Periodontal parameters in adult patients with clear aligners orthodontics treatment versus three other types of brackets: A cross-sectional study

Evaluation of dental plaque reduction using microcurrent-emitting toothbrushes in orthodontic patients: a randomized, double-blind, crossover clinical trial

This study aimed to compare the effectiveness of microcurrent-emitting toothbrushes (MCTs) and ordinary toothbrushes in reducing the dental plaque index (PI) and dental caries activity among orthodontic patients. The evaluation was performed using a crossover study design involving 22 orthodontic patients randomly assigned to the MCT or ordinary toothbrush groups. The participants used the designated toothbrush for 4 weeks and had a 1-week wash-out time before crossover to the other toothbrush. PI (Attin's index) and dental caries activity were measured at baseline and at the end of each 4-week period. Additionally, patients completed questionnaires to assess patient satisfaction for "freshness in mouth" and "cleansing degree." The results showed that the MCT group had a significant reduction in PI (p = 0.009), whereas the ordinary toothbrush group did not (p = 0.595). There was no significant difference in the dental caries activity between the two groups (p > 0.05). Patient satisfaction assessment revealed that 65% patients in the MCT group had more than "fair" experience of freshness, in contrast to 50% of patients in the ordinary toothbrush group. Satisfaction with cleansing degree was similar in both groups. Overall, these findings suggest that MCTs are more effective in reducing dental PI than ordinary toothbrushes.

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).

The Influence of Orthodontic Treatment on Periodontal Health between Challenge and Synergy: A Narrative Review

By correctly repositioning teeth, orthodontic therapy improves both the function and appearance of an occlusion. The relationship between teeth and the tissues that surround and support them significantly influences these alterations. With ever more adults seeking orthodontic care, orthodontists are increasingly seeing patients with periodontal issues. Concerns about the patient's appearance, such as uneven gingival margins or functional issues caused by inflammatory periodontal diseases, should be accounted for when designing orthodontic treatment plans. Furthermore, orthodontics may increase the chances of saving and recovering a degraded dentition in cases of severe periodontitis. Today, general dentists, dontists, and orthodontists play integrative roles that enable them to achieve the best possible results for their patients. This review will improve the results of interdisciplinary treatments and increase cooperation between dental specialists by drawing attention to the essential connection between orthodontics and periodontics in regular clinical practice.

Periodontal health status, oral microbiome, white-spot lesions and oral health related to quality of life-clear aligners versus fixed appliances: A systematic review, meta-analysis and meta-regression

Objective

: Assess and evaluate the different indicators of oral health-related quality of life (OHRQoL) among patients treated with clear aligners (CAs) versus those treated with conventional fixed orthodontics (FAs).

Methods

: An electronic search was performed on the database is Web of Science, Scopus, and Embase databases. Randomized and non-randomized control trials, cross-sectional, prospective cohort and retrospective trials were included. Quality was assessed with risk of bias tool and risk of bias in non-randomised studies. Meta-analyses were performed with random effects models, estimating the standardized and non-standardized mean differences, odds ratio and risk ratio as the measure of effect. The effect on time was determined using a meta-regression model.

Results

: Thirty one articles were included in the qualitative synthesis and 17 in the meta-analysis. CAs had a significantly lower negative impact on QoL, with an "important" effect size, while the influence of time was not significant. Periodontal indicators plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing show significantly better values in patients treated with CAs, with moderate to large effect sizes. PI and GI have a significant tendency to improve over time. In microbiological indicators, CAs present a lower biofilm mass without differences in the percentage of patients with high counts of Streptococcus mutans and Lactobacilli bacteria. The risk of white spot lesion onset is ten times lower in carriers of CAs.

Conclusions

: Patients wearing CAs show better periodontal indicators, less risk of white spot development, less biofilm mass and a better QoL than patients with FAs.

The incidence and severity of open gingival embrasures in adults treated with clear aligners and fixed appliances: a retrospective cohort study

BACKGROUND

To evaluate the incidence and severity of open gingival embrasures (OGEs) in adult patients treated with clear aligners and fixed appliances.

METHODS

Two hundred non-extraction adult subjects with less than 5 mm of crowding (mean age, 24.6 ± 3.8 years) were enrolled in this retrospective study. The subjects were divided into the clear aligner (n = 100) and fixed appliance group (n = 100). The intraoral photographs were utilized to determine the incidence of OGEs in the upper arch between maxillary central incisors, as well as the lower arch between mandibular central incisors. Crown overlap, crown shape, posttreatment root angulation, the distance from the interproximal contact point (ICP) to the alveolar bone crest (ABC) after treatment and interproximal enamel reduction (IPR) were determined in the two groups.

RESULTS

The incidence of OGEs between maxillary and mandibular central incisors after orthodontic treatment was 35.0% and 38.0% in the clear aligner group, respectively, significantly higher than that (18.0% and 24.0%) in the fixed appliance group (P < 0.05). The average area of an OGE after clear aligner treatment was larger both in the maxilla (0.16 ± 0.12mm²) and mandible (0.21 ± 0.24mm²) compared with that (0.05 ± 0.03mm² and 0.05 ± 0.06mm²) after fixed appliance treatment (P < 0.05). No difference was found regarding pretreatment crown overlap, crown shape, treatment duration, posttreatment root angulation, amount and distribution of IPR and the distance from ICP to ABC.

CONCLUSIONS

The incidence and severity of OGEs were higher in adults treated with clear aligners. Clinicians should be aware of the risk of OGEs during treatment with clear aligners.

Assessment of the periodontal health status and gingival recession during orthodontic treatment with clear aligners and fixed appliances: A systematic review and meta-analysis

BACKGROUND

The aim was to assess periodontal health maintenance and gingival recessions development in patients undergoing an orthodontic treatment with clear aligners (CA) and fixed appliances (FA).

MATERIAL AND METHODS

An electronic search in MEDLINE, Scopus, The Cochrane Library, and Web of Science was performed up to September 2022 to identify all potential articles. Two investigators independently selected the studies according to the inclusion criteria. Prospective and retrospective studies assessing the periodontal health status and gingival recession development during the orthodontic treatment with buccal FA and CA were included. Case series, cross-sectional studies, and studies with less than two months of follow-up were excluded. Two investigators independently extracted the data from included articles and assessed risk of bias across studies using the Cochrane Collaboration tool. Qualitative and quantitative analyses of the data were performed. Pairwise meta-analysis using a random-effects model were used to compare periodontal indices between FA and CA treatment in different follow-up periods.

RESULTS

From the 129 potential studies, finally 12 studies were included. Only 8 could be included in the quantitative analysis. CA seems to slightly maintain better periodontal health indices. Only plaque index in a mid-term follow-up (mean difference (MD): -0.99; 95%; Confidence interval (CI) [-1.94 to -0.03]; P=.04; I2=99%), and pocket probing depth at a long-term follow-up (MD: -0.93mm; 95% CI [-1.16 to 0.7]; P<0.0001) reported statistically significant results favoring CA.

CONCLUSIONS

Up to the date there is not enough evidence to conclude that CA maintains better periodontal health during an orthodontic treatment than FA.

A Study to Assess and Evaluate the Gingival Response During and after the Fixed Orthodontics Treatment Experienced by Adult Patients

Objective

The purpose of this research was to examine patients' periodontal health before, during, and after treatment using a fixed orthodontic device.

Methods

Forty normal teenagers with full sets of permanent teeth and a clinical need for fixed orthodontics participated. Individuals were chosen from the Class I population who would benefit from utilizing traditional orthodontic braces and techniques that did not need extractions. Respondents were sent to the periodontist for required checkups after the placement of a fixed orthodontic device at 3-, 6-, 12-, and 24-month intervals, respectively, till the conclusion of orthodontic treatment.

Results

After having a fixed orthodontic device put in place, patients had a rise in the average values of the Plaque Index and Sulcus Bleeding Index at each checkup. Keeping an eye on the progression three months, six months, a year, and two years after the initiation of orthodontic treatment reveals a statistically significant difference in the presence of gingival hyperplasia.

Conclusion

Patients' periodontal health before, during, and after fixed orthodontic treatment shows the need for close collaboration between the orthodontist and the periodontist.

Comparative analysis of individual oral hygiene during treatment with bracket systems and aligners

Relevance. Individual oral hygiene is the primary way to prevent major dental diseases. Fixed orthodontic appliances (braces) may become a barrier to good individual oral care. Aligners can provide an alternative to braces, allowing adequate toothbrushing when removed.Aim. To compare hygiene levels among patients undergoing orthodontic treatment with conventional bracket systems and aligners.Materials and methods. The study assessed oral hygiene levels at the baseline, two weeks and three months after the beginning of orthodontic treatment. The study used the PHP index to evaluate oral hygiene levels..Results. Three months later, the comparative analysis revealed that 10% of patients with braces had good oral hygiene, 30% had acceptable oral hygiene, and 60% had poor. Twenty per cent of patients with aligners had good oral hygiene, 60% had acceptable oral hygiene, and 20% had poor.Conclusions. Individual oral hygiene level in patients with fixed orthodontic appliances is significantly lower than in patients with removable appliances.

Effects of Multibracket Orthodontic Treatment versus Clear Aligners on Periodontal Health: An Integrative Review

Objective: This integrative review aimed to identify studies comparing the periodontal health in patients wearing multibracket orthodontic appliances and clear aligners. Materials and methods: An integrative literature search was performed through different databases, PubMed/Medline, PMC, and the Cochrane Library. This work was submitted to a search strategy following the PICO method and included the focus question: “Could the chosen orthodontic appliance change significantly the oral hygiene of the patient, impairing the periodontal health?” This work included analytical and controlled studies on humans published between 2005 and 2020, in the English language, establishing a comparison of the periodontal status in patients undergoing orthodontic multibracket and clear aligners therapies. The main periodontal indexes assessed were plaque index (PI), pocket depth (PD), gingival index (GI), and bleeding on probing (BoP). Results: The electronic research displayed 386 articles on PMC, 106 on PubMed, and 40 on the Cochrane Library. After removal, just 25 articles were selected for full-text screening, but just eight studies were eligible for this integrative review. It was enumerated that 204 patients were treated with aligners and 294 with multibracket orthodontic appliances, mainly elastomeric ligated brackets. Only the plaque index displayed a significant difference between the two groups and general data obtained showed a better control for periodontal health in the clear aligners. Limitations such as age, malocclusion severity, therapeutic choice, and different time measure was observed. In addition, the oral hygiene instruction and follow-up by a professional were different, and the role of malocclusion was not present in the studies. Conclusions: Within the limitations of this study, better results for periodontal health were found in the clear aligners. Therefore, more studies are necessary to affirm that aligners are synonymous with better gingival conditions in comparison with multibracket appliances. Other variables such as oral hygiene instructions, motivation, and supportive treatment tend to be more prevalent than the type of appliance itself in the periodontal evaluation.

Efficacy of root canal therapy combined with basic periodontal therapy and its impact on inflammatory responses in patients with combined periodontal-endodontic lesions

OBJECTIVE

To investigate the effect of root canal and basic periodontal therapies on the efficacy and inflammatory response in patients with pulpal-periodontal disease.

METHODS

Clinical data of 103 patients with combined periodontal-endodontic lesions were retrospectively analyzed. The patients were divided into a control group (n=50, treated with conventional root canal therapy) and an observation group (n=53, treated with root canal and basic periodontal therapies). The clinical efficacy after treatment, as well as the probing pocket depth (PD), periodontal indices, inflammatory factors release, and pain level (visual analogue scale) before and after treatment were compared between the two groups. The status of diseased teeth and adverse reactions after treatment were recorded.

RESULTS

After 1 month of treatment, the observation group had lower incidences of loosening of teeth, periodontitis and total adverse reactions, as well as higher tooth retention rate and effective rate as compared with the control group (all P<0.05). The PD, BI, PLI, GI and serum levels of interleukin-6 (IL-6) and interleukin-1β (IL-1β) all decreased in both groups after 1 month of treatment, and the decreases were more in the observation group than those in the control group (all P<0.05). Compared with before treatment, scores of visual analogue scale decreased in both groups 48 hours after the drug was sealed and 1 month after treatment, and the decreases were more in the observation group than those in the control group (all P<0.05).

CONCLUSION

Root canal and basic periodontal therapies can significantly reduce the pain, control the progression of oral inflammation, improve periodontal health and increase the retention rate of affected teeth in patients with combined periodontal-endodontic lesions, showing safety and efficacy.