Effects of probiotics on salivary Streptecoccus mutans and Lactobacillus levels in orthodontic patients.

INTRODUCTION: In this study, we aimed to determine the effect of regular probiotic consumption on microbial colonization in saliva in orthodontic patients and to comparatively evaluate the difference between the systemic consumption of probiotic products and the local application. METHODS: This study included 3 groups with 15 orthodontic patients in each. The control group included patients who had no probiotic treatment, the subjects in the kefir group consumed 2 × 100 ml of kefir (Atatürk Orman Ciftligi, Ankara, Turkey) per day, and the subjects in the toothpaste group brushed their teeth with toothpaste with probiotic content (GD toothpaste; Dental Asia Manufacturing, Shah Alam, Selangor, Malaysia) twice a day. Samples were collected at 3 times: beginning of the study, 3 weeks later, and 6 weeks later. The salivary flow rate, buffer capacity, and Streptococcus mutans and Lactobacillus levels in the saliva were evaluated. Chair-side kits were used to determine the S mutans and Lactobacillus levels. RESULTS: A statistically significant decrease was observed in the salivary S mutans and Lactobacillus levels in the kefir and toothpaste groups compared with the control group (P <0.05). A statistically significant increase was observed in the toothpaste group compared with the control and kefir groups in buffer capacity. Changes in the salivary flow rate were not statistically significant. CONCLUSIONS: The regular use of probiotics during fixed orthodontic treatment reduces the S mutans and Lactobacillus levels in the saliva.

Effect of a single-tufted toothbrush on the control of dental biofilm in orthodontic patients: A randomized clinical trial.

OBJECTIVE: To compare the effect of a single-tufted toothbrush combined or not with a conventional toothbrush to control dental biofilm in healthy orthodontic patients. MATERIALS AND METHODS: Twenty orthodontic patients were randomly assigned to receive three different treatments: Group 1-conventional toothbrush; Group 2-single-tufted toothbrush and Group 3-combination of single-tufted and conventional toothbrushes. Stained plaque index (SPI), visible plaque index (VPI) and gingival bleeding index (GBI) were recorded. The data were analysed by Kolmogorov-Smirnov test. Wilcoxon test was used for intragroup comparison and Friedman test for the intergroup comparison (α = 5%). RESULTS: Intragroup analysis showed that VPI and SPI significantly decreased (P < 0.05) after 72 hour in Group 3. Anterior and posterior teeth did not show any significant statistical differences after 72 hour (P > 0.05), but VPI values in the labial surfaces were different to Group 3 (P < 0.05) in comparison with the other groups after 72 hour. Group 3 showed a statistically significant reduction (P < 0.05) for SPI in the interproximal surfaces when compared with Group 1. CONCLUSION: The combination of single-tufted and conventional toothbrushes was effective for controlling dental biofilm formation in orthodontic patients.

Changes in periodontal and microbial parameters after the space maintainers application.

AIM: This study aims to evaluate the clinical and microbiological changes accompanying the inflammatory process of periodontal tissues during treatment with space maintainers (SMs). MATERIALS AND METHODS: The children were separated into fixed (Group 1, n = 20) and removable (Group 2, n = 20) appliance groups. A full periodontal examination, including probing pocket depth (PPD), bleeding on probing (BOP), and plaque index (PI), was performed. Anaerobic microorganisms in the crevicular fluid were detected with the culture method. Clinical and microbial evaluations were performed before (T0) applications. as well as at three (T1), and 9 months intervals (T2) after the application of the fixed or removable appliances. RESULTS: The PI, PPD, and BOP scores at the testing sites of both groups increased significantly from before treatment (T0) to the 9 months' time frame (T2) (P < 0.05), The presence of anaerobic bacteria in the subgingival dental plaque increased from T0 (n = 13, 65%) to T1 (n = 16, 80%) in the fixed SM group, but not statistically significant. The same values were obtained in T1 and T2 (n = 16, 80%). CONCLUSION: Although, the results of this study demonstrate that the application of fixed or removable SM appliances in children induced an increase of clinical periodontal parameters, anaerobic microbiota consisting of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forshia were not observed in any of the samples in short-term. Further long-term and comprehensive investigations are necessary.

High potential of adhesion to biotic and abiotic surfaces by opportunistic Staphylococcus aureus strains isolated from orthodontic appliances.

Orthodontic and other oral appliances act as reservoir of opportunistic pathogens that can easily become resistant to antibiotics and cause systemic infections. The aim of this study was to investigate the ability of Staphylococcus aureus strains isolated from healthy patients with orthodontic appliances, to adhere to biotic (HeLa cells) and abiotic surfaces (polystyrene and dental alloy). Adhesive ability to polystyrene was tested by crystal violet staining and quantitative biofilm production on dental alloy surfaces was evaluated by MTT reduction assay. In addition, the presence of icaA and icaD genes was achieved by polymerase chain reaction (PCR). Qualitative biofilm production revealed that 70.6% of strains were slime producers. The metabolic activity of S. aureus biofilms on dental alloy surfaces was high and did not differ between tested strains. Moreover, all the isolates were adhesive to HeLa cells and 94% of them harbor icaA and icaD genes. Considerable adhesion and internalization capacity to the epithelial HeLa cells and strong biofilm production abilities together, with a high genotypic expression of icaA/icaD genes are an important equipment of S. aureus to colonize orthodontic appliances and eventually to disseminate towards other body areas.

Microbiological assessment of aerosol generated during debond of fixed orthodontic appliances.

INTRODUCTION: The aims of this study were to describe bacterial load and diversity of the aerosol created during enamel cleanup after the removal of fixed orthodontic appliances and to assess the effect of a preprocedural mouth rinse. METHODS: The study involved the sampling of ambient air adjacent to the patient's mouth during adhesive removal using a slow-speed handpiece and a spiral fluted tungsten carbide bur without water irrigation. Sampling was carried out during enamel cleanup with or without a preprocedural mouth rinse of either sterile water or chlorhexidine. Airborne particles were collected using a viable inertial impactor simulating the human respiratory tree. The bacteria collected were analyzed using both culture and molecular techniques. RESULTS: Bacteria produced during debond and enamel cleanup can reach all levels of the respiratory tree. The use of a preprocedural mouth rinse, either sterile water or chlorhexidine, increased the numbers and diversity of the bacteria in the air. CONCLUSIONS: When using a slow-speed handpiece and a spiral fluted tungsten carbide bur for enamel cleanup after orthodontic treatment, the bacterial load and diversity of the aerosol produced are lower when a preprocedural mouth rinse is not used.

Antimicrobial efficacy of orthodontic primer added with silver nanoparticles. Cross-sectional in vitro study. / Eficacia antimicrobiana del primer ortodóncico adicionado con nanopartículas de plata. Estudio transversal in vitro.

The antimicrobial efficacy of the silver nanoparticles (NPsAg), incorporated into the adhesive (primer) placed in the enamel adjacent to fixed orthodontic appliances (brackets), was evaluated. An experimental study was performed on 40 premolars in vitro, which were divided into two groups with brackets, one cemented with conventional primer and another added with NPsAg, placed in culture media previously inoculated with Streptococcus mutans, and sampled for culturing and counting colony forming units (UFC) on days 1, 15 and 30. A decrease in the presence of Streptococcus mutans in the samples after 15 days with nanoparticle aggregation was observed, and a reduction in the effect of said nanoparticles after 30 days. This reduction of the nanoparticles effects can be due to the absence of mechanical cleaning, which favored the bacterial aggregation on the biofilm, affecting its antimicrobial effect. This suggest the need for realizing studies in "vivo" which will allow the observation of the behavior of the biometals on the buccal medium. The NPsAg added to the primer are an effective tool to prevent the demineralization of the enamel around the fixed orthodontic appliances.

The antimicrobial effect of chlorhexidine varnish on mutans streptococci in patients with fixed orthodontic appliances: a systematic review of clinical efficacy.

OBJECTIVE: To conduct a systematic review aimed to determine the antimicrobial efficacy of chlorhexidine varnishes (CHX-V) on mutans streptococci (MS) in patients during orthodontic treatment with fixed appliances. MATERIALS AND METHODS: A systematic computerized database search was conducted using Ovid MEDLINE, Scopus and EMBASE up to September 2014. A Google search was also conducted to further identify articles that met the eligibility criteria. Clinical trials which used CHX-V alone as the intervention to investigate the antimicrobial effect of the varnish in subjects undergoing orthodontic treatment were included. Outcome measures included MS level reduction and/or decreased caries incidence from baseline data. RESULTS: Nineteen articles were identified for full-text reading; eleven articles met the criteria for inclusion in this review. Type and concentration of CHX-V, bacterial sampling method, application frequency, sampling schedule, risk of bias and study outcomes are presented. CONCLUSION: A limited number of studies with low risk of bias were available to address the antimicrobial efficacy of CHX-V on MS in patients during orthodontic treatment with fixed appliances. Therefore, while the majority of studies found CHX-V to be an effective antimicrobial against MS at an interval of 3-4 weeks, the strength of the recommendation is weak. Longitudinal studies are needed to determine whether this antimicrobial effect will contribute to clinically significant caries reduction in patients undergoing orthodontic treatment with fixed appliances.

Effects of Fixed and Removable Space Maintainers on Plaque Accumulation, Periodontal Health, Candidal and Enterococcus Faecalis Carriage.

OBJECTIVE: To evaluate the effects of space maintainers on plaque accumulation, periodontal health and oral microflora. SUBJECTS AND METHODS: The study participants comprised 38 patients aged 4-10 years requiring either fixed or removable space maintainers. Plaque index, gingival index, bleeding on probing index, candidal colonization and Enterococcus faecalis were recorded just before the application of space maintainers (T0) and during treatment at the 1st (T1), 3rd (T2) and 6th (T3) month. RESULTS: The gingival and bleeding on probing index scores increased significantly (gingival index from 0.20 ± 0254 to 0.54 ± 0417 and bleeding on probing index from 7.18 ± 9.946 to 18.07 ± 14.074) in the regions with fixed space maintainers at T3 (p < 0.01). The mean Candida counts also increased (for removable appliances from 1.90 ± 3.638 to 1.98 ± 3.318, p < 0.05, and for fixed appliances from 4.25 ± 4.587 to 4.52 ± 4.431, p < 0.001). The salivary E. faecalis counts at T3 also increased significantly with the use of fixed and removable appliances (for removable appliances from 5.93 ± 2.65 to 85.53 ± 34.1 and for fixed appliances from 4.95 ± 2.94 to 123.59 ± 29.51, p < 0.001). A positive correlation was found between the plaque (r = 0.67), gingival (r = 0.76) and bleeding on probing index scores (r = 0.76) and the candidal colonization for the fixed space maintainers (p < 0.01, p < 0.001). CONCLUSIONS: In this study, both fixed and removable space maintainers led to an increase in the number of microorganisms in the oral cavity as well as to increases in the periodontal index scores. Patients should be informed that space maintainers may serve as a source of infection and that special attention must be given to their oral hygiene.

Axenic culture of a candidate division TM7 bacterium from the human oral cavity and biofilm interactions with other oral bacteria.

The diversity of bacterial species in the human oral cavity is well recognized, but a high proportion of them are presently uncultivable. Candidate division TM7 bacteria are almost always detected in metagenomic studies but have not yet been cultivated. In this paper, we identified candidate division TM7 bacterial phylotypes in mature plaque samples from around orthodontic bonds in subjects undergoing orthodontic treatment. Successive rounds of enrichment in laboratory media led to the isolation of a pure culture of one of these candidate division TM7 phylotypes. The bacteria formed filaments of 20 to 200 µm in length within agar plate colonies and in monospecies biofilms on salivary pellicle and exhibited some unusual morphological characteristics by transmission electron microscopy, including a trilaminated cell surface layer and dense cytoplasmic deposits. Proteomic analyses of cell wall protein extracts identified abundant polypeptides predicted from the TM7 partial genomic sequence. Pleiomorphic phenotypes were observed when the candidate division TM7 bacterium was grown in dual-species biofilms with representatives of six different oral bacterial genera. The TM7 bacterium formed long filaments in dual-species biofilm communities with Actinomyces oris or Fusobacterium nucleatum. However, the TM7 isolate grew as short rods or cocci in dual-species biofilms with Porphyromonas gingivalis, Prevotella intermedia, Parvimonas micra, or Streptococcus gordonii, forming notably robust biofilms with the latter two species. The ability to cultivate TM7 axenically should majorly advance understanding of the physiology, genetics, and virulence properties of this novel candidate division oral bacterium.

Microbial contamination of laboratory constructed removable orthodontic appliances.

OBJECTIVES: This study aims to determine whether laboratory constructed removable orthodontic appliances are free from microbial contamination prior to clinical use and to evaluate the dental hospital cross-infection procedures to ensure that patient-derived contamination does not enter the construction process, thereby propagating a cycle of cross-contamination. MATERIALS AND METHODS: The construction process of removable orthodontic appliances from three individuals was evaluated at every stage, from impression to final delivery of the appliance using molecular microbiological techniques. The bacterial profiles at each stage of appliance construction were obtained using denaturing gradient gel electrophoresis, along with the bacterial profiles of the three participants' saliva. This enabled the bacterial profiles found at each stage of construction to be compared directly with the saliva of the person for whom the appliance was being constructed. Bacteria were identified at each stage using 16S rDNA PCR amplification and sequence phylogeny. RESULTS: There was no evidence of bacterial cross-contamination from patients to the laboratory. The current process of disinfection of impression appears to be adequate. Contamination was found on the final removable appliances (0.97 × 10(2)-1.52 × 10(3) cfu ml(-1)), and this contamination occurred from within the laboratory itself. CONCLUSIONS: Every effort is made to reduce potential cross-infection to patients and dental professionals. Newly constructed removable appliances were shown not to be free from contamination with bacteria prior to clinical use, but this contamination is environmental. Further studies would be required to determine the level of risk this poses to patients. CLINICAL SIGNIFICANCE: Dental professionals have a duty of care to minimise or eradicate potential risks of cross-infection to patients and other members of the team. To date, much less attention has been paid to contamination from the orthodontic laboratory, so contamination and infection risks are unknown.

Effect of 2 elastomeric ligatures on microbial flora and periodontal status in orthodontic patients.

INTRODUCTION: The aim of this study was to compare the effects of a nonconventional elastomeric ligature (Slide; Leone, Florence, Italy) with those of a conventional elastomeric ligature (Ormco, Orange, Calif) on microbial flora and periodontal status in orthodontic patients. METHODS: A total of 13 orthodontic patients scheduled for fixed orthodontic treatment were selected for this study. The use of Slide and conventional elastomeric ligatures in fixed orthodontic appliances was tested. Microbial and periodontal records were obtained before bonding and 1 and 5 weeks after bonding. For the statistical analysis and calculations, SPSS software (version 15.0; SPSS, Chicago, Ill) was used. In the statistical decisions, P <0.05 values were accepted as significantly different. RESULTS: No significant differences between Slide and conventional elastomeric ligatures were evident at 1 week or 5 weeks after bonding, with regard to gingival index, plaque index, gingival bleeding index, or pocket depth scores (P >0.05). Similarly, aerobic and anaerobic bacteria counts did not differ significantly on the surface or on the elastics (P >0.05). CONCLUSIONS: Although the Slide ligatures cover the total surface of the bracket, they do not cause significantly more plaque accumulation or periodontal problems than do the conventional elastomeric ligatures.

Antimicrobial effect of Melaleuca alternifolia dental gel in orthodontic patients.

The aim of this study was to evaluate the antimicrobial effect and sensorial analysis of the gel developed with the essential oil of Melaleuca alternifolia. Thirty-four volunteers, divided into 2 groups, were monitored for 4 weeks. Initially, clinical biofilm (plaque index) and saliva samples (bacteria count) were collected, from which the standard values for each patient were obtained. For 7 days, group 1 used the melaleuca gel (Petite Marie/All Chemistry, São Paulo, Brazil), and group 2 used Colgate Total (S.B. Campo, São Paulo, Brazil). After 7 days, the plaque index was performed again, as well as the bacteria count and the sensorial analysis (appearance, color, odor, brightness, viscosity, and first taste sensation). The volunteers were instructed to return to their usual dental hygiene habits for 15 days. After this, group 1 started using Colgate Total, and group 2 started using the melaleuca gel, with the same evaluation procedures as the first week. The data were analyzed statistically with a significance level of 5%. In the bacteria count and clinical disclosure, the melaleuca gel was more effective in decreasing the dental biofilm and the numbers of bacteria colonies. According to the data from the sensory evaluation, Colgate Total (the control) showed better results regarding flavor and first sensation (P <0.05). We concluded that melaleuca gel is efficient in bacteria control but needs improvement in taste and first sensation.

Tips for maintaining sterilization in your orthodontic work station.

Sterilization and disinfection have been a matter of concern amongst dental health care workers since long. Delicate materials, electrical parts, orthodontic pliers, orthodontic wire cutters, are to be treated according to the manufacturer's instructions to safe guard the life of the instrument as well as to claim warranty for any damage incurred. Sterilization procedures used in Orthodontics should be simple but effective and of relatively short duration so that there is a readily available supply of sterile instruments and materials. The procedure should not cause any appreciable damage to dental instruments and other materials. An attempt has been made through this article, to provide information concerning methods and means of disinfection and sterilization of orthodontic clinics, instruments, materials and also waste disposal which can be adopted in private clinics as well as in hospital set ups.

[Mechanism and risk factors of oral biofilm formation]. / Mechanizm i czynniki ryzyka powstawania biofilmu bakteryjnego jamy ustnej.

Recent microbiological investigations completely changed our understanding of the role of biofilm in the formation of the mucosal immune barrier and in pathogenesis of chronic inflammation of bacterial etiology. It is now clear that formation of bacterial biofilm on dental surfaces is characteristic for existence of oral microbial communities. It has also been proved that uncontrolled biofilms on dental tissues, as well as on different biomaterials (e.g. orthodontic appliances), are the main cause of dental diseases such as dental caries and periodontitis. The aim of this paper is to explain mechanisms and consequences of orthodontic biofilm formation. We will discuss current opinions on the influence of different biomaterials employed for orthodontic treatment in biofilm formation and new strategies employed in prevention and elimination of oral biofilm ("dental plaque").

Microbial contamination of "as received" and "clinic exposed" orthodontic materials.

INTRODUCTION: Our objective was to determine whether components of fixed orthodontic appliances as received from the manufacturers and after exposure to the clinical environment are free from microbial contamination before clinical use. A pilot molecular microbiologic laboratory study was undertaken at a dental hospital in the United Kingdom. METHODS: A range of orthodontic materials "as received" from the manufacturers and materials "exposed" to the clinical environment were studied for bacterial contamination. After growth on blood-rich media, cultured bacteria were identified by 16S rDNA polymerase chain reaction amplification and sequence phylogeny. RESULTS: Bacteria were isolated from "as received" bands, archwires, and impression trays, but the level of contamination was low (0.5 × 10(1) to 1.825 × 10(2) CFU/mL(-1)). Various bacterial species were isolated from "clinic exposed" bands, archwires, impression trays, coil springs, and elastomeric modules, but the level of contamination was low (0.5 × 10(1) to 8.0 × 10(1) CFU/mL(-1)). The most commonly identified bacterial species was Staphylococcus epidermidis, followed by Kocuria, Moraxella, and Micrococcus species. CONCLUSIONS: New materials "as received" from the manufacturers and those exposed to the clinical environment are not free from bacterial contamination before use in patients, but this contamination is low considering the potential for aerosol and operator contamination and could be considered insignificant. Further studies would be required to determine the level of risk that this poses.

Effect Of Elastomeric Separator On Microbial Count In Gingival Crevicular Fluid.

BACKGROUND: The separators are a preliminary step for band insertion, but there is a potential risk of bacteraemia during their placement, particularly in susceptible patients. The objective of the study is to determine the effect of separators on the bacterial count in gingival crevicular fluid (GCF) and to assess the efficacy of chlorhexidine mouth rinse and saline irrigation in the reduction of the bacterial count. METHODS: This randomized controlled trial was conducted on 51 participants who were divided into three equal g roups randomly (brushing only/control, saline irrigation, and 2% chlorhexidine mouthwash rinse). The inclusion criteria were age between 18-25 years, good oral hygiene, gingival and plaque index <1, no previous orthodontic treatment, and healthy individuals. The bacterial count was obtained from GCF samples after two hours, on the third day, and on the seventh day. Kruskal Wallis test was used to compare the bacterial count among the three groups, and post hoc analysis was done using Dunn's test. Friedman test was applied to see the difference at three-time points in each group. RESULTS: In both saline and chlorhexidine groups the mean bacterial count decreased significantly from baseline to 3rd day and 7th day after separator placement (p<0.001). For the third day, a significant difference was found in control versus saline and control versus chlorhexidine. No significant difference was found between saline and chlorhexidine on the third day. Similar results were found on the 7 thday. For controls, the bacterial count increased with time and for both saline and chlorhexidine groups the bacterial count decreased. The highest decrease in the bacterial count was found for the chlorhexidine group. CONCLUSIONS: After the placement of separators, there was an increase in the bacterial count in GCF. Notably, chlorhexidine was found to be more effective than saline irrigation in reducing the bacterial count.

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.

Longitudinal changes in gingival crevicular fluid after placement of fixed orthodontic appliances.

INTRODUCTION: Bacterial plaque is an etiologic factor in the development of gingival inflammation and periodontitis. The presence of orthodontic bands and brackets influences plaque growth and maturation. The purposes of this research were to monitor microbiologic and periodontal changes after placement of orthodontic attachments over a 1-year period and to link these changes to alterations in cytokine concentrations in the gingival crevicular fluid (GCF). METHODS: This longitudinal split-mouth trial included 24 patients. Supragingival and subgingival plaque composition, probing depth, bleeding on probing, and GCF flow and composition were assessed at baseline (Tb) and after 1 year (T52). A statistical comparison was made over time and between the banded and bonded sites. Prognostic factors for the clinical reaction at T52 in the GCF at Tb were determined. RESULTS: Between Tb and T52, the pathogenicity of the plaque and all periodontal parameters increased significantly, but intersite differences were not seen, except for bleeding on probing. The cytokine concentrations in the GCF did not differ significantly between the sites or between Tb and T52. The interleukin-6 concentration in the GCF at Tb was a significant predictive value for the GCF flow at T52 (P <0.05). The same relationship was found between the interleukin-8 concentration at Tb and the increase in probing depth at T52 (P <0.05). CONCLUSIONS: Interleukin-6 and interleukin-8 concentrations before orthodontic treatment were shown to be significant predictive factors for some potential inflammatory parameters during treatment.

Longitudinal changes in microbiology and clinical periodontal parameters after removal of fixed orthodontic appliances.

The aim of this longitudinal study was to monitor patients' microbiological and clinical parameters from bracket placement up to 3 months post-treatment. Twenty-four patients (10 males and 14 females, aged 14.6 ± 1.0 years) were included in this investigation. Microbiology (sub- and supragingival), periodontal probing depth (PPD), bleeding on probing (BOP), and gingival crevicular fluid (GCF) flow were assessed at baseline (T1), at bracket removal (T2), and 3 months post-treatment (T3). A statistical comparison was made over time and between the banded, bonded, and control sites. Repeated measurements on patients were taken into account by modelling the patients as a random factor. Except for PPD and BOP, values were log-transformed before analysis. Corrections for simultaneous hypothesis testing were performed via simulation. The results demonstrated that sub- and supragingival colony-forming units ratio (CFU ratio aerobe/anaerobe) decreased significantly (relatively more anaerobes) at T2 compared with T1. Between T2 and T3 no significant increase in CFU ratio was seen, resulting in a significantly lower CFU ratio at T3 compared with T1 for subgingival plaque. The difference concerning supragingival plaque between T3 and T1 was not significant. Clinical parameters PPD, POB, and GCF flow showed a significant increase between T1 and T2. Between T2 and T3 these variables decreased significantly but remained significantly higher than at T1 [except for BOP values at the bonded sites (P = 0.0646)]. Placement of fixed orthodontic appliances has an influence both on microbial and clinical periodontal parameters, which were only partly normalized, 3 months following the removal of the appliances.

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.