Abstract
Objective: Inflammation is one of the most common complications observed when using orthodontic miniscrews. Chlorhexidine mouthwash can beused to prevent and reduce the degree of inflammation, but long-term use of this solution may lead to some side effects. This study sought to evaluatethe peri-miniscrew antibacterial effect of 1% chitosan, a biomaterial with antibacterial properties, relative to 0.2% chlorhexidine mouthwash.Methods: A randomized, double-blind clinical trial was conducted at the Dental Teaching Hospital and Oral Biology Research Laboratory at theUniversity of Indonesia from February to June 2019. Thirty subjects (25 females and five males) were randomly assigned to rinse with 1% chitosan(n=10), 0.2% chlorhexidine digluconate (n=10), and Aquadest (n=10) in addition to their usual oral hygiene procedure for 4 days. Peri-miniscrewclinical inflammation signs were recorded and peri-miniscrew plaque collected before and after 4 days of rinsing. The total bacterial and red-complexbacteria count in plaque samples were evaluated by a real-time polymerase chain reaction.Results: Chitosan and chlorhexidine showed antibacterial activity, reducing total bacterial count around orthodontic miniscrews (p<0.05). Theantibacterial activity of chitosan on total bacteria was not significantly different from that of chlorhexidine (p≥0.05). Regarding the antibacterialactivity of chitosan on red-complex bacteria, the best result seen was a 58% bacteria count reduction in Tannerella denticola.Conclusion: Chitosan has potential antibacterial activity and could be used in mouthwash to maintain peri-miniscrew hygiene.
Highlights
Nowadays, miniscrews have been widely used in orthodontic treatment due to their superiority relative to other anchorage devices
The total bacteria count after rinsing was not significantly different between the chlorhexidine and chitosan groups (p=0.821). These results suggest that chitosan was as effective as chlorhexidine in reducing the total bacteria count
The results showed that the chlorhexidine group presented reductions of 55.8% in P. gingivalis count, 25.3% in T. forsythia count, and 42.6% in T. denticola count
Summary
Miniscrews have been widely used in orthodontic treatment due to their superiority relative to other anchorage devices. Miniscrews are versatile, easy to install and remove, function independently of the patient’s cooperation, and are relatively affordable [1,2]. They bear risks and impart complications that may occur during the installment procedure, orthodontic treatment, and the removal procedure [3]. The environment condition around the miniscrew neck – which is dark, anaerobic, and full of nutrition (amino acids and peptides) – promotes anaerobic bacterial growth that may lead to peri-miniscrew inflammation [4]. One of the ways to prevent bacterial growth is by rinsing with an antibacterial mouthwash. Chlorhexidine is the gold standard mouthwash that can be used to prevent and reduce bacterial growth and inflammation [6]. The use of chlorhexidine mouthwash on a daily basis may exhibit some side effects, such as oral mucosa irritation, taste perception alteration, burning sensation, and tooth staining [7]
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