Virtual bracket removal: a comparative assessment of different software packages.

BACKGROUND: High precision intra-oral scans, coupled with advanced software, enable virtual bracket removal (VBR) from digital models. VBR allows the delivery of retainers and clear aligners promptly following debonding, thus reducing the patients' appointments and minimizing the likelihood of tooth movement. The objective of this study was to compare the enamel surface before bonding and after VBR using three different Computer-aided design (CAD) software and to compare their accuracy. METHODS: Maxillary scans of 20 participants starting orthodontic treatment were selected for inclusion in the study, who exhibited mild to moderate crowding and required bonding of brackets on the labial surface of permanent maxillary teeth (from the maxillary left first molar to the maxillary right first molar). Two intra-oral scans were conducted on the same day, before bonding and immediately after bonding using CEREC Omnicam (Sirona Dental Systems, Bensheim, Germany). The virtual removal of the brackets from the post-bonding models was performed using OrthoAnalyzer (3Shape, Copenhagen, Denmark), Meshmixer (Autodesk, San Rafael, Calif, USA), and EasyRx (LLC, Atlanta, GA, USA) software. The models that underwent VBR were superimposed on the pre-bonding models by Medit Link App (Medit, Seoul, South Korea) using surface-based registration. The changes in the enamel surface following VBR using the three software packages were quantified using the Medit Link App. RESULTS: There was a significant difference among the 3Shape, Meshmixer, and EasyRx software in tooth surface change following VBR. Specifically, EasyRx exhibited lower levels of accuracy compared to the other two VBR software programs (p<.001, p<.001). A significant difference in enamel surface change was observed between tooth segments across all software groups, in both incisors and molars, with VBR of the molars exhibiting the lowest level of accuracy (3Shape p=.002, Meshmixer p<.001, EasyRx p<.001). Regarding the direction of tooth surface changes following VBR, it was observed that all three groups exhibited a significant increase in the percentage of inadequate bracket removal across all teeth segments. CONCLUSIONS: 3Shape and Meshmixer manual VBR software were found to be more accurate than EasyRx automated software, however, the differences were minimal and clinically insignificant.

Synthesis and Characterization of a Sustained Nitric Oxide-Releasing Orthodontic Elastomeric Chain for Antimicrobial Action.

The acidic byproducts of bacteria in plaque around orthodontic brackets contribute to white spot lesion (WSL) formation. Nitric oxide (NO) has antibacterial properties, hindering biofilm formation and inhibiting the growth of oral microbes. Materials that mimic NO release could prevent oral bacteria-related pathologies. This study aims to integrate S-nitroso-acetylpenicillamine (SNAP), a promising NO donor, into orthodontic elastomeric ligatures, apply an additional polymer coating, and evaluate the NO-release kinetics and antimicrobial activity against Streptococus mutans. SNAP was added to clear elastomeric chains (8 loops, 23 mm long) at three concentrations (50, 75, 100 mg/mL, and a control). Chains were then coated, via electrospinning, with additional polymer (Elastollan®) to aid in extending the NO release. NO flux was measured daily for 30 days. Samples with 75 mg/mL SNAP + Elastollan® were tested against S. mutans for inhibition of biofilm formation on and around the chain. SNAP was successfully integrated into ligatures at each concentration. Only the 75 mg/mL SNAP chains maintained their elasticity. After polymer coating, samples exhibited a significant burst of NO on the first day, exceeding the machine's reading capacity, which gradually decreased over 29 days. Ligatures also inhibited S. mutans growth and biofilm formation. Future research will assess their mechanical properties and cytotoxicity. This study presents a novel strategy to address white spot lesion (WSL) formation and bacterial-related pathologies by utilizing nitric oxide-releasing materials. Manufactured chains with antimicrobial properties provide a promising solution for orthodontic challenges, showing significant potential for academic-industrial collaboration and commercial viability.

Changes in the arch width and buccal corridor after fixed orthodontic treatment with Damon self-ligating system: premolar extraction vs. non-extraction.

INTRODUCTION: Extraction vs. non-extraction is a crucial decision in orthodontic therapy. OBJECTIVE: The aim of the present study was to investigate the changes in the dental arch width and buccal corridor after orthodontic treatment using extraction and non-extraction therapy with Damon self-ligating system. MATERIAL AND METHODS: This retrospective study consisted of 35 patients (20 female and 15 male patients with median age of 12.5 years), treated by extracting 4 or 2 premolars, and 37 patients (16 female and 21 male patients with the median age of 12.8 years), treated without premolar extraction. Both groups were treated with Damon self-ligating system. Plaster models before (T0) and after (T1) treatment were measured, and the arch width values were determined at the level of the first molars, second premolars, canines and palatal rugae. Buccal corridor width was measured using the extraoral images at T0 and T1. Paired t-test was used for the analysis of the normally distributed data, and Wilcoxon Mann-Whitney U test was used for the data with non-normal distribution. Values of p<0.05 were set as statistically significant. RESULTS: The upper intercanine width increased significantly in both groups (p<0.01). In the non-extraction group, the arch width increased significantly in the maxillary second premolar and first molar region (p<0.01) as well as in the region of the canines (p=0.04), second premolars (p=0.01) and first molars (p<0.01) of the mandible. The buccal corridor decreased significantly in the non-extraction group (p<0.01). CONCLUSION: Premolar extraction in combination with Damon self-ligating system did not lead to reduction of the dental arch width in the maxilla, nor did it increase the size of the buccal corridors.

Comparison of the accuracy of two techniques for three-dimensional digital indirect bonding of orthodontic brackets: A randomized controlled trial.

OBJECTIVE: This study aimed to clinically compare the accuracy of bracket positioning between three-dimensionally (3D) printed indirect bonding trays and vacuum-formed trays made over 3D-printed models. MATERIAL AND METHODS: Fourteen patients, planned for fixed orthodontic therapy, were randomly divided into two equal groups. For both groups, both dental arches were scanned, to acquire virtual models, brackets were virtually positioned from central incisors to second premolars, and scans for the final bracket positions were performed. In the first group, transfer trays were 3D-printed. In the second group, virtual models were 3D-printed, and vacuum-formed soft sheets were thermoformed on the printed model. Teeth were indirectly bonded and then scanned. Superimposition of the virtual and the final bracket positioning scans was performed to measure linear and angular deviations in brackets positions. RESULTS: The first group showed significantly less occlusogingival and buccolingual linear errors than the second group. No significant differences in angular deviations were found between both groups. The frequencies of clinically acceptable linear errors within 0.5 mm and angular errors within 2° showed no statistically significant difference between both groups (p> 0.05 for all measurements). The transfer errors in both groups showed linear directional biases toward the mesial, gingival and labial directions. There was no statistically significant difference in the rate of immediate debonding between both groups (10.7% and 7.1% for the first and the second groups, respectively, p=0.295). CONCLUSIONS: 3D-printed indirect bonding trays were more accurate than vacuum-formed trays, in terms of linear deviations. Both types of trays showed similar angular control.

A digitalized analysis of incisal changes among orthodontically treated patients: A retrospective comparative study.

Background: To compare incisor angulation and/or position changes among orthodontically treated patients with metal brackets and clear aligners. Methods: A total of sixty-two participants of both sexes, aged-16-40 years old, with CL I skeletal pattern and mild crowding following strict eligibility criteria were included. The patients were divided into two groups based on their treatment approach. Pre and post lateral cephalograms were collected from Riyadh Elm University (REU) and then digitally analyzed using WEBCEPH (Medical Image Analysis) software. Eight angular and two linear measurements were used for the assessment. Results: The upper incisor angulation and position showed statistically significant differences when orthodontic clear aligners were used. In contrast, no significant difference was observed with the conventional orthodontic treatment. However, the upper incisal palatal root torque decreased after clear aligner therapy compared to conventional treatment. The inter-incisal angle demonstrated a significant increase with clear aligners compared to conventional treatment. Conclusions: The current study revealed the importance of definitive guidelines upon and after treatment, in addition to determining incisor changes. Orthodontic clear aligners are distinct from conventional treatments in controlling the incisors' angulation and position. The expansion treatment modality precedes Interproximal reduction in increasing the arch perimeter.

Comparative in-vivo bond failure rate of orthodontic brackets when bracket base is treated with micro-abrasive blasting vs. acid etching: eighteen month randomized control trial and scanning electron microscope study.

Background: The aim of this study was threefold. Firstly, it aimed to introduce and detail a novel method for chemically etching the bases of stainless-steel orthodontic brackets. Secondly, the study sought to investigate the structural alterations within the brackets' microstructure following chemical etching compared to those with sandblasted bases, using electron microscopy analysis. Lastly, the study aimed to evaluate and compare the long-term durability and survivability of orthodontic brackets with chemically etched bases versus those with sandblasted bases, both bonded using the conventional acid etch technique with Transbond XT adhesive, over an 18-month follow-up period. Methods: The study was a randomized clinical control trial with triple blinding and split-mouth study design and consisted of two groups. The brackets in the sandblasted group were prepared by sandblasting the intaglio surface of the base of the bracket with 50 µm SiO2 particles. Hydrofluoric acid was used to roughen the base in the acid-etched group. The bases of the brackets were viewed under an electron microscope to analyze the topographical changes. Results: A total of 5,803 brackets (3,006 acid-etch, 2,797 sandblasted) in 310 patients were bonded, in a split-mouth design by the same operator. The patients were followed for 18 months. The failure rate of 2.59% and 2.7% was noted in an acid-etched and sandblasted group, respectively. There was a close approximation of curves in the Kaplan-Meier plot, and the survival distribution of the two groups in the log-rank (Mantel-Cox) test was insignificant; x2 = 0.062 (P value = 0.804). Conclusion: Acid etching if the bases of the brackets can be used as an alternative to sandblasting furthermore acid etching can be performed on the chair side.

Experimental Bracket Design Performance on Bonding and Polymerization of Orthodontic Composite.

Objective: To evaluate the enamel bonding ability and orthodontic adhesive resin degree of conversion using the experimental bracket design. Material and Methods. Thirteen bovine teeth were used in the study. The experimental bracket was modified with a translucent region in the center of its body. After enamel etching, Orthocem orthodontic adhesive (FGM, Joinville, Brazil) was applied on the bracket base for bonding. The groups were divided as follows (n = 10 per group): (1) control (CB) with standard brackets and (2) spot bracket (SB) with experimental brackets featuring a 0.8 mm translucent region at the center using carbide bur. Shear bond strength (SBS) was evaluated after 24 hours in a universal testing machine and adhesive remnant index (ARI). The degree of conversion (DC) was analyzed using Raman spectroscopy (n = 3 per group). Data were then analyzed using Student's t-test and Mann-Whitney statistical methods. Results: The SB group exhibited a higher mean SBS (10.33 MPa) compared to the CB Group (8.77 MPa). However, there was no statistical difference between the groups (p = 0.376). Both SB and CB groups had a mean ARI score of 1. Raman analysis revealed a higher degree of conversion in the SB group (49.3%) compared to the CB group (25.9%). Conclusions: The experimental support showed a higher degree of adhesive conversion, although there was no significant increase in bond strength.

Influence of elastomeric and steel ligatures on periodontal health during fixed appliance orthodontic treatment: a systematic review and meta-analysis.

INTRODUCTION: Metallic and elastomeric ligatures are widely used in orthodontics to secure the archwire within the bracket slots, but elastomeric ligatures have traditionally been associated with increased microbial colonization, which could adversely affect periodontal health. AIM: This systematic review compares the periodontal effects of elastomeric and steel ligatures used for orthodontic fixed appliances. METHODS: Unrestricted literature search of 7 databases (MEDLINE, Scopus, Web of Science, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Virtual Health Library) up to July 2023 were performed for randomized / non-randomized clinical studies on humans comparing the two ligation methods during fixed-appliance therapy. After duplicate study selection, data extraction, and risk-of-bias assessment with the Risk of Bias (RoB) 2 or the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool, random-effects meta-analyses of Mean Differences (MD) or Standardized Mean Differences (SMD) and their 95% confidence intervals (CIs) were carried out, followed by assessment of certainty of existing evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: A total of 11 studies (3 randomized / 8 non-randomized) with 354 patients (mean age 14.7 years and 42% male) were included. No statistically significant differences were seen for plaque index (5 studies; SMD = 0.48; 95% CI = -0.03 to 1.00; P = 0.07), gingival index (2 studies; MD = 0.01; 95% CI = -0.14 to 0.16; P = 0.89), probing pocket depth (2 studies; MD = 0; 95% CI = -0.17 to 0.16; P = 0.97), or Streptococcus mutans counts (4 studies; SMD = 0.40; 95% CI=-0.41 to 1.20; P = 0.21). Elastomeric ligatures were associated with moderately increased total bacterial load (3 studies; SMD = 0.43; 95% CI = 0.10 to 0.76; P = 0.03). Confidence in these estimates was low in all instances due to the inclusion of non-randomized studies with high risk of bias. CONCLUSIONS: Existing low quality evidence indicates that ligature method does not seem to influence the periodontal health during fixed treatment, even if elastomeric ligatures are associated with a moderate increase of bacterial load. REGISTRATION: PROSPERO (CRD42023444383).

Performance of two laser motion modes versus conventional orthodontic ceramic brackets debonding technique on enamel surface topography.

The risk of enamel deterioration that frequently coexists with debonding of orthodontic teeth brackets elevates the mandate for finding an optimum approach for debonding them without harmful effects. This in-vitro study is intended to compare the effects of two different laser modes (scanning and circular) and a conventional method on the enamel surface after debonding orthodontic brackets. 66 extracted premolars were assigned into 3 groups. After that, light-cure composite resin was used to attach the ceramic brackets to the teeth. Amongst the test groups, Group I: specimens that were debonded using conventional debonding using pliers; Group 2: specimens that were debonded using Er, Cr: YSGG laser applications using the circular motion method; and Group 3: specimens that were debonded using Er, Cr: YSGG laser applications using the scanning motion method. Adhesive Remnant Index (ARI) assessment, intra-pulpal temperature increase, enamel surface roughness after polishing, and assessment of the microstructure of enamel were carried out with scanning electron microscopy. The gathered information was examined statistically. The conventional debonding method had a significantly higher proportion of adhesive remnant index (ARI) scores of 2 and 3 in comparison to the circular (p < .004) and scanning laser groups (p < .001). There was no significant difference in ARI scores between the circular and scanning laser groups (p > .05). Moreover, the circular and scanning laser debonding methods resulted in a significantly higher proportion of Enamel Surface Roughness (ESR) scores of 0 and a lower proportion of ESR scores of 3 compared to the conventional technique group (p < .001). However, there was no significant difference in ESR scores between the circular and scanning laser methods (p = .945). Lastly, the average intra-pulpal temperature was significantly higher in the circular laser group (1.9 ± 0.5 ) compared to the scanning laser group (0.9 ± 0.2) with p < .001. Er, Cr: YSGG laser irradiation is a tool that shows promise for debonding ceramic brackets with minimal harm to the enamel surface. The scanning laser technique is more desirable due to the lower intra-pulpal temperature increase.

Reduction of surface treatment time by combination of citric acid and ascorbic acid while restoring shear bond strength of metal brackets bonded to bleached enamel: a pilot study.

BACKGROUND: To investigate the effect of a 50% ascorbic acid with 50% citric acid solution on the immediate shear bond strength (SBS) of metallic brackets after tooth bleaching. The enamel etching pattern and the required quantity of these combined acids as antioxidants following 35% hydrogen peroxide (HP) bleaching were also determined. METHODS: The stability of the solution at room temperature was assessed at various time intervals. Fifty teeth were randomly divided into five groups: non-bleached (G1), bleached then acid etched (G2), bleached followed by a 10-minute treatment with 10% sodium ascorbate and acid etched (G3), 5-minute treatment with 50% ascorbic acid (G4), and 5-minute treatment with a combination of 50% ascorbic acid and 50% citric acid (G5). Groups G2, G3, G4 and G5 were bleached by 35% HP gel for a total of 32 min. Acid etching in groups G1, G2, and G3 was performed using 37% phosphoric acid (Ormco®, Orange, CA, USA) for 15 s. In all groups, metal brackets were immediately bonded using Transbond™ XT primer and Transbond™ PLUS adhesive, with light curing for 40 s. The SBS was tested with a universal testing machine, and statistical analysis was conducted using one-way ANOVA followed by Tukey's HSD test. The level of significance was set at p < 0.05 for all statistical tests. RESULTS: Stability tests demonstrated that the combined acids remained effective for up to 21 days. Group G5 significantly increased the SBS of bleached teeth to the level of G1 (p < 0.05), while G3 did not achieve the same increase in SBS (p > 0.05). SEM analysis revealed enamel etching patterns similar to those of both control groups (G1 and G2). Kinetic studies at 6 min indicated that the antioxidation in G5 reacted 0.2 mmole lower than in G3 and G4. CONCLUSION: 5-minute application of the combined acids enhanced the SBS of bleached teeth comparable to unbleached teeth. The combined acids remain stable over two weeks, presenting a time-efficient, single-step solution for antioxidant application and enamel etching in orthodontic bracket bonding.

Use of Antimicrobial Silver Coatings on Fixed Orthodontic Appliances, Including Archwires, Brackets, and Microimplants: A Systematic Review.

Orthodontic treatments, while essential for achieving optimal oral health, present challenges in infection control due to the propensity for bacterial adhesion and biofilm formation on orthodontic appliances. Silver-coated orthodontic materials have emerged as a promising solution, leveraging the potent antimicrobial properties of silver nanoparticles (AgNPs). Antibacterial coatings are used in orthodontics to prevent the formation of bacterial biofilms. This systematic review evaluated the literature on antimicrobial silver coatings on fixed orthodontic appliances, including archwires, brackets, and microimplants. Two evaluators, working independently, rigorously conducted a comprehensive search of various databases, including PubMed, PubMed Central, Embase, Scopus and Web of Science. This systematic review comprehensively examined in vitro studies investigating the antimicrobial efficacy of silver-coated orthodontic archwires, brackets, and microimplants. The review registered in PROSPERO CRD42024509189 synthesized findings from 18 diverse studies, revealing consistent and significant reductions in bacterial adhesion, biofilm formation, and colony counts with the incorporation of AgNPs. Key studies demonstrated the effectiveness of silver-coated archwires and brackets against common oral bacteria, such as Streptococcus mutans and Staphylococcus aureus. Microimplants coated with AgNPs also exhibited notable antimicrobial activity against a range of microorganisms. The systematic review revealed potential mechanisms underlying these antimicrobial effects, highlighted implications for infection prevention in orthodontic practice, and suggested future research avenues. Despite some study heterogeneity and limitations, the collective evidence supports the potential of silver-coated orthodontic materials in mitigating bacterial complications, emphasizing their relevance in advancing infection control measures in orthodontics.

Application of an Antibacterial Coating Layer via Amine-Terminated Hyperbranched Zirconium-Polysiloxane for Stainless Steel Orthodontic Brackets.

The massive growth of various microorganisms on the orthodontic bracket can form plaques and cause diseases. A novel amine-terminated hyperbranched zirconium-polysiloxane (HPZP) antimicrobial coating was developed for an orthodontic stainless steel tank (SST). After synthesizing HPZP and HPZP-Ag coatings, their structures were characterized by nuclear magnetic resonance spectroscopy, scanning electron microscopy, thickness measurement, contact angle detection, mechanical stability testing, and corrosion testing. The cell toxicity of the two coatings to human gingival fibroblasts (hGFs) and human oral keratinocytes (hOKs) was detected by cell counting kit eight assays, and SST, HPZP@SST, and HPZP-Ag@SST were cocultured with Staphylococcus aureus, Escherichia coli, and Streptococcus mutans for 24 hr to detect the antibacterial properties of the coatings, respectively. The results show that the coatings are about 10 µm, and the water contact angle of HPZP coating is significantly higher than that of HPZP-Ag coating (P < 0.01). Both coatings can be uniformly and densely distributed on SST and have good mechanical stability and corrosion resistance. The cell counting test showed that HPZP coating and HPZP-Ag coating were less toxic to cells compared with SST, and the toxicity of HPZP-Ag coating was greater than that of HPZP coating, with the cell survival rate greater than 80% after 72 hr cocultured with hGFs and hOKs. The antibacterial test showed that the number of bacteria on the surface of different materials was ranked from small to large: HPZP@SST < HPZP-Ag@SST < SST and 800 µg/mL HPZP@SST showed a better bactericidal ability than 400 µg/mL after cocultured with S. aureus, E. coli, and S. mutans, respectively (all P < 0.05). The results showed that HPZP coating had a better effect than HPZP-Ag coating, with effective antibacterial and biocompatible properties, which had the potential to be applied in orthodontic process management.

A longitudinal pilot study examining the influence of the orthodontic system chosen in adult patients (brackets versus aligners) on oral health-related quality of life and anxiety.

BACKGROUND: In recent years, the demand for orthodontic treatment with aligners has increased, led by patient need, as aligners typically provide them with improved aesthetics and less physical discomfort. In deciding with the patient on an appropriate orthodontic system, it is important to take into account the potential discomfort and the perceptions that patients have in relation to their treatment. The objective of this study was to analyze the influence of brackets or aligners on oral health-related quality of life (OHRQoL) and anxiety levels in a sample of adult patients during the first month of treatment. METHODS: The pilot study was carried out at the Dental Clinic of the University of Salamanca between November 2023 and February 2024. Eighty adult patients who initiated orthodontic treatment were selected and divided into two groups: the brackets group (Victory®; 3 M Unitek, California, USA) (n = 40) and the aligners group (Invisalign®; Align Technology, California, USA) (n = 40). OHRQoL was analyzed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire, and anxiety was analyzed using the State-Trait Anxiety Inventory (STAI). The follow-up time was one month, with scores recorded at the beginning (T0) and one month after starting treatment (T1). RESULTS: The mean patient age was 33.70 (± 5.45) years old. The total sample (n = 80) consisted of 66.2% men and 33.8% women. In the brackets group, one month after starting treatment, the dimension with the highest impact was that of physical pain (5.62 ± 1.51). In the aligners group, where the dimension of psychological disability had the highest score (4.22 ± 1.02). In the brackets group the total OHIP score was higher at one month (T1) (33.98 ± 6.81) than at the start of treatment (T0) (21.80 ± 3.34); this greater impact on OHRQoL one month after starting treatment was not observed in the aligners group (T1 = 27.33 ± 6.83; T0 = 27.33 ± 6.22). The orthodontic system used did not influence participants' anxiety (p > 0.05). Age and sex were not influential factors in either OHRQoL or anxiety. CONCLUSIONS: The bracket system significantly influenced patients' OHRQoL. In the sample studied, no influence of the orthodontic system (brackets versus aligners) on anxiety was observed.

Investigation of mechanical properties, remineralization, antibacterial effect, and cellular toxicity of composite orthodontic adhesive combined with silver-containing nanostructured bioactive glass.

BACKGROUND: The formation of white spots, which represent early carious lesions, is a major issue with fixed orthodontics. The addition of remineralizing agents to orthodontic adhesives may prevent the formation of white spots. The aim of this study was to produce a composite orthodontic adhesive combined with nano-bioactive glass-silver (nBG@Ag) for bracket bonding to enamel and to investigate its cytotoxicity, antimicrobial activity, remineralization capability, and bond strength. METHODS: nBG@Ag was synthesized using the sol-gel method, and characterized using transmission electron microscopy (TEM), X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy with an attenuated total reflectance attachment (ATR-FTIR). The cytotoxicity test (MTT) and antimicrobial activity of adhesives containing 1%, 3%, and 5% (wt/wt) nBG@Ag were evaluated, and the shear bond strength of the adhesives was measured using a universal testing machine. Remineralization was assessed through microhardness testing with a Vickers microhardness tester and scanning electron microscopy (SEM). Statistical analyses were conducted using the Shapiro-Wilk test, Levene test, one-way ANOVA, Robust-Welch test, Tukey HSD method, and two-way ANOVA. RESULTS: The biocompatibility of the adhesives was found to be high, as confirmed by the lack of significant differences in the cytotoxicity between the sample and control groups. Discs made from composites containing nBG@Ag exhibited a significant reduction in the growth of Streptococcus mutans (p < 0.05), and the antibacterial activity increased with higher percentages of nBG@Ag. The shear bond strength of the adhesives decreased significantly (p < 0.001) after the addition of nanoparticles, but it remained above the recommended value. The addition of nBG@Ag showed improvement in the microhardness of the teeth, although the differences in microhardness between the study groups were not statistically significant. The formation of hydroxyapatite deposits on the tooth surface was confirmed through SEM and energy-dispersive X-ray spectroscopy (EDX). CONCLUSION: Adding nBG@Ag to orthodontic adhesives can be an effective approach to enhance antimicrobial activity and reduce enamel demineralization around the orthodontic brackets, without compromising biocompatibility and bond strength.

Evaluation of the re-bond strength of debonded metal and ceramic brackets following Er: YAG laser treatment.

BACKGROUND: Failure of orthodontic bracket bonds is a common occurrence during orthodontic treatment. This study investigated the impact of Er: YAG laser-based removal of adhesive from the bases of metal and ceramic brackets for re-bonding. METHODS: A total of 168 extracted premolars were collected from patients. 84 metal brackets were used to be bonded on the buccal surface of the premolars in Groups 1, 2, 3 and 4, while 84 ceramic brackets were applied in Groups I, II, III and IV. Group 1/I represented the initial bonding group, with Group 2/II being the re-bonding group with new brackets, while Groups 3/III and 4/ IV received recycled brackets treated by Er: YAG laser or flaming respectively. Both the first and second de-bonding were performed in all samples using a universal testing machine to determine the shear bond strength (SBS). The adhesive remnant index (ARI) was evaluated using a stereo-microscope. The new and the treated bracket bases were evaluated using scanning electron microscopy (SEM). Differences in initial bonding and re-bonding ability were analyzed through one-way ANOVAs, and differences in ARI were assessed with the Kruskal-Wallis test. RESULTS: Greater amounts of adhesive residue were observed on ceramic brackets treated by laser. The SBS values for recycled metal brackets in Group 3 (26.13 MPa) were comparable to Group 1 (23.62 MPa) whereas they differed significantly from Group 4 (12.54 MPa). No significant differences in these values were observed when comparing the 4 groups with ceramic brackets. ARI score in Group 4 (2-3 points) differed significantly from the three other groups (P < 0.05). For Group I, II, III and IV, similar ARI scores were observed (P > 0.05). SEM analysis didn't show apparent damage of bracket bases consisting of either metal or ceramic material treated by Er: YAG laser. CONCLUSIONS: Er: YAG laser treatment was superior to flame treatment as a means of removing adhesive without damaging the brackets. SBS values and ARI scores following Er: YAG laser treatment were similar to those for new brackets, offering further support for Er: YAG laser treatment as a viable means of recycling debonded brackets.

Does surface priming increase the bond strength of orthodontic brackets? An experimental study.

OBJECTIVE: To evaluate the effects of metal primer II (MP II) on the shear bond strength (SBS) of orthodontic brackets bonded to teeth and bis-acryl composite provisional material (Bis-Acryl). MATERIAL AND METHODS: Twenty extracted human premolars specimens and 20 premolar shaped Bis-Acryl specimens were obtained and randomly divided into two surface groups. The first group consisted of human premolars (T) bonded to brackets in the conventional way while in the second (T-MP) MP II was applied on the bracket base before bonding. Similarly, one group of provisional material (PM) was prepared according to conventional treatment and another with the application of MP-II metal bonder (PM-MP). In all cases Ortho-brackets (Victory Series, 3 M) were bonded employing Transbond XT resin cement. Then the brackets were debonded under shear and the results were statistically analyzed by two-way analysis of variance and Holm Sidak at α = .05. The debonded surfaces of all specimens were examined by light microscopy and the Adhesive Remnant Index (ARI) was recorded. RESULTS: The SBS results exhibited significant differences er (p < .001). For both the T and TM the application of MP-II increased the SBS compared to respective control groups (p < .001). The T-C group was found inferior compared to PM-C (p < .001) and the same is true for the comparison between T-MP and PM-MP (p < .001). ARI indexes demonstrated that the tooth groups were characterized by a predominantly adhesive failure at the resin-dentin interface. In contrast, the control group for provisional crowns (PM-C) showed a predominantly cohesive failure mode, which moved to predominantly adhesive after the application of MP II. CONCLUSION: The application of MP II enhances the SBS on both, human enamel and provisional crown materials.

Effect of fence tray matching care on excess adhesive and bracket placement accuracy for orthodontic bonding: an in vitro study.

OBJECTIVE: This study aimed to evaluate the effect of fence tray matching care (FTMC) in bracket bonding by measuring excess adhesive, as well as linear and angular deviations, and by comparing it with the half-wrapped tray (HWT). MATERIALS AND METHODS: An intraoral scanner was used to acquire data on the maxillary dental arch of a patient with periodontitis.Furthermore, 20 maxillary dental arch models were 3D printed. Using 3Shape, PlastyCAD software, and 3D printing technology, 10 FTMC (method I) and HWT (method II) were obtained. By preoperative preparation, intraoperative coordination, and postoperative measurement, the brackets were transferred from the trays to the 3D-printed maxillary dental arch models. Additionally, the bracket's excess adhesive as well as linear and angular deviations were measured, and the differences between the two methods were analyzed. RESULTS: Excess adhesive was observed in both methods, with FTMC showing less adhesive (P< 0.001), with a statistical difference. Furthermore, HWT's vertical, tip and torque, which was significantly greater than FTMC (P< 0.05), with no statistical difference among other respects. The study data of incisors, canines, and premolars, showed that the premolars had more adhesive residue and were more likely to have linear and angular deviations. CONCLUSIONS: The FTMC had higher bracket bonding effect in comparison to HWT, and the adhesive residue, linear and angular deviations are smaller. The fence tray offers an intuitive view of the precise bonding of the bracket, and can remove excess adhesive to prevent white spot lesions via care, providing a different bonding method for clinical applications.

Antibacterial, cytotoxic and mechanical properties of a orthodontic cement with phosphate nano-sized and phosphorylated chitosan: An in vitro study.

OBJECTIVES: Evaluate, in vitro, the effect of incorporating nano-sized sodium trimetaphosphate (TMPnano) and phosphorylated chitosan (Chi-Ph) into resin-modified glass ionomer cement (RMGIC) used for orthodontic bracket cementation, on mechanical, fluoride release, antimicrobial and cytotoxic properties. METHODS: RMGIC was combined with Chi-Ph (0.25%/0.5%) and/or TMPnano (14%). The diametral compressive/tensile strength (DCS/TS), surface hardness (SH) and degree of conversion (%DC) were determined. For fluoride (F) release, samples were immersed in des/remineralizing solutions. Antimicrobial/antibiofilm activity was evaluated by the agar diffusion test and biofilm metabolism (XTT). Cytotoxicity in fibroblasts was assessed with the resazurin method. RESULTS: After 24 h, the RMGIC-14%TMPnano group showed a lower TS value (p < 0.001); after 7 days the RMGIC-14%TMPnano-0.25%Chi-Ph group showed the highest value (p < 0.001). For DCS, the RMGIC group (24 h) showed the highest value (p < 0.001); after 7 days, the highest value was observed for the RMGIC-14%TMPnano-0.25%Chi-Ph (p < 0.001). RMGIC-14%TMPnano, RMGIC-14%TMPnano-0.25%Chi-Ph, RMGIC-14%TMPnano-0.5%Chi-Ph showed higher and similar release of F (p > 0.001). In the SH, the RMGIC-0.25%Chi-Ph; RMGIC-0.5%Chi-Ph; RMGIC-14%TMPnano-0.5%Chi-Ph groups showed similar results after 7 days (p > 0.001). The RMGIC-14%TMPnano-0.25%Chi-Ph group showed a better effect on microbial/antibiofilm growth, and the highest efficacy on cell viability (p < 0.001). After 72 h, only the RMGIC-14%TMPnano-0.25%Chi-Ph group showed cell viability (p < 0.001). CONCLUSION: The RMGIC-14%TMPnano-0.25%Chi-Ph did not alter the physical-mechanical properties, was not toxic to fibroblasts and reduced the viability and metabolism of S. mutans. CLINICAL RELEVANCE: The addition of phosphorylated chitosan and organic phosphate to RMGIC could provide an antibiofilm and remineralizing effect on the tooth enamel of orthodontic patients, who are prone to a high cariogenic challenge due to fluctuations in oral pH and progression of carious lesions.