Evaluation of Antibacterial Properties and Cytological Impact of TiO 2 -coated Orthodontic Brackets: A Split-mouth Randomized Trial

Objective: Comparative evaluation of antibacterial and anti-adherent properties of surface-modified stainless steel (SS) orthodontic brackets against Streptococcus mutans ( S. mutans). Materials and Methods: The study was conducted on 120 SS orthodontic McLaughlin, Bennett, Trevisi (MBT) 0.022″ slot by Leone, Italy. Orthodontic brackets that constituted the sample size were divided into 6 groups, consisting of 20 samples each in two control (non-surface coated) and four experimental groups. The experimental group’s surface coatings were photocatalytic zinc oxide (ZnO) and photocatalytic titanium oxide (TiO2), which were carried out by radiofrequency (RF) magnetron sputtering method for surface modification. Brackets were subjected to microbiological tests against S. mutans. For anti-adherence, weight change, pre- and postexposure, was evaluated to gauge the adherence of bacteria and colony-forming units/milliliter (CFU/mL) count measuring the survival rate of bacterial cells for antibacterial activity. Results: The TiO2-coated group showed statistically significant anti-adherence ( P-value < .05) against S. mutans than control and ZnO groups. The CFU count of TiO2 group was lower than control as well as ZnO group. Conclusion: TiO2 is superior to ZnO and should be continued to be considered for surface modification of orthodontic brackets against White Spot Lesions (WSLs) and gingivitis.

Stainless steel (SS) orthodontic brackets may have varying corrosion resistance when used with mouthwashes during orthodontic treatment. Studying their effects on orthodontic brackets will be beneficial. The study's objective was to analyze the surface characteristics of SS orthodontic brackets and their resistance to corrosion, exposed to chlorhexidine and povidone-iodine mouth rinses - an in vitro and in vivo study. The in vitro test: MBT 0.022" slot SS orthodontic brackets were immersed in three groups - Group A - Modified Meyer-Fusayama artificial saliva (AS), Group B - Chlorhexidine, and Group C - Povidone-iodine mouthwash. The in vivo test: Brackets were conventionally bonded on the patient's teeth and divided into Group I - control group, Group II - patients used chlorhexidine, and Group III used povidone-iodine mouth rinse. The corrosion resistance and surface characteristics of SS brackets were determined using scanning electron microscope (SEM), electrochemical impedance spectroscopy, and X-ray photoelectron spectroscopy. Higher corrosion resistance was obtained for brackets immersed in chlorhexidine mouth rinse. The polarization resistance value of the orthodontic SS bracket was 109 MΩ, 1383 MΩ, and 769 MΩ immersed in AS, chlorhexidine, and povidone-iodine mouth rinse, respectively. After surface chemical analysis, XPS data showed the largest intensity peak of metallic chromium (CrO) fresh sample and in the sample immersed in chlorhexidine mouthwash. According to SEM, brackets immersed in chlorhexidine showed a relatively smooth surface. In this study, chlorhexidine was found to be less corrosive followed by povidone-iodine.

Objectives: Development of white spot lesions (WSLs) in the course of orthodontic treatment would compromise the satisfaction of patients and clinicians. One suggested preventive strategy is to incorporate antimicrobial agents into orthodontic adhesive systems or to coat brackets with them. Several clinical and experimental studies have evaluated the effect of antimicrobial agents, but no consensus has been reached on the best preventive approach. Thus, the aim of this narrative review was to assess the clinical and experimental studies on the effect of incorporation of antimicrobial agents in orthodontic adhesives and brackets. Methods: PubMed (Medline), Scopus, and Google Scholar were searched for related articles published from 1990 to 2020. Both clinical and experimental studies were included in this review. Results: Different antimicrobial agents can be added to adhesive systems to control the formation of WSLs, and also preserve the bond strength of adhesives. Same as adhesive systems, coating of brackets with antibacterial agents can be performed to control bacterial proliferation and demineralization of enamel. Conclusion: Antimicrobial agents incorporated in bonding systems or used for coating of brackets can confer antimicrobial properties with no significant negative effect on bonding properties. However, clinical and long-term studies are required to confirm their effectiveness and absence of side effects.

As hindrance of remineralisation process occurs during orthodontic therapy resulting in decalcification of enamel because number of plaque retention sites increases due to banding and bonding of appliances to teeth. The present analytic study was undertaken to assess the occurrence of white spot lesions in permanent molars of children with and without orthodontic therapy and to evaluate the effect of Casein PhosphoPeptide-Amorphous Calcium Phosphate (CPP-ACP) on white spot lesions in post-orthodontic patients in a given period of time. The study comprised of examination of 679 first permanent molars which were examined to assess the occurrence of smooth surface white spot lesions in children of 8 to 16 years age group. Group I comprised subjects without any orthodontic treatment and Group II comprised of subjects who had undergone orthodontic therapy. The sample size was calculated using the epi-info6 computer package. Treatment group included 20 post-orthodontic patients examined with at least one white spot lesion within the enamel who received remineralizing cream (GC Tooth Mousse, Recaldent, GC Corporation.) i.e., CPP-ACP cream two times a day for 12 consecutive weeks. Computerized image analysis method was taken to evaluate white spot lesions. These frequency and percentages were compared with chi-square test. For comparison of numeric data, paired t-test was used. Of the total 278 (49.6%) first permanent molars showed occurrence of smooth surface white spot lesions out of 560 in Group I and 107 (89.9%) first permanent molars showed presence of white spot lesions out of 119 debanded first permanent molars of children examined in Group II. CPP-ACP therapy group showed reduction in severity of codes which was found to be highly significant after 12 weeks and eight weeks on gingival-third, p-value (<0.001) and significant after eight weeks and four weeks on middle-third according to ICDAS II criteria and computerized image analysis. CPP-ACP therapy minimum for 12 weeks is highly recommended as post-orthodontic treatment need in management of smooth surface white spot lesions on teeth undergoing fixed orthodontic therapy according to the present study.

BackgroundThis study aimed to evaluate the efficacy of polydopamine (PDA) functionalization on orthodontic brackets in inhibiting biofilm formation and promoting surface bioactivity to buffer the acidity of caries-causing bacteria around orthodontic brackets and prevent demineralization. The stability of the coating in artificial saliva (AS) and distilled water was evaluated, along with its effect on pH changes in simulated body fluid (SBF) and distilled water.MethodsMaxillary incisor orthodontic brackets underwent PDA functionalization using a dopamine hydrochloride solution following a specific protocol. Biofilm formation on both control (Br-0) and coated (Br-PDA) brackets was assessed immediately after coating and after two months of aging (Aged Br-PDA) in artificial saliva. The adherent biofilm bacteria on brackets were quantified with colony count assessment and optical density. Surface morphology, Bioactivity, and coating stability were analyzed using Scanning Electron Microscopy (SEM). Coated and uncoated samples were immersed in SBF and deionized water, and pH changes were monitored over 7 days using a pH meter.ResultsPDA-functionalized brackets, both freshly coated (1.08 OD) and aged for two months (1.6 OD), showed significantly reduced biofilm formation compared to non-functionalized control brackets (2.07 OD), with p-value < 0.05. This reduction was confirmed through optical density measurements and colony-forming unit (CFU) counts (1.63E + 06, 4.53E + 07, and 7.56E + 07 respectively, p-value < 0.05). SEM analysis revealed alterations in surface morphology and composition, suggesting enhanced biointeraction in the coated brackets. Stability assessments in artificial saliva and deionized water demonstrated the durability of the coating. pH measurements indicated minimal changes in SBF and water, with PDA-functionalized brackets showing slight alterations.ConclusionsOur research findings suggest that PDA-functionalized brackets possess promising antimicrobial properties and stability, offering potential applications in orthodontic treatment to mitigate biofilm formation and prevent white spot lesions around orthodontic brackets. Further investigation is required to optimize the coating formulation and explore its long-term efficacy in clinical settings.

Introduction: Robusta coffee (Coffea canephora) is one of the most produced and popular types of coffee in Indonesia. Robusta coffee is included as an acidic beverage because it has an average pH of 5.6 which can increase corrosion. Stainless steel orthodontic bracket is a type of orthodontic bracket that has more resistance to corrosion, however, exposure to stainless steel orthodontic bracket by robusta coffee (Coffea canephora) which has an average pH of 5.6 can increase the corrosion process so that more Fe ions are released. Objective: To determine the effect of soaking stainless steel orthodontic bracket with robusta coffee (Coffea canephora) on increasing the release of Fe ions Methods: Laboratory experiment with post test only control group design. The experiment was divided into two groups, namely the control and treatment groups. In the control group there were 16 stainless steel orthodontic brackets which were soaked in 20 ml of artificial saliva in an incubator at 370C for 24 hours. In the treatment group there were 16 stainless steel orthodontic brackets soaked in 10 ml of artificial saliva and 10 ml of robusta coffee (Coffea canephora) in an incubator at 370C for 24 hours. After that, a test was carried out using AAS tool to see the release of Fe ions contained in the test solution. Results: Robusta coffee (Coffea canephora) increases the release of Fe ions in stainless steel orthodontic brackets. In the treatment group that were soaked in robusta coffee, there was an average of 7.96 ppm of Fe ions released, while in the control group only 4.07 ppm of Fe ions were released. Conclusion: Robusta coffee (Coffea canephora) has been shown to increase the release of Fe ions on stainless steel orthodontic brackets

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Reducing white spot lesions in orthodontic populations with fluoride rinsing

Conventional methods for orthodontic metal brackets debonding produce forces that are high enough to cause enamel scratches, fracture, and patient’s discomfort. The aim of this study was to assess the effectiveness of Er,Cr:YSGG laser in debonding metal orthodontic brackets in comparison to conventional debonding method. Stainless steel orthodontic brackets were bonded on the buccal surface of 30 freshly extracted human premolars teeth which were divided into two groups: (1) control group; conventional bracket debonding, using debonding plier and (2) test group; Er,Cr:YSGG laser (2.78 μm, 6 W, 20 Hz, 60 μs pulse duration) were used for laser debonding. Adhesive Remnants Index (ARI) was assessed using scanning electron microscope images and statistically compared between both groups. The time needed for debonding in both groups was also recorded and statistically compared. The results of this study showed that in test group, the used laser irradiation parameters effectively debonded all metal brackets. Mann-Whitney U test showed lower ARI scores in the test irradiated group when compared to the control group. The results also showed that higher time values were needed for debonding of metal brackets in test group when compared to the control group. The Er,Cr:YSGG laser can be used for effective debonding of stainless steel orthodontic brackets.

Plaque control during the course of orthodontic treatment is not an easy task, and dental caries are not an unlikely complication. We examined the possibility of controlling dental caries with Nd-YAG laser irradiation in orthodontic patients. As a preliminary experiment, we used the Nd-YAG laser to irradiate an extracted tooth and then left it to soak in lactic acid. The decay of the tooth was evaluated with a scanning electron microscope (SEM); tooth decay was inhibited by the action of the laser. Twenty patients undergoing orthodontic treatment for early decalcification of the teeth (white spot lesions) were selected, and photographs were taken of their oral cavities. White spot lesions on the four incisors and two canines of the maxilla were traced on tracing paper, and their areas were calculated by computer. Ten of the patients received laser treatment and acidulated phosphate fluoride solution (APF); the other ten acted as the control group. Between 11 and 12 months later, we photographed the oral cavity as we had previously; the white spot lesions were again traced and their areas calculated. The changes in the areas of the white spots of the laser-irradiated and control groups showed the following increases: laser-irradiated group, 1.41 times; controls, 2.87 times. The difference was statistically significant. These results demonstrate that Nd-YAG laser irradiation with application of APF acts as an effective method of caries control during orthodontic treatment.

Introduction: Oral cavity is a natural habitat of bacteria which proliferates when an orthodontic appliance is placed which leads to enamel demineralisation or white spot lesions. In order to reduce the bacterial proliferation, the surface coating of brackets using nano particles came into existence. Aim: The aim of this systematic review is to assess the different surface modifications using nano coating materials and evaluate the antibacterial properties of these nano coated orthodontic brackets. Materials and Methods: A systematic review was conducted in September 2021, analysing the microbial adhesion and antibacterial properties of orthodontic brackets after application of nano-coating against uncoated brackets was conducted from the available electronic database during January 2000 to June 2021, which included PubMed, Embase, Google Scholar. Because of the less number of in-vivo studies, in-vitro studies were also included. An analysis on the microbial adhesion and antibacterial effects of various orthodontic brackets was done. The results were tabulated after performing risk of bias assessment for each study. Results: Based on the inclusion and exclusion criteria, 13 studies were included in the study. Risk of bias was medium for majority of the selected studies. As per the previous literature, bacterial adherence of Streptococcus mutans, Streptococcus sobrinus, Aggregatibacter actinomycetemcomitans, Lactobacillus acidophilus, Actinomyces viscous and Candida albicans was reported lower in groups of brackets coated with silver nano particles than that in the groups of brackets without the addition of silver nano particles. The corrosion level on the silver or silver platinum (Ag-Pt)-coated specimens was lower than that on the non coated specimens. Conclusion: The stainless-steel orthodontic brackets coated with various nano coating materials like silver, silver-platinum, titanium, Zinc Oxide (ZnO) and Copper Oxide (CuO) exhibited adequate antibacterial effect. This shows that in orthodontic patients, especially the one susceptible to caries, the amount of plaque accumulation is significantly reduced when nano-coated orthodontic brackets are used. They reduce the microbial colony count and prevent enamel demineralisation and white spot lesions. Further clinical trials must be carried out on a large scale to confirm the results.

Assessment of antibacterial and cytotoxic effects of orthodontic stainless steel brackets coated with different phases of titanium oxide: An in-vitro study.

In this study a surface penetrating sealant was used around bonded stainless steel orthodontic brackets. The investigation attempted to identify the effect of surface penetrating sealants on the microleakage associated with orthodontic stainless steel brackets bonded with light cured composite resin. A total of 58 bovine teeth were used for this study, orthodontic brackets were bonded with light cured orthodontic resin. The following groups were assigned: (I) Finished but unsealed, (II) Finished and sealed, and (III) Un-finished but unsealed. The brackets were activated using orthodontic elastics, stained, sectioned, and evaluated under magnification. The following statistical analysis was done Mann-Whitney U test for two independent samples, then confirmed with a Kruskal-Wallis One-Way analysis of variance by ranks. The second and third groups were statistically better in respect of marginal integrity as compared to the first.

Orthodontic treatment improves dental aesthetics. However, the prolonged duration of treatment and patient's oral hygiene results in more significant biofilm buildup and boosting concentrations of acidogenic bacteria, resulting in enamel demineralization. Plasma treatment technology has developed an interest in enhancing appliances' surface properties. The present study aimed to investigate cytotoxicity and antibacterial activity represented by anti-adhesion and anti-biofilm formation of Argon plasma treatment on orthodontic brackets against Streptococcus mutans and Lactobacillus acidophilus and evaluation the effect of change in plasma exposure duration on these properties in vitro. The study included three groups, group 1: untreated stainless steel brackets, group 2: brackets treated for 15 min, and group 3: brackets treated for 30 min. S.mutans and L.acidophilus were isolated from patients undergoing fixed orthodontic treatment. Microbiological tests included adhesion assay using plate counting method and biofilm formation assay using ELISA plate reader. S. mutans&amp; L. acidophilus were cultivated in three groups, and their adherence and biofilm formation were measured and compared. The biocompatibility of treated stainless steel brackets was evaluated by MTT assay. Results showed that groups 2 &amp; 3 had better anti-adhesion and anti-biofilm activity when compared with group 1, with a significant difference between group 1 &amp;group 3, in which group 3 recorded the lowest biofilm formation and the highest anti- anti-A adhesion activity. MTT showed that groups 2 and 3 exhibited more than 80% cell viability after 24, 48, and 72 hours. Plasma surface treatment of metal brackets possesses antibacterial activity against S.mutans and L.acidophilus; alteration exposure time impacts the development of these properties. Keywords. Plasma treatment, Argon gas, orthodontic brackets, biofilm, antimicrobial.

Introduction: White Spot Lesions (WSLs) observed during or after fixed orthodontic therapy has known to cause several dental problems clinically and aesthetically. It becomes imperative to understand the perception of treating dentists of the paediatric dentists to whom the children first visit, and also of the treating orthodontists and restorative dentists. Aim: To assess the knowledge, attitude, and practices of dentists regarding WSLs related to orthodontic treatment, and also to assess the preferences of these dentists regarding its management. Materials and Methods: A cross-sectional survey was planned for a period of two months (15th August 2020 to 15th October 2020) using a close ended, multiple choice questionnaire directed to evaluate the perspective of 260 dentists of Saudi Arabia towards white spot lesions associated with orthodontic treatment. The self designed validated questionnaire was prepared and mailed to dentists across the Kingdom of Saudi Arabia. Descriptive statistics followed by Chi-sqaure test was done to compare variables in the questionnaire. Results: A total of 52 paediatric dentists, 53 orthodontists, 51 restorative dentists, and 104 general dentists participated in the study. Out of 260 dentists, 236 (90.8%) of them have observed WSLs in their patients during/after orthodontic treatment. Adolescent patients more commonly complained of undesirable aesthetics due to WSLs. Incisors were the most commonly affected teeth. All dentists except orthodontists believed that they were proficient in diagnosing superficial or deep WSLs (p-value=0.005). Most dentists preferred professional application of high concentration topical fluorides. Most patients demanded an instant correction of these WSLs as reported by all groups of dentists. Conclusion: WSLs are commonly observed by dentists during the initial 7 to 12 months period of starting orthodontic therapy, more commonly on incisor teeth among the adolescent age group. The dentists recommended maintaining good oral hygiene as the most effective way of preventing WSLs. They also believed that high concentration fluoride agents are well suited for treating superficial lesions and composite resin restorations for deeper lesions.