Influence of Different Orthodontic Brackets on Adherence of Microorganisms In Vitro

Antimicrobial efficacy of zinc oxide nanoparticle-coated aligners on Streptococcus mutans and Candidaalbicans

INTRODUCTION

This study aimed to assess the antimicrobial effect of zinc oxide (ZnO) nanocoating on aligners.

METHODS

Twenty-six samples of aligners were sputter-coated with ZnO nanoparticles and compared with 26 uncoated samples. The antimicrobial effect was assessed on Streptococcus mutans and Candida albicans. The thickness of the ZnO coating was standardized at 100 nm. The antimicrobial effect was evaluated for 7 days at the following time points: 6 hours, 12 hours, first day, second day, fourth day, and seventh day. Colony culture tests were performed for microbial evaluation.

RESULTS

ZnO-coated aligners showed significant antimicrobial efficacy against S mutans at all time points tested (P <0.001). The antimicrobial effect was observed up to 2 days after a decline. The activity against C albicans was minimal at all time points, and no statistical significance was observed (P >0.05).

CONCLUSIONS

ZnO-nanocoated aligners were effective against S mutans, with the maximum antibacterial effect observed until 2 days and lasting for 7 days. The effect against C albicans was minimal. ZnO-coated aligners appears to be a promising technique to facilitate antimicrobial efficacy against S mutans.

Effectiveness of Different Sterilization Methods on Clinical Orthodontic Materials

Background

Orthodontic appliances such as wires and brackets received from manufacturers come unsterilized and may be contaminated with various microorganisms before being used in the mouth. In this study, we evaluated and identified the bacterial contamination on orthodontic appliances along with the disinfecting efficacy of ultraviolet (UV) light and various sterilization methods.

Methods

Different orthodontic appliances were obtained from manufacturers divided into 5 sterilization methods and a control group (control, UV, dry heat and steam autoclave, ethyl alcohol, and 2% glutaraldehyde). Microbiological and DNA sequencing was performed on the appliances to identify the contaminated bacteria.

Results

Bacterial contamination identified on the orthodontic appliances were Staphylococcus aureus, Staphylococcus epidermidis, Lactobacilli, Klebsiella pneumoniae, Bacillus licheniformis, and Bacillus cereus. UV sterilization method effectively prevented the bacterial growth when compared to the control (unsterilized) orthodontic appliances.

Conclusion

We concluded that the orthodontic appliances received from the manufacturer showed bacterial contamination. All of the tested sterilization methods including UV light were effective in eliminating the bacterial contamination on the orthodontic appliances. Since UV light does not cause change in material properties and is cost effective with relative ease of use, its use in clinical practice for the disinfection of orthodontic appliances is suggested before placement in the mouth.

Comparison of Streptococcus mutans Adhesion on New and Recycled Metal Brackets: An In Vitro Study

Background: Evaluation of adhesion of Streptococcus mutans on recycled orthodontic brackets is significant, as Streptococcus mutans is the main causative factor in enamel demineralization and many clinicians, in their practice, resort to reconditioning of brackets, as it is cost-effective. Thus, this study aimed to evaluate and compare the adhesion of Streptococcus mutans on new brackets of three different companies (Group I, Group II, and Group III) and brackets recycled by three different recycling methods (RC I: flame heating followed by acid bath; RC II: flame heating followed by ultrasonic cleaning and electropolishing; RC III: flame heating followed by sandblasting and electropolishing).

Materials and methods: A total of 10 brackets from each group were incubated with 10⁸ colony-forming units (CFUs) of Streptococcus mutans in trypticase soy broth overnight. The brackets were then washed with phosphate-buffered saline and treated with 0.25% trypsin for 20 minutes followed by vertexing the solution to remove the adhered bacteria and then the solution was plated on the blood agar and incubated overnight. The total viable count of bacteria was quantified.

Results: Comparing all the three groups and recycling methods, Group II brackets showed significantly more adhesion, Group I brackets showed lesser adhesion, and Group III brackets showed intermediate adhesion. When comparing recycling methods, all the three methods of recycling with all the three groups showed more bacterial adhesion than the control brackets, which was statistically insignificant (P > 0.05).

Conclusion: Recycled brackets showed more bacterial adhesion and electropolishing resulted in reduced bacterial adhesion.

Oral colonization of Candida albicans and Streptococcus mutans in children with or without fixed orthodontic appliances: A pilot study

Background/purpose

Adolescents undergoing fixed orthodontic therapy have an increased risk of oral diseases due to additional plaque accumulation sites. However, the effect of fixed orthodontics appliances (FOAs) on the colonization of Candida albicans (Ca) and Streptococcus mutans (Sm), two synergistic oral pathogens, is largely unknown and was, therefore, the primary objective of this pilot investigation.

Material and methods

Sixteen children aged 10–15 years were enrolled, nine in the FOA and seven in the control groups. Saliva and occlusal plaque were collected, and the Ca and Sm levels were quantified with a quantitative real-time polymerase chain reaction (qPCR) assay.

Results

A trend of higher Ca levels was observed in the saliva and occlusal plaque of the FOA group, while the control group contained higher levels of Sm. Furthermore, for Sm levels, a positive correlation between saliva and occlusal plaque was shown in both the FOA and control groups; in contrast, Ca levels were negatively correlated between these samples only in the FOA group. Between Ca and Sm, a positive correlation was observed in saliva and occlusal plaque in the control group; however, this relationship was disrupted in the FOA group.

Conclusion

Our preliminary study demonstrated that the presence of FOAs disturbs the colonization of Ca and Sm within the oral cavity. This perturbation might increase orthodontic patients’ risk for Ca- and Sm-related diseases.

Analysis of Chlorhexidine Modified Cement in Orthodontic Patients: A Double-Blinded, Randomized, Controlled Trial

OBJECTIVES

The aim of this study was to evaluate the microbiological and mechanical properties of glass ionomer cement (GIC) modified by chlorhexidine (CLX) for the purpose of cementing bands to the teeth of orthodontic patients.

MATERIALS AND METHODS

Ten patients, between the ages of 19 and 33 years, in the initial stage of orthodontic treatment, were randomly designated to two groups using the split-mouth design (n = 10). One group (GICEX) had bands cemented with GIC modified by CLX and a Control group (GIC), evaluated at time intervals before (T0), 3 months (T3), and 6 months (T6) after cementation. Total microbiological counts were performed, and color stability of tooth enamel, salivary pH, and the adhesive remnant index (ARI) were evaluated.

STATISTICAL ANALYSIS

The Friedman and Dunn's tests, Mann-Whitney, one-way analysis of variance, and Tukey, and paired and non-paired t-tests (p< 0.05) were used.

RESULTS

In T3, there was evidence of significant reduction in the quantity of colony forming unit (CFU) in GICEX group in comparison with the Control (p = 0.041). In T6, the quantity of CFU was similar to the quantity in T3 and significantly different to control (p = 0.045); Control group demonstrated a similar quantity of CFU between the experimental time intervals (p = 0.066). Salivary pH demonstrated significant difference only between the time intervals T0 and T6 (p = 0.022). The tooth enamel color (p = 0.366) and ARI (p = 0.343) values demonstrated no significant changes.

CONCLUSION

The incorporation of CLX into GIC demonstrated effective antibacterial action, allowed a good bond of the cement to the enamel, a high rate of survival of the bands, did not change the color of the tooth enamel, and maintained the salivary pH at physiological levels.

Evaluation of antimicrobial potential and surface morphology in thin films of titanium nitride and calcium phosphate on orthodontic brackets

INTRODUCTION

The goal of this research was to experimentally evaluate the surface morphology and adhesion capacity of Streptococcus mutans (U159) on brackets with thin films of titanium nitride (TN) and of titanium nitride doped with calcium phosphate (TNCP).

METHODS

Twenty-four metallic brackets were equally allocated to 3 groups (n = 8), according to the type of covering (no covering, TNCP, and TN). The coatings were deposited by cathodic cage (TNCP and TN groups) and were evaluated by scanning electron microscopy and energy dispersive x-ray spectrometry. The biofilm formation of S. mutans on the surface of brackets was determined by crystal violet assay and subsequent optical density quantification.

RESULTS

There was homogeneity on the surface morphology of the tie wing area in all groups, whereas the TNCP group has presented particles in the slot. After 24 hours, a biofilm of S. mutans was formed in all the observed groups. The optical density obtained in all 3 groups was similar (no covering, 0.347 ± 0.042; TNCP, 0.238 ± 0.055; TN, 0.226 ± 0.057), with no statistically relevant difference (P = 0.06).

CONCLUSIONS

The thin film of TNCP has altered the surface of the bracket's slot, whereas the coatings of TN and TNCP have not altered the superficial morphology of the tie wings. The presence of coatings have not influenced the formation of the S. mutans biofilm on the surface of metallic brackets.

Nanomaterials Application in Orthodontics

Nanotechnology has gained importance in recent years due to its ability to enhance material properties, including antimicrobial characteristics. Nanotechnology is applicable in various aspects of orthodontics. This scientific work focuses on the concept of nanotechnology and its applications in the field of orthodontics, including, among others, enhancement of antimicrobial characteristics of orthodontic resins, leading to reduction of enamel demineralization or control of friction force during orthodontic movement. The latter one enables effective orthodontic treatment while using less force. Emphasis is put on antimicrobial and mechanical characteristics of nanomaterials during orthodontic treatment. The manuscript sums up the current knowledge about nanomaterials' influence on orthodontic appliances.

Oral colonization by Candida species in orthodontic patients before, during and after treatment with fixed appliances: A prospective controlled trial

Background

Orthodontic treatment with fixed appliances is associated with changes in oral microbiota, including increased Candida colonization. The Candida fungus can cause oral lesions and infections such as candidiasis and angular cheilitis, and is harmful to both the patient and the orthodontist. Poor hygiene facilitates the colonization of these microorganisms. The key aim was to quantify the colonization of C. albicans in patients prior to beginning orthodontic treatment, and during the treatment process.

Material and Methods

A total of 124 patients (43 males and 80 females) with a mean age of 19.5 years, who required treatment with metal or aesthetic (ceramic) braces, were studied. Microbiological samples were taken from the oral cavity using the swab technique throughout the treatment and cultured on a Sabouraud Dextrose Agar plate and, if positive, cultured on a CHROMagar® Candida plate.

Results

In contrast to other published studies, no statistically significant increase in C. albicans colonization was observed during the orthodontic treatment. The fixed appliances had no influence on the presence, absence or level of colonization by C. albicans and there were no significant differences between the different appliances studied.

Conclusions

Our study showed that frequency of oral hygiene measures by study participants did not affect the rate of oral carriage of Candida in a statistically significant manner. This observation contrasted with published literature, which suggests that thorough brushing is important to prevent the build-up of Candida species.

Key words:Orthodontics, fixed appliances, oral microflora, Candida albicans.

Antibacterial Effects of MicroRepair®BIOMA-Based Toothpaste and Chewing Gum on Orthodontic Elastics Contaminated In Vitro with Saliva from Healthy Donors: A Pilot Study

Several new products with innovative formulations are being proposed to facilitate oral care. Here, we evaluated the effects of a commercially available product, a toothpaste and chewing gum named Biorepair Peribioma, on oral microorganisms of healthy subjects. Saliva from six volunteers was collected during 20 min of mastication of a traditional gum (gum A) and the Biorepair Peribioma gum (gum P). Orthodontic elastics (OE) were in vitro contaminated with salivary samples, both A and P, and subsequently exposed or not to a Biorepair Peribioma toothpaste-conditioned supernatant (Tp-SUP). The salivary samples were tested for initial microbial load; hence, the contaminated OE were assessed for microbial growth, adhesion, biofilm formation and persistence; moreover, species identification was assessed. We found that the salivary samples A and P had similar microbial load; upon contamination, microbial adhesion onto the OE was detected to a lower extent when using saliva P with respect to saliva A. Microbial growth and biofilm formation, assessed at 24 h, remained at lower levels in OE exposed to saliva P, compared to saliva A. This difference between salivary samples A and P was confirmed when measuring biofilm persistence (48 h), while it was lost in terms of microbial re-growth (48 h). The Tp-SUP treatment drastically affected microbial load at 24 h and strongly impaired biofilm formation/persistence, in OE exposed to both salivary samples A and P. Finally, such treatment resulted in consistent overgrowth of Lactobacilli, bacterial species originally present both in the Biorepair Peribioma toothpaste and gum. In conclusion, by an in vitro pilot study, we show that the Biorepair Peribioma toothpaste and gum deeply affect oral microorganisms’ behavior, drastically impairing their ability to contaminate and produce plaque onto orthodontic devices.

The Microflora Diversity and Profiles in Dental Plaque Biofilms on Brackets and Tooth Surfaces of Orthodontic Patients

Objective: Fixed orthodontic appliances may influence the oral environment through accumulation of plaque, decreased plaque pH, and increased gingival inflammation. These changes in the oral cavity can potentially lead to periodontal disease, demineralization, and other infectious diseases.

Materials and Methods: To investigate the changes in biofilm throughout the initial 2 weeks, we placed a stainless steel bracket on the upper second premolar and collected plaque samples on the bracket and on the tooth surface at different time points (0, 24, 48 h and 1 and 2 weeks) and plated on tryptic soy agar blood agar plate, and kept at 37°C in an anaerobic chamber for 5 days to determine the CFUs of bacteria. At the end of 2 weeks, we removed the bracket and elastomeric module, and we isolated genomic DNA from the bacterial biofilm for identification of bacteria by 16S rRNA PCR analysis. We also analyzed the morphology of biofilm on the bracket by scanning electron microscope.

Results: Our results show that the bacterial biofilm was significantly increased on the bracket in all the subjects, whereas on the tooth surface, the CFUs were not significantly increased. PCR assay showed that biofilm on orthodontic brackets from all subjects showed colonization by Streptococcus gordonii, Porphyromonas gingivalis and Streptococcus mutans were observed on some of the subjects after 48 h, whereas Aggregatibacter actinomycetemcomitans biofilm was observed in all the time points except 24 h.

Conclusion: This study demonstrated that both periodontal and cariogenic bacterial biofilms were formed on the bracket as early as 24 h.

Polyphenols Inhibit Candida albicans and Streptococcus mutans Biofilm Formation

Background:Streptococcus mutans (S. mutans) and Candida albicans (C. albicans) are two major contributors to dental caries. They have a symbiotic relationship, allowing them to create an enhanced biofilm. Our goal was to examine whether two natural polyphenols (Padma hepaten (PH) and a polyphenol extraction from green tea (PPFGT)) could inhibit the caries-inducing properties of S. mutans and C. albicans. Methods: Co-species biofilms of S. mutans and C. albicans were grown in the presence of PH and PPFGT. Biofilm formation was tested spectrophotometrically. Exopolysaccharides (EPS) secretion was quantified using confocal scanning laser microscopy. Biofilm development was also tested on orthodontic surfaces (Essix) to assess biofilm inhibition ability on such an orthodontic appliance. Results: PPFGT and PH dose-dependently inhibited biofilm formation without affecting the planktonic growth. We found a significant reduction in biofilm total biomass using 0.625 mg/mL PPFGT and 0.16 mg/mL PH. A concentration of 0.31 mg/mL PPFGT and 0.16 mg/mL PH inhibited the total cell growth by 54% and EPS secretion by 81%. A reduction in biofilm formation and EPS secretion was also observed on orthodontic PVC surfaces. Conclusions: The polyphenolic extractions PPFGT and PH have an inhibitory effect on S. mutans and C. albicans biofilm formation and EPS secretion.

Enamel demineralization around metal and ceramic brackets: an in vitro study

Aim

To evaluate the degree of enamel demineralization of teeth bonded with ceramic and metal brackets.

Materials and methods

In this cross-sectional experimental in vitro study, 60 extracted human premolar teeth were selected according to the experimental criteria. They were divided into three groups; 20 premolar teeth in each group. Teeth in group 1 were bonded with "ceramic brackets", and teeth in group 2 were bonded with "metal brackets", while teeth in group 3 served as the "control group" without any brackets. Teeth in all groups were then immersed in demineralization media, de-bonded, sectioned into three parts (proximal 1, middle, and proximal 2), and evaluated to determine the level of enamel demineralization under a Scanning Electron Microscope.

Results

On tooth level, the results show that the control group has significantly less enamel demineralization compared to the other two experimental groups, with mean values of 145.3 µm and 192.7 µm, respectively (P=0.000). The mean value of enamel demineralization in the metal group is 55.93 µm, compared to 72.55 µm in the ceramic group, which is significantly less (P≤0.05), while there is no difference between the control and metal group with regard to enamel demineralization. On section level, the control group has significantly less enamel demineralization in all three sections compared to the ceramic group, while a significant difference is found in one of the proximal sections when compared with the metal group. Moreover, the ceramic group has significantly higher enamel demineralization in the middle section compared to the metal group (73.54 µm, 46.5 µm, respectively) (P=0.000), while there is no statistical significant difference between the two experimental groups in proximal sections.

Conclusion

In vitro, non-bonded teeth show least demineralization compared to the bonded teeth. Teeth bonded with ceramic brackets show significantly higher enamel demineralization compared to teeth bonded with metal brackets.

Microbiological characterisation of the colonisation by Candida sp in patients with orthodontic fixed appliances and evaluation of host responses in saliva

OBJECTIVES

We investigated the colonisation by Candida spp in patients using orthodontic fixed appliances by characterising the isolated Candida strains and by evaluating the host oral mucosa response through the measure of human β-defensins 3 (HBD-3) expression and Interleukin-1ß/IL-10.

METHODS

Ninety patients were enrolled after signing an informed consent. Prevalence, susceptibility to fluconazole, genotyping and oral fungal burden of Candida sp. isolated were determined. Host responses were evaluated by measuring HBD-3 expression as well as IL-1ß and IL-10 in saliva.

RESULTS

The colonisation rate reached 6.7% (6/90), and 5 patients were colonised with C. albicans strains and one with one with C. tropicalis. The fluconazole MIC90/susceptibility of C. albicans strains ranged 1/0.25-1 μg/mL. However, isolated strains did not present different genotype (SAB>0.9), C. albicans colonisation seems to be influenced by the duration of treatment and by level expression of HBD3 that were higher in colonised patients (not statistically different). A negative correlation between the fungal burden and IL-1ß levels was found in colonised patients but not for IL-10.

CONCLUSIONS

Our study revealed that patients with orthodontic fixed appliances were mainly colonised by C. albicans, which was related to a decrease in HBD-3 expression and IL-1ß levels.

Surface roughness implant-retained mandibular bar and ball joint overdentures and adherence of microorganisms

Objective:

The aim of this study is to assess the surface roughness of the implant-retained mandibular bar overdenture (BOD) and the implant-retained mandibular ball joint overdenture (BJOD) in jaw and its relation with the adhesion of molds and yeasts and mesophyll aerobe, in time 30 and 180 days in mouth.

Materials and Methods:

Five-systems titanium bar CARES^® and synOcta^® Straumann^® Dental Implant System, Holding AG Inc., Basel, Switzerland (BOD), and five-systems joint ball Klockner^® Implant System; Soadco Inc., Escaldes-Engordany; Andorra (BJOD), were used in two parallel groups of five participants, in an essay to simple blind person. To 30 and 180 days, the overdentures were withdrawn and evaluated the Ra: ųm. SJ-301^® Mitutoyo Corporation Inc., Kanagawa, Japan, and the adhesion of microorganisms (colony-forming unit/ml).

Results:

The results were as follows: the R_a: Um (30^th and 180^th): BOD, 0.965–1.351; BJOD, 1.325–2.384. Adhesion: Molds and yeasts, BOD, 2.6 × 10² and 4.6 × 10³; BJOD, 3.0 × 10² and 5.3 × 10⁴. Adhesion: Mesophyll aerobe, BOD, 3.8 × 10⁶ and 5.8 × 10⁶; BJOD, 4.3 × 10⁶ and 7.1 × 10⁷.

Conclusions:

At 30 days (P = 0.489), there were no differences in BOD and BJOD for adhesion of molds and yeasts and mesophyll aerobe between both overdentures. At 180 days (P = 0.723), there were differences in the adhesion of mold and yeast and mesophyll aerobe, being greater in BJOD.

Green Tea Polyphenols and Padma Hepaten Inhibit Candida albicans Biofilm Formation

Candida albicans (C. albicans) is the most prevalent opportunistic human pathogenic fungus and can cause mucosal membrane infections and invade the blood. In the oral cavity, it can ferment dietary sugars, produce organic acids and therefore has a role in caries development. In this study, we examined whether the polyphenol rich extractions Polyphenon from green tea (PPFGT) and Padma Hepaten (PH) can inhibit the caries-inducing properties of C. albicans. Biofilms of C. albicans were grown in the presence of PPFGT and PH. Formation of biofilms was tested spectrophotometrically after crystal violet staining. Exopolysaccharides (EPS) secretion was quantified using confocal scanning laser microscopy (CSLM). Treated C. albicans morphology was demonstrated using scanning electron microscopy (SEM). Expression of virulence-related genes was tested using qRT-PCR. Development of biofilm was also tested on an orthodontic surface (Essix) to assess biofilm inhibition ability on such appliances. Both PPFGT and PH dose-dependently inhibited biofilm formation, with no inhibition on planktonic growth. The strongest inhibition was obtained using the combination of the substances. Crystal violet staining showed a significant reduction of 45% in biofilm formation using a concentration of 2.5mg/ml PPFGT and 0.16mg/ml PH. A concentration of 1.25 mg/ml PPFGT and 0.16 mg/ml PH inhibited candidal growth by 88% and EPS secretion by 74% according to CSLM. A reduction in biofilm formation and in the transition from yeast to hyphal morphotype was observed using SEM. A strong reduction was found in the expression of hwp1, eap1, and als3 virulence associated genes. These results demonstrate the inhibitory effect of natural PPFGT polyphenolic extraction on C. albicans biofilm formation and EPS secretion, alone and together with PH. In an era of increased drug resistance, the use of phytomedicine to constrain biofilm development, without killing host cells, may pave the way to a novel therapeutic concept, especially in children as orthodontic patients.

Shear bond strength and adhesive remnant index of orthodontic brackets bonded to enamel using adhesive systems mixed with TiO2 nanoparticles

INTRODUCTION

It is recently suggested that titanium dioxide (TiO2) nanoparticles can be added to bracket luting agents in order to reduce bacterial activity and protect the enamel. However, it is not known if this addition can affect the shear bond strength (SBS) below clinically acceptable levels. Therefore, this study examined this matter within a comprehensive setup.

METHODS

This in vitro experimental study was conducted on 120 extracted human premolars randomly divided into four groups (n=30): in groups 1 and 2, Transbond XT light-cured composite with or without TiO2 was applied on bracket base; in groups 3 and 4, Resilience light-cured composite with or without TiO2 was used. Brackets were bonded to teeth. Specimens in each group (n=30) were divided into three subgroups of 10 each; then incubated at 37°C for one day, one month, or three months. The SBS and adhesive remnant index (ARI) were calculated and compared statistically within groups.

RESULTS

The SBS was not significantly different at one day, one month or three months (p>0.05) but composites without TiO2 had a significantly higher mean SBS than composites containing TiO2 (p<0.001). The SBS of Transbond XT was significantly higher than that of Resilience (p<0.001). No significant differences were noted in ARI scores based on the type of composite or addition of TiO2 (p>0.05).

CONCLUSIONS

Addition of TiO2 nanoparticles to Transbond XT decreased its SBS to the level of SBS of Resilience without TiO2; thus, TiO2 nanoparticles may be added to Transbond XT composite for use in the clinical setting.

Oral Candida in Patients with Fixed Orthodontic Appliance: In Vitro Combination Therapy

BACKGROUND

Fixed orthodontic appliance (FOA) increases the cariogenic microorganisms of mouth including candida. The aim was to evaluate the pharmacodynamic effects of some antibacterial drugs in combination with most applicable antifungal agents on candida isolated from patients with FOA.

METHODS

Three antifungal agents (amphotericin B (AMB), ketoconazole (KET), and itraconazole (ITZ)) and three antibacterial drugs (ciprofloxacin (CIP), doxycycline (DOX), and metronidazole (MET)) with serial concentrations have been used and microdilution broth method has been done for single and combination therapy, then fungal growth was assessed spectrophotometrically, and the combinations were evaluated by bliss independent analysis.

RESULTS

According to bliss independent interaction, the synergistic interactions depended on ΔE values that showed the best for CIP was with AMB (ΔE = 55.14) followed with KET (ΔE = 41.23) and lastly ITR (ΔE = 39.67) at CIP = 150 mg/L. DOX was optimal with KET (ΔE = 42.11) followed with AMB (ΔE = 40.77) and the lowest with ITR (ΔE = 9.12) at DOX = 75 mg/L. MET is the best with AMB (ΔE = 40.95) and then with ITR (ΔE = 35.45) and finally KET (ΔE = 15.15) at MET 200 mg/L. Moreover, usage of higher concentrations of antibacterial agents revealed inhibitory effects.

CONCLUSION

This study uncovers the optimum antibiotic combination therapy against cariogenic candida with FOA by usage of low therapeutic concentrations.

Antimicrobial effect, frictional resistance, and surface roughness of stainless steel orthodontic brackets coated with nanofilms of silver and titanium oxide: a preliminary study

Nano-silver and nano-titanium oxide films can be coated over brackets in order to reduce bacterial aggregation and friction. However, their antimicrobial efficacy, surface roughness, and frictional resistance are not assessed before. Fifty-five stainless-steel brackets were divided into 5 groups of 11 brackets each: uncoated brackets, brackets coated with 60 µm silver, 100 µm silver, 60 µm titanium, and 100 µm titanium. Coating was performed using physical vapor deposition method. For friction test, three brackets from each group were randomly selected and tested. For scanning electron microscopy and atomic-force microscopy assessments, one and one brackets were selected from each group. For antibacterial assessment, six brackets were selected from each group. Of them, three were immediately subjected to direct contact with S. mutans. Colonies were counted 3, 6, 24, and 48 h of contact. The other three were stored in water for 3 months. Then were subjected to a similar direct contact test. Results pertaining to both subgroups were combined. Groups were compared statistically. Mean (SD) friction values of the groups 'control, silver-60, silver-100, titanium-60, and titanium-100' were 0.55 ± 0.14, 0.77 ± 0.08, 0.82 ± 0.11, 1.52 ± 0.24, and 1.57 ± 0.41 N, respectively (p = .0004, Kruskal-Wallis). Titanium frictions were significantly greater than control (p < .05), but silver groups were not (p > .05, Dunn). In the uncoated group, colony count increased exponentially within 48 h. The coated groups showed significant reductions in colony count (p < .05, two-way-repeated-measures ANOVA). In conclusions, all four explained coatings reduce surface roughness and bacterial growth. Nano-titanium films are not suitable for friction reduction. Nano-silver results were not conclusive and need future larger studies.

Combined chlorhexidine-sodiumfluoride mouthrinse for orthodontic patients: Clinical and microbiological study

Background

Orthodontic appliances impede good dental plaque control by brushing. Antimicrobial mouth rinses were suggested to improve this performance. We therefore aimed to investigate the effects of combined mouthrinse containing chlorhexidine (CHX) and sodium fluoride (NaF) on clinical oral hygiene parameters,and plaque bacterial level.

Material and Methods

In this double-blind clinical study, 60 fixed orthodontic patients aged 14-25 years were randomly assigned to one of four mouthrinses groups: 1- combined CHX /NaF 2- CHX 0.06% 3- NaF0.05% 4-placebo. Following baseline examination patients were instructed to use the assigned mouthrinse twice daily for 21 days. Bleeding index (BI), modified gingival index (MGI) and plaque index (PI) were determined at the baselineand after three weeks of rinsing. Samples from supragingival plaque were obtained for the assessment of total bacterial, Streptococcus mutans and Lactobacilli colony counts. Data were analyzed by Wilcoxon, Kruskal-Wallis, and Mann-Whitney tests.

Results

Clinical parameters; All three active mouth rinses induced significant improvements of BI, MGI, and PI (P<0.05). Results of CHX/NaF were slightly, but not significantly, better than CHX. CHX/NaF and CHX induced significantly more changes than NaF and placebo. Microbiological measurements; Except placebo, other mouthrinses reduced total bacterial, Streptococcus mutans, and Lactobacilli counts significantly (P<0.05). CHX/NaF acted against Lactobacilli significantly more than others.

Conclusions

Adding CHX0.06%/NaF0.05% combined mouth rinse to daily oral hygiene regimen of orthodontic patients significantly improved oral hygiene status. Effect of this combined mouth rinse on dental plaque Lactobacilli was remarkable. However, large controlled trials could provide more definitive evidence.

Key words:Mouthrinse, fluoride, chlorhexidine, plaque.

Are self-ligating brackets related to less formation of Streptococcus mutans colonies? A systematic review

OBJECTIVE

To verify, by means of a systematic review, whether the design of brackets (conventional or self-ligating) influences adhesion and formation of Streptococcus mutans colonies.

METHODS

SEARCH STRATEGY

four databases (Cochrane Central Register of Controlled Trials, Ovid ALL EMB Reviews, PubMed and BIREME) were selected to search for relevant articles covering the period from January 1965 to December 2012.

SELECTION CRITERIA

in first consensus by reading the title and abstract. The full text was obtained from publications that met the inclusion criteria.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data using the following keywords: conventional, self-ligating, biofilm, Streptococcus mutans, and systematic review; and independently evaluated the quality of the studies. In case of divergence, the technique of consensus was adopted.

RESULTS

The search strategy resulted in 1,401 articles. The classification of scientific relevance revealed the high quality of the 6 eligible articles of which outcomes were not unanimous in reporting not only the influence of the design of the brackets (conventional or self-ligating) over adhesion and formation of colonies of Streptococcus mutans, but also that other factors such as the quality of the bracket type, the level of individual oral hygiene, bonding and age may have greater influence. Statistical analysis was not feasible because of the heterogeneous methodological design.

CONCLUSIONS

Within the limitations of this study, it was concluded that there is no evidence for a possible influence of the design of the brackets (conventional or self-ligating) over colony formation and adhesion of Streptococcus mutans.

Changes in the oral environment after placement of lingual and labial orthodontic appliances

Background

This study compared the oral hygiene and caries risk of patients treated with labial and lingual orthodontic appliances throughout a prospective evaluation of the status of the oral environment before and after bracket placement.

Methods

A total of 20 orthodontic patients aged 19 to 23 years were included in the study and were divided into two groups: 10 patients wore Roth labial appliance (American Orthodontics, Sheboygan, WI, USA) and 10 patients wore STb lingual appliance (Ormco Corporation, Glendora, CA, USA). Plaque index (PI), gingival bleeding index (GBI), salivary flow rate, saliva buffer capacity, salivary pH, and Streptococcus mutans and Lactobacillus counts in saliva were determined at three time points: before orthodontic appliance placement (T0), 4 weeks after bonding (T1), and 8 weeks after bonding (T2). After appliance placement, all patients were periodically educated to the oral hygiene procedures. Wilcoxon rank and Mann-Whitney U tests were used to determine intragroup and intergroup differences as regards qualitative data. To compare quantitative data between the groups, chi-square and Fisher's exact tests were undertaken, while intragroup differences were tested with McNemar test. The level of statistical significance was set at p < 0.05.

Results

Statistical analysis of the data obtained revealed a statistically significant difference between the data of T0 and T1 and the data of T0 and T2 of the PI scores and between T0 and T2 of the GBI scores in the group treated with the lingual appliance. The GBI value increased significantly between T0 and T1 but decreased significantly between T1 and T2 (p < 0.01) in the group treated with labial appliance. S. mutans counts increased significantly between T0 and T2 in the saliva samples of patients treated with lingual appliance. No statistically significant differences were found between S. mutans and Lactobacillus counts at the three terms of saliva collection in patients treated with labial appliance. No statistically significant differences were found between the two groups at the three time points as regards the salivary flow rate and saliva buffer capacity.

Conclusions

Lingual and labial orthodontic appliances showed a different potential in modifying the investigated clinical parameters: patients wearing STb lingual orthodontic appliance had more plaque retention 4 and 8 weeks after bonding, while there were more gingival inflammation and more S. mutans counts 8 weeks after bonding. No differences were found between the two groups as regards the Lactobacillus counts, the salivary flow rate, and saliva buffer capacity.

Mechanisms of interaction between Candida albicans and Streptococcus mutans: an experimental and mathematical modelling study

OBJECTIVE

To evaluate the mechanisms of microbial interaction between the oral pathogens Candida albicans and Streptococcus mutans.

MATERIALS AND METHODS

Growth kinetics for the two micro-organisms, cultured individually or together, were followed experimentally for 36 h. The different growth curves were analysed by means of mathematical modelling.

RESULTS

Under the experimental conditions, S. mutans final concentration, when grown individually, was 5-times that of C. albicans. Contrarily, when both micro-organisms grew together, this ratio was inversed and C. albicans final concentration was even higher than that of S. mutans. When both micro-organisms share the niche, a model including linear competition among one another was best suited to reproduce the experimental observations. The results of this model show that the initial growth rates of both species are positively influenced by their mutual interaction. However, at longer incubation times, C. albicans prevents bacterial growth and achieves concentrations 4-times higher than when grown individually.

CONCLUSIONS

The results suggest that C. albicans biofilm formation could be potentiated by the presence of S. mutans by two mechanisms: synergically at short times and by competition at longer periods.

The influence of different types of fixed orthodontic appliance on the growth and adherence of microorganisms (in vitro study)

Orthodontic appliances serve as different impact zones and modify microbial adherence and colonization, acting as foreign reserves and possible sources of infection. This study was conducted to investigate the effect of different types of fixed orthodontic appliances on the growth and adherence of microorganisms in oral flora which are Streptococcus mutans (S. mutans) and Candida albicans. Sixty-four of four different fixed orthodontic appliance-samples were used, divided into four groups of sixteen. Type I: Sapphire brackets- Coated wires, type II: Sapphire brackets- Stainless steel wires, type III: Stainless steel brackets- Coated wires and type IV: Stainless steel brackets- Stainless steel wires. Oral strains of S. mutans and Candida albicans were studied in the present study using biochemical test then microbial suspensions were prepared to do the tests of each microorganism including the antimicrobial effects of different appliance-samples on the growth of microorganisms and their adhesion tests. The results showed significant differences between the different appliances in terms of inhibition zone formation (P<0.001). The adhesion test, which is classified into low, medium and high, showed the adhesion of S. mutans, is low with type I and II, medium with type III and high with type IV, whereas the adhesion of Candida albicans is medium with both type I and II and high with both type III and IV with high significant differences (P<0.001). Appliance with high esthetic appearance, sapphire brackets and coated arch wire, showed the least adherence of S. mutans and Candida albicans in comparison to other appliances with less esthetic and more metal components.

Key words:Orthodontic appliance, Adherence, Streptococcus mutans, Candida albicans.

Adherence of Streptococcus mutans and Candida albicans to different bracket materials

Objective:

To quantify the adherence of Streptococcus mutans and Candida albicans on brackets made of stainless steel, plastic, ceramic, titanium, and gold, and to evaluate the various sites of adherence of these microorganisms with scanning electron microscopy (SEM).

Materials and Methods:

Brackets made of stainless steel, plastic, ceramic, titanium, and gold were used. The adherence of S. mutans and C. albicans were studied. The brackets were placed in flat-bottomed vials containing basal medium with 20% sucrose added; the flasks were inoculated with each of the microbial suspensions. The samples were incubated at 37°C for 48 h, after which the brackets were removed. The cells adhering to the glass were counted and the brackets were studied with SEM.

Results:

When evaluated together, the adherence of S. mutans and C. albicans was increased in the ceramic bracket group. When evaluated separately, metallic brackets had increased number of colony-forming units (CFUs) of S. mutans and the use of titanium brackets increased the CFUs of C. albicans. SEM demonstrated that the adherence of S. mutans and C. albicans together varied according to the bracket materials, with ceramic having the greatest and stainless steel having the least adherence.

Conclusions:

Oral hygiene may be of greater concern with esthetic brackets since this study shows that microbial adhesion is greater with these brackets.

Molecular detection of in-vivo microbial contamination of metallic orthodontic brackets by checkerboard DNA-DNA hybridization

INTRODUCTION

Knowing the microbiota that colonizes orthodontic appliances is important for planning strategies and implementing specific preventive measures during treatment. The purpose of this clinical trial was to evaluate in vivo the contamination of metallic orthodontic brackets with 40 DNA probes for different bacterial species by using the checkerboard DNA-DNA hybridization (CDDH) technique.

METHODS

Eighteen patients, 11 to 29 years of age having fixed orthodontic treatment, were enrolled in the study. Each subject had 2 new metallic brackets bonded to different premolars in a randomized manner. After 30 days, the brackets were removed and processed for analysis by CDDH. Data on bacterial contamination were analyzed descriptively and with the Kruskal-Wallis and Dunn post tests (α = 0.05). Forty microbial species (cariogenic microorganisms, bacteria of the purple, yellow, green, orange complexes, "red complex +Treponema socranskii," and the cluster of Actinomyces) were assessed.

RESULTS

Most bacterial species were present in all subjects, except for Streptococcus constellatus, Campylobacter rectus, Tannerella forsythia, T socranskii, and Lactobacillus acidophillus (94.4%), Propionibacterium acnes I and Eubacterium nodatum (88.9%), and Treponema denticola (77.8%). Among the cariogenic microorganisms, Streptococcus mutans and Streptococcus sobrinus were found in larger numbers than L acidophillus and Lactobacillus casei (P <0.001). The periodontal pathogens of the orange complex were detected in larger numbers than those of the "red complex +T socranskii" (P <0.0001). Among the bacteria not associated with specific pathologies, Veillonella parvula (purple complex) was the most frequently detected strain (P <0.0001). The numbers of yellow and green complex bacteria and the cluster of Actinomyces were similar (P >0.05).

CONCLUSIONS

Metallic brackets in use for 1 month were multi-colonized by several bacterial species, including cariogenic microorganisms and periodontal pathogens, reinforcing the need for meticulous oral hygiene and additional preventive measures to maintain oral health in orthodontic patients.

Antibacterial effect of silver-platinum coating for orthodontic appliances

OBJECTIVE

To develop a hard coating for stainless surfaces based on silver (Ag)-platinum (Pt) alloys.

MATERIALS AND METHODS

Ag-Pt alloys, which have high degree of biocompatibility, excellent resistance to sterilization conditions, and antibacterial properties to different bacteria, are associated with long-term antibacterial efficiency. Approximately 1.03-µm to 2.34-µm-thick coatings, as determined by scanning electron microscopy, were deposited on stainless surfaces by the simultaneous vaporization of both metals (Ag and Pt) in an inert argon atmosphere. The coating was done by physical vapor deposition. Microorganisms and eukaryotic culture cells were grown on these surfaces.

RESULTS

The coatings released sufficient Ag ions when immersed in phosphate-buffered saline and showed significant antimicrobial potency against Streptococcus mutans and Aggregatibacter actinomycetemcomitans strains. At the same time, human gingival fibroblast cells were not adversely affected.

CONCLUSION

Ag-Pt coatings on load-bearing orthodontic bracket surfaces can provide suitable antimicrobial activity during active orthodontic treatment.

Virulence modulation of Candida albicans biofilms by metal ions commonly released from orthodontic devices

The installation of metal devices leads to an increase in the salivary concentration of metal ions and in the growth of salivary Candida spp. However, the relationship between released metal ions and Candida virulence has not been previously examined. The objective of this study was to evaluate whether metal ions affect fungal virulence. We prepared culture media containing Ni(2+), Fe(3+), Cr(3+), Co(2+) or a mixture of these metal ions at concentrations similar to those released in saliva of orthodontic patients. Biofilms of Candida albicans SC5314 were grown for 72 h and their biomasses were determined. The supernatants were analyzed for secretory aspartyl protease (SAP) and hemolysin activities. To verify changes in virulence following treatment with metals, proteolytic and hemolytic activities were converted into specific activities. The results revealed that all ions, except Co(2+), caused increases in biofilm biomass. In addition, Ni(2+) caused an increase in SAP activity and Fe(3+) reduced hemolytic activity. However, the SAP and hemolysin activities in the presence of the mixture of ions did not differ from those of control. These results indicate that metal ions released during the degradation of orthodontic appliances can modulate virulence factors in C. albicans biofilms.

Influence of cigarette smoke condensate on cariogenic and candidal biofilm formation on orthodontic materials

INTRODUCTION

An experimental analysis was made to quantify the adherence rates and the biofilm formation capacity of Streptococcus mutans ATCC25175 and Candida albicans SC5314 on orthodontic material surfaces in the presence of cigarette smoke condensate (CSC).

METHODS

Metal brackets, bands, acrylic resin, and polyurethane elastic rings were coated with stimulated saliva and submitted to adhesion and biofilm formation tests with and without CSC in a dynamic system.

RESULTS

The CSC increased the adhesion of S mutans ATCC25175 to the acquired pellicle (P <0.05) for bands (4.08 times), acrylic resin (2.89 times), and brackets (3.37 times) and reduced it in polyurethane elastic (2.66 times; P <0.05). S mutans ATCC25175 biofilm biomass was increased by CSC only on brackets (1.60 times; P <0.05). In the presence of CSC, the adhesion of C albicans SC5314 increased (P <0.05) on bands (1.81 times), brackets (9.61 times), elastics (29,133 times), and acrylic resin (177 times). Greater formation of C albicans SC5314 biofilm caused by CSC (P <0.05) was observed on acrylic resin (2.13 times) and brackets (2.32 times).

CONCLUSIONS

The results indicated that cigarette tobacco smoke can interfere with the adhesion and biofilm formation of these microorganisms to various orthodontic materials.

Microbial contamination of orthodontic buccal tubes from manufacturers

This study aimed to test the sterility of new unused orthodontic buccal tubes received from manufacturers. Four different types of buccal tubes were used straight from the manufactures package without any additional sterilizing step. Of these buccal tubes tested, three genera of bacteria, implicated as opportunistic pathogens, namely Micrococcus luteus, Staphylococcus haemolyticus and Acinetobacter calcoaceticus were recovered from these buccal tubes. Our data showing microbial contamination on buccal tubes highlights the need of sterilization before clinical use. We also suggest that manufacturers should list the sterility state of orthodontic buccal tubes on their packaging or instructions stating the need for sterilization.

Microbial Adhesion on Different Bracket Types in vitro

Objective: To test the hypothesis that there are differences in total bacterial counts and capacity for biofilm formation between seven different bracket types.

Material and Methods: By means of an in vitro experiment, seven commercially available bracket systems (Damon [A], Clarity [B], Mystique [C], Speed [D], Victory MBT [E], Micro-loc [F], and Generus [G]) were compared. A total of 25 premolar brackets of each bracket system were incubated in brain heart infusion medium containing the saliva and bacteria of two orthodontic patients. After 72 hours, the amounts of aerobe and anaerobe bacteria were determined by counting the colony-forming units (CFU). The CFU ratio (aerobe/anaerobe) also was calculated, and the black pigmented bacteria were analyzed.

Results: Significant differences between the different bracket types in terms of biofilm formation were found. Bracket types can be arbitrarily divided into low, intermediate, and high plaque-retaining brackets. The group with low adhesion consists of bracket types E, F, and G; the group with high adhesion of bracket types A, B, and C; and type D exhibits intermediate adhesion. The group with high microbial adhesion (A, B, and C) did present significantly lower CFU ratios (aerobe/anaerobe) than were exhibited by the other bracket systems (P &lt; .05).

Conclusion: The hypothesis is accepted. Orthodontic brackets serve as different loci for biofilm formation; in this in vitro study, significant differences were noted between the different types of brackets.

The effects of orthodontic appliances on Candida in the human mouth

BACKGROUND

Candida is an opportunistic pathogen present in about 50-60% of the healthy human population, and becomes pathogenic when the host immune defence is undermined such as in HIV infection. Adhesion and colonization of the oral cavity by Candida albicans is an initial step in candidosis, and the presence of orthodontic and other oral appliances seems to alter the oral ecological environment, hence may tip the balance to favour the candidal presence.

OBJECTIVE

The purpose of this paper was to review the literature with specific attention to prevalence; intra-oral density of the candidal organisms; and Candida carriage status in orthodontic patients before, during, and after treatment.

CONCLUSIONS

The limited amount of literature demonstrated that the density of Candida increases; the most common Candida species isolated in the orthodontic patients was C. albicans; and that there seems to be a direct relationship between the presence of a removable appliance, Candida, and low salivary pH levels. No healthy patients developed Candida infection from the orthodontic appliances. However, there seems to be a trend that some non-Candida carriers converted to Candida carriers following the insertion of the appliances by unknown mechanism. This may indicate a more cautious approach when providing orthodontic treatments to immunocompromised children concerning the possible increased risk of candidal infection.

Oral bacterial adhesion forces to biomaterial surfaces constituting the bracket-adhesive-enamel junction in orthodontic treatment

Bacterial adhesion to biomaterial surfaces constituting the bracket-adhesive-enamel junction represents a growing problem in orthodontics, because bacteria can adversely affect treatment by causing demineralization of the enamel surface around the brackets. It is important to know the forces with which bacteria adhere to the surfaces of these junction materials, as the strength of these forces will determine how easy it will be to remove the bacteria. We compared the adhesion forces of five initially colonizing and four cariogenic strains of bacteria to an orthodontic adhesive, stainless steel, and enamel, with and without a salivary conditioning film. Adhesion forces were determined using atomic force microscopy and a bacterial probe. In the absence of a salivary conditioning film, the strongest bacterial adhesion forces occurred to the adhesive surface (-2.9 to -6.9 nN), while adhesion forces to the enamel surfaces were lowest (-0.8 to -2.7 nN). In the presence of a salivary conditioning film, adhesion forces were reduced strongly, to less than 1 nN, and the differences between the various materials were reduced. Generally, however, initial colonizers of dental hard surfaces presented stronger adhesion forces to the different materials (-4.7 and -0.6 nN in the absence and presence of a salivary conditioning film, respectively) than cariogenic strains (-1.8 and -0.5 nN).

Microbiological Evaluation of Octenidine Dihydrochloride Mouth Rinse after 5 Days' Use in Orthodontic Patients

Objective: To determine the absolute and relative antibacterial activity of octenidine dihydrochloride (OCT) against total and cariogenic bacteria in saliva samples of patients with fixed orthodontic appliances during 5 days of usage.

Materials and Methods: The study group consisted of 5 male and 13 female subjects who were selected from patients in the Clinic of Orthodontics. Each patient was given physiologic saline (PS), chlorhexidine gluconate (CHX), polyvinylpyrrolidone-iodine complex (PVP-I), and OCT every morning for 5 days, each separated by a 2-week interval. Total and cariogenic bacteria in saliva samples of orthodontically treated patients with fixed appliances were collected during 5 days of usage. Unstimulated saliva was collected as a baseline sample. Saliva samples were collected at 15 minutes, and on the second, third, and fifth day after rinsing the mouth with any of the solutions for 30 seconds, and bacterial counts were detected.

Results: OCT showed an ultimate reduction of total viable oral bacteria, Lactobacillus species, and Streptococcus mutans in vivo. OCT also had a significantly greater inhibitory effect than 0.2% CHX and 7.5% PVP-I, from the beginning of the study until the fifth day after the orthodontic appliances were bonded (P &lt; .1).

Conclusions: OCT compared favorably with respect to CHX and PVP-I complex in orthodontically treated patients with fixed appliances (P ≤ .1).