Abstract
(1) Background: The use of removable orthodontic appliances, which is common in early ages, requires careful hygiene, as several different microorganisms are found on their surface during the orthodontic treatment. (2) Methods: Comprehensive electronic searches were conducted up to May 2021. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs), prospective or retrospective, evaluating the efficacy of cleaning and disinfection methods for acrylic removable orthodontic appliances, redacted in the English language, were included. Three independent blinding review authors were involved in study selection, data extraction, and bias assessment. (3) Results: A total of 2491 records were screened and eight studies (six RCTs and two CCTs) fulfilled the inclusion criteria. Among the overall cleaning and disinfection methods described in the included studies, four categories could be defined: liquid antimicrobial agents, commercial tablet cleansers, natural plant extracts and incorporation of quaternary ammonium methacryloxy silicate, all of which demonstrated superior efficacy compared to the placebo/negative control. However, the different methods were not compared with each other. (4) Conclusions: Biofilm control on acrylic orthodontic removable appliances can be performed using the different cleaning and disinfection methods considered in the included studies. Further studies are needed to define the most effective technique. Registration: PROSPERO CRD 42021269297.
Highlights
Oral hygiene has always been a challenge in orthodontics and the relation between orthodontic treatments and caries development, or periodontal diseases has been well studied [1,2]
P (Population/Problem): Removable acrylic orthodontic appliances worn by orthodontic patients; I (Intervention): Cleaning and disinfection methods; C (Comparison): Placebo or negative control; O (Outcome): Global biofilm amount, S. mutans colony count or, Candida colony count on removable acrylic orthodontic appliances
Further evaluation was conducted on 25 full-text articles, which led to eight articles eligible for this systematic review
Summary
Oral hygiene has always been a challenge in orthodontics and the relation between orthodontic treatments and caries development, or periodontal diseases has been well studied [1,2]. Orthodontic treatment induces several modifications of the oral environment, including a decrease in salivary pH [3], a facilitation of dental biofilm adherence on the orthodontic surface appliance, and an increase in cariogenic (S. mutans, Lactobacillus sp.) and periodontal pathogenic microorganisms levels (T. denticola, A. actinomycetemcomitans) [4,5,6,7]. Hygiene methods in patients undergoing orthodontic treatment with fixed appliances have been widely addressed in the literature, whether it was brushing method [8] possibly assisted with smartphone application [9], use of mouthwashes [10], or direct use of antimicrobial agents in brackets, wires and orthodontic adhesives [11,12].
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