Effects of Orthokin, Sensikin and Persica mouth rinses on the force degradation of elastic chains and NiTi coil springs

Physico-mechanical and antimicrobial properties of an elastomeric ligature coated with reduced nanographene oxide-nano curcumin subjected to dual-modal photodynamic and photothermal inactivation against Streptococcus mutans biofilms

BACKGROUND

White spot lesions (WSLs) are a common side effect of fixed orthodontic treatment. Streptococcus mutans is the primary causative agent of WSLs and dental caries on the teeth during treatment. According to the unique features of reduced graphene oxide-nano curcumin (rGO-nCur), this study aimed to investigate the mechanical properties and antimicrobial potency of rGO-nCur coated orthodontic elastomeric ligatures as a novel coating composite following dual-modal photodynamic inactivation (PDI) and photothermal inactivation (PTI) against S. mutans biofilms.

METHODS

After confirmation of rGO-nCur synthesis and coating elastomeric ligatures with different concentration levels of 1.25, 2.5, 5, 7.5, and 10 % of rGO-nCur, tensile strength, force decay, extension to tensile strength, and contact angle of the coated elastomeric ligatures were measured using universal testing machine and sessile drop method, respectively. To investigate the mechanism through which irradiated rGO-nCur can inhibit the formation of S. mutans biofilms, intracellular reactive oxygen species (ROS) generation, and increase in temperature of rGO-nCur solutions under the 450 and 980 nm laser irradiation, respectively, were measured. The anti-biofilm activity and inhibition of water-insoluble extracellular polysaccharide (EPS) production ability of irradiated rGO-nCur coated elastomeric ligatures using a 450 nm diode laser (195 J/cm2), a 980 nm diode laser (195 J/cm2), and a combination of both (78 J/cm2 of irradiation from each one) (i.e., PDI, PTI, and dual-modal PDI/PTI, respectively) were determined. Also, the expression of virulence genes involved in biofilm formation (comDE, gtfD, and smuT) was assessed by quantitative real-time polymerase chain reaction (RT-qPCR) following the mentioned treatment. One-way ANOVA test and Tukey post-hoc test at a p-value equal to/or less than 0.05 were used to analyze the obtained data.

RESULTS

The synthesis of GO nano-sheets in a layered structure with a thickness of 0.76 nm was confirmed by AFM analysis. FESEM showed that the exfoliated sheet of synthesized GO had several micrometers in lateral size. DLS revealed that the mean particle size and density index of synthesized nCur were 57.47 ± 2.14 nm and 10 % respectively. In DLS analysis, rGO-nCur showed more positive surface charge (24 mV) than the nano-sheets of GO. FESEM confirmed the coating of rGO-nCur on elastomeric ligatures. ANOVA revealed that tensile strength of 1.25, 2.5, and 5 % rGO-nCur coated elastomeric ligatures were not decreased statistically significantly (P > 0.05). Mean tensile strength and recorded force of 7.5 and 10 % rGO-nCur coated elastomeric ligatures decreased significantly after 14 days' immersion in the artificial saliva (P < 0.05). On the 28th day of the study, the mean of the tensile strength of elastomeric ligatures coated with 10 % rGO-nCur (13.03 ± 0.10 N) was recorded as 55.90 % of the initial tensile strength (23.31 ± 0.41 N in uncoated elastomeric ligatures), while the mean tensile strength of elastomeric ligatures coated with 7.5 % rGO-nCur (16.01 ± 0.10 N) was measured as 68.94 % of the initial tensile strength (23.22 ± 0.09 N in uncoated elastomeric ligatures). When comparing the coated elastomeric ligatures at 7.5 % and 10 % to the original uncoated elastomeric ligatures at similar time intervals, statistically significant decreases in extension to tensile strength (0.42 to 0.71 mm or 3.02 to 5.05 %; all P < 0.05) were observed. The largest contact angle was measured in elastomeric ligatures coated by 10 % rGO-nCur followed by 7.5 and 5 % rGO-nCur (128 ± 2.19°, 117 ± 2.23°, and 99 ± 1.83°; respectively). The results revealed a rise of 6.4-fold in intracellular ROS and an 11.2 °C increase in the temperature of rGO-nCur solutions following the 450 nm and 980 nm laser irradiation, respectively. The 5 % rGO-nCur coated elastomeric ligature mediated dual-modal PDI/PTI showed the most inhibition of the biofilm formation of S. mutans by 83.62 % (P = 0.00). Significant reductions in water-insoluble EPS were detected in biofilm cultures of S. mutans on 1.25 % rGO-nCur coated elastomeric ligatures following irradiation with dual waves of the 450 nm and 980 nm diode lasers (i.e., dual-modal PDI/PTI; 96.17 %; P = 0.00). The expression levels of comDE, gtfD, and smuT virulence genes were significantly downregulated (7.52-, 13.92-, and 8.23-fold, respectively) in the biofilm cultures of S. mutans on 1.25 % rGO-nCur coated elastomeric ligatures following dual-modal PDI/PTI in comparison with biofilm cultures on non-coated elastomeric ligatures.

CONCLUSION

5 % rGO-nCur coated elastomeric ligatures following irradiation with dual waves of the 450 and 980 nm diode lasers (dual-modal PDI/PTI), without adverse effects on the physico-mechanical properties of elastomeric ligatures, can be used to inhibit the formation of S. mutans biofilms on the coated elastomeric ligatures around orthodontic brackets.

Effect of mouthwashes on the force decay of polymeric ligature chains used for dental purposes: a systematic review and meta-analysis

BACKGROUND

External factors such as the daily use of antimicrobial mouthwashes to maintain oral hygiene and to reduce the microbial activity can contribute to alter the mechanical properties of the elastomeric chains used during orthodontic treatments, causing loss of effectiveness. This systematic review and a meta-analysis assessed the rate of force decay and degradation of the polymeric chains depending on the type of mouthwash.

METHODS

A systematic search of the literature were there was an exposure of orthodontic elastomeric chains to certain mouthwashes was conducted in the electronic databases of PubMed, Cochrane Library (CENTRAL), Scopus, EMBASE and Web of Science, as well as grey literature (Opengrey). No limit was placed on publication year and research was done up to June 2022. Based on inclusion/ exclusion criteria, data were extracted by two independent reviewers. For the quantitative analysis, studies were analysed with a mixed-effect (random effect) meta-regression model, with beta coefficients and R [2] values. I [2] index and Q and Egger tests were used to find heterogeneity among studies.

RESULTS

A total of 178 potentially eligible studies were identified, of which 14 were eventually included in the qualitative analysis and 14 in the quantitative meta-analysis. The meta-analysis showed that all the mouthwashes were associated with a greater force decay than the control groups. After 7 days (p = 0.005) significant differences were found among the different mouthwashes, with those containing alcohol having significantly higher impact on the force decay than those containing chlorhexidine 0.2%, sodium fluoride or Persica. However, at 24 h (p = 0.200), 14 days (p = 0.076), 21 days (p = 0.120) and 28 days (p = 0.778) no statistically significant differences among the different mouthwashes were found, although those containing alcohol presented a strong tendency.

CONCLUSION

Although mouthwashes tend to increase the speed of force decay of elastomeric chains, especially those containing alcohol, clorhexidine 0.2% can be a good alternative due to its low impact on the force decay and its ability to maintain low microbial activity. More in vitro and in vivo studies comparing different manufacturers and other agents should be performed.

Evaluation of force decay rate in orthodontic elastomeric chains in the environment of various mouthwashes: A systematic review

Background

Different studies about the effects of mouthwashes on force reduction by elastomeric chains are reported in the literature. Hence, this review was done for the assessment of force degradation in the elastomeric chains in different mouthwash compositions. This study helps to improve the clinical performance of elastomeric chains used in orthodontics, reducing force degradation, and finally assisting clinicians in choosing better and more efficient methods for their treatments.

Materials and Methods

In this review article, an extensive search was performed in the electronic databases of Cochrane Library, Web of Science, PubMed, and Scopus from the year 1990-2020. No language restriction was considered and manually investigated the reference lists of all articles related to the title. Out of 450 obtained articles, 14 in vitro studies were chosen based on the inclusion criteria, and their quality was assessed using modified CONSORT. This systematic review was limited and written based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol.

Results

Based on the results achieved, mouthwashes containing alcohol caused considerable force degradation in the elastomeric chains compared to the alcohol-free ones and mouthwashes with fluoride caused lesser force degradation compared to other types.

The Effects of Zinc-Containing Mouthwashes on the Force Degradation of Orthodontic Elastomeric Chains: An In Vitro Study

Objective

This study aimed to evaluate and compare the force degradation of two types of elastomeric chains following different periods of immersion in zinc-containing mouthwashes.

Materials and Methods

Four hundred and forty pieces of Elasto-Force and Super Elasto-Force elastomeric chains were divided into two control and eight experimental groups. The pieces were stretched to 25 mm on pins mounted on an acrylic block and stored in distilled water at 37°C. The experimental groups were immersed in four different types of mouthwash for one minute twice a day throughout the test period. Ten continuous thermocycles per day between cold and hot water baths (5–55°C) were carried out. Forces were measured at six-time intervals (initial, 24 hours, 1, 3, 6, and 8 weeks). The mean force was calculated and compared among different elastomeric chains, mouthwashes, and times using the t-test and one-way ANOVA test followed by Tukey's HSD test. The level of significance was set at 0.05.

Results

Both types of elastomeric chains had significant force degradation over time (74–79% at 8 weeks). The Super Elasto-Force generated a higher force level than the Elasto-Force elastomeric chain at all time points. SmartMouth Clinical DDS mouthwash had a significantly lower effect on force degradation than other mouthwashes with no significant difference compared to control groups.

Conclusions

Depending on these results: there is no clinically significant difference between both types of elastomeric chains, although Super Elasto-Force delivered a higher force level. The pH of the mouthwashes could play a role in force degradation over time, rather than other ingredients including zinc. The SmartMouth mouthwash had the minimum effect on force degradation of elastomeric chains, followed by Halita, Listerine Total Care Zero, and Breath Rx, respectively.

Canine and molar movement, rotation and tipping by NiTi coils versus elastomeric chains in first maxillary premolar extraction orthodontic adolescents: A randomized split-mouth study

PURPOSE

The primary objective was to compare canine and molar movement between NiTi coil and elastomeric chains. The secondary objective was to compare the side effects of these techniques (rotation and tipping).

MATERIALS AND METHODS

This single-blind randomized split-mouth clinical trial was done prospectively. Healthy patients who needed extraction of the first maxillary premolars and did not require anchorage reinforcement techniques for orthodontic treatment were included. Following initial levelling and alignment a dental cast and panoramic radiographs were taken (pre-space closure documents) and canine retraction was done using elastomeric chains on one side and NiTi closed coil spring on the other side. After four months, the same documents were taken and movement (mm), as well as rotation (degree) and tipping (degree) of canines and first molars, were calculated by comparison of pre and post space closure documents by a blinded examiner. Data were analysed by independent samples t-test and Mann-Whitney U test with a significance level of 0.0125.

RESULTS

Overall 20 patients completed the study. The average canine movement was 3.88 and 5.45mm (distal movement) in elastomeric chains and NiTi coil groups, respectively (P=0.001). For molars, the movement was 1.20 and 1.15mm (mesial movement), respectively (P=0.529). The mean rotation of the canine in elastomeric chains and NiTi coil groups were 4.50° and 7.43° (mesiobuccal rotation), respectively (P=0.006). For the molars, the mean rotation was 0.23° and 1.90° (mesiolingual rotation), respectively (P=0.307). Average tipping of the canine in elastomeric chains and NiTi coil groups were 4.52° and 7.55° (distal tipping), respectively (P=0.011). For the molars, the numbers were 1.45° and 4.80° (mesial tipping), respectively (P=0.028).

CONCLUSION

Canine retraction by NiTi coil springs is faster compared to elastomeric powerchains with the cost of more canine tipping and rotation and more molar tipping. No significant difference was found in molar movement, rotation and tipping between the two techniques.

Comparison of in vivo and in vitro force decay of elastomeric chains/modules: a systematic review and meta analysis

BACKGROUND

The study evaluated and compared the force decay of orthodontic elastomeric chains/modules in both in vivo and in vitro settings.

METHODS

A protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was formulated and registered with the International Prospective Register of Systematic Reviews. A total of 53 articles (44 in vitro and 9 in vivo studies) found via search of the electronic databases of Cochrane and the National Library of Medicine (MEDLINE; PubMed), and manual search of the gray literature from institutional library resources, were selected. Data extraction, quality analysis, risk of bias assessment, and meta-analysis of the level of force decay of elastomeric chains/modules were conducted per standard protocol, and suitable statistical analyses were applied.

RESULTS

The mean force decay in the in vivo setting was 41.9% at 24 hours, 42.6% after 1 week, 46.8% after 2 weeks, and 55.0% after 3 weeks. Similarly, the force decay in the in vitro studies was 38.9% at 24 hours, 42.1% after 1 week, 44.6% after 2 weeks, and 51.1% after 3 weeks. However, at the 95% confidence interval, the force decay rates of in vivo and in vitro studies overlap, with a statistically insignificant difference in force decay observed in the in vivo and in vitro settings.

CONCLUSIONS

This systematic review and meta-analysis observed more force decay in the in vivo studies versus the in vitro studies (although this difference was statistically insignificant), with the maximum force decay occurring during the initial days, with a reduction to approximately 50% within 3 weeks. Hence, change of the elastomeric chains/module, at intervals of 3 weeks, is advised. (PROSPERO registration no. CRD42020209535).

Effect of citric acid on force decay of orthodontic elastomeric chains

BACKGROUND

This study aimed to assess the effect of citric acid, as a weak acid commonly used in food industry, on elastomeric chain force decay.

MATERIALS AND METHODS

In this in vitro, experimental study, sixty elastomeric chains from two commercial brands of American Orthodontics and Ortho Technology (n = 30) were cut into five-piece segments. Elastomeric chains of each brand were randomly divided into two groups of control (artificial saliva) and citric acid. All elastomeric chains were incubated in artificial saliva at 37°C. Experimental samples were immersed in 10 mL of citric acid for 90 s daily and were then transferred back to the artificial saliva. The elastomeric chain force was measured at baseline (before the experiment), 1 day, 1 week, 2 weeks, and 3 weeks using an electromechanical universal testing machine. Data were analyzed using t-test, Kruskal-Wallis test, and Mann-Whitney U-test at 0.05 level of significance.

RESULTS

The elastomeric chain force gradually degraded over time. The difference in this respect was not significant at 2 and 3 weeks in any group (P > 0.05). On initiation of the experiment, the force in the citric acid group experienced a greater decay than that in the control group; the difference between the citric acid and control groups in both the brands was significant at all time points until the end of the 3^rd week (P < 0.05). The difference between the American Orthodontics and Ortho Technology brands in the control and citric acid groups was significant at all time points (P < 0.001).

CONCLUSION

Elastomeric chains in both the citric acid and artificial saliva groups experienced force decay over time. Force decay was greater in the citric acid group. Thus, citric acid can effectively decrease the elastomeric chain force. The Ortho Technology chain force was higher than that of American Orthodontics in both the groups at all time points.

Comparative evaluation of force decay pattern in orthodontic active tiebacks exposed to five different mouth rinses: An in vitro Study

Background. This study compared the force decay pattern of two different orthodontic active tiebacks (ATBs) exposed to five different commercially available mouth rinses.

Methods. In this in vitro study, 90 transparent ATBs and 90 gray ATBs were divided into six groups; one was the control group, and the others were exposed to one of these mouth rinses twice a day for 60 seconds: Listerine, chlorhexidine, Orthokin, Persica, and fluoride. The initial force of each ATB was 250 g at a 24-mm extension. The force of ATBs was measured on days 1, 7, 14, and 28 using a digital gauge.

Results. The highest percentage of force loss was observed between days 14 and 28 (P<0.05). At the end of the study, the Persica group exhibited the highest force degradation in both ATB types. In the transparent ATBs, it was followed by Orthokin, Listerine, fluoride, chlorhexidine, and control groups, respectively. In the gray ATBs, Orthokin, chlorhexidine, control, Listerine, and fluoride groups exhibited the highest force decay in descending order. In some groups, the differences between transparent and gray ATBs were significant. In the control group, the force of transparent ATB was significantly higher than gray ones on days 7 and 14 but not significantly after four weeks.

Conclusion. ATBs’ force degradation could be exacerbated by the use of some mouth rinses. There were some differences between force relaxation patterns of transparent and gray ATBs. The data could be beneficial in choosing appropriate O-rings for making ATBs.

Evaluation of the force degradation and deformation of the open-closed and open springs of NiTi: An in vitro study

OBJECTIVE

The aim of this study was to evaluate the force degradation and deformation over time of an open-closed and open coil spring.

MATERIAL AND METHODS

40 NiTi springs were divided into 2 groups according to the manufacturer (20 specimens per group): Morelli™ (Sorocaba, SP, Brazil) and Orthopli™ (Philadelphia, PA, USA). Then, they were subdivided into 2 groups according to the type of spring (n=10): open spring and open-closed spring. The springs were submitted to the initial compression test in a Universal Test Machine (Instron) in 43.3% of the initial length and analyzed in 3 points (0.5mm, 3.25mm and 6.5mm). After this, the springs were activated with a 240 gf and those maintained for 4 weeks in artificial saliva in the oven at 37°C, and analyzed by a new compression test with the same initial parameters. Scanning Electron Microscopy/Energy Dispersive X-Ray Spectroscopy (SEM/EDS) analyzed the spring's morphology. Two-way repeated measures Analysis of Variance was applied for each brand and extension of compression. Student t-test with correction of Bonferroni was used to compare open spring vs open-closed springs and pairwise t-test was used to compare initial vs final period. The level of significance was set at 95% in all tests. The most representative images were selected (SEM/EDS).

RESULTS

The Orthopli™ open-closed spring showed a statistically higher deformation (14.52±0.37) in relation to open spring (14.85±0.19) after 4 weeks (P<0.05). No statistical difference was observed between the types of Morelli™ springs (P>0.05). Orthopli™ open-closed spring showed force values statistically higher than the open spring in the initial and final time (P<0.05). Regardless of the type of spring, the initial force was significantly higher than the final force (P<0.05).

CONCLUSIONS

The orthodontist should not rely on the indicated force range without considering the type of spring (open or open-closed), the manufacturer and the amount of compression of the spring.

Effect of Bleaching Mouthwash on Force Decay of Orthodontic Elastomeric Chains

INTRODUCTION

Force decay elastomeric chains are significant, and it is a clinical problem.

AIM

The aim of this study was to evaluate the effects of bleaching agent in the mouthwash on the force decay of orthodontic chains.

MATERIALS AND METHODS

In this experimental study, 160 gray closed elastomeric chains were randomly divided into three groups (one control and two test groups). Four loops of chains were stretched for 25 mm on custom-made jig. Control group specimens were immersed in artificial saliva during the test period. Test group specimens were immersed twice a day for 30 seconds in the whitening (LISTERINE® HEALTHY WHITE™) and daily sodium fluoride (LISTERINE® TOTAL CARE ZERO) mouthwashes. All specimens were immersed in artificial saliva at 37°C. Force was measured at different time points (initial, 1, 7, 14, 21, 28 days). Statistical analysis was performed by two-way analysis of variance (ANOVA) and Bonferroni methods (a = 0.05).

RESULTS

Force of elastomeric chains was decreased dramatically in all groups during the experiment. After 24 hours, force was decreased by 42.18, 48.34, and 53.38% in control group, daily, and bleaching mouthwash groups respectively. The corresponding numbers after 4 weeks were 66.30, 76.73, and 86.48. The difference between three groups at days 1 and 28 was statistically significant (p < 0.05).

CONCLUSION

Within the limitations of the current in vitro study, bleaching and sodium fluoride mouthwashes could cause force decay of orthodontic elastomeric chains. Whitening mouthwash is more weakening for elastomeric chains.

CLINICAL SIGNIFICANCE

Use of whitening mouthwash by orthodontic patients could decrease the force of elastomeric chains, so it could be recommended to use them for a short time.