | - Badri Thiruvenkatachari
- Division of Dentistry, University of Manchester, Manchester, UK; Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, India.
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Lucchese A, Marcolina M, Mancini N, Ferrarese R, Acconciaioco S, Gherlone E, Bonini C, Manuelli M, Polimeni A. A comparison of the alterations of oral microbiome with fixed orthodontic therapy and clear aligners: a systematic review. J Oral Microbiol 2025; 17:2372751. [PMID: 39902218 PMCID: PMC11789220 DOI: 10.1080/20002297.2024.2372751] [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: 10/20/2023] [Revised: 04/19/2024] [Accepted: 06/09/2024] [Indexed: 02/05/2025] Open
Abstract
Aim The oral microbiome plays a fundamental role in maintaining homeostasis of the oral cavity. In the last decade there has been an increasing use of clear aligners, which guarantee aesthetics and comfort for the patient. The aim of this work is to conduct a systematic review regarding the alterations in bacterial flora and oral health with aligner and fixed orthodontic therapy. Design A systematic review was conducted following the PRISMA Statement. Using the search strategy "(clear aligners OR Invisalign) AND (fixed therapy OR fixed orthodont * therapy) NOT (thermoplastic retainers) AND (oral microbiome OR oral microbiota * OR oral microbiology * OR oral health)", in the main scientific databases. Two scales were applied to assess the quality of scientific evidence: ROBINS-I and RoB 2. Results A total of 484 articles emerged of which 9 met our inclusion/exclusion criteria. Afterwards the application of the rating scales, 1 article was found to be at low risk of bias, 6 at moderate and 2 at serious risk of bias. Conclusion Both therapies cause an alteration of the oral microbiome, but the changes induced by the aligners seem to be compatible with a better oral health compared to fixed appliances.
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Affiliation(s)
- Alessandra Lucchese
- Department of Life Sciences, Health and Healthcare Professions, Link Campus University, Rome, Italy
- Unit of Orthodontics, School of Dentistry, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Orthodontics, Division of Dentistry, IRCSS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Unit of Dentistry, Research Center for Oral Pathology and Implantology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Experimental Hematology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
- Cell Therapy Immunomonitoring Laboratory Monitoraggio Immunologico Terapie Cellulari (MITiCi), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Marta Marcolina
- Department of Life Sciences, Health and Healthcare Professions, Link Campus University, Rome, Italy
- Unit of Orthodontics, School of Dentistry, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Orthodontics, Division of Dentistry, IRCSS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Unit of Dentistry, Research Center for Oral Pathology and Implantology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Experimental Hematology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
- Cell Therapy Immunomonitoring Laboratory Monitoraggio Immunologico Terapie Cellulari (MITiCi), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Nicasio Mancini
- Department of Medicine and Innovation Technology, University of Insubria (DIMIT), Varese, Italy
- Laboratory of Medical Microbiology and Virology University Hospital of Varese, Varese, Italy
| | | | - Serena Acconciaioco
- Department of Life Sciences, Health and Healthcare Professions, Link Campus University, Rome, Italy
- Unit of Orthodontics, School of Dentistry, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico Gherlone
- Unit of Orthodontics, Division of Dentistry, IRCSS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Bonini
- Experimental Hematology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
- Cell Therapy Immunomonitoring Laboratory Monitoraggio Immunologico Terapie Cellulari (MITiCi), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Manuelli
- Department of Life Sciences, Health and Healthcare Professions, Link Campus University, Rome, Italy
- Unit of Orthodontics, School of Dentistry, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Orthodontics, Division of Dentistry, IRCSS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Unit of Dentistry, Research Center for Oral Pathology and Implantology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Experimental Hematology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
- Cell Therapy Immunomonitoring Laboratory Monitoraggio Immunologico Terapie Cellulari (MITiCi), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
- Private Practice Pavia, Bologna, Milan, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
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Wang C, Zhang C, He S, Wang Q, Gao H. The microbiome alterations of supragingival plaque among adolescents using clear aligners: a metagenomic sequencing analysis. Prog Orthod 2024; 25:48. [PMID: 39676101 DOI: 10.1186/s40510-024-00547-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 11/15/2024] [Indexed: 12/17/2024] Open
Abstract
BACKGROUND White spot lesions (WSLs) may develop in adolescents undergoing clear aligner (CA) therapy with poor oral hygiene. The specific effects of CAs on the microbial composition and functional characteristics of supragingival plaques remain unclear. The present study investigated the shift in the supragingival microbial community induced by CAs in adolescents through metagenomic technology. METHODS Fifteen adolescents (12-15 years old) with Invisalign appliances were recruited. Supragingival plaque specimens were obtained twice, before treatment (T1) and three months after treatment (T2). All the bacterial plaque specimens were analyzed for microbial communities and functions using metagenomic analyses. RESULTS A total of 2,840,242,722 reads disclosed 180 phyla, 3,975 genera, and 16,497 microbiome species. During the first three months, the microbial community was relatively stable. The genus level revealed a higher relative abundance of Capnocytophaga, Neisseria, and Arachnia in the T2 period. Furthermore, the functional analysis suggested that the relative abundances of folate biosynthesis, biotin metabolism and biofilm formation-vibrio cholerae were increased in the T2 period compared to the T1 period. Finally, virulence factor analysis demonstrated that the relative abundance of genes associated with type IV pili (VF0082) and polar flagella (VF0473) was higher in the T2 period than in the T1 period. CONCLUSION In adolescents undergoing CA therapy with poor plaque control, caries progresses quickly within three months and noticeable WSLs develop on the tooth surface. Although the microbial community remained relatively steady and CA therapy did not cause significant changes in the overall functional gene composition in the first three months, virulence factors, including type IV pili and flagella, were more abundant and actively contributed to microorganism adhesion and biofilm formation.
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Affiliation(s)
- Chunlin Wang
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Chao Zhang
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Shan He
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Qiuyu Wang
- Department of Orthodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Hai Gao
- Department of Periodontology and Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, S366 Jiangnan Boulevard, Haizhu District, Guangzhou, Guangdong, 510280, China.
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8
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Thilagalavanian A, Weir T, Meade MJ. Analysis of predicted and achieved root angulation changes in teeth adjacent to maxillary premolar extraction sites in patients treated with the Invisalign appliance. Am J Orthod Dentofacial Orthop 2024; 166:423-432. [PMID: 39066745 DOI: 10.1016/j.ajodo.2024.06.014] [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: 05/01/2024] [Revised: 06/01/2024] [Accepted: 06/01/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION This study aimed to investigate the expression of root angulation in canine, premolar, and first molar teeth adjacent to first and second premolar extraction sites in the maxilla after treatment with an initial series of Invisalign aligners (Align Technology, Santa Clara, Calif). METHODS Adult patients (aged ≥18 years) with at least 1 first and/or second premolar extraction in the maxilla and satisfying strict selection criteria were evaluated. Digital models representing pretreatment, predicted, and posttreatment were obtained from Align Technology's digital interface, ClinCheck. The Geomagic Control X (version 2017.0.3; 3D systems, Rock Hill, NC) software facility was used to determine and compare the root angulation of adjacent canine, premolar, and first molar teeth at different time points. RESULTS The predicted angulation of teeth was significantly different (P <0.02) than that achieved in most patients. When adjacent teeth roots were planned to tip away from the extraction site, there was an overexpression of the movement. When teeth roots were planned to tip into the extraction site, underexpression occurred, and movement was in the opposite direction in some instances. There was no difference in root angulation outcomes according to the prescribed number of aligners, 1- or 2-week wear protocols, and sex (P >0.05). Attachments were influential in controlling angulation in first-premolar extractions (P = 0.05), but optimized attachments were not any more effective than conventional attachments (P >0.05). CONCLUSIONS The achieved root angulation in teeth adjacent to premolar extraction sites in the maxilla after treatment with an initial series of Invisalign aligners differed significantly from that predicted. Attachments play a minor role in the predictability of root angulation outcomes.
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Affiliation(s)
- Abirami Thilagalavanian
- From the Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tony Weir
- From the Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Maurice J Meade
- From the Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.
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9
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Liu Q, Song Z. Incidence, severity, and risk factors for white spot lesions in adolescent patients treated with clear aligners. Orthod Craniofac Res 2024; 27:704-713. [PMID: 38629950 DOI: 10.1111/ocr.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 10/11/2024]
Abstract
OBJECTIVES This study was aimed to clarify the incidence, severity, and clinical risk factors for white spot lesions (WSLs) in adolescent patients treated with clear aligners. METHODS Pre-treatment and post-treatment intraoral photographs of 203 adolescent patients undergoing clear aligner therapy were retrospectively evaluated to assess the occurrence and severity of WSLs. Information on patients' general oral condition and orthodontic treatment was collected from clinical medical documents, retrospective questionnaires, and ClinCheck® software. Independent risk factors and model performance were determined by multivariate logistic regression and receiver operating characteristic curve analysis. RESULTS Thirty-five percent of adolescent patients developed WSLs during clear aligner treatment. Logistic regression analysis revealed that the presence of WSLs before treatment (OR 2.484, 95% CI 1.245-4.957), frequency of drinking carbonated beverages (OR 1.508, 95% CI 1.045-2.177), and number of anterior attachments (OR 2.192, 95% CI 1.502-3.198) were risk factors for the occurrence of WSLs in adolescent patients treated with clear aligners (P < .05), whereas the number of times they brushed each day (OR 0.656, 95% CI 0.454-0.947) and frequency of aligner cleaning after eating while wearing them (OR 0.611, 95% CI 0.433-0.861) were protective factors against WSLs (P < .05). CONCLUSIONS The incidence of WSLs was high in adolescent patients treated with clear aligners. Few brushings each day, pre-treatment WSLs, a high frequency of drinking carbonated beverages, a low frequency of aligner cleaning after eating while wearing them, and a high number of anterior attachments are strongly associated with the development of WSLs in adolescent patients treated with clear aligners.
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Affiliation(s)
- Qian Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhixin Song
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
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10
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Mundada R, Tanpure SB, Mapare S, Karra A, Yannawar V, Gilani R. The Effect of Nanoparticles Against Streptococcus mutans in the Orthodontic Primer Used for Aligner Attachment: An In Vitro Study. Cureus 2024; 16:e68359. [PMID: 39355471 PMCID: PMC11443300 DOI: 10.7759/cureus.68359] [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: 07/27/2024] [Accepted: 08/28/2024] [Indexed: 10/03/2024] Open
Abstract
Objective This study investigates the antimicrobial properties of silver (1%) and chitosan (1%) nanoparticles against Streptococcus mutans (S. mutans) when added to an orthodontic primer used for aligner attachments. While aligner treatments are becoming increasingly popular for their aesthetics and convenience, their attachments can create retention sites for bacteria, potentially leading to white spot lesions (WSLs). This in vitro study aims to address this issue by enhancing the antimicrobial efficacy of aligner primers. Methodology Thirty freshly extracted teeth were classified into the following three groups: Group A with the standard primer, Group B with chitosan nanoparticles mixed in the primer, and Group C with silver nanoparticles mixed in the primer. The samples were incubated with S. mutans and bacterial colonies were counted at 12, 24, 48, and 72 hours. Results The results showed a significant reduction in colony-forming units (CFUs) in the groups with nanoparticles compared to the control group, with silver nanoparticles exhibiting a higher antimicrobial effect than chitosan. Conclusions This study suggests that incorporating silver nanoparticles into orthodontic primers can effectively reduce bacterial growth, potentially improving oral hygiene and reducing the risk of WSLs in patients undergoing aligner treatment.
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Affiliation(s)
- Ram Mundada
- Department of Orthodontics and Dentofacial Orthopedics, Dr. Hedgewar Smruti Rugna Seva Mandal's Dental College and Hospital, Hingoli, IND
| | - Saurabh B Tanpure
- Department of Orthodontics and Dentofacial Orthopedics, Dr. Hedgewar Smruti Rugna Seva Mandal's Dental College and Hospital, Hingoli, IND
| | - Sagar Mapare
- Department of Orthodontics and Dentofacial Orthopedics, Dr. Hedgewar Smruti Rugna Seva Mandal's Dental College and Hospital, Hingoli, IND
| | - Arjun Karra
- Department of Orthodontics and Dentofacial Orthopedics, Dr. Hedgewar Smruti Rugna Seva Mandal's Dental College and Hospital, Hingoli, IND
| | - Vijay Yannawar
- Department of Orthodontics and Dentofacial Orthopedics, Dr. Hedgewar Smruti Rugna Seva Mandal's Dental College and Hospital, Hingoli, IND
| | - Rizwan Gilani
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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11
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Levrini L, Giannotta N, Mastrapasqua RF, Farronato D, Maurino V, Deppieri A, Tasquier F, Saran S. Assessment of Food Masticatory Capability with Clear Aligners. Dent J (Basel) 2024; 12:217. [PMID: 39057004 PMCID: PMC11276165 DOI: 10.3390/dj12070217] [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: 05/15/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Nowadays, aligners represent a possible therapeutical approach that combines both esthetic and function in order to address dental malocclusion. However, they require a significant level of compliance from the patient. According to the manufacturer, at least 22 h of wearing a day is demanded to reach the optimal therapeutical level; hence, aligners can only be removed during meals. Patients' compliance might increase and the duration of the treatment might decrease if they were allowed to eat with aligners on. The idea of patients keeping the aligners on during meals has been contemplated, not only to favor patients' compliance but also treatment effectiveness. This study aims to assess the degree of chewing difficulty that aligners cause when eating certain kinds of food and the quantity of residue left. MATERIAL AND METHODS A questionnaire titled "Questionnaire for the Assessment of Masticatory Function with Aligners" was administered using Google Forms to 240 patients in treatment with clear aligners. The survey was validated through the reliability test using the test-retest method. This method had a higher correlation coefficient of 0.9 across all items (with a cutoff of 0.8) with statistical significance, and an excellent internal correlation coefficient (α > 0.9). The statistical analysis performed consisted of descriptive analysis, frequencies, percentages, Pearson's correlation test and Friedman's test. RESULTS Pearson's test showed a statistically significant correlation between all items except between meat or clams and yogurt or ice cream and with mozzarella or soft cheese regarding food chewing difficulties. Pearson's test showed a statistically significant correlation between all items regarding food residues. A total of 69.2% of the cohort reported some movements of aligners during mastication. In total, 88.3% of them affirmed not to have perceived deformations or breakage of aligners during chewing. Furthermore, 79.2% of them declared that they would continue to eat if eating with aligners was proven to speed up treatment. CONCLUSIONS Wearing clear aligners while chewing foods such as yogurt, ice cream, soft cheese, bread, rice, etc., can be possible and can help shorten the duration of orthodontic treatment, benefiting both the patient and the orthodontist. However, further research using qualitative methods is needed to understand the barriers and facilitators to chewing food with aligners.
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Affiliation(s)
- Luca Levrini
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (L.L.); (N.G.); (A.D.); (F.T.)
| | - Nicola Giannotta
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (L.L.); (N.G.); (A.D.); (F.T.)
| | | | - Davide Farronato
- Department of Medicine and Surgery, School of Dentistry, University of Insubria, 21100 Varese, Italy; (D.F.); (V.M.)
| | - Vittorio Maurino
- Department of Medicine and Surgery, School of Dentistry, University of Insubria, 21100 Varese, Italy; (D.F.); (V.M.)
| | - Alessandro Deppieri
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (L.L.); (N.G.); (A.D.); (F.T.)
| | - Federico Tasquier
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (L.L.); (N.G.); (A.D.); (F.T.)
| | - Stefano Saran
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (L.L.); (N.G.); (A.D.); (F.T.)
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12
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Shankarappa S, Burk JT, Subbaiah P, Rao RN, Doddawad VG. White spot lesions in fixed orthodontic treatment: Etiology, pathophysiology, diagnosis, treatment, and future research perspectives. J Orthod Sci 2024; 13:21. [PMID: 38784071 PMCID: PMC11114457 DOI: 10.4103/jos.jos_205_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/16/2024] [Accepted: 01/30/2024] [Indexed: 05/25/2024] Open
Abstract
White spot lesions (WSLs) refer to localized areas of hypo-mineralization limited to the enamel of the teeth surface, which is noticeable clinically to the naked eye on drying of the teeth. During fixed orthodontic treatment, it is very hard for the patient to maintain excellent oral hygiene as the brackets, bands, wires, elastics, and other appliances and attachments worn intra-orally provide a platform for food retention, plaque formation, and then colonization by acidogenic bacteria like Streptococcus mutans and Lactobacillus. This review aims to elaborate and focus on etiology, pathophysiology, diagnosis, treatment aspect, and future scope for research about the WSLs occurring due to fixed orthodontic treatment.
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Affiliation(s)
- Suma Shankarappa
- Department of Orthodontics and Dentofacial Orthopedics, JSS Dental College and Hospital, A Constituent College of JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Jerusha Titus Burk
- Department of Orthodontics and Dentofacial Orthopedics, JSS Dental College and Hospital, A Constituent College of JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Pradeep Subbaiah
- Department of Orthodontics and Dentofacial Orthopedics, JSS Dental College and Hospital, A Constituent College of JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Raghunath Nagasundara Rao
- Department of Orthodontics and Dentofacial Orthopedics, JSS Dental College and Hospital, A Constituent College of JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Vidya Gowdappa Doddawad
- Department of Oral Pathology and Microbiology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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13
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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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14
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Jiang W, Wang Z, Zhou Y, Shen Y, Yen E, Zou B. Bioceramic micro-fillers reinforce antibiofilm and remineralization properties of clear aligner attachment materials. Front Bioeng Biotechnol 2024; 11:1346959. [PMID: 38318418 PMCID: PMC10840140 DOI: 10.3389/fbioe.2023.1346959] [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: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction: Clear aligners, while offering a more hygienic alternative to fixed appliances, are still associated with challenges including plaque accumulation and enamel demineralization. The aim of the present study was to investigate the antibiofilm and remineralization effectiveness of innovative flowable composite attachments containing bioceramic micro-fillers. Methods: Four experimental attachments were formulated and bonded to human enamel specimens: 3M Filtek Supreme flowable composite (Filtek SF) + 10% bioactive glass 45S5 (BAG), Filtek SF + 30% BAG, Filtek SF + 10% Bredigite (BRT), Filtek SF + 30% BRT. Plaque biofilms were grown on the bonded enamel using a standardized protocol and the biofilm-killing effect was assessed by confocal laser scanning microscopy and scanning electron microscopy. Vickers microhardness was measured to evaluate the remineralization effect of the attachments containing bioceramic fillers after acid challenge. Shear bond test was performed to assess the bonding strength. Results: Attachments with bioceramic fillers significantly inhibited plaque biofilm growth in 3 weeks on enamel, contributing over 20% bacterial cell killing in 10% filler groups and over 30% killing in 30% filler groups. All four experimental groups demonstrated significantly higher microhardness values than the control group without fillers on the attachment side. The shear bonding strength was not compromised in the attachments with micro-fillers. Discussion: Proper incorporation of bioceramic micro-fillers in attachments provides an innovative approach for clear aligner therapy with reinforced antibiofilm and remineralization effects without weakening shear bonding strength.
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Affiliation(s)
- Wenhui Jiang
- Division of Orthodontics, Department of Oral Health Science, Faculty of Dentistry, The University of British Columbia, Vancouver, BC, Canada
| | - Zhejun Wang
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC, Canada
| | - Yinghong Zhou
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC, Canada
| | - Edwin Yen
- Division of Orthodontics, Department of Oral Health Science, Faculty of Dentistry, The University of British Columbia, Vancouver, BC, Canada
| | - Bingshuang Zou
- Division of Orthodontics, Department of Oral Health Science, Faculty of Dentistry, The University of British Columbia, Vancouver, BC, Canada
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15
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Mendes Ribeiro SM, Aragón MLSDC, Espinosa DDSG, Shibasaki WMM, Normando D. Orthodontic aligners: between passion and science. Dental Press J Orthod 2024; 28:e23spe6. [PMID: 38198351 PMCID: PMC10768648 DOI: 10.1590/2177-6709.28.6.e23spe6] [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: 10/02/2023] [Accepted: 11/10/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION The benefits and safety of using orthodontic aligners have been reported more by clinical experience and expert opinion than by scientific evidence. Another important aspect is that aligners are constantly evolving. It is important to obtain evidence that allows for new updates in manufacturing technology, in the development of new movement planning protocols, in the incorporation and design of attachments, and in the aid of skeletal anchorage. METHODS Evidence retrieved from six electronic databases (CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and the Joanna Briggs Library) is presented by means of questions and answers. CONCLUSIONS There is evidence that the aligners presented different levels of difficulty in performing each type of movement, with rotational and vertical movements being the most difficult to perform. Regarding perception of pain due to tooth movement, it seems to have less impact at the beginning of treatment; but dealing with more phonoarticulatory changes seems to require more treatment time in more complex cases. Aligners do not prevent the occurrence of root resorption, although the incidence and severity of resorption may be reduced, making oral hygiene easier and accepting the risk of white spots, caries and periodontal disease. Given the conflicting evidence, the release of bisphenol-A from the aligner cannot be denied. Solutions must be found to reduce the environmental impact of aligners disposal. There is an urgent need for well-designed randomized controlled trials.
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Affiliation(s)
| | | | | | | | - David Normando
- Universidade Federal do Pará (UFPA), Departamento de Ortodontia (Belém/PA, Brazil)
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16
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Llera-Romero AS, Adobes-Martín M, Iranzo-Cortés JE, Montiel-Company JM, Garcovich D. Periodontal health status, oral microbiome, white-spot lesions and oral health related to quality of life-clear aligners versus fixed appliances: A systematic review, meta-analysis and meta-regression. Korean J Orthod 2023; 53:374-392. [PMID: 37989575 PMCID: PMC10663575 DOI: 10.4041/kjod22.272] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/25/2023] [Accepted: 08/28/2023] [Indexed: 11/23/2023] Open
Abstract
Objective : Assess and evaluate the different indicators of oral health-related quality of life (OHRQoL) among patients treated with clear aligners (CAs) versus those treated with conventional fixed orthodontics (FAs). Methods : An electronic search was performed on the database is Web of Science, Scopus, and Embase databases. Randomized and non-randomized control trials, cross-sectional, prospective cohort and retrospective trials were included. Quality was assessed with risk of bias tool and risk of bias in non-randomised studies. Meta-analyses were performed with random effects models, estimating the standardized and non-standardized mean differences, odds ratio and risk ratio as the measure of effect. The effect on time was determined using a meta-regression model. Results : Thirty one articles were included in the qualitative synthesis and 17 in the meta-analysis. CAs had a significantly lower negative impact on QoL, with an "important" effect size, while the influence of time was not significant. Periodontal indicators plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing show significantly better values in patients treated with CAs, with moderate to large effect sizes. PI and GI have a significant tendency to improve over time. In microbiological indicators, CAs present a lower biofilm mass without differences in the percentage of patients with high counts of Streptococcus mutans and Lactobacilli bacteria. The risk of white spot lesion onset is ten times lower in carriers of CAs. Conclusions : Patients wearing CAs show better periodontal indicators, less risk of white spot development, less biofilm mass and a better QoL than patients with FAs.
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Affiliation(s)
| | | | | | | | - Daniele Garcovich
- Department of Dentistry, Universidad Europea de Valencia, Valencia, Spain
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Yan J, Cao L, Luo T, Qin D, Hua F, He H. In vitro evaluation of a novel fluoride-coated clear aligner with antibacterial and enamel remineralization abilities. Clin Oral Investig 2023; 27:6027-6042. [PMID: 37620439 DOI: 10.1007/s00784-023-05216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To investigate the antibacterial and enamel remineralization performances as well as physicochemical properties and biocompatibility of a fluoride-coated clear aligner plastic (FCAP). MATERIALS AND METHODS FCAP and normal clear aligner plastic (CAP) was bought from the manufacturer (Angelalign Technology Inc, China). The FCAP was observed under scanning electron microscopy. Its element composition, resistance to separation, contact angle, and protein adhesion performance were characterized. Colony-forming unit (CFU) count and 3-(4,5)-dimethylthiazol(-z-y1)-3,5-diphenyltetrazolium bromide (MTT) assay were used to evaluate the antibacterial ability of Streptococcus mutans. Fluoride release-recharge patterns were obtained. Apatite formation was evaluated after immersing FCAP in artificial saliva. Enamel remineralization capability was evaluated in the demineralization model (immersing samples in demineralization solution for 36 h) and pH cycling model (immersing samples in demineralization solution and remineralization solution in turns for 14 days). Cell Counting Kit-8 (CCK-8) and live/dead cell staining kits were used for cytotoxicity assay. RESULTS The FCAP showed uniformly distributed fluoride and did not compromise protein adhesion performance. CFU count (5.47 ± 0.55 for CAP, 3.63 ± 0.38 for FCAP) and MTT assay (0.41 ± 0.025 for CAP, 0.28 ± 0.038) indicated that the FCAP had stronger antibacterial activity compared with normal CAP (P < 0.05 for both evaluations). The FCAP could release fluoride continuously for 14 days and could be recharged after immersing in NaF solution. The FCAP could induce the formation of hydroxyapatite in artificial saliva and could reduce the microhardness decrease, color change, and mineral loss of enamels in both two models (P < 0.05 for all evaluations). CCK-8 and live/dead cell staining analyses showed that the coating did not compromise the biocompatibility of the clear aligner (P > 0.05 for CCK-8 evaluation). CONCLUSIONS The FCAP had antibacterial, fluoride recharge, and enamel remineralization abilities while it did not compromise physicochemical properties and biocompatibility. CLINICAL RELEVANCE The FCAP has the potential to prevent enamel demineralization during clear aligner treatment.
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Affiliation(s)
- Jiarong Yan
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lingyun Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Ting Luo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Danchen Qin
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Center for Orthodontics and Pediatric Dentistry at Optics Valley Branch, School & Hospital of Stomatology , Wuhan University, Wuhan, China.
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Hong He
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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18
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Taher BB, Rasheed TA. The Impact of Adding Chitosan Nanoparticles on Biofilm Formation, Cytotoxicity, and Certain Physical and Mechanical Aspects of Directly Printed Orthodontic Clear Aligners. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:2649. [PMID: 37836290 PMCID: PMC10574519 DOI: 10.3390/nano13192649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
Aligner treatment is associated with bacterial colonization, leading to enamel demineralization. Chitosan nanoparticles have been demonstrated to have antibacterial properties. This in vitro study aims to determine the effect of adding chitosan nanoparticles to directly 3D-printed clear aligner resin with regard to antibiofilm activity, cytotoxicity, degree of conversion, accuracy, deflection force, and tensile strength. Different concentrations (2%, 3%, and 5% w/w) of chitosan nanoparticles were mixed with the clear resin, and the samples were then 3D printed. Additionally, the thermoforming technique for aligner manufacturing was utilized. The obtained specimens were evaluated for antibiofilm activity against Streptococcus mutans bacteria and cytotoxicity against L929 and 3T3 cell lines. Additionally, Fourier transform infrared spectroscopy via attenuated total reflection analysis was used to assess the degree of conversion. Geomagic Control X software was utilized to analyze the accuracy. In addition, the deflection force and tensile strength were evaluated. The results indicated a notable reduction in bacterial colonies when the resin was incorporated with 3 and 5% chitosan nanoparticles. No significant changes in the cytotoxicity or accuracy were detected. In conclusion, integrating biocompatible chitosan nanoparticles into the resin can add an antibiofilm element to an aligner without compromising the material's certain biological, mechanical, and physical qualities at specific concentrations.
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Affiliation(s)
- Botan Barzan Taher
- Department of Pedodontics, Orthodontics and Preventive Dentistry, College of Dentistry, University of Sulaimani, Sulaymaniyah 46001, Iraq;
| | - Tara Ali Rasheed
- Department of Pedodontics, Orthodontics and Preventive Dentistry, College of Dentistry, University of Sulaimani, Sulaymaniyah 46001, Iraq;
- College of Dentistry, American University of Iraq-Sulaimani, Sulaymaniyah 46001, Iraq
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19
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Shrivastava A, Mohanty P, Dash BP, Jena S, Sahoo N. Proficiency of Clear Aligner Therapy: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e45072. [PMID: 37842499 PMCID: PMC10568240 DOI: 10.7759/cureus.45072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
The aim of this study was to evaluate the efficacy and efficiency of orthodontic treatment using clear aligner therapy (CAT). This efficiency was measured using the Peer Assessment Rating (PAR) index, the American Board of Orthodontics (ABO) index, or the similarity between the final ClinCheck and the final scanned models. A search was done electronically between 1998 and 2021 using the Cochrane Library, PubMed, and Google Scholar databases. Three reviewers individually rated the articles. The ROBINS tool and the Cochrane risk of bias tool were used to evaluate the quality of observational research and randomized controlled trials, respectively. The degree of certainty for each selected outcome was evaluated using the grading of recommendations assessment, development, and evaluation (GRADE) approach. Six studies with a total of 166 participants were considered after the full texts of 61 potential reports were reviewed. This research included in the review covered the period from 1998 to 2021 in retrospect. According to the current systematic review and meta-analysis, transparent aligners had a successful outcome. In mild to moderate cases, aligner treatment appears to have a significant advantage in terms of efficiency (treatment time); nonetheless, insufficient evidence of efficacy was observed based on multiple cross-sectional investigations. When compared to traditional brackets, clear aligners provided a more stable course of treatment.
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Affiliation(s)
- Akshay Shrivastava
- Department of Orthodontics and Dentofacial Orthopaedics, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (KIIT) (Deemed to be University), Bhubaneswar, IND
| | - Pritam Mohanty
- Department of Orthodontics, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (KIIT) (Deemed to be University), Bhubaneswar, IND
| | - Bhagabati P Dash
- Department of Orthodontics and Dentofacial Orthopaedics, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (KIIT) (Deemed to be University), Bhubaneswar, IND
| | - Sanghamitra Jena
- Department of Orthodontics and Dentofacial Orthopaedics, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (KIIT) (Deemed to be University), Bhubaneswar, IND
| | - Nivedita Sahoo
- Department of Orthodontics and Dentofacial Orthopaedics, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (KIIT) (Deemed to be University), Bhubaneswar, IND
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20
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Horan OGA, Al-Khateeb SN. Comparison of three orthodontic bonding systems in white spot lesion development: a randomized clinical trial. Angle Orthod 2023; 93:531-537. [PMID: 37017436 PMCID: PMC10575644 DOI: 10.2319/111422-781.1] [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: 11/01/2022] [Accepted: 02/01/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES To compare the development of white spot lesions (WSLs) during fixed orthodontic therapy among a conventional three-step bonding system, a self-etching primer bonding system, and a one-step adhesive bonding system. MATERIALS AND METHODS Seventy-five patients were randomly allocated into three groups (group 1, conventional bonding system, n = 25; group 2, self-etch primer, n = 25; group 3, primer mixed with adhesive composite, n = 25). Quantitative light-induced fluorescence (QLF) was used to assess WSL parameters. Images were captured and then analyzed before treatment and at 2 months and 4 months after bond up. Lesion area (pixels), mean fluorescence loss (ΔF), and the number of newly developed WSLs were compared within and among the three groups. The significance level was P ≤ .05. RESULTS The mean increase in lesion area was 31.3 ± 2.8 pixels, 38.4 ± 4.3 pixels, and 119.5 ± 5.3 pixels for groups 1, 2, and 3, respectively (P ≤ .001). For ΔF, the loss was 3.3% ± 0.3%, 4.4% ± 0.2%, and 6.6% ± 0.2% for groups 1, 2, and 3, respectively. These changes were significantly different (P ≤ .01 to P ≤ .001). The incidence of newly developed lesions was 9.5 WSLs in group 1, 10 WSLs in group 2, and 15.9 WSLs in group 3. CONCLUSIONS The lack of primer contributed to the development of a larger number of and more severe WSLs.
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Affiliation(s)
| | - Susan N Al-Khateeb
- Corresponding author: Dr Susan N. Al-Khateeb, Department of Preventive Dentistry, Division of Orthodontics, Faculty of Dentistry, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan (e-mail: )
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21
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Raghavan S, Abu Alhaija ES, Duggal MS, Narasimhan S, Al-Maweri SA. White spot lesions, plaque accumulation and salivary caries-associated bacteria in clear aligners compared to fixed orthodontic treatment. A systematic review and meta- analysis. BMC Oral Health 2023; 23:599. [PMID: 37635207 PMCID: PMC10463770 DOI: 10.1186/s12903-023-03257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE To analyse the available evidence regarding the incidence and severity of white spot lesions (WSLs), plaque accumulation and salivary caries-associated bacteria(SCB) in clear aligners (CA) verses conventional fixed (CF) orthodontic appliances. METHODS Electronic searches of MEDLINE, Scopus, Embase, Google Scholar, Clinical trial registry, OpenGrey and ProQuest were done for all relevant studies. Eligibility criteria were; Randomized Controlled Trials and Non-Randomized Studies that compared the incidence and severity of WSLs, plaque accumulation and SCB between CA and CF appliances in patients undergoing orthodontic treatment. The risk of bias(ROB) and certainty of evidence was assessed independently by two reviewers using Cochrane's ROB and GRADEpro, respectively. Standardized mean difference (SMD) was used to estimate the effect size using STATA 17 software. RESULTS A total of 14 studies met the eligibility criteria, and eight were suitable for meta-analysis. The qualitative results showed lower incidence and severity of WSLs, plaque accumulation, and SCB in CA group compared to CF appliances. The pooled results showed significantly lower plaque accumulation(SMD - 1.58;95%CI:-2.57,0.58;p = 0.002) in CA compared to CF appliances. CONCLUSIONS A moderate-quality evidence reveals less plaque accumulation and less SCB in CA, which might be related to the reduced incidence and severity of WSLs associated with CA when compared with CF appliances. However, the results of the present study should be interpreted with caution given the high ROB among some of the included studies as well as the marked heterogeneity across the studies. CLINICAL RELEVANCE For patients who can be treated with either CA or CF appliances, CA may be a better choice concerning oral health. REGISTRATION Open Science Framework (DOI: https://doi.org/10.17605/osf.io/kcpvb ).
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Affiliation(s)
- Shailaja Raghavan
- College of Dental Medicine, QU Health, Qatar University, Doha, P.O. Box: 2713, Qatar.
| | - Elham S Abu Alhaija
- College of Dental Medicine, QU Health, Qatar University, Doha, P.O. Box: 2713, Qatar
| | - Mandeep Singh Duggal
- College of Dental Medicine, QU Health, Qatar University, Doha, P.O. Box: 2713, Qatar
| | | | - Sadeq Ali Al-Maweri
- College of Dental Medicine, QU Health, Qatar University, Doha, P.O. Box: 2713, Qatar
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22
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Consoli Senno MV, Robles Ruíz JJ. [Characteristics of white spot lesions associated with orthodontic treatment: a review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2023; 11:e168. [PMID: 38287997 PMCID: PMC10809967 DOI: 10.21142/2523-2754-1103-2023-168] [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: 07/05/2023] [Accepted: 09/09/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction The purpose of this literature review is to provide scientific evidence on the characteristics of white spot lesions (WSL) during orthodontic treatment, their incidence, prevalence, risk factors related to their development, progression, and regression, as well as explain the most used diagnostic methods. Materials and methods An exhaustive search was carried out in the databases of Pubmed, Scopus, Science Direct and Embase up to the date of November 30, 2022. Cross-sectional studies that evaluated white spot lesions before and after orthodontic treatments were included. Two researchers carefully selected the articles evaluated and analyzed different key topics on the subject. Results It was found that the prevalence and incidence of white spots during orthodontic treatment varies widely depending on the diagnostic method used, the type of orthodontic technique used and the time of orthodontic treatment. The incidence of white spot lesions is highest in patients treated with conventional braces, followed by those who used self-ligating braces, and was lowest in patients who used aligners. The most affected teeth are the upper lateral incisors and upper maxillary canines at the level of the gingival third. Conclusions The incidence of white spots is associated with orthodontic treatment, being closely related to the treatment technique used and the treatment time. There is a regression of the LMB during the first year after removal of the appliance.
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Affiliation(s)
- Michella Vicenza Consoli Senno
- Division of orthodontic, Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur Division of orthodontic Universidad Científica del Sur Lima Peru
| | - Julissa Janet Robles Ruíz
- Division of orthodontic, Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur Division of orthodontic Universidad Científica del Sur Lima Peru
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23
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Bonafé ACF, Oliveira DFLM, Fernandes EE, Garcia MT, Bressane A, de Oliveira W, de Mello Rode S. Microbiological evaluation in invisible aligner chemical cleaning methods against Candida albicans and Streptococcus mutans. Am J Orthod Dentofacial Orthop 2023:S0889-5406(23)00272-X. [PMID: 37294233 DOI: 10.1016/j.ajodo.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION This study aimed to assess the efficacy of chemical agents in removing Candida albicans and Streptococcus mutans biofilm from invisible aligners. METHODS The samples were made of EX30 Invisalign trays, biofilm was cultured by standardized suspensions of C. albicans ATCC strain and S. mutans clinical strain on the sample. The treatments used were 0.5% sodium hypochlorite (NaClO) (20 minutes), 1% NaClO (10 minutes), chlorhexidine (5 minutes), peroxide (15 minutes), and orthophosphoric acid (15 seconds). The control group received phosphate-buffered saline for 10 minutes. The colony-forming units per milliliter of each microorganism were determined by serial dilutions seeded in plates with selective culture mediums for each one. Data were analyzed by the Kruskal-Wallis and Conover-Iman tests at an α of 0.05. RESULTS For the C. albicans biofilm group, the control group had 9.7 Log10 of microorganism growth, and all treatment groups had statistically significant biofilm reduction, in which chlorhexidine presented the highest inhibition of 3 Log10, followed by alkaline peroxide and orthophosphoric acid both with 2.6 Log10, 1% NaClO (2.5 Log10), and 0.5% NaClO (2 Log10). As for S. mutans, the control group had 8.9 Log10 of growth, and a total microorganism inhibition was reached by chlorhexidine, 1% NaClO, and orthophosphoric acid, whereas alkaline peroxide inhibited growth to 7.9 Log10 and 0.5% NaClO 5.1 Log10. CONCLUSIONS Within the limitations, chlorhexidine and orthophosphoric acid had greater efficacy in both biofilms. In addition, 1% NaClO and alkaline peroxide also had significant effects; therefore, their incorporation aligners disinfection protocols are valid.
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Affiliation(s)
- Ana Carolina Ferreira Bonafé
- Department of Diagnosis and Surgery, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil.
| | | | - Ellen Eduarda Fernandes
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil
| | - Maíra Terra Garcia
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil
| | - Adriano Bressane
- Department of Environment Engineering, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil
| | - Wagner de Oliveira
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil
| | - Sigmar de Mello Rode
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University, São José dos Campos, Brazil
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Shi Y, Zhang N, Liu J, Wang J, Shen S, Zhang J, An X, Si Q. Preparation of Nanocomposites for Antibacterial Orthodontic Invisible Appliance Based on Piezoelectric Catalysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115336. [PMID: 37300063 DOI: 10.3390/s23115336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
Compared to fixed orthodontic appliances with brackets, thermoplastic invisible orthodontic aligners offer several advantages, such as high aesthetic performance, good comfort, and convenient oral health maintenance, and are widely used in orthodontic fields. However, prolonged use of thermoplastic invisible aligners may lead to demineralization and even caries in most patients' teeth, as they enclose the tooth surface for an extended period. To address this issue, we have created PETG composites that contain piezoelectric barium titanate nanoparticles (BaTiO3NPs) to obtain antibacterial properties. First, we prepared piezoelectric composites by incorporating varying amounts of BaTiO3NPs into PETG matrix material. The composites were then characterized using techniques such as SEM, XRD, and Raman spectroscopy, which confirmed the successful synthesis of the composites. We cultivated biofilms of Streptococcus mutans (S. mutans) on the surface of the nanocomposites under both polarized and unpolarized conditions. We then activated piezoelectric charges by subjecting the nanocomposites to 10 Hz cyclic mechanical vibration. The interactions between the biofilms and materials were evaluated by measuring the biofilm biomass. The addition of piezoelectric nanoparticles had a noticeable antibacterial effect on both the unpolarized and polarized conditions. Under polarized conditions, nanocomposites demonstrated a greater antibacterial effect than under unpolarized conditions. Additionally, as the concentration of BaTiO3NPs increased, the antibacterial rate also increased, with the surface antibacterial rate reaching 67.39% (30 wt% BaTiO3NPs). These findings have the potential for application in wearable, invisible appliances to improve clinical services and reduce the need for cleaning methods.
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Affiliation(s)
- Yingying Shi
- School of Stomatology, Lanzhou University, Lanzhou 730030, China
| | - Ningning Zhang
- School of Stomatology, Lanzhou University, Lanzhou 730030, China
| | - Jiajie Liu
- School of Stomatology, Lanzhou University, Lanzhou 730030, China
| | - Junbin Wang
- School of Stomatology, Lanzhou University, Lanzhou 730030, China
| | - Shuhui Shen
- School of Stomatology, Lanzhou University, Lanzhou 730030, China
| | - Jingxiang Zhang
- School of Civil Engineering and Mechanics, Lanzhou University, Lanzhou 730030, China
| | - Xiaoli An
- School of Stomatology, Lanzhou University, Lanzhou 730030, China
| | - Qingzong Si
- School of Stomatology, Lanzhou University, Lanzhou 730030, China
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25
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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: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Liu Z, Sun T, Chen Y, Mo X, Kao H, Chen HJ. Integrated Multiplex Sensing Clear Aligner for In Situ Monitoring of Dental Enamel Demineralization. ACS Biomater Sci Eng 2023. [PMID: 37115517 DOI: 10.1021/acsbiomaterials.3c00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Clear aligners have become one of the most important tools in orthodontic treatment. However, over a lengthy period of orthodontic treatment, enamel demineralization or even dental caries could be susceptible for occurrence. Therefore, early diagnosis of enamel demineralization has been widely investigated. Nevertheless, for reasons including bulky monitoring equipment and complexity of operation, few techniques reported to date possessed clinical utility. The combination of flexible electronics and electrochemical sensing technology presented a promising strategy. Herein, an integrated multiplex sensing clear aligner (IMSCA) system, including a clear aligner with a multiplex sensor array patch, was developed for in situ monitoring of Ca2+, pH, and PO43- in the oral environment to provide a foundation for early diagnosis of enamel demineralization. The IMSCA exhibited a broad linear response range, great selectivity, temporal stability, reproducibility, and biological safety. Results of enamel demineralization simulating experiments and human permanent tooth demineralization experiments validate the capability of the IMSCA to indicate the occurrence of enamel demineralization. All results ultimately point to the promising clinical utility of the IMSCA, which facilitates the quantitative characterization of enamel demineralization in complex oral environments. This study provides a novel strategy in the early diagnosis of enamel demineralization.
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Affiliation(s)
- Ziqi Liu
- School of Electronics and Information Technology, State Key Laboratory of Optoelectronic Materials and Technologies, Sun Yat-Sen University, Guangzhou 510006, China
| | - Tiancheng Sun
- School of Electronics and Information Technology, State Key Laboratory of Optoelectronic Materials and Technologies, Sun Yat-Sen University, Guangzhou 510006, China
| | - Yiyin Chen
- Department of Orthodontics, State Key Laboratory of Oral Diseases & National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xiaoyi Mo
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Hsiaohan Kao
- Xiamen Chang Gung Hospital, Xiamen 361021, China
| | - Hui-Jiuan Chen
- School of Electronics and Information Technology, State Key Laboratory of Optoelectronic Materials and Technologies, Sun Yat-Sen University, Guangzhou 510006, China
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Ren X, Zhang Y, Xiang Y, Hu T, Cheng R, Cai H. The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment: a systematic review and meta-analysis. BMC Oral Health 2023; 23:204. [PMID: 37024817 PMCID: PMC10077628 DOI: 10.1186/s12903-023-02920-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Mouthwashes were convenient adjuncts to mechanical cleaning procedures. This review aimed to evaluate the efficacy of mouthwashes on oral microorganisms and gingivitis in orthodontic patients. METHODS By April 16, 2022, multiple databases and grey literature were searched based on the PICOS strategy. Randomized controlled trials in orthodontic patients evaluating the efficacy of mouthwashes with at least one microbial parameter and/or plaque- and/or gingival inflammation-related index were included. Relevant data were extracted, and the risk of bias was evaluated using Cochrane's tool. Individual mean and standard deviation of the outcomes in mouthwashes and placebos/blank controls were pooled to estimate the weighted mean differences (WMDs) and 95% confidence intervals (95%CIs). Sensitivity analysis, and certainty of evidence were evaluated. RESULTS Of 1684 articles, 32 studies satisfied the eligibility criteria, and nine were included for meta-analysis. Missing outcome data was the primary source of bias. Compared to blank controls, the short-term application of fluoride mouthwashes significantly reduced the colony counts of Mutans streptococci (MS), while the long-term application may not be effective. Compared to placebos or blank controls, Chlorhexidine mouthwashes significantly reduced the colony counts of multiple microorganisms in the short-term. Compared to placebos or blank controls, herbal mouthwashes showed the inhibitory effect of MS in the short-term, with some results lacking statistical significance. After meta-analysis, significant lower plaque- and gingival inflammation-related indexes were observed in the Chlorhexidine mouthwashes groups [Gingival Index: WMD = -0.45, 95%CI = -0.70 to -0.20 (placebos as control); WMD = -0.54, 95%CI = -0.96 to -0.13 (blank controls); Plaque Index: WMD = -0.70, 95%CI = -1.12 to -0.27 (blank controls)]. Significant lower gingival inflammation-related indexes were observed in the herbal mouthwashes groups [Gingival Index: WMD = -0.20, 95%CI = -0.32 to -0.09 (blank controls)]. CONCLUSIONS The short-term application of fluoride mouthwashes may reduce the colony counts of cariogenic bacteria, but the long-term effect is not evident. Chlorhexidine may reduce the colony counts of multiple microorganisms in the short-term. Short-term application Chlorhexidine and herbal mouthwashes may effectively reduce plaque- and gingival inflammation-related indexes. However, the risk of bias, inconsistency, and imprecision in the included studies may reduce the certainty of the evidence.
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Grants
- 72104162 National Natural Science Foundation of China
- 72104162 National Natural Science Foundation of China
- 72104162 National Natural Science Foundation of China
- 72104162 National Natural Science Foundation of China
- 72104162 National Natural Science Foundation of China
- 72104162 National Natural Science Foundation of China
- LCYJ2020-DL-4 Research and Develop Program, West China Hospital of Stomatology, Sichuan University
- LCYJ2020-DL-4 Research and Develop Program, West China Hospital of Stomatology, Sichuan University
- LCYJ2020-DL-4 Research and Develop Program, West China Hospital of Stomatology, Sichuan University
- LCYJ2020-DL-4 Research and Develop Program, West China Hospital of Stomatology, Sichuan University
- LCYJ2020-DL-4 Research and Develop Program, West China Hospital of Stomatology, Sichuan University
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Affiliation(s)
- Xiaolin Ren
- Department of Preventive Dentistry, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3Rd Section, Renmin South Road, Chengdu, Sichuan, China
| | - Yuhan Zhang
- Department of Preventive Dentistry, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3Rd Section, Renmin South Road, Chengdu, Sichuan, China
| | - Yong Xiang
- Department of Preventive Dentistry, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3Rd Section, Renmin South Road, Chengdu, Sichuan, China
| | - Tao Hu
- Department of Preventive Dentistry, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3Rd Section, Renmin South Road, Chengdu, Sichuan, China
| | - Ran Cheng
- Department of Preventive Dentistry, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3Rd Section, Renmin South Road, Chengdu, Sichuan, China.
| | - He Cai
- Department of Preventive Dentistry, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3Rd Section, Renmin South Road, Chengdu, Sichuan, China.
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Cao L, Yan J, Luo T, Yan H, Hua F, He H. Antibacterial and fluorescent clear aligner attachment resin modified with chlorhexidine loaded mesoporous silica nanoparticles and zinc oxide quantum dots. J Mech Behav Biomed Mater 2023; 141:105817. [PMID: 37015147 DOI: 10.1016/j.jmbbm.2023.105817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVES To develop an antibacterial and fluorescent clear aligner attachment resin via the incorporation of chlorhexidine loaded pore-expanded mesoporous silica nanoparticles (CHX@pMSN) and amino-silane functionalized zinc oxide quantum dots (aZnOQDs), and to evaluate its antibacterial activity, fluorescence capability, esthetic properties, mechanical performance and biocompatibility. METHODS CHX@pMSN and aZnOQDs were incorporated into the commercial resin composites (Filtek Z350 XT, 3M) at different mass fractions, control group: Filtek; fluorescent attachment resin (FAR): Filtek + 3 wt% aZnOQDs; antibacterial and fluorescent attachment resin (AFAR)-1: Filtek + 3 wt% aZnOQDs + 1 wt% CHX@pMSN; AFAR-2: Filtek + 3 wt% aZnOQDs + 3 wt% CHX@pMSN; AFAR-3: Filtek + 3 wt% aZnOQDs + 5 wt% CHX@pMSN. CHX release, antibacterial activity, fluorescence capability, color change, stain resistance, degree of conversion, depth of cure, polymerization shrinkage, water sorption and solubility, softening in solvent, flexural strength, flexural modulus, shear bond strength, and cytotoxicity were evaluated comprehensively. RESULTS CHX could be continuously released from the AFAR groups for up to 30 days. CFU, MTT, lactic acid production, SEM and CLSM evaluation showed AFAR-2 and AFAR-3 could effectively inhibit S. mutans biofilms even after 1-month aging. Only AFAR-3 showed clinically perceptible color change and all the experimental groups were not more susceptible to staining. AFAR-1 and AFAR-2 could suppress polymerization shrinkage and enhance the resistance to degradation without compromising other properties, including degree of conversion, water sorption and solubility, flexural strength, flexural modulus, and shear bond strength. Depth of cure of all the four experimental groups was significantly decreased (p < 0.05) but still within the ISO standard. CCK-8 assay and live/dead cell staining denied the cytotoxicity of experimental resins. Fluorescence intensity tests showed that FAR and AFAR-2 could emit strong yellowish fluorescence under the excitation of ultraviolet for up to six months. CONCLUSIONS AFRA-2 possessed long-term antibiofilm activity, strong fluorescence capability and satisfying biocompatibility without compromising esthetic and mechanical properties. This study proposed a new strategy for reducing bacteria accumulation around the attachment, which is also promising in helping orthodontists to remove the attachment thoroughly and precisely.
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Anita P, Sathyanarayana HP, Kumar K, Ramanathan K, Kailasam V. Antimicrobial efficacy of zinc oxide nanoparticle-coated aligners on Streptococcus mutans and Candidaalbicans. Am J Orthod Dentofacial Orthop 2023; 163:338-346. [PMID: 36411228 DOI: 10.1016/j.ajodo.2021.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This study aimed to assess the antimicrobial effect of zinc oxide (ZnO) nanocoating on aligners. METHODS Twenty-six samples of aligners were sputter-coated with ZnO nanoparticles and compared with 26 uncoated samples. The antimicrobial effect was assessed on Streptococcus mutans and Candida albicans. The thickness of the ZnO coating was standardized at 100 nm. The antimicrobial effect was evaluated for 7 days at the following time points: 6 hours, 12 hours, first day, second day, fourth day, and seventh day. Colony culture tests were performed for microbial evaluation. RESULTS ZnO-coated aligners showed significant antimicrobial efficacy against S mutans at all time points tested (P <0.001). The antimicrobial effect was observed up to 2 days after a decline. The activity against C albicans was minimal at all time points, and no statistical significance was observed (P >0.05). CONCLUSIONS ZnO-nanocoated aligners were effective against S mutans, with the maximum antibacterial effect observed until 2 days and lasting for 7 days. The effect against C albicans was minimal. ZnO-coated aligners appears to be a promising technique to facilitate antimicrobial efficacy against S mutans.
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Affiliation(s)
- Prathima Anita
- Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | | - Kennedy Kumar
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Krishnapriya Ramanathan
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Vignesh Kailasam
- Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
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Lazar L, Vlasa A, Beresescu L, Bud A, Lazar AP, Matei L, Bud E. White Spot Lesions (WSLs)-Post-Orthodontic Occurrence, Management and Treatment Alternatives: A Narrative Review. J Clin Med 2023; 12:1908. [PMID: 36902696 PMCID: PMC10003622 DOI: 10.3390/jcm12051908] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Although treatment with fixed or mobile appliances has become an important part of modern orthodontics, side effects such as white spot lesions (WSLs) have a negative impact on the aesthetic outcome of orthodontic treatment. The purpose of this article was to review current evidence on the diagnosis, risk assessment, prevention, management and post-orthodontic treatment of these lesions. Data collection was performed electronically, and the initial search using the keywords "white spot lesions", "orthodontics", "WSL", "enamel" and "demineralization" in different combinations resulted in 1032 articles for the two electronic databases used. Ultimately, a total of 47 manuscripts were considered relevant to the aim of this research and included in this review. The results of the review indicate that WSLs remain a significant problem during orthodontic treatment. According to studies in the literature, the severity of WSLs correlates to the duration of treatment. Using toothpaste with more than 1000 ppm fluoride at home reduces the frequency of WSL separation and regular application of varnishes in the office reduces the frequency of the occurrence of WSLs only in the context of maintaining a strict hygiene regime. The old hypothesis that elastomeric ligatures retain more dental plaque than metal ones has been refuted. There are no differences in the appearance of WSLs between conventional brackets and self-ligating brackets. Clear aligner mobile devices develop fewer WSLs but are more extensive as opposed to conventional fixed devices, while lingual orthodontic appliances have a lower incidence of WSLs, and the most effective device for preventing these lesions is WIN, followed by Incognito.
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Affiliation(s)
- Luminita Lazar
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade, 540139 Târgu-Mureș, Romania
| | - Alexandru Vlasa
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade, 540139 Târgu-Mureș, Romania
| | - Liana Beresescu
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade, 540139 Târgu-Mureș, Romania
| | - Anamaria Bud
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade, 540139 Târgu-Mureș, Romania
| | - Ana Petra Lazar
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade, 540139 Târgu-Mureș, Romania
| | - Larisa Matei
- Department of Oral and Maxillo-Facial Surgery, Clinical Hospital of Târgu-Mureș, 540139 Târgu-Mureș, Romania
| | - Eugen Bud
- Faculty of Dental Medicine, University of Medicine and Pharmacy, Science and Technology George Emil Palade, 540139 Târgu-Mureș, Romania
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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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da Silva VM, Ayub PV, Massaro C, Janson G, Garib D. Comparison between clear aligners and 2 × 4 mechanics in the mixed dentition: a randomized clinical trial. Angle Orthod 2023; 93:3-10. [PMID: 36066265 PMCID: PMC9797137 DOI: 10.2319/032322-237.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/01/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To compare the efficacy and efficiency between clear aligners and 2 × 4 fixed appliances for correcting maxillary incisor position irregularities in the mixed dentition. MATERIALS AND METHODS The sample comprised 32 patients from 7 to 11 years of age randomly allocated into two parallel treatment groups: the clear aligners group, 14 patients (6 girls, 8 boys) with a mean initial age of 9.33 years (standard deviation [SD] = 1.01) treated with clear aligners; and the fixed appliances group, 13 patients (9 girls, 4 boys) with a mean initial age of 9.65 years (SD = 0.80) treated with partial (2 × 4) fixed appliances. Digital models were acquired before treatment and after appliance removal. Primary outcomes were incisor irregularity index and treatment time. Secondary outcomes were arch width, perimeter, length, size and shape, incisor leveling, incisor mesiodistal angulation, plaque index, and white spot lesion formation (International Caries Detection and Assessment System index). Intergroup comparisons were evaluated using t-tests or Mann-Whitney U-tests with Holm-Bonferroni correction (P < .05). RESULTS Treatment time was approximately 8 months in both groups. No intergroup differences were observed for changes in any of the variables. Similar posttreatment arch shapes were observed in both groups. CONCLUSIONS Clear aligners and 2 × 4 mechanics displayed similar efficacy and efficiency for maxillary incisor position corrections in the mixed dentition. The choice of appliance should be guided by clinician and family preference.
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Yan J, Hua F, Cao L, Yang H, He H. Multifunctional modification of orthodontic adhesives with ZnO quantum dots. Dent Mater 2022; 38:1728-1741. [PMID: 36137833 DOI: 10.1016/j.dental.2022.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To develop a multifunctional orthodontic adhesive (QDA) using ZnO quantum-dots (ZnQDs) as modifier and investigate the antibacterial capability, fluorescence property as well as biocompatibility and bonding property. METHODS ZnQDs were synthesized using sol-gel method. XPS, XRD, FT-IR, HRTEM, SAED, DLS and spectrofluorimetry were used to characterize ZnQDs. ZnQDs were incorporated into Transbond XT adhesive paste with 20 %, 30 %, 40 % mass fraction, respectively, to form the multifunctional adhesives (QDAs). Antibacterial capability was evaluated with MTT kit, CFU count and Live/Dead Bacterial Staining Kit. Ultraviolet photography and spectrofluorimetry were used to confirm the fluorescence property of QDAs. Biocompatibility assay was performed on gingival fibroblasts and subcutaneous tissue of rats. Softening in solvent rate, shear bond strength and degree of conversion (DC) were measured. RESULTS The synthesized ZnQDs presented excellent crystallinity and fluorescence properties. MTT assay, CFU count and CLSM analysis indicated that QDAs had significant antibacterial activity compared with Transbond XT adhesive paste. CCK-8 assay and Live/Dead cell staining analysis denied the cytotoxicity of QDAs and histological analysis proved that QDAs all had no inflammatory irritation to subcutaneous tissue. Softening in solvent, shear bond strength and DC evaluations indicated that 20 % mixing ratio of ZnQDs could enhance the resistance to degradation without influencing the bond strength and DC. Ultraviolet photography and spectrofluorimetry analysis proved the fluorescence capability of QDAs. SIGNIFICANCE ZnQDs can impart antibacterial and fluorescence properties to orthodontic adhesives without affecting biocompatibility and bonding performance. QDAs can be multifunctional orthodontic adhesives to reduce bacterial adhesion around brackets and help orthodontists remove residual adhesives precisely when needed.
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Affiliation(s)
- Jiarong Yan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lingyun Cao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hongye Yang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Prosthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
| | - Hong He
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Inchingolo AD, Malcangi G, Semjonova A, Inchingolo AM, Patano A, Coloccia G, Ceci S, Marinelli G, Di Pede C, Ciocia AM, Mancini A, Palmieri G, Barile G, Settanni V, De Leonardis N, Rapone B, Piras F, Viapiano F, Cardarelli F, Nucci L, Bordea IR, Scarano A, Lorusso F, Palermo A, Costa S, Tartaglia GM, Corriero A, Brienza N, Di Venere D, Inchingolo F, Dipalma G. Oralbiotica/Oralbiotics: The Impact of Oral Microbiota on Dental Health and Demineralization: A Systematic Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1014. [PMID: 35883998 PMCID: PMC9323959 DOI: 10.3390/children9071014] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 12/17/2022]
Abstract
The oral microbiota plays a vital role in the human microbiome and oral health. Imbalances between microbes and their hosts can lead to oral and systemic disorders such as diabetes or cardiovascular disease. The purpose of this review is to investigate the literature evidence of oral microbiota dysbiosis on oral health and discuss current knowledge and emerging mechanisms governing oral polymicrobial synergy and dysbiosis; both have enhanced our understanding of pathogenic mechanisms and aided the design of innovative therapeutic approaches as ORALBIOTICA for oral diseases such as demineralization. PubMed, Web of Science, Google Scholar, Scopus, Cochrane Library, EMBEDDED, Dentistry & Oral Sciences Source via EBSCO, APA PsycINFO, APA PsyArticles, and DRUGS@FDA were searched for publications that matched our topic from January 2017 to 22 April 2022, with an English language constraint using the following Boolean keywords: ("microbio*" and "demineralization*") AND ("oral microbiota" and "demineralization"). Twenty-two studies were included for qualitative analysis. As seen by the studies included in this review, the balance of the microbiota is unstable and influenced by oral hygiene, the presence of orthodontic devices in the oral cavity and poor eating habits that can modify its composition and behavior in both positive and negative ways, increasing the development of demineralization, caries processes, and periodontal disease. Under conditions of dysbiosis, favored by an acidic environment, the reproduction of specific bacterial strains increases, favoring cariogenic ones such as Bifidobacterium dentium, Bifidobacterium longum, and S. mutans, than S. salivarius and A. viscosus, and increasing of Firmicutes strains to the disadvantage of Bacteroidetes. Microbial balance can be restored by using probiotics and prebiotics to manage and treat oral diseases, as evidenced by mouthwashes or dietary modifications that can influence microbiota balance and prevent or slow disease progression.
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Affiliation(s)
- Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Alexandra Semjonova
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Giovanni Coloccia
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Sabino Ceci
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Grazia Marinelli
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Chiara Di Pede
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Anna Maria Ciocia
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Giulia Palmieri
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Giuseppe Barile
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Vito Settanni
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Nicole De Leonardis
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Biagio Rapone
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Fabio Piras
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Fabio Viapiano
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Filippo Cardarelli
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 6, 80138 Naples, Italy;
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy; (A.S.); (F.L.)
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy; (A.S.); (F.L.)
| | - Andrea Palermo
- Implant Dentistry College of Medicine and Dentistry Birmingham, University of Birmingham, Birmingham B46BN, UK;
| | - Stefania Costa
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, School of Dentistry, University of Messina, 98125 Messina, Italy;
| | - Gianluca Martino Tartaglia
- UOC Maxillo-Facial Surgery and Dentistry, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy;
- Department of Orthodontics, Faculty of Medicine, University of Milan, 20100 Milan, Italy
| | - Alberto Corriero
- Unit of Anesthesia and Resuscitation, Department of Emergencies and Organ Transplantations, Aldo Moro University, 70124 Bari, Italy; (A.C.); (N.B.)
| | - Nicola Brienza
- Unit of Anesthesia and Resuscitation, Department of Emergencies and Organ Transplantations, Aldo Moro University, 70124 Bari, Italy; (A.C.); (N.B.)
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (A.S.); (A.M.I.); (A.P.); (G.C.); (S.C.); (G.M.); (C.D.P.); (A.M.C.); (A.M.); (G.P.); (G.B.); (V.S.); (N.D.L.); (B.R.); (F.P.); (F.V.); (F.C.); (D.D.V.); (G.D.)
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Weyland MI, Jost-Brinkmann PG, Bartzela T. Management of white spot lesions induced during orthodontic treatment with multibracket appliance: a national-based survey. Clin Oral Investig 2022; 26:4871-4883. [PMID: 35338421 PMCID: PMC8956138 DOI: 10.1007/s00784-022-04454-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/13/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The study aimed to survey current strategies against enamel demineralization during multibracket therapy (MBT) and guide a prevention concept based on existing scientific evidence. MATERIALS AND METHODS The survey comprised questions on the prevention and management of white spot lesions (WSL). The questionnaire was sent via email to orthodontists working in practices and universities throughout Germany. The analysis involved descriptive statistics using the chi-square test (p < 0.05). RESULTS A prevention protocol was used before MBT by 80.6% of the participants. Less than a quarter of the participants regularly applied topical fluoride (gel or varnish) during MBT. According to the respondents' assessment, the prevalence of WSL during MBT is 11.6%, mainly observed in 12- to 15-year-old male patients. Orthodontists graduating after 2000 tended to recommend and apply fluoride-containing materials more often than their senior colleagues (p = 0.039). Participants from private practices applied fluoride varnish or gel more frequently than those from university clinics (p = 0.013). Fluoridation was the most common (70.7%) treatment for WSL after MBT, followed by resin infiltration (21.2%). The majority (80.9%) of the participants favor a guideline for preventing WSL. CONCLUSIONS WSL prevention during MBT is challenging. Males in puberty are predominantly affected. Younger orthodontists are more concerned about the prevention of WSL during MBT. CLINICAL RELEVANCE The non-negligible prevalence of individuals with WSL emphasizes the need for dental education and health care reform. This would help to implement standardized procedures and establish innovative applications.
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Affiliation(s)
- Manon Isabelle Weyland
- Dept. of Orthodontics and Dentofacial Orthopedics, Center for Oral Health Sciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Paul-Georg Jost-Brinkmann
- Dept. of Orthodontics and Dentofacial Orthopedics, Center for Oral Health Sciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Theodosia Bartzela
- Dept. of Orthodontics and Dentofacial Orthopedics, Center for Oral Health Sciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
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Bisht S, Khera AK, Raghav P. White spot lesions during orthodontic clear aligner therapy: A scoping review. J Orthod Sci 2022; 11:9. [PMID: 35754408 PMCID: PMC9214451 DOI: 10.4103/jos.jos_170_21] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/04/2021] [Accepted: 01/17/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND White spot lesions (WSL) are an unsightly and a rather frequent drawback of orthodontic treatment. The complex design of fixed orthodontic appliances (FAs) makes it difficult to perform proper oral hygiene, which amounts to white spot lesions being three times more prevalent in patients wearing orthodontic appliances. As clear thermoplastic aligners (CAs) are removable appliances, it has been speculated that they allow better oral hygiene maintenance and thus less incidence of WSLs. OBJECTIVES This evidence-based scoping review aims to identify the scope and nature of the evidence on white spot lesions during orthodontic clear aligner therapy. TYPES OF STUDIES REVIEWED Strategic and thorough search of the literature for randomized Controlled Trials, Case-Control, Cohort studies, Case reports, full research articles, and review papers on humans published in English in five major databases was undertaken till July 2021 using free text and Medical Subject Headings (MESH) terms, followed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify five studies for data extraction. RESULTS Evidence was summarized for study characteristics, diagnostic methods for the detection of white spot lesions, and incidence of white spot lesions during clear aligner therapy. The literature supports that orthodontic treatment with CAs was associated with a low incidence of WSLs when compared with fixed mechanotherapy, with a major role of patient education, motivation, and compliance in maintaining oral hygiene. PRACTICAL IMPLICATIONS The general perception is that clear aligners are more hygienic and show no incidence of white spot lesions. However, our scoping review supports that WSLs can occur with this form of orthodontic treatment also. WSLs in clear aligners could be attributed to the practice of having composite attachments that cover a significant portion of the tooth surface. Thus, regardless of the type of appliance used, a periodic reinforcement by the orthodontist to maintain oral hygiene is necessary for patient motivation, allowing for better oral hygiene practice, and as a result, leads to prevention of WSLs.
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Affiliation(s)
- Shrestha Bisht
- Department of Orthodontics, Subharti Dental College, Swamivivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Amit Kumar Khera
- Department of Orthodontics, Subharti Dental College, Swamivivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Pradeep Raghav
- Department of Orthodontics, Subharti Dental College, Swamivivekanand Subharti University, Meerut, Uttar Pradesh, India
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Motivation, Perception, and Behavior of the Adult Orthodontic Patient: A Survey Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2754051. [PMID: 35281602 PMCID: PMC8916849 DOI: 10.1155/2022/2754051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/11/2022] [Accepted: 02/17/2022] [Indexed: 01/14/2023]
Abstract
Purpose The article is aimed at improving the understanding of the sociocultural profile of adult orthodontic patients and their expectations. In particular, it addresses three main aspects: the motivation and needs that underpin the decision to start orthodontic treatment, how it influences the patients' daily life, and the different oral hygiene demands. Materials and Methods An online survey was completed by 276 patients undergoing orthodontic treatment with different techniques. The questions asked concerned gender, age, type of appliance, any previous orthodontic treatments, type of any previous retainers, reasons for therapy, satisfaction, pain, problems in eating, daily number of teeth brushings and flossings before and during the treatment, perception of cost, sensation of visibility of the appliance, and if they would recommend orthodontic treatment. Results A significant role within our sample is played by gender; 87.94% consisted of female patients out of which 72.57% wanted to improve their aesthetics, while only 54.84% of male patients cited the same reason. Invisible aligners were preferred by 67.70% of the patients due to them being considered the least painful, causing the fewest problems with eating, and the least visible. Metal braces were perceived as the less expensive treatment. Over a third of the patients (33.85%) had previously undergone orthodontic treatment, among them 54.05% wore a mobile retainer, 31.08% a fixed one, and 14.86% both. Daily tooth brushing and flossing increased during therapy with clear aligners by 48.94% and 126.39%, respectively. Conclusions The greatest demand for orthodontic treatments comes from women, as they pay more attention to aesthetics, which makes the clear aligners the most common choice. The relapse after orthodontic treatment seems to cause a higher demand for retreatment, and oral hygiene habits significantly improve during orthodontic treatment, especially with the clear aligners.
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Prevalence of white spot lesions during clear aligner therapy: a systematic review. AUSTRALASIAN ORTHODONTIC JOURNAL 2022. [DOI: 10.2478/aoj-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives: To determine if an association exists between the prevalence of white spot lesions (WSLs) and orthodontic treatment using clear aligners.
Methods: Electronic databases were searched with no restrictions on year. Article selection criteria included human clear aligner studies conducted during the permanent dentition and with a full description of the applied technique and oral hygiene status.
Results: The search strategy resulted in a total of 4177 articles. After title and abstract screening, 156 relevant articles were identified from which five remained after the application of the exclusion criteria. The articles were mostly classified as having a low risk of bias.
Conclusions: Clear aligner therapy induces a lower development rate of new WSLs than orthodontic treatment by fixed appliances. In patients who have poor oral hygiene and/or existing WSLs, clear aligner treatment could be recommended.
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Geraldeli S, Maia Carvalho LDA, de Souza Araújo IJ, Guarda MB, Nascimento MM, Bertolo MVL, Di Nizo PT, Sinhoreti MAC, McCarlie VW. Incorporation of Arginine to Commercial Orthodontic Light-Cured Resin Cements-Physical, Adhesive, and Antibacterial Properties. MATERIALS (BASEL, SWITZERLAND) 2021; 14:4391. [PMID: 34442914 PMCID: PMC8401166 DOI: 10.3390/ma14164391] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
(1) Background: The amino acid arginine is now receiving great attention due to its potential anti-caries benefits. The purpose of this in vitro study was to evaluate the shear bond strength (SBS), ultimate tensile strength (UTS), and antimicrobial potential (CFU) of two arginine-containing orthodontic resin cements. (2) Methods: Forty bovine incisors were separated into four groups (n = 10): Orthocem, Orthocem + arginine (2.5 wt%), Transbond XT, and Transbond XT + arginine (2.5 wt%). The brackets were fixed to the flat surface of the enamel, and after 24 h the SBS was evaluated using the universal testing machine (Instron). For the UTS test, hourglass samples (n = 10) were made and tested in a mini-testing machine (OM-100, Odeme). For the antibacterial test (colony forming unit-CFU), six cement discs from each group were made and exposed to Streptococcus mutans UA159 biofilm for 7 days. The microbiological experiment was performed by serial and triplicate dilutions. The data from each test were statistically analyzed using a two-way ANOVA, followed by Tukey's test (α = 0.05). (3) Results: The enamel SBS mean values of Transbond XT were statistically higher than those of Orthocem, both with and without arginine (p = 0.02033). There was no significant difference in the SBS mean values between the orthodontic resin cements, either with or without arginine (p = 0.29869). The UTS of the Transbond XT was statistically higher than the Orthocem, but the addition of arginine at 2.5 wt% did not influence the UTS for either resin cement. The Orthocem + arginine orthodontic resin cement was able to significantly reduce S. mutans growth, but no difference was observed for the Transbond XT (p = 0.03439). (4) Conclusion: The incorporation of arginine to commercial orthodontic resin cements may be an efficient preventive strategy to reduce bacterial growth without compromising their adhesive and mechanical properties.
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Affiliation(s)
- Saulo Geraldeli
- Department of General Dentistry, Division of Biomedical Materials, School of Dental Medicine, East Carolina University, Greenville, NC 27834-4354, USA
| | - Lucas de Almeida Maia Carvalho
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Campinas 13414-903, SP, Brazil; (L.d.A.M.C.); (I.J.d.S.A.); (M.B.G.); (M.V.L.B.); (P.T.D.N.); (M.A.C.S.)
| | - Isaac Jordão de Souza Araújo
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Campinas 13414-903, SP, Brazil; (L.d.A.M.C.); (I.J.d.S.A.); (M.B.G.); (M.V.L.B.); (P.T.D.N.); (M.A.C.S.)
| | - Maurício Bottene Guarda
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Campinas 13414-903, SP, Brazil; (L.d.A.M.C.); (I.J.d.S.A.); (M.B.G.); (M.V.L.B.); (P.T.D.N.); (M.A.C.S.)
| | - Marcelle M. Nascimento
- Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, FL 32610-0412, USA;
| | - Marcus Vinícius Loureiro Bertolo
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Campinas 13414-903, SP, Brazil; (L.d.A.M.C.); (I.J.d.S.A.); (M.B.G.); (M.V.L.B.); (P.T.D.N.); (M.A.C.S.)
| | - Paolo Túlio Di Nizo
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Campinas 13414-903, SP, Brazil; (L.d.A.M.C.); (I.J.d.S.A.); (M.B.G.); (M.V.L.B.); (P.T.D.N.); (M.A.C.S.)
| | - Mário Alexandre Coelho Sinhoreti
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Campinas 13414-903, SP, Brazil; (L.d.A.M.C.); (I.J.d.S.A.); (M.B.G.); (M.V.L.B.); (P.T.D.N.); (M.A.C.S.)
| | - V. Wallace McCarlie
- Department of Pediatric Dentistry and Orthodontics, Division of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, East Carolina University, Greenville, NC 27834-4354, USA;
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Soh J, Wang ZD, Zhang WB, Kau CH. Smile Attractiveness Evaluation of Patients Selected for a U.S.-Based Board Certification Examination. Eur J Dent 2021; 15:630-638. [PMID: 34303318 PMCID: PMC8630961 DOI: 10.1055/s-0041-1726670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives
The aims of this study were to assess smile attractiveness of a collection of 68 smiling photographs of successfully treated cases submitted to the American Board of Orthodontics (ABO) clinical examination and identify variables that influence the assessment.
Materials and Methods
A panel of 81 non-Caucasian assessors from various clinical disciplines were instructed to score the smile attractiveness on a visual analog scale from 1 (least attractive) to 10 (most attractive) and to select which components contributed to a lesser attractive smile. The mean, standard deviations (SDs), and quartiles of the smile attractiveness were obtained with descriptive statistics. Multilinear regression analysis was performed to investigate the scores of the perceived quality of smile attractiveness when the clinical disciplines and gender of the assessors were the factors taken into consideration. Receiver operating characteristic (ROC) curve was generated to establish the relationship between smile attractiveness and the achievement of a perfect smile.
Results
The mean (SD) rating of each clinical photograph of the anterior occlusion on smiling ranged from 3.11 (1.47) as the least attractive smile to 7.59 (1.45) as the most attractive smile. The overall mean (SD) score for smile attractiveness was 5.30 (1.10). Problems associated with teeth, gingiva, and lips corresponded with a reduction of the smile attractiveness score by 1.56, 1.82, and 1.47, respectively. Gender was not associated with smile attractiveness ratings. Orthodontists, periodontists, and prosthodontists demonstrated no difference in the ratings, while plastic surgeons were more critical than orthodontists regarding smile attractiveness.
Conclusions
This study suggested that only 2 out of 68 AOB validated treatment finishes had a perfect and attractive smile.
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Affiliation(s)
- Jen Soh
- Private Practice, Singapore, Singapore
| | - Zheng Dong Wang
- Department of Orthodontics, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Wei Bing Zhang
- Department of Orthodontics, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Chung How Kau
- Department of Orthodontics, The University of Alabama at Birmingham, Birmingham, Alabama, United States
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Nemec M, Bartholomaeus HM, H. Bertl M, Behm C, Ali Shokoohi-Tabrizi H, Jonke E, Andrukhov O, Rausch-Fan X. Behaviour of Human Oral Epithelial Cells Grown on Invisalign ® SmartTrack ® Material. MATERIALS (BASEL, SWITZERLAND) 2020; 13:5311. [PMID: 33255259 PMCID: PMC7727678 DOI: 10.3390/ma13235311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/18/2022]
Abstract
Invisalign aligners have been widely used to correct malocclusions, but their effect on oral cells is poorly known. Previous research evaluated the impact of aligners' eluates on various cells, but the cell behavior in direct contact with aligners is not yet studied. In the present study, we seeded oral epithelial cells (cell line Ca9-22) directly on Invisalign SmartTrack material. This material is composed of polyurethane and co-polyester and exhibit better mechanical characteristics compared to the predecessor. Cell morphology and behavior were investigated by scanning electron microscopy and an optical cell moves analyzer. The effect of aligners on cell proliferation/viability was assessed by cell-counting kit (CCK)-8 and 3,4,5-dimethylthiazol-2-yl-2,5-diphenyl tetrazolium bromide (MTT) assay and live/dead staining. The expression of inflammatory markers and proteins involved in epithelial barrier function was measured by qPCR. Cells formed cluster-like structures on aligners. The proliferation/viability of cells growing on aligners was significantly lower (p < 0.05) compared to those growing on tissue culture plastic (TCP). Live/dead staining revealed a rare occurrence of dead cells on aligners. The gene expression level of all inflammatory markers in cells grown on aligners' surfaces was significantly increased (p < 0.05) compared to cells grown on TCP after two days. Gene expression levels of the proteins involved in barrier function significantly increased (p < 0.05) on aligners' surfaces after two and seven days of culture. Aligners' material exhibits no cytotoxic effect on oral epithelial cells, but alters their behavior and the expression of proteins involved in the inflammatory response, and barrier function. The clinical relevance of these effects has still to be established.
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Affiliation(s)
- Michael Nemec
- Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (M.N.); (M.H.B.); (C.B.); (E.J.)
| | - Hans Magnus Bartholomaeus
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (H.M.B.); (H.A.S.-T.); (X.R.-F.)
| | - Michael H. Bertl
- Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (M.N.); (M.H.B.); (C.B.); (E.J.)
| | - Christian Behm
- Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (M.N.); (M.H.B.); (C.B.); (E.J.)
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (H.M.B.); (H.A.S.-T.); (X.R.-F.)
| | - Hassan Ali Shokoohi-Tabrizi
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (H.M.B.); (H.A.S.-T.); (X.R.-F.)
| | - Erwin Jonke
- Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (M.N.); (M.H.B.); (C.B.); (E.J.)
| | - Oleh Andrukhov
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (H.M.B.); (H.A.S.-T.); (X.R.-F.)
| | - Xiaohui Rausch-Fan
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (H.M.B.); (H.A.S.-T.); (X.R.-F.)
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Kaur H, Kochhar AS, Gupta H, Singh G, Kubavat A. Appropriate orthodontic appliances during the COVID-19 pandemic: A scoping review. J Oral Biol Craniofac Res 2020; 10:782-787. [PMID: 33106770 PMCID: PMC7577275 DOI: 10.1016/j.jobcr.2020.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The esoteric Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) infection or COVID-19 has been an unusual plummet in dental/orthodontic practice. Based on current recommendations for various amendments in an orthodontic practice, this scoping review aims to identify orthodontic appliances that are most appropriate to us during this on-going pandemic. METHODS Electronic databases (PubMed, Scopus, Web of Science, Science Direct, and Google Scholar) were searched up until August 11, 2020. Full-text articles in English with keywords "COVID-19 and Orthodontics" and related search terms were included. RESULTS Out of 17 retracted articles, only 4 articles were found to be brief the choice for orthodontic appliances in pandemic times speculating clear aligner therapy (CAT) to be a pragmatic solution. The remaining articles were also thoroughly studied and the new norms set by the pandemic were determined. Criteria for orthodontic appliance selection included careful patient screening and collection of records, minimal physical visits, efficient use of technology, virtual consultations but the use of PPE for physical appointments; and lesser AGPs with a lesser risk of airborne transmission. CONCLUSIONS Subject to regional demands, CAT can be considered as the relatively safer modality-predictable and effective apposite to fixed orthodontic appliances in these unprecedented times.
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Affiliation(s)
- Harneet Kaur
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | | | - Harshita Gupta
- Department of Orthodontics and Dentofacial Orthopaedics, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
| | - Gurkeerat Singh
- Department of Orthodontics and Dentofacial Orthopaedics, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
| | - Ajay Kubavat
- Department of Orthodontics and Dentofacial Orthopaedics, Narsinhbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India
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