Effects of Different Sterilization Methods on Orthodontic Wires: An In Vitro Study

Objective

The purpose of this study was to determine the effect of common methods of sterilization on the tensile strength of Beta titanium, Stainless steel, Australian Stainless steel, Copper Nickel-Titanium, and Nickel-Titanium wires. It also aimed to evaluate the changes in tensile strength values caused by repeated cycles of sterilization.

Materials and Methods

A sample of 225 orthodontic wires, i.e., beta-titanium, stainless steel, Australian stainless steel, copper nickel-titanium, and nickel-titanium wires, were collected from different manufacturers. These wires were divided into three groups, which consists of Groups 1, 2, and 3. Four methods of sterilization used in this study were as follows: (i) autoclave (250°F for 20 min), (ii) dry heat sterilization (375°F for 20 min), (iii) ethylene oxide sterilization (54°C for 4 hrs), and (iv) 2.45% acidic glutaraldehyde (10 hrs).

Results

The results of this study showed that there was increase in tensile strength of beta-titanium and nickel-titanium wires using autoclave and dry heat sterilization. No statistically significant difference in tensile strength of stainless steel and Australian stainless steel archwires. The tensile strength of copper nickel-titanium wires decreased following 0, 1, and 5 cycles of sterilization.

Conclusion

The lack of statistically significant differences established in the study of new and sterilized orthodontic archwires gives us reason to conclude that the orthodontic arch wires can be sterilized because the sterilizing processes do not affect their tensile strength and the orthodontists could thus ensure the maximum safety of their patients.

Properties of Superelastic Nickel-Titanium Wires after Clinical Use

The aim of the present study was to describe and determine changes in the superelastic properties of NiTi archwires after clinical use and sterilization. Ten archwires from five different manufacturers (GAC, 3M, ODS, GC, FOR) were cut into two segments and evaluated using a three-point bending test in accordance with ISO 14841:2006. The center of each segment was deflected to 3.1 mm and then unloaded to 0 N to obtain a load-deflection curve. Deflection at the end of the plateau and forces at 3, 2, 1 and 0.5 mm on the unloading curve were recorded. Plateau slopes were calculated at 2, 1 and 0.5 mm of deflection. Data obtained were statistically analyzed to determine differences (p < 0.001). Results showed that the degree of superelasticity and exerted forces differed significantly among brand groups. After three months of clinical use, FOR released a greater force for a longer activation period. GC, EURO and FOR archwires seemed to lose their mechanical properties. GC wires released more force than other brand wires after clinical use. Regarding superelasticity after sterilization, GAC, 3M and FOR wires recovered their properties, while EURO archwires lost more.

Fit and forget: The future of dental implant therapy via nanotechnology

Unlike orthopedic implants, dental implants require the orchestration of both osseointegration at the bone-implant interface and soft-tissue integration at the transmucosal region in a complex oral micro-environment with ubiquitous pathogenic bacteria. This represents a very challenging environment for early acceptance and long-term survival of dental implants, especially in compromised patient conditions, including aged, smoking and diabetic patients. Enabling advanced local therapy from the surface of titanium-based dental implants via novel nano-engineering strategies is emerging. This includes anodized nano-engineered implants eluting growth factors, antibiotics, therapeutic nanoparticles and biopolymers to achieve maximum localized therapeutic action. An important criterion is balancing bioactivity enhancement and therapy (like bactericidal efficacy) without causing cytotoxicity. Critical research gaps still need to be addressed to enable the clinical translation of these therapeutic dental implants. This review informs the latest developments, challenges and future directions in this domain to enable the successful fabrication of clinically-translatable therapeutic dental implants that would allow for long-term success, even in compromised patient conditions.

Enhanced Corrosion Resistance and Local Therapy from Nano-Engineered Titanium Dental Implants

Titanium is the ideal material for fabricating dental implants with favorable biocompatibility and biomechanics. However, the chemical corrosions arising from interaction with the surrounding tissues and fluids in oral cavity can challenge the integrity of Ti implants and leach Ti ions/nanoparticles, thereby causing cytotoxicity. Various nanoscale surface modifications have been performed to augment the chemical and electrochemical stability of Ti-based dental implants, and this review discusses and details these advances. For instance, depositing nanowires/nanoparticles via alkali-heat treatment and plasma spraying results in the fabrication of a nanostructured layer to reduce chemical corrosion. Further, refining the grain size to nanoscale could enhance Ti implants' mechanical and chemical stability by alleviating the internal strain and establishing a uniform TiO₂ layer. More recently, electrochemical anodization (EA) has emerged as a promising method to fabricate controlled TiO₂ nanostructures on Ti dental implants. These anodized implants enhance Ti implants' corrosion resistance and bioactivity. A particular focus of this review is to highlight critical advances in anodized Ti implants with nanotubes/nanopores for local drug delivery of potent therapeutics to augment osseo- and soft-tissue integration. This review aims to improve the understanding of novel nano-engineered Ti dental implant modifications, focusing on anodized nanostructures to fabricate the next generation of therapeutic and corrosion-resistant dental implants. The review explores the latest developments, clinical translation challenges, and future directions to assist in developing the next generation of dental implants that will survive long-term in the complex corrosive oral microenvironment.

Nanotopography Evaluation of NiTi Alloy Exposed to Artificial Saliva and Different Mouthwashes

Nitinol (NiTi) alloy is a widely used material for the production of orthodontic archwires. Its corrosion behavior in conditions that exist in the oral cavity still remains a great characterization challenge. The motivation behind this work is to reveal the influence of commercially available mouthwashes on NiTi orthodontic archwires by performing non-electrochemical corrosion tests and quantifying the changes in the nanotopography of commercially available NiTi orthodontic wires. In this study, we examined the behavior of NiTi alloy archwires exposed for 21.5 days to different corrosive media: artificial saliva, Eludril^®, Aquafresh^®, and Listerine^®. The corrosion was characterized by contact mode atomic force microscopy (AFM) before and after the corrosion tests. A novel analysis methodology was developed to obtain insight into locations of material gain or material loss based on standard surface roughness parameters Sa, Sdr, Ssk, and S10z. The developed methodology revealed that fluoride-containing mouthwashes (Aquafresh^® and Listerine^®) dominantly cause material loss, while chloride-containing mouthwash (Eludril^®) can cause both material loss and material gain. The sample exposed to artificial saliva did not display significant changes in any parameter.

The effect of fluoride gel on tensile properties, surface morphology and chemical composition of two types of orthodontic wires (an in-vitro study)

OBJECTIVE:

Stainless steel and nickel-titanium wires are commonly used in fixed orthodontic appliances. Orthodontists often prescribe fluoride gel to avoid demineralization of teeth. This study investigated the effect of acidulated phosphate fluoride gel on the tensile properties, surface morphology and surface chemical composition of stainless steel and nickel-titanium wires.

METHODS:

Forty samples of stainless steel and nickel-titanium wires were examined, twenty for each type. Each wire type was divided into four subgroups. The first subgroup was not immersed in fluoride gel and considered as control, while the other three subgroups were immersed in 10 mL of fluoride gel for different periods of time. Then, the wires were removed from the gel, rinsed in a distilled water and left to dry. The ultimate tensile force of each wire was measured using a tensile testing machine. Scanning electron microscope (SEM) and energy-dispersive X-ray spectroscopy (EDX) were used to examine the control and 24 h immersed subgroups.

RESULTS:

One-way analysis of variance ANOVA showed that there were no significant differences in the ultimate tensile forces between control and fluoride-treated subgroups (P = 0.172 for SS wires and P = 0.672 for NiTi wires). However, changes in the surface morphology and elemental composition of wires were shown by the SEM and EDX.

CONCLUSIONS:

Although immersion of stainless steel and nickel-titanium wires in the fluoride gel did not affect their tensile properties, however, surface deterioration was evident. So, further investigations are recommended to study the effect of these changes on the oral health of patients.

Effects of salivary pH on coating durability of two different aesthetic archwire coatings under a simulated intraoral environment

Objectives

This study compared the effects of normal salivary pH, and acidic pH found in patients with poor oral hygiene, on the durability of aesthetic archwire coated with epoxy resin and polytetrafluoroethylene (PTFE).

Methods

The posterior parts of the archwires were sectioned into 20 mm segments (N = 102) and divided among six groups. Four groups were treated with different pH levels and two served as controls. The specimens were immersed in individual test tubes containing 10 ml of artificial saliva adjusted to a pH of 6.75 or 3.5. The tubes were sealed and stored in a 37 °C water bath for 28 days. After 28 days, the specimens were ligated to brackets embedded in an acrylic block and subjected to mechanical stress using an electronic toothbrush for 210 s. The specimens were photographed, and images were measured for coating loss using AutoCAD® software. Surface morphology was observed using a scanning electron microscope (SEM).

Results

Significant coating loss (p < 0.001) was found in the epoxy resin groups, regardless of pH value, but not in the PTFE groups. The acidic pH caused epoxy resin layer coating loss by twice as much as normal pH. SEM revealed existing manufacturing defects on the as-received epoxy resin coating, whereas the retrieved epoxy resin demonstrated rupture, roughness, and coating loss in multiple locations.

Significance

Epoxy resin coatings demonstrate poor durability in acidic environments. This condition is worsened by the existing manufacturing defects found on as-received archwires. Hence, archwires coated with epoxy resin are not recommended in patients with poor oral hygiene.

In vivo assessment of the corrosion of nickel-titanium orthodontic archwires by using scanning electron microscopy and atomic force microscopy

This study was undertaken to assess in vivo the corrosion in two commercial nickel-titanium (NiTi) orthodontic archwires removed from the oral cavity of patients using fluoride mouthwashes. Five volunteers took part in this study on the corrosion behavior of two brands of NiTi archwires (3M and AO (brand of archwire)) during use of two mouthwashes with neutral sodium fluoride 1.1%, one with acidulated fluoride 1.1%, and one with placebo and a control group. Each patient used one mouthwash in three different periods of time for 1 min a day for 30 days. The archwires were assessed with scanning electron microscopy and atomic force microscopy for qualitative and quantitative analysis. The values obtained with atomic force microscopy (AFM) were submitted to normality test, two-way analysis of variance, and Tukey's test at a significance level of 5%. The AFM images showed a gradual qualitative increase in the roughness of both types of wire between the treatments: control < placebo < neutral fluoride < acidulated fluoride. The arithmetic average of the roughness and root mean square of the roughness were similar. As for 3M archwires, only the acidulated fluoride group differed statistically from the others. As for AO archwires, the control and placebo groups did not differ from each other, but differed from the other fluoride treatments. The group using neutral fluoride also differed significantly from the acidulated fluoride group. 3M archwires were not affected by daily oral challenges. AO archwires were not affected by daily oral challenges either; their association with fluoride, either neutral or acidulated, increased their roughness.

An evaluation of two types of nickel-titanium wires in terms of micromorphology and nickel ions' release following oral environment exposure

Background

This study aimed to compare superelastic and heat-activated nickel-titanium orthodontic wires’ surface morphology and potential release of nickel ions following exposure to oral environment conditions.

Methods

Twenty-four 20-mm-length distal cuts of superelastic (NiTi Force I®) and 24 20-mm-length distal cuts of heat-activated (Therma-Ti Lite®) nickel-titanium wires (American Orthodontics, Sheboygan, WI, USA) were divided into two equal groups: 12 wire segments left unused and 12 segments passively exposed to oral environment for 1 month. Scanning electron microscopy and atomic force microscopy were used to analyze surface morphology of the wires which were then immersed in artificial saliva for 1 month to determine potential nickel ions’ release by means of atomic absorption spectrophotometer.

Results

Heat-activated nickel-titanium (NiTi) wires were rougher than superelastic wires, and both types of wires released almost the same amount of Ni ions. After clinical exposure, more surface roughness was recorded for superelastic NiTi wires and heat-activated NiTi wires. However, retrieved superelastic NiTi wires released less Ni ions in artificial saliva after clinical exposure, and the same result was recorded regarding heat-activated wires.

Conclusions

Both types of NiTi wires were obviously affected by oral environment conditions; their surface roughness significantly increased while the amount of the released Ni ions significantly declined.