Effects of Fixed Orthodontic Treatment Using Conventional, Copper-Included, and Epoxy-Coated Nickel-Titanium Archwires on Salivary Nickel Levels: A Double-Blind Randomized Clinical Trial

Orthodontic archwires, especially nickel-titanium (NiTi) ones, are a major source of nickel release. Despite their importance, no in vivo studies have assessed the ion release from conventional or new generations of NiTi archwires (copper-included and epoxy-coated). This double-blind parallel randomized clinical trial was done on 84 saliva specimens sampled at two time points from 42 orthodontic patients. The patients were randomly divided into three groups of NiTi, copper NiTi (NiTiCu), and epoxy NiTi archwires (n = 14 each). The effects of 2-month treatment, wire types, gender, and age on pretreatment, posttreatment, and time-dependent differences were analyzed statistically (α = 0.05). Salivary nickel concentrations were 10.4571 ± 0.77168 and 11.0779 ± 0.81232 μg/L, respectively, in the baseline and second month. This increase was significant (P = 0.0000, paired t test). The extents of nickel increase in different groups were 0.8279 ± 0.14 (NiTi), 0.6493 ± 0.10 (NiTiCu), and 0.385 ± 0.11 (epoxy-coated NiTi) μg/L (P = 0.0000, one-way analyses of variance (ANOVA)). Differences between each two archwire types were significant (P = 0.000, Tukey). Age and gender did not play a role. It can be concluded that NiTi archwires might increase nickel salivary levels. Epoxy-coated NiTi followed by copper NiTi archwires might release less nickel compared to conventional NiTi ones.