Exposure to the oral environment enhances the corrosion of metal orthodontic appliances caused by fluoride-containing products: Cytotoxicity, metal ion release, and surface roughness

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This study aimed to evaluate the metal ion release, cytotoxicity, and surface roughness of clinically used metal orthodontic appliances after immersion in different fluoride product solutions compared with those of new appliances. Used fixed appliances were debonded from 36 patients after their treatment was done. New appliances were as-received. Each used and new group comprised 36 sets of 20 brackets and 4 tubes that were divided into 3 groups by archwire type; stainless steel, nickel-titanium, and beta-titanium. The samples in each group were divided into 3 subgroups and immersed in solutions of fluoride toothpaste, 1.23% acidulated phosphate fluoride, or artificial saliva without fluoride as a control group. The immersion times were estimated from the recommended time for using each fluoride product for 3months. The samples were then immersed in Dulbecco's Modified Eagle's Medium for 7days. The cytotoxicity test was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay using primary gingival fibroblasts. Chromium, nickel, and iron ion release were detected using inductively coupled plasma mass spectroscopy. The surface roughness of the brackets and wires was measured by a scanning electron microscope and a noncontact optical 3-dimensional surface characterization and roughness measuring device. The data were analyzed using the paired t test and 2-way analysis of variance. Used brackets demonstrated a significantly higher ion release, surface roughness, and cytotoxicity than the new brackets. Acidulated phosphate fluoride significantly increased the ion release and surface roughness; however, it significantly decreased cell viability, especially in the titanium molybdenum subgroup. Used brackets were significantly prone to further corrosion. Acidulated phosphate fluoride gel should not be used in orthodontic patients with fixed metal appliances.