Orthodontic debonding and tooth sensitivity of anterior and posterior teeth

What is the most effective method for reducing pain during debonding procedures? A systematic review

OBJECTIVE

This study aimed to investigate the most effective methods in controlling pain during debonding procedures.

MATERIAL AND METHODS

Electronic searches in published and unpublished studies were performed. Restricted to the English language and publication date up to 23/3/2024, the searches in published literature covered the following databases: MEDLINE, PubMed, EMBASE, Tripe, Web of Science, Scopus and PubMed Central. However, unpublished literature was searched at ClinicalTrials.gov, National Research Register, and ProQuest Dissertations and Theses. Lists of all eligible studies were checked for further scrutiny. Risk of bias for randomized and non-randomized control trials was assessed using ROB2 and ROBINS Cochrane tools.

RESULTS

Thirteen RCTs and two non-RCTs were included. All the reviewed articles studied the pain during debonding events and included 886 patients aged between 12-65. They used different scales such as VAS, NRS, Wong-Baker faces, and others scales. Two studies have shown that the lift-off plier causes less pain than other pliers when comparing different types of dental instruments. However, when comparing different adjunctive techniques, two studies have found that using a wafer causes less pain, while two studies have reported no significant difference between methods and one study has found that using finger pressure causes less pain. In addition, three separate studies have found that utilizing an ultrasonic device, as well as a thermal device and laser radiation, can lead to lower pain scores. Furthermore, two studies have demonstrated that using medication has a positive impact on reducing pain.

CONCLUSIONS

According to reported evidence, applying finger pressure is more effective in relieving pain in the anterior teeth, while wafer biting is more effective in the posterior teeth. Pain-relieving medications like paracetamol or ibuprofen can also effectively reduce debonding pain. Promising procedures, such as using diode or Er-YAG lasers, and thermal devices, may also be effective, but further studies are needed to confirm their efficacy. The protocol of this systematic review was registered with the PROSPERO International Database under ID number CRD42024529190. This review follows the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the instructions provided in the Cochrane Handbook.

In vitro comparison of different composite resins for aligner attachment production : Amount of adhesive flash, flash removal time, and shear bond strength

INTRODUCTION

The aim of this in vitro study was to determine the difference between aligner attachments constructed from four different composite resins in terms of adhesive flash amount, removal time, and shear bond strength.

MATERIALS AND METHODS

In all, 80 extracted human premolars were divided into four groups (N = 20) based on the type of composites used for the fabrication of aligner attachments (Group 1: GC Aligner Connect and Group 2: GC Ortho Connect [both from GC Dental Products, Tokyo, Japan]; Group 3: Z350 XT flowable and Group 4: Filtek Z350 XT Universal [both from 3M Unitek, Monrovia, CA, USA]). After bonding, the attachments were scanned with the iTero Element® (Align® Technology, San Jose, CA, USA). The amount of adhesive flash in the overflowing areas was analyzed by comparing the bonded attachments before and after removing the adhesive flash via the software 3D Geomagic Control (3DS Systems, Rock Hill, SC, USA). A color map was used to reveal the percentage of overflowing resin. Flash adhesive removal time per tooth and shear bond strength of the attachments were also analyzed. The significance level was set at p < 0.05.

RESULTS

The median values for the overflowing flash adhesive (surface deviation values) were 0.26, 0.29, 0.35, and 0.26 mm for Groups 1, 2, 3, and 4, respectively, with a significant difference between the groups (3 > 1, 2, 4; p < 0.001, effect size (η2) = 0.215). The percentage of red color deviation in overflowing areas was mostly observed in Group 3 (58.8%), while the green color was mostly noted in Group 4 (25%; p < 0.05). The time for removal of the adhesive flash was significantly higher in Group 1 than in Groups 2, 3, and 4 (p < 0.001, η2 = 0.340). The mean bond strength of Group 4 (19.27 ± 6.37 MPa) was higher than those of Groups 1 (11.42 ± 2.54 MPa) and 2 (14.43 ± 4.61 MPa; p < 0.001 and p = 0.015, η2 = 0.261).

CONCLUSION

Z350 XT flowable composite showed a higher overflow value and percentage of color deviation than the attachments made from the other resins. The universal restorative resin Filtek Z350 XT Universal was found to be advantageous in terms of both causing less flash adhesive and demonstrating higher bond strength to the tooth.

Effect of attachment flash on clear aligner force delivery: an in vitro study

BACKGROUND

The introduction of auxiliaries such as composite attachment has improved the force delivery of clear aligner (CA) therapy. However, the placement of the attachment may give rise to a flash, defined as excess resin around the attachment which may affect CA force delivery. This in vitro study aims to determine the differences in the force generated by the attachment in the presence or absence of flash in CA.

MATERIALS AND METHODS

Tristar Trubalance aligner sheets were used to fabricate the CAs. Thirty-four resin models were 3D printed and 17 each, were bonded with ellipsoidal or rectangular attachments on maxillary right central incisors. Fuji Prescale pressure film was used to measure the force generated by the attachment of CA. The images of colour density produced on the films were processed using a calibrated pressure mapping system utilising image processing techniques and topographical force mapping to quantify the force. The force measurement process was repeated after the flash was removed from the attachment using tungsten-carbide bur on a slow-speed handpiece.

RESULTS

The intraclass correlation coefficient showed excellent reliability (ICC = 0.96, 95% CI = 0.92-0.98). The average mean force exerted by ellipsoidal attachments with flash was 8.05 ± 0.16 N, while 8.11 ± 0.18 N was without flash. As for rectangular attachments, the average mean force with flash was 8.48 ± 0.27 N, while 8.53 ± 0.13 N was without flash. Paired t-test revealed no statistically significant difference in the mean force exerted by CA in the presence or absence of flash for both ellipsoidal (p = 0.07) and rectangular attachments (p = 0.41). Rectangular attachments generated statistically significantly (p < 0.001) higher mean force than ellipsoidal attachments for flash and without flash.

CONCLUSION

Although rectangular attachment generated a significantly higher force than ellipsoidal attachment, the force generated by both attachments in the presence or absence of flash is similar (p > 0.05).

Prevalence of dentin hypersensitivity after orthodontic treatment: A cross-sectional study

INTRODUCTION

The prevalence of cervical dentin hypersensitivity in patients after corrective orthodontic treatment has been poorly studied, although such hypersensitivity is very common. This study aimed to assess the prevalence of dentin hypersensitivity in patients who received corrective orthodontic treatment, the impact of general oral problems on quality of life, and the impact of hypersensitivity on the quality of life of this population.

METHODS

This observational, cross-sectional study evaluated 232 patients who finished orthodontic treatment between 2000 and 2020 for self-reported hypersensitivity and clinically diagnosed hypersensitivity. The following tests were used: tactile, evaporative (bellows), evaporative (triple syringe), and thermal. The patients were also evaluated regarding their quality of life using questionnaires (Oral Health Impact Profile-14 and Dentine Hypersensitivity Experience Questionnaire). We evaluated data with nonparametric statistics.

RESULTS

The prevalence of hypersensitivity was higher in women and in those aged <30 years; the most affected teeth were the mandibular incisors and premolars; different diagnostic tests for hypersensitivity may indicate different prevalence values; patients with hypersensitivity had a lower quality of life in most of the domains of both of the tests that were used.

CONCLUSIONS

The prevalence of hypersensitivity among patients after orthodontic treatment may be higher than in the general population. Further investigation is needed to indicate the possible factors associated with orthodontic tooth movement.

Do different orthodontic pliers used in bracket debonding have different effects on pain and sensitivity? A prospective split-mouth study

OBJECTIVES

The assessment of whether different orthodontic pliers used in bracket debonding have different effects on pain and sensitivity experience.

MATERIALS AND METHODS

Thirty-three patients (17 females, 16 males) with metal brackets were included in the study. Compressed air and freshly melted ice water were applied to each tooth (6-6) in upper and lower arch before bracket debonding (T0), just after debonding (T1), and 1 week after debonding (T2). Bracket remover plier (BRP) and Weingart plier (WP) were used to debond brackets. A numeric rating scale (NRS) was used to assess sensitivity for each tooth at T0, T1, and T2. Tooth pain was assessed for each tooth using NRS during bracket debonding.

RESULTS

Statistically higher pain scores were found in teeth U4 (upper first premolar) (p = 0.017) and L6 (lower first molar) (p = 0.026) in Weingart plier group. No statistically significant difference was found during debonding in the other teeth between groups. Statistically high sensitivity score was found at T1 time point in tooth U3 (upper canine) by applying air stimulus in Weingart plier group (p = 0.024). There was no statistically significant difference between the sensitivity scores measured at T2 time point by applying air and cold stimuli between groups.

CONCLUSIONS

Although the debonding pain scores were statistically significant in two teeth and the sensitivity score in one tooth, there was no clinical significance between the two pliers in terms of pain and sensitivity.

CLINICAL RELEVANCE

Both debonding pliers gave clinically similar results in terms of pain and sensitivity.

The Effect of MI Varnish™ on Caries Increment and Dietary Habits among 6- and 12-Year-Old Children in Riga, Latvia: A 3-Year Randomized Controlled Trial

Aims: This randomized controlled trial investigated the effect of MI Varnish™ (5% NaF/CPP-ACP) on caries increment in 6- and 12-year-old children in Riga, Latvia within 36 months. Methods: Forty-eight 6-year-old children (Group 1) and forty-seven 12-year-old children (Group 3) received quarterly varnish application, while forty-eight 6-year-old children (Group 2) and thirty-seven 12-year-old children (Group 4) did not have varnish applied. All children/parents received the same preventive advice. All children were visually examined using ICDAS-II criteria. Questionnaires on dietary habits were completed by the children/parents at baseline and after 36 months. DMFS and dfs were calculated from ICDAS data. The statistical analysis was performed (α = 0.05) using a Chi-squared test, paired t-test (Welch test) and the Pearson correlation coefficient. The trial registration number is ISRCTN10584414. Results: In Group 1 versus Group 2, the DMFS(SD) (Baseline/36 months) values were 5.02(5.85)/13.21(6.67) (p < 0.001) versus 2.65(4.54)/10.81(6.14) (p < 0.001), respectively; the dfs(SD) (Baseline/36 months) values were 36.75(12.96)/24.04(12.9) (p < 0.001) versus 33.67(12.74)/23.88(11.91) (p < 0.001), respectively. In Group 3 versus Group 4, the DMFS(SD) (Baseline/36 months) values were 48.62(23.18)/70.96(23.28) (p < 0.001) versus 34.73(17.99)/54.95(16.09) (p < 0.001), respectively; the dfs(SD) (Baseline/36 months) values were 1.7(4.4)/0 (p < 0.05) versus 2(6.39)/0 (p = 0.06), respectively. The prevalence of caries (dfs + DMFS) decreased by 4.52 (p < 0.001) and 1.63 (p < 0.001) in Groups 1 and 2, respectively, but increased by 20.64 (p < 0.001) and 18.22 (p < 0.001) in Groups 3 and 4, respectively. An analysis of the questionnaires indicated the habitual, frequent consumption of a sugary diet by all the children. A significant correlation (r = 0.321; p < 0.05) was observed between caries increment and the frequency of daily intake of sugary snacks, soft drinks and tea with sugar at baseline only in Group 1. Conclusions: A quarterly application of MI varnish (CPP-ACP/fluoride) reduced caries increment in 6- and 12-year-old children in Riga, Latvia.

Class II Treatment in Growing Patients: Preliminary Evaluation of the Skeletal and Dental Effects of a New Clear Functional Appliance

Objective: The purpose of this retrospective preliminary study was to analyze the skeletal and dentoalveolar effects of a new clear functional appliance in a sample of patients close to growth spurt with class II malocclusion attributable to mandibular retrusion. Materials and methods: A sample of growing patients underwent functional Class II correction using F22® (Sweden and Martina, Due Carrare (PD), Italy) Young, realized combining the aesthetic characteristics of the F22® clear aligner with the structural features of a functional appliance. For each patient, a digital setup was performed by a single operator to plan a mandibular advancement to the therapeutic position. Cephalometric analysis before and after treatment was performed. The purpose of the statistical analysis was to evaluate dental and skeletal changes associated with F22® Young device, and whether there were statistically significant differences in anatomical measurements between the beginning and end of treatment. Results: 15 patients, 7 females and 8 males of average age 10.3, were treated with the F22® Young appliance for an average period of 10 months ± 0.5 (maximum 11.5 months, minimum 10.5 months). The data showed that the SNB angle increase was statistically significant from T0 to T1, leading to a reduction in the ANB angle. Values for the mandible length, both total (Co-Gn) and at the base (Go-Pg), significantly increased. Conclusions: According to this preliminary study, F22® Young appliance is effective in promoting mandibular advancement when used near the pubertal growth peak. The device is comfortable and aesthetic, which certainly promoted patient compliance, a key factor for treatment success.

Berlin and Epworth Surveys to Predict Obstructive Sleep Apnea for Adults on Biomimetic Oral Appliance Therapy: A Nonrandomized Clinical Trial

Background

Two questionnaires (Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS)) are the widely used screening instruments for subjects suffering from sleep disorders. Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. The biomimetic oral appliance therapy (BOAT) offers an alternative nonsurgical method, which can improve symptoms and indices of OSA on objective sleep testing.

Aim

To describe testing the ability of BQ and EES for prediction of BOAT outcomes during OSA.

Methods

Seventeen adults (9 males, 8 females; age, mean (SD): 45.76 (10.31), BMI mean (SD): 33.5(13.43)) who underwent an overnight sleep study were diagnosed by a sleep specialist physician. The BQ and EES were recorded before and after BOAT treatment. Subjects with mild-to-moderate OSA had 2 months of follow-up visits and underwent a final overnight sleep study to measure apnea-hypopnea index (AHI). The subjects were asked to wear the appliance for 10–12 hours/day and at night. Findings were analyzed statistically using paired t-tests.

Result

As per sleep test results, pre-BOAT AHI measures versus post-BOAT AHI measures showed significant improvement. Comparing the BQ before versus after treatment showed that at the pretreatment stage, 66.0% of patients had high-risk score, whereas 34% had low-risk score. After treatment, 66.0% of patient had low-risk scores, whereas 34% had high-risk scores. As for the ESS, treatment resulted in significant reduction of total score from 10.43 ± 6.32 to 5.00 ± 5.20 (P < 0.01, paired t-test). Finally, there was a mild negative correlation between AHI and each of the BQ and ESS scores that was not statistically significant (r = −0.420, N = 26, P > 0.05, and r = −0.41, N = 26, P > 0.05, respectively).

Conclusion

The BOAT device may provide a useful form of therapy to improve OSA-related PSG parameters such as AHI. Both BQ and ESS were predictive to improvements detected by the sleep study during BOAT device use.

Orthodontic Management of a Rare Incidence Bilateral Maxillary Canine-First Premolar Transposition Using Fixed Appliance

Objective

A change in the location of two permanent teeth within the same quadrant of the dental arch is known as tooth transposition. This article illustrates the nonextraction treatment of a bilaterally complete transposition between maxillary canines and first premolars, using fixed mechanics. Material and Method. Upper and lower preadjusted, edgewise, fixed appliances with MBT prescription (0.022^″ × 0.028^″ slot size brackets) were used for the treatment. After providing room for the canine teeth, the piggyback technique was used to bring the right canine to the arch in the position of the first premolar. In the final phase of treatment, both the upper and lower arches had 0.019 × 0.025 stainless steel wire with Class II elastic 4 oz on the right and left sides.

Result

It showed that the maxillary first premolars and canines were favorably aligned into transposed position. The upper right and left premolars occluded with the lower canines in Class I relationship and good intercuspation as well as skeletal and molar Class I relationships were maintained with a pleasant facial profile.

Conclusion

The early diagnosis plays a significant role as much as considering esthetics and function factors in deciding which treatment strategy should be followed. The key to a successful and stable result is substantial treatment planning and careful orthodontic management.

The Effects of Periodontal Laser Therapy on Pain in Adult Patients with Orthodontic Treatment: A Randomized Clinical Trial

(1) Background: Pain is the most common complaint of patients with fixed orthodontic treatment, especially when applying and activating the orthodontic device. The effectiveness of low-level laser therapy (LLLT) in reducing pain caused by the orthodontic treatment has been frequently studied over the last few years. In this study, we aim to evaluate the influence of laser therapy on pain caused by orthodontic forces acting on periodontal tissues during fixed orthodontic treatment. (2) Methods: A total of 36 patients who met the inclusion criteria were submitted to laser therapy after beginning a fixed orthodontic treatment. For each patient, one half-arch was treated with laser (HL), the opposite one being the control half-arch (HC). The evaluation of pain was conducted by asking the patients to rate their pain on a VAS scale from 0 to 10. (3) Results: Analyzing the VAS score values reported after applying the orthodontic device, we noticed that the pain increased in the first few hours, it was the highest 24 h after application, and it decreased towards the 7th day. The pain reported by most patients was significantly reduced in the HL compared to the HC, in all three moments that were evaluated (p < 0.0001). (4) Conclusions: Repeated LLLT in patients with orthodontic treatment leads to a significant decrease in pain levels, as the comparison between the laser half-arch and the control half-arch showed.

Siloranes-Suitability of a Novel Adhesive for Orthodontic Bracket Bonding

Recently, an epoxy-based resin-Filtek Silorane-has been proposed for restorative fillings. It was the aim of the investigation to evaluate the suitability of this novel resin for orthodontic bracket bonding on unground enamel. Shear bond strength was measured for two adhesives-Filtek Silorane, Transbond XT-in combination with steel, ceramic and polymer brackets. For Filtek Silorane etching was performed with the Silorane self-etching primer, as well as phosphoric acid. The Transbond XT samples were etched with phosphoric acid only and served as the control group. All samples were thermo-cycled (1000×, 5-55 °C). Shear testing was carried out with an Instron 3344. In addition, ARI scores were evaluated. The Shear bond strength showed a weak adhesion of Filtek Silorane to unprepared enamel, either with the self-etching primer or the conventional etching (0.87-4.28 MPa). The Shear bond strength of the control group was significantly higher (7.6-16.5 MPa). The ARI scores showed a clear failure at the enamel-adhesive interface for all Filtek Silorane samples. For the combination of Transbond XT and different brackets the failure was found at the adhesive-bracket interface. The novel epoxy-based resin Filtek Silorane is not appropriate for bracket bonding to unprepared enamel.

Management of Gingival Bleeding in Periodontal Patients with Domiciliary Use of Toothpastes Containing Hyaluronic Acid, Lactoferrin, or Paraprobiotics: A Randomized Controlled Clinical Trial

Periodontitis is an irreversible oral disease causing the destruction of tooth-supporting tissues. In addition to scaling and root planing (SRP) procedures, patients should achieve a correct domiciliary oral hygiene in order to maintain a healthy status. The aim of the present study was to evaluate the efficacy of different toothpastes in reducing gingival bleeding in periodontal patients. In addition to a professional treatment of SRP, 80 patients were randomly divided into four groups according to the toothpaste assigned for the daily domiciliary use using an electric toothbrush: Group 1 (Biorepair Gum Protection), Group 2 (Biorepair Plus Parodontgel), Group 3 (Biorepair Peribioma PRO), and Group 4 (Meridol Gum Protection) (control group). After baseline (T0), patients were visited after 15 days (T1), 3 months (T2), and 6 months (T3). At each appointment, the following periodontal indexes were assessed: bleeding on probing (BoP), full-mouth bleeding score (FMBS), and modified sulcus bleeding index (mSBI). All the experimental toothpastes caused an immediate significant modification of the three clinical indexes measured, except for the control product. Biorepair Peribioma PRO, with its paraprobiotic content, was also the only toothpaste causing a prolonged effect, reducing BoP even at T3. Accordingly, both hyaluronic acid and lactoferrin appear as reliable supports for the domiciliary management of periodontal disease. In spite of this, paraprobiotics are likely to show the most important benefit thanks to their immunomodulating mechanism of action.

Surface Analysis and Spectrophotometric Evaluation of Different Esthetic Restorative Materials Frequently Exposed to a Desensitizing Agent

Background

Patients with tooth sensitivity are frequently exposed to desensitizing agents on a regular basis. These agents might have an impact on the surface properties and color of existing oral restorations. Accordingly, this study aimed to investigate the color stability, surface microhardness, and surface roughness of resin-modified glass ionomer (RMGIC), amalgomer CR, nanohybrid, and bulk-fill resin composites restorative materials after frequent exposure to a desensitizing agent. Materials and Methods. One hundred and twenty specimens were prepared; 10 specimens for each restorative material were equally subdivided into control and desensitizing-agent-exposed groups in each test. Surface microhardness and surface roughness were evaluated using the Vickers microhardness tester and surface profilometer, respectively. The color change was measured by using a spectrophotometer using the CIE L^∗a^∗b^∗ formula. Surface topography was analyzed using a scanning electron microscope (SEM). The collected data were analyzed with Student's t-test, one-way ANOVA, and Tukey post hoc tests for pairwise comparison at a level of significance of 0.05.

Result

The frequent use of a desensitizing agent significantly decreased surface hardness of RMGIC, amalgomer, and bulk-fill composite materials. However, nanohybrid composite exhibited a significant surface hardness increase. The surface roughness of RMGIC, amalgomer, and nanohybrid composite increased significantly. Meanwhile, the bulk-fill resin composite showed a nonsignificant decrease. Both RMGIC and amalgomer exhibited significantly higher values of color change in comparison to those of nanohybrid and bulk-fill composites.

Conclusion

The bulk-fill composite seems to be more resistant to discoloration and surface topographical changes than other tested materials on frequent exposure to the desensitizing agent. However, this exposure may pose a negative impact on its surface hardness. Bulk-fill resin composite may be the most suitable esthetic restorative in patients who frequently use desensitizing agents.

Comparative Evaluation of Different Numerical Pain Scales Used for Pain Estimation during Debonding of Orthodontic Brackets

Introduction

Patients experience various levels of discomfort during orthodontic treatment, i.e., after placement of separators, orthodontic implant placement, and archwire placement and during debonding. Various pain control methods have been developed to relive pain during debonding, i.e., finger pressure (FP), elastomeric wafer (EW), and stress relief (SR).

Aim

To analyse various pain scales commonly used to determine the effect of different pain control methods during debonding of orthodontic brackets. Study Design. A comparative cross-sectional study performed on a sample of 60 patients (n = 60) including 14 males and 46 females who were ready for debonding and who were divided into three groups, i.e., finger pressure (FP), elastomeric wafer (EW), and stress relief (SR).

Materials and Methods

A 100 mm Visual Analog Scale (VAS) was used to record the pain intensity for each tooth. Another scale known as Pain Catastrophizing Scale (PCS) was used to evaluate the patient's general attitude towards pain perception. The armamentarium and operator were kept same for all the patients. Statistical analysis used was the Kruskal-Wallis test, used for intergroup and intragroup comparison of pain scores.

Results

Lowest total pain score was recorded in the FP group (P=0.043) on intergroup comparison, while on intragroup comparison, higher pain scores were recorded in lower anterior region (P=0.02) in all three groups. There was no significant difference between the pain scores reported by the male and female subjects.

Conclusion

FP is an effective method of pain control. And teeth in the anterior region of lower and upper arches are more sensitive to pain. In terms of cognitive-affective constructs, although the VAS has been widely used in previous studies, the PCS has been detailed to show the most reliable association with physical discomfort and emotional distress.