Buccal Tubes Research Articles

Accidental ingestion of a fractured piece of orthodontic aligner: a case report

BackgroundIngestion and aspiration of orthodontic devices are rare occurrences, typically associated with components such as expansion keys, archwire segments, dislodged fixed appliances (including brackets, buccal tubes, and bands), as well as fractured metal or plastic appliances. This article describes the clinical diagnosis and treatment process of a case of accidental ingestion of a fractured piece of orthodontic aligner.Case presentationA 31-year-old female under orthodontic treatment by aligners accidentally ingested a fractured piece of the aligner. The special difficulty of this case is that the transparent orthodontic aligner has a low radiopacity. At the beginning, no foreign body was found in the commonly used soft tissue window, causing difficulty in its location until greyscale was adjusted to lung window. The 2-centimeter fractured piece was taken out under anesthesia and endoscopic surgery.ConclusionMaterials with low radiopacity should be read with a lower grayscale range. Fractured orthodontic appliances with low retention force should not continue to be worn until consultation with attending doctor.

A scanning electron microscopy investigation of the precision of three orthodontic bracket slot systems

ObjectiveOne of the most imprortant factors in achieving ideal teeth positions is the precision of the slot dimensions of orthodontic brackets into the archwires are inserted.This study aimed to assess the accuracy of the dimensions of orthodontic bracket slots and molar buccal tube apertures and to compare them with the specifications provided by the manufacturers.MethodA total of sixty brackets and ten molar buccal tubes with varying slot heights were examined using a scanning electron microscope from the mesial side. The dimensions and morphology of these bracket slots and buccal tubes apertures were assessed using the AutoCAD Software. A one-sample t-test was conducted to compare the measurements with the values provided by the manufacturer.ResultsThe findings of the present study indicated that the height of the measured bracket slots and buccal tube apertures dimensions were significantly larger than the actual dimensions and exhibiting divergent walls. On the other hand, the depth of the brackets slots showed significantly smaller values than the actual one.ConclusionA need for careful consideration when selecting a commercially accessible brand for everyday use is essential as certain materials may not meet acceptable standards.

An in Vitro Effectiveness and Evaluation of Sodium Hypochlorite for Orthodontic Buccal Tube Disinfection

Contamination of fixed orthodontic components caused by non-compliance with hygiene both during the manufacturing and packaging processes can cause cross-infection. Although the literature has demonstrated the need for sterilization or disinfection of fixed orthodontic components prior to insertion in the oral cavity, these are still not widely used in orthodontic practice. This study aims to evaluate bacterial contamination in vitro and the disinfection effect of 0.5% sodium hypochlorite on orthodontic buccal tubes. A total of 12 roth type 1 Molar buccal tubes with slots of 0.020 and still well sealed in the packaging were divided into three groups: group 1 chlorhexidine 2% (n=4), group 2 distilled water (n=4) as control, and group 3 sodium hypochlorite 0.5% (n=4) as treatment. Microbiological and biochemical tests were carried out on the three groups of first molars to detect any bacterial contamination. The buccal tube showed that it was contaminated with bacteria and then disinfected using a 2% chlorhexidine solution, distilled water and 0.5% sodium hypochlorite. Bacterial contamination was detected in all control and treatment groups. The treatment group with 0.5% sodium hypochlorite disinfection showed optimal decontamination (p 0.05) compared to the negative control group. Therefore, In vitro sodium hypochlorite 0.5% had the effect of reducing bacterial contamination of the buccal tube Roth type 1 molar with 0.020 slots.

Impact of COVID-19 Lockdown on Patients Undergoing Orthodontic Treatment: A Survey Based Study

OBJECTIVE: To evaluate how the COVID-19 lockdown influenced patients receiving orthodontic therapy. METHODOLOGY: An Ambispective study was done by collecting the data from July to August 2022. An investigative questionnaire containing 17 questions wascirculated to 325 respondents/patients. The data wascollected using a convenience sampling technique. Patients undergoing orthodontic treatment with fixed appliances aged 18 to 40 years were included in the study. Both male and female respondents who participated in the survey varied in terms of their ages, i.e., between 18 to 40 years. Version 24 of a statistical package for social sciences (SPSS) has been used for data analysis. RESULTS: According to the study's findings, the lockdown's impact on patients undergoing orthodontic treatments was significant. For instance, anxiety & psychological distress were created during the lockdown because of concerns regarding the closure of hospitals and delayed visits to orthodontists or problems in getting appointments. Because of this, patients feared prolonged treatment durations and orthodontic emergencies,including discomfort, wires pinching them, ruptured skin, damaged brackets, ligature ties and bondable buccal tubes, etc. CONCLUSION: Due to covid-19 lockdown, patients found difficulty in their regular appointments or monthly checkups as the hospitals were closed. Patients also experienced mental distress, making it imperative to comprehend the psychology of individuals experiencing orthodontic care. KEYWORDS: COVID-19 lockdown, Orthodontic treatment, Psychological distress, Treatment needs, Pandemic, Emergencies

Management of impinging “Nickel titanium palatal expander” in cleft palate cases by “Soft flow” (temporary mucosal protector)

The temperature-activated Arndt nickel titanium palatal expander has been a good choice for cleft palate applications because it creates transverse maxillary expansion, uprights and rotates the maxillary molars, and allows a smooth transition to fixed retention with no requirement for patient compliance and little manipulation by the clinician. But the clinical problem sometimes encountered is the impinging of “Nickel-Titanium” metal component of the Nickel titanium palatal expander on the soft palate. “Soft Flow” is a Temporary Mucosal Protector introduced recently in the orthodontic market which prevents the impinging of micro- implants or hooks of the molar buccal tubes. The following article highlights the clinical problem encountered after placement of Nickel Titanium Palatal Expander and how “Soft Flow” helps to overcome it.

Comparative Evaluation Of The Shear Bond Strength Of Two Different Orthodontic Bonding Agents On Artificial Crown Surfaces: An Invitro Study

INTRODUCTION: Bonding of buccal tubes to the tooth is an essential procedure in orthodontic treatment. With the increase in the number of adult patients seeking fixed orthodontic treatment, there is a need to find a more reliable procedure to bond the artificial crown surface. Successful orthodontic treatment requires sufficiently high and durable bond between buccal tubes and ceramic/zirconia surfaces. There is a need for a bonding agent which can provide maximum bond strength to all surfaces. This study aimed to assess and compare the shear bond strength and adhesive remnants of orthodontic buccal tubes to natural teeth, ceramic crowns and zirconia crowns using two different bonding systems. METHODS: In this in vitro study, 60 extracted human molar teeth were randomly assigned to three groups (n=20) and then divided into two subgroups(n=10). Bonding of buccal tubes to enamel, ceramic and zirconia surfaces was done using Assure plus universal bonding resin and Enhance LC. The shear bond strength of buccal tubes to the enamel, ceramic and zirconia surfaces were determined by universal testing machine. The SBSs and ARI scores were statistically analysed with and Kruskal Wallis test. RESULTS: The mean shear bond strength of buccal tubes to enamel, ceramic and zirconia surfaces bonded with Assure plus and Enhance LC was highest for enamel followed by zirconia surfaces respectively. Non-parametric Kruskal-Walli’s test found significant differences regarding the shear bond strength and adhesive remnant index (ARI). CONCLUSION: Bonding of buccal tubes to enamel, zirconia, and ceramic surfaces with Assure universal bonding resin and Enhance LC provided adequate bond strength. Thus, it may be used for bonding of orthodontic buccal tubes to the artificial crown surfaces in the clinical setting.

Accuracy of 3-dimensional–printed customized transfer tray using a flash-free adhesive system in digital indirect bonding: An in vivo study

This paper evaluated the accuracy of a computer-aided design and manufacturing indirect bonding technique using a new customized 3D-printed transfer tray and a flash-free adhesive system for orthodontic bonding. This invivo study analyzed 106 teeth selected from 9 patients undergoing orthodontic treatment. Quantitative deviation analysis was performed to evaluate the bonding positioning errors, assessing the differences between the virtually planned and the clinically transferred bracket position after indirect bonding procedures by superimposing 3-dimensional dental scans. Estimated marginal means were evaluated for individual brackets and tubes, arch sectors, and overall collected measurements. A total of 86 brackets and 20 buccal tubes were analyzed. Among individual teeth, mandibular second molars showed the highest positioning errors, whereas maxillary incisors reported the lowest values. Considering arch sectors, the posterior areas showed greater displacements than the anterior areas, as the right side compared to the left side, with a higher error rate reported for the mandibular arch than the maxillary arch. The overall bonding inaccuracy measurement was 0.35 mm, below the clinical acceptability limit of 0.50 mm. The accuracy of a 3-dimensional-printed customized transfer tray using a flash-free adhesive system in computer-aided design and manufacturing indirect bonding was generally high, with greater positioning errors for posterior teeth.

Use of Buccal Tubes Supported by Mini-Implants in a Patient with Multiple Missing Molars

When a patient has multiple missing molars or a partially edentulous jaw, it is difficult to align and level the teeth because posterior anchorage is insufficient. The purpose of this report was to introduce the use of buccal tubes supported by orthodontic mini-implants. A 26-year-old female was presented for orthodontic treatment before prosthodontic treatment. Many posterior teeth were missing or needed to be extracted, and there was an anterior crossbite. Mini-implants were placed in the mandibular right and left molar, and anterior palate areas. Levers welded with double buccal tubes were inserted into the brackets on LIM plates supported by mini-implants. By inserting the main archwire with intrusion overlay into these double buccal tubes supported by mini-implants, retraction and intrusion of the anterior teeth were achieved like a routine orthodontic case. Also, appropriate spaces for prosthodontic restorations were established. In the case of multiple missing molars, tooth movements including the retraction of the anterior teeth can be achieved by using buccal tubes supported by mini-implants.

Salivary Electrolytes in Patients Undergoing Fixed Orthodontic Treatment

The base metal alloys are more susceptible to corrosion than nobl ealloys, and fixed orthodontic appliances are generally made of base alloys. Fixed orthodontic appliances in the oral cavity are exposed to destructive physical and chemical agents, resulting in metallic corrosion. The present study aimed to evaluate the concentration of cobalt, zinc, and magnesium in patients' saliva with fixed orthodontic appliances at three different times. Saliva samples from 18 patients (9 males and 9 females) between 15-25 years were taken at three different time points. Group I: Pretreatment saliva sample, group II: one month after appliance placement, Group III: four months after appliance placement. The fixed appliance consists of 20 stainless steel brackets, 4 buccal tubes, and a super elastic nickel-titanium arch wire. Inductively Coupled Plasma Optical Emission Spectrometry analyzed the level of ions in salivary samples. Ions are recorded in parts per billion. Statistical analysis was performed by non-parametric tests (Friedman) and one-way repeated measures ANOVA. Levels of cobalt, magnesium, and zinc ions in saliva were highest in group II, lowest in group I for both zinc and cobalt, and lowest in group III for magnesium. On a pair wise comparison between different groups, it was statistically significant for all groups (<0. 005) except for cobalt and magnesium level between group I and group III and zinc level between groups II and III. Cobalt, magnesium, and zinc levels in saliva were increased after placing a fixed orthodontic appliance.

To Compare the Stress Magnitude on Roots of Mandibular Incisors at Different Inclinations With Different Arch Wires During Intrusion Mechanics—A Fem Study

Introduction: Force is applied through brackets in fixed mechanotherapy which generates stress in periodontal ligament and root of the teeth and is difficult to measure directly. Finite element analysis is used as a solution for understanding this biomechanical response. So the aims and objectives of this study were to evaluate the stress magnitude induced in the labial and lingual surface of mandibular incisors using superelastic NiTi arch wires of different cross-section at different inclination through finite element analysis. Materials and Methods: Finite element model of all mandibular teeth including periodontal ligament, alveolar bone, buccal tubes, brackets, and arch wire were constructed using mechanical elastic properties of the materials. Three different NiTi arch wires, round (0.016″), square (0.016″ × 0.016″), and rectangular (0.016″ × 0.022″), were placed into the bracket slots and models were constructed which were analyzed for stress distribution on root surface and periodontal ligament with 3 different cross-sections at 90°, 100°, and 110° with Ansys Version 14 software. Conclusion: Labial stress was found highest in round arch wire as compared to square and rectangular wire. Lingual stress was found to be slightly more in rectangular wire as compared to round and square arch wire.

A 3-Year Audit of the Failure Rate of First Molar Buccal Tubes among Orthodontic Patients in a Nigerian Population

Background: This study aimed to assess the bond failure rate of molar buccal tubes during active orthodontic treatments and the effect of age of the patient, gender, dental arches (maxillary and mandibular), and side of the arch on molar buccal tube bond failure. Methods: This was a retrospective study that assessed the bond failure of molar buccal tubes. Data were obtained from the case files of orthodontic patients undergoing orthodontic treatment and included subjects' age, gender, presence or absence of molar bond failure, well as the time the failure occurred. Statistical analysis was performed using IBM SPSS software version 23. Results: Participants comprised 96 subjects; 59 females (61.5%) and 37 males (38.5%). A total of 384 buccal tubes were bonded with a failure rate of 18%. The highest occurrence of bond failure was observed in the 1st month and the 2nd month after setup. Bond failure was observed in a higher percentage of the male population (43.2%) compared to females (37.3%). The difference in bond failure between gender was statistically insignificant. The prevalence of bond failure was significantly higher in younger patients (≤15 years, 61.7%, P = 0.0005). There was no significant effect of gender, time, dental arch, and side of the arch on the prevalence of bond failure. Conclusion: Buccal tube bond failure rate in our study was found to be 18%. Bond failure was significantly higher in the younger population compared to the adults. There was no significant effect of gender, time, or side of the arch on buccal tube bond failure.

Comparison of shear bond strength and ARI of four different adhesive systems used to bond molar tubes: An in vitro study

The purpose of this in vitro study was to determine and compare the shear bond strength and ARI score of one traditional etch-and-rinse adhesive system serving as control, with those of two other all-in-one adhesives but with enamel acid etching preceding their application, and of one new 8th generation all-in-one bonding agent combined with a traditional adhesive used to bond stainless steel buccal tubes to molar teeth. Four groups of teeth were formulated according to the adhesive system used to bond the tubes on the molars. Shear bond strength was measured using a universal testing machine (Hounsfield, UK). After debonding, each enamel surface was imaged using Inspex HD l080p Vesa camera (Ash Technologies Ltd., Ireland) to determine the ARI score. The mean SBSs in MPa for the four groups were respectively: A: 9.640 (±3.69), B: 10.261 (±3.03), C: 9.689 (±2.48), D: 8.412 (±3.02). No statistically significant differences were neither found through one-way ANOVA to exist between the group means (P: 0.715), nor for the ARI score frequence through Chi2 (P: 0.534). Maxcem Elite showed four and G-Premio Bond zero instances of enamel fracture. 1.SBSs of all adhesives and ARI score distributions did not present any significant differences when used to bond stainless steel molar tubes. 2.All adhesives presented with acceptable shear bond strengths for clinical use. 3.Maxcem Elite under the tested conditions presented the greatest and G-Premio the least number of enamel fractures.

The analysis of inter- and intrapopulation variability of Milnesium eurystomum Maucci, 1991 reveals high genetic divergence and a novel type of ontogenetic variation in the order Apochela

Tardigrada are a phylum of cosmopolitan invertebrates inhabiting both terrestrial and marine ecosystems. The carnivorous species are usually characterized by a wide buccal tube, which constitutes the first and rigid part of the digestive system. Among tardigrades, only the genus Milnesium is considered exclusively carnivorous and includes the largest known species in the phylum. Some members of the genus exhibit developmental variability in taxonomically important morphological traits such as the number of points on the secondary branches of claws and cuticular sculpturing. Milnesium eurystomum is one of the largest tardigrades, with body length reaching 1.2 mm, and it is equipped with an exceptionally wide buccal tube, enabling this animal to feed on various prey, including other tardigrade species. Importantly, M. eurystomum, as well as other species with wide buccal tubes, were described solely using mature females, thus their developmental variability remains unknown. Interestingly, small Milnesium specimens with remarkably wide buccal tubes have never been reported, raising a question of whether such hatchlings and juveniles (first and second life stages) are extremely rare and simply have never been reported, or their buccal apparatus morphology is different from adults and thus constitutes as an undescribed buccal tube developmental variability. To answer this question, we analysed four populations of M. eurystomum originating from Greenland, Svalbard and Scotland. Due to discrepancies in species delineation based on different types of data, we parallelly applied various methods of species delimitation, both morphological and molecular. Thanks to ontogenetic analysis, we show and describe a novel type of developmental variability in the size and shape of the buccal tube. We also provide novel morphological traits and data for this species, together with the first record and characterization of males. Finally, we discuss the consequences of our findings for the taxonomy of Milnesium and tardigrades in general.

Analysis of the influence of a new type of buccal tube base mesh design on the adhesive layer stress distribution and bond strength

The three-dimensional finite element method was used to analyse the effect of changing the buccal tube baseplate shape on the stress magnitude and distribution at the interface between the buccal tube and the adhesive layer in a buccal tube-adhesive layer-tooth continuum under shear and tensile loads. A stress regression analysis was used to select the optimum mesh design and was verified by in vitro bond strength testing. This study involved buccal tubes with triangular mesh bases (100–400 µm mesh lengths, 100–200 µm mesh spacings, and 0, 45 and 90° angles) and a traditional quadrilateral mesh base. A finite element model of the buccal tube, adhesive layer and tooth were established. The stresses in the adhesive layer-buccal tube interface were recorded under mesial loads, distal loads, vertical loads and tensile loads. The average bond strength was measured by debonding the buccal tube with a universal testing machine and crosshead at a speed of 0.5 mm/min. Increasing the mesh length and mesh spacing decreased the von Mises stress and the first principal stress at the triangular mesh base-adhesive interface. Further analysis showed that the lowest stress and maximum mean bond strength were exhibited by the triangular mesh base (400 µm mesh length, 200 µm mesh spacing). Changes in the shape and size of the base grids affected the stress magnitude and distribution at the adhesive layer interface. The optimal triangular mesh base design in this study provides new ideas for clinical applications.

Biomechanical influence of anchorages on orthodontic space closing mechanics by sliding method.

This study aims to analyse the stress distributions and initial displacements of teeth during the space closing stage through a three-dimensional finite element method. Computed tomography images of a patient were used to reconstruct the detailed teeth and alveolar bone, and brackets with stainless steel archwire were modelled according to the orthodontic prescriptions. The second premolars and first molars were chosen as the anchorages in the model 6-force, with buccal tubes attached to the second molars in the model 6-force-7, and the second molars as additional anchorages in the model 7-force. The results indicated that a movement of lingual lateral inclination occurred on the incisors during the retraction, and the frictional force between the teeth and the archwire significantly reduced the stress on the teeth and periodontal structures. Graphical abstract Malocclusion is one of the most common issue in dentistry with high prevalence and orthodontic treatment need. The extraction of first premolar teeth was normally needed at the beginning of the treatment. And the straight wire appliance together with the sliding mechanics was used for space closure at the end of the treatment. However, side effects like root resorption also found after the surgery. Biomechanically, the stress distributions and initial displacements of teeth during space closing stage might be a crucial factor contributed to those undesirable side effects. And different selections of anchorages might alter the biomechanical environment during the treatment. Thus, the purpose of the current study was to analyse the stress distributions and initial displacements, with the different anchorage selections, of teeth during space closing stage through 3D finite element method.

Tensile and Shear Breaking Force of the Joints Between Stainless-Steel Orthodontic Bands and Buccal Tube Attachments Joined by Laser and TIG Welding Without Filler Material

Orthodontic appliances usually require the joining of different stainless-steel parts in order to achieve adequate control over tooth movement during the active treatment. The aim of this study was to assess the tensile and shear breaking force of the joints between forty orthodontic bands and forty attachments (buccal tubes), joined by laser and TIG welding, without filler material. For the laser welding technique, we used an XXS Laser (OROTIG) welding unit and for the TIG welding technique, a PUK D2 (LAMPERT) welding unit. The tensile and shear breaking force of the welded joints was determined using the Z010 Zwick/Roell testing machine. The independent-samples t-test showed statistically significant differences between the laser and TIG groups for both the tensile and the shear breaking force tests, the laser welded samples having better mechanical strength than the TIG welded samples. For practical use, under normal loading forces, both techniques are suitable for this particular application in orthodontics. In patients with parafunctional habits, that could develop higher bite forces, the failure of the welded joints might occur if the welding surface is not increased, especially for the TIG welding technique.

Adhesive luting of orthodontic devices to silica-based ceramic crowns-comparison of shear bond strength and surface properties.

The aim of this study was to analyse the impact of different clinical conditioning approaches and an ammonium polyfluoride- and trimethoxysilylpropyl methacrylate-based experimental primer for intraoral luting of buccal tubes on silica-based ceramic surfaces. A total of 60 leucite-reinforced glass ceramic molar crowns were conditioned using different methods (n = 10): I-roughening, hydrofluoric acid, silane; II-roughening, silane; III-roughening, experimental coupling agent; IV-experimental coupling agent; V-roughening; VI-no treatment. A buccal tube was adhesively luted to the ceramic surface. Subsequently, water storage, thermocycling and chewing simulation were carried out. The shear bond strength (SBS) was determined, and changes in the surface were assessed. All tubes of the control group (group VI) debonded after incubation. The conditioning methods using coupling agents revealed mean values for SBS of 61.56MPa (group I), 45.53MPa (group III), 41.65MPa (group II), and 23.14MPa (group IV). In groups I-III, both composite residues and cracks/tear-outs were detected. The conditioning of silicate ceramic surfaces with a suitable coupling agent system appears to allow sufficient adhesive luting of buccal tubes. The intraoral luting of fixed appliance elements on silicate ceramic surfaces using an ammonium polyfluoride- and trimethoxysilylpropyl methacrylate-based ceramic primer can withstand orthodontic forces. Ammonium polyfluoride- and trimethoxysilylpropyl methacrylate-based ceramic primers revealed promising results for the intraoral adhesive luting of orthodontic devices to silica-based ceramic crowns.

An in vitro assessment of microbial contamination of “As received” and “bench-top exposed” orthodontic materials

Introduction: The assumption of sterility of packed materials used in orthodontics may lead practitioners to use them without the necessary sterilization. Hence, this study was undertaken to assess the microbial contamination of the orthodontic materials “as received” from the manufacturers and materials exposed in the clinical environment before using it in the patient. Materials and Methods: Orthodontic materials obtained from 3 different manufacturers (3M, GAC, TP Orthodontics) were divided into 2 categories (“as received” from the manufacturers and “bench top” materials exposed to the clinical environment).Microbiological investigation was carried out using aerobic and anaerobic culture media. Identification of Bacterial species was done and colony forming units (CFU/ml) were measured. Result: The most commonly used orthodontic materials were found to be contaminated. The species identified were Klebsiella, Streptococci and Citrobacter from elastomeric chains, molar bands, buccal tubes and lingual sheaths. Conclusion: new packed materials are not always free from bacterial contamination and it is pivotal for manufacturers to state and the practitioners to ensure the sterility of materials before using in oral cavity. Keywords: Orthodontic materials, Microbial contamination, Sterilization.

Emergency appointments in orthodontics

Introduction Patients undergoing fixed orthodontic treatment are usually recalled electively for the adjustments of the appliances, but sometimes they appear suddenly for emergency visit which must be addressed immediately. The primary objective of this study was to assess the nature and frequency of emergency visits made by patients under labial fixed orthodontic therapy. The secondary objective was to compare these visits between genders and age groups. Materials and Methods The study was conducted at orthodontic clinic, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. All the patients undergoing fixed labial orthodontic treatment were included and followed up for a period of 6 months. The reason for emergency appointment was recorded along with the demographic and clinical details. Chi-square test was used to find out the possible association between gender and age group with emergency appointment. Results Of 327 patients undergoing active fixed orthodontic therapy, 199 were female and 128 were male. A total of 176 emergency appointments were encountered during the study period of 6 months. The most common reason was the loosening of brackets or bondable buccal tubes (118) followed by loosening of bands (45). Other reasons were trauma to the buccal mucosa by the overextended wire (5), detachment of buccal tubes from the band (5), tearing of bands (3), breakage of acrylic plate (2), loosening of ligature tie (1), and dislodgement of elastomeric chain (1). Emergency appointments were not found to have statistically significant association with age group (χ2 = 0.073, P = 0.787) or the gender (χ2 = 3.196, P = 0.074). Conclusions Loosening of the brackets or bondable buccal tubes was the most common cause for emergency visit. No significant association was found between the gender and age group with such visits.

Evaluation of Salivary Nickel, Chromium and Iron Ions in Patients Treated with Fixed Orthodontic Appliances in Vivo Study

Background and objectives: Most fixed orthodontic appliances are made of stainless steel and Nickel-Titanium alloys, which can release metal ions into the oral cavity. The present study aimed to determine the release of Nickel, Chromium and Iron ions into saliva of patients treated with a fixed orthodontic appliance. Subjects and methods: Saliva samples from 18 patients (9 males and 9 females) between 15-25 years were taken at three different time points, group A: before placement of the appliance directly (baseline), group B: one month after appliance placement, Group C: four months after appliance placement. The fixed appliance consists of 20 stainless steel brackets, 4 buccal tubes, and superelastic Nickel-Titanium archwires. Level of ions in salivary samples was analyzed by Inductively Coupled Plasma Optical EmissionSpectrometry. Ions recorded in parts per billion. Statistical analysis was performed by nonparametric tests (Friedman) and one way repeated measures ANOVA. Results: Level of Nickel, Chromium and Iron ions in saliva were highest in group B and lowest in group A. on a pairwise comparison between different groups, it was statistically significant for all groups (< 0.05) except for Iron levels between group A and group C which was not statistically significant. Conclusion: Nickel, Chromium and Iron levels in saliva were increased after the placement of fixed orthodontic appliance.