Original Article http://dx.doi.org/10.1590/1678-77572016-0231
,QÀXHQFHRIUHVLQPRGL¿HGJODVV LRQRPHUDQGWRSLFDOÀXRULGHRQOHYHOV of Streptococcus mutans in saliva and ELR¿OPDGMDFHQWWRPHWDOOLFEUDFNHWV
Abstract Marcela Cristina Damião ANDRUCIOLI1 Gisele FARIA2 Paulo NELSON-FILHO1
'HFDOFL¿FDWLRQ RI HQDPHO GXULQJ ¿[HG RUWKRGRQWLF DSSOLDQFH WUHDWPHQW remains a problem. White spot lesions are observed in nearly 50% of SDWLHQWVXQGHUJRLQJRUWKRGRQWLFWUHDWPHQW7KHXVHRIÀXRULGHFRQWDLQLQJ orthodontic materials has shown inconclusive results on their ability to reduce GHFDOFL¿FDWLRQ7KHDLPVRIWKLVLQYHVWLJDWLRQZHUHWRFRPSDUHWKHOHYHOVRI
Fábio Lourenço ROMANO1
Streptococcus mutans 60 LQ VDOLYD DQG ELR¿OP DGMDFHQW WR RUWKRGRQWLF
Mírian Aiko Nakane MATSUMOTO1
EUDFNHWVUHWDLQHGZLWKDUHVLQPRGL¿HGJODVVLRQRPHUFHPHQW 50*,& )XML ORTHO LC) and a light cured composite resin (Transbond XT), and to analyze WKHLQÀXHQFHRIWRSLFDODSSOLFDWLRQRIWKHDFLGXODWHGSKRVSKDWHÀXRULGH (APF) on SM counts. In a parallel study design, two groups (n=14/15) were used with random allocation and high salivary SM counts before treatment. %LR¿OPZDVFROOHFWHGIURPDUHDVDGMDFHQWWRWKHEUDFNHWVRQWHHWK DQG%RWKVDOLYDDQGELR¿OPZHUHFROOHFWHGRQWKHth, 21st, 35th, and 49thGD\VDIWHUDSSOLDQFHSODFHPHQW7RSLFDOÀXRULGHDSSOLFDWLRQZDVFDUULHG out on the 35th day. Bonding with RMGIC did not alter SM counts in saliva RUELR¿OPDGMDFHQWWRWKHEUDFNHWV2QWKHRWKHUKDQGWKHELR¿OPDGMDFHQW WREUDFNHWVUHWDLQHGZLWKFRPSRVLWHUHVLQVKRZHGDVLJQL¿FDQWLQFUHDVHLQ SM counts along the trial period. Topical application of 1.23% APF did not UHGXFH VDOLYDU\ RU ELR¿OP 60 FRXQWV UHJDUGOHVV RI WKH ERQGLQJ PDWHULDO ,QFRQFOXVLRQÀXRULGHWRSLFDODSSOLFDWLRQGLGQRWVKRZHI¿FDF\LQUHGXFLQJ SM. The use of RMGIC as bonding materials allowed a better control of 60FIXFRXQWVLQGHQWDOELR¿OPKLQGHULQJWKHVLJQL¿FDQWLQFUHDVHRIWKHVH PLFURRUJDQLVPV DORQJ WKH WULDO SHULRG ZKLFK ZDV REVHUYHG LQ WKH ELR¿OP adjacent to the composite material. Keywords: Orthodontics. Glass ionomer cements. Streptococcus mutans. $FLGXODWHGSKRVSKDWHÀXRULGH'HQWDOPDWHULDOV
Submitted: June 28, 2016 0RGL¿FDWLRQ 2FWREHU Accepted: December 06, 2016
Corresponding address: Dr. Marcela Cristina Damião Andrucioli Departamento de Clínica Infantil - Faculdade de Odontologia de Ribeirão Preto Universidade de São Paulo Avenida do Café, S/N, Monte Alegre - 14040-904 Ribeirão Preto - SP - Brazil Phone: +55-16-3602-4099 - Fax: +55-16-3633-0999 e-mail: [email protected]
1 Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Clínica Infantil, Ribeirão Preto, SP, Brasil. 2 Universidade Estadual Paulista, Faculdade de Odontologia de Araraquara, Departamento de Odontologia Restauradora, Araraquara, SP, Brasil.
J Appl Oral Sci.
196 2017;25(2):196-202
,QÀXHQFHRIUHVLQPRGL¿HGJODVVLRQRPHUDQGWRSLFDOÀXRULGHRQOHYHOVRIStreptococcus mutansLQVDOLYDDQGELR¿OPDGMDFHQWWRPHWDOOLFEUDFNHWV
Introduction
same cross-over effect onto the control side. The aims of this parallel designed clinical trial was
'HFDOFL¿FDWLRQ DURXQG RUWKRGRQWLF EUDFNHWV LV D common problem and a potential risk of orthodontic treatment, especially in patients with poor oral hygiene13,237KHUHLVDVLJQL¿FDQWLQFUHDVHLQVDOLYDU\ DQG ELR¿OP OHYHOV RI Streptococcus mutans (SM) in QHDUO\RISDWLHQWVXQGHUJRLQJ¿[HGRUWKRGRQWLF treatment, concomitant with an increased risk to dental caries2,14,17. Fixed orthodontic appliances induce
to compare the effect of two orthodontic bonding materials (RMGIC and composite resin) on the levels RI 60 LQ VDOLYD DQG ELR¿OP DGMDFHQW WR RUWKRGRQWLF brackets and to evaluate if a 1.23% acidulated SKRVSKDWH ÀXRULGH JHO DSSOLFDWLRQ FDQ LQÀXHQFH WKH reduction of SM counts.
Material and methods
intraoral changes, such as a low-pH environment, which increase enamel susceptibility to the formation
Eligible participants were screened among patients
of white spot lesions (WSL) caused by organic
ZLWK LQGLFDWLRQ IRU RUWKRGRQWLF WUHDWPHQW ZLWK ¿[HG
DFLGV SURGXFHG E\ GHQWDO ELR¿OP EDFWHULD :6/ DUH
appliances, who had complete permanent dentition,
potentially irreversible and can be observed as early as
were free of caries, had good general health, and had
1 month after the beginning of orthodontic treatment,
not used antibiotics and/or antimicrobial mouthwashes
causing aesthetic problems
in the previous 3 months. The minimum sample size
.
1,3,11,12
$QHIIHFWLYHELR¿OPFRQWUROLVWKHPDLQPHDVXUHWR
IRU HDFK JURXS ZLWK SRZHU DQG D VLJQL¿FDQFH
SUHYHQWHQDPHOGHFDOFL¿FDWLRQLQRUWKRGRQWLFSDWLHQWV
OHYHO RI ZDV LGHQWL¿HG DV IRU DQ H[SHFWHG
but it depends on patient compliance4 and thus, other
difference of 30% between the groups. Twenty-nine
SUHYHQWLYHPHDVXUHVVXFKDVWRSLFDOÀXRULGHVKRXOGEH
12-20-year-old patients who met the inclusion criteria
. There are several forms of delivering
associated
2,8,17
and presented high salivary SM counts were enrolled
WRSLFDO ÀXRULGH GXULQJ RUWKRGRQWLF WUHDWPHQW ZKLFK
in the study. Following the approval of the research
include toothpastes, mouthrinses, gel, varnishes,
project by the institutional Ethics Committee (process
ÀXRULGHUHOHDVLQJPDWHULDOVVXFKDVERQGLQJPDWHULDOV
#2005.1.1013.58.7), all subjects or their parents/
and elastics1,3,4,24.
caregivers received verbal and written information
The use of glass ionomer cement (GIC) for
about the study purposes and procedures and signed
bracket bonding is a mean to release fluoride
an informed consent form for participation. All patients
from a rechargeable source to sites at higher risk
ZHUH UHVLGHQW LQ DQ DUHD ZLWK ÀXRULGDWLRQ RI WKH
. Resin
SXEOLFZDWHUVXSSO\%LR¿OPGHSRVLWVZHUHHOLPLQDWHG
for developing dental caries
1,3,4,9,11,12,19,24,25
modified GIC (RMGIC) is a good alternative for
with meticulous rubber cup/pumice prophylaxis, and
orthodontic bonding as they offer protection against
patients received general oral hygiene instructions
GHPLQHUDOL]DWLRQE\ÀXRULGHUHOHDVHDQGSUHVHQWKLJKHU
and were oriented to brush their teeth 3 times a
resistance to bracket debonding than conventional
day after meals using a toothbrush (Professional®,
GIC1,5,6,14,15,21,22,24,30.
Colgate-Palmolive Indústria and Comércio Ltda., São
The antimicrobial activity of GIC is due to a
3DXOR63%UD]LO DQGDÀXRULGHFRQWDLQLQJGHQWLIULFH
FRPELQDWLRQ RI ÀXRULGH UHOHDVH IURP WKH FHPHQWV
(Colgate Máxima Proteção Anticaries ®, Colgate-
and decrease of pH during the setting reaction,
Palmolive Indústria and Comércio Ltda., São Paulo,
which increases the sensitivity of microorganisms to
SP, Brazil) supplied by the researchers throughout
ÀXRULGH
. Furthermore, the literature shows that
7,14,28
ÀXRULGHUHFKDUJLQJUHVWRUHWKHDQWLEDFWHULDOSURSHUWLHV RIWKHUHVLQPRGL¿HGJODVVLRQRPHUFHPHQWV27.
WKH H[SHULPHQWDO SHULRG 1R RWKHU ÀXRULGH VRXUFHV were used. Before the beginning of the study, the number
7KHLQÀXHQFHRI*,&RQWKHFRQWURORI60FRXQWVLQ
of SM colony-forming units (cfu) in the saliva of all
VDOLYDDQGELR¿OPKDVEHHQH[WHQVLYHO\HYDOXDWHGLQ
eligible individuals was determined. For this purpose,
clinical trials. However, these studies have employed
2.0 mL of non-stimulated saliva were collected from
the split-mouth design whereby the test material
each patient before placement of the appliance (T0).
is allocated to two quadrants of the mouth and the
The material collected was placed in properly labeled
control material is allocated to the other two quadrants
15x100 mm sterile tubes containing 4 to 5 glass beads.
. This trial design can lead to
Aliquots of 0.05 mL of diluted pure non-stimulated
at the same time
11,16,18,29
J Appl Oral Sci.
197 2017;25(2):196-202
ANDRUCIOLI MCD, FARIA G, NELSON-FILHO P, ROMANO FL, MATSUMOTO MAN
saliva samples were seeded on SB-20M solid culture
performed, as describe before for saliva (T0).
medium, prepared according to Saravia, et al.26 (2013). The number of colony forming units (cfu) per
Statistical analysis
milliliter of saliva was counted under aseptic conditions
The original data measured in cfu were transformed
under a stereomicroscope (Nikon, Tokyo, Japan) with
in log10 for statistical analysis and are reported as
UHÀHFWHGOLJKW&RORQLHVZLWK06FKDUDFWHULVWLFVZHUH
log(cfu)/mL. The SM log(cfu)/mL means in saliva
transferred to tubes containing thioglycollate (Difco
before orthodontic treatment (T0) and in saliva and
Laboratories Inc., Detroit, MI, USA) and incubated
ELR¿OP EHWZHHQ WKH WZR JURXSV DW HDFK FROOHFWLRQ
at 37 C during 24 h for biotyping. The growth of
time (T7d, T21d, T35d, and T49d) were compared using
06FIXZDVYHUL¿HGDIWHUWKHLQFXEDWLRQSHULRGDQG
the Student’s t test for independent samples and the
the following tests were performed for biochemical
Levene test was used to evaluate the homogeneity of
LGHQWL¿FDWLRQ IHUPHQWDWLRQ RI PDQQLWRO VRUELWRO
variances. The hypothesis of equality of SM log(cfu)/
UDI¿QRVH DQG PHOLELRVH UHVLVWDQFH WR EDFLWUDFLQ
mL means in saliva before treatment (T0) and in saliva
hydrolysis of arginine and sculin, production of H2O2,
DQGELR¿OPDWWKHGLIIHUHQWFROOHFWLRQWLPHV 77d, T21d,
and sensitivity to 2.0 IU bacitracin.
T35d, and T49d) was tested using repeated measures
o
In all patients, sterile new Edgewise metallic
ANOVA and Tukey’s test. Data were analyzed using
orthodontic brackets (0.022x0.028-inch slot)
a GraphPad Prism statistical software (GraphPad
(Generus, GAC International Inc., Bohemia, NY, USA)
6RIWZDUH,QF6DQ'LHJR&$86$ DQGDVLJQL¿FDQFH
were bonded in all teeth with a RMGIC (Fuji Ortho LC;
level of 5% was set for all analyses.
CG Corporation, Tokyo, Japan - experimental group, n=14) or an orthodontic light-cured composite resin
Results
(Transbond XT, 3M Unitek, Monrovia, CA, USA - control group, n=15). The 29 patients were randomized to
Analysis of the SM log(cfu)/mL means in saliva at
the two groups using the SAS (Statistical Analysis
T0 by the Student’s t test for pairwise comparisons
Systems) version 9.1.3 for Windows (SAS Institute
(p=0.42) and the Levene test for homogeneity
Inc., Cary, NC, USA) statistical software.
(p=0.27) showed that the groups were similar.
6DOLYD DQG ELR¿OP VDPSOHV ZHUH FROOHFWHG IURP
Regarding the effect of the tested materials on
both groups at 7 (T7d), 21 (T21d), 35 (T35d), and 49
SM log(cfu)/mL means in saliva, no statistically
(T49d) days after orthodontic appliance placement. On
VLJQL¿FDQWGLIIHUHQFHVZHUHIRXQGDPRQJWKHFROOHFWLRQ
the 35th day, 1.23% APF gel was topically applied for
times within the Fuji-Ortho (p=0.09) and Transbond
PLQDIWHUFROOHFWLRQRIVDOLYDDQGELR¿OPVDPSOHV$W
XT (p=0.25) groups (Figure 1). Furthermore, no
HDFKFROOHFWLRQWLPHELR¿OPZDVUHPRYHGZLWKDVWHULOH
VLJQL¿FDQWGLIIHUHQFHVZHUHIRXQGLQWKH60 log(cfu)/
probe in a single and continuous movement around
mL means in saliva between the Fuji-Ortho and
brackets of the maxillary right canine (13), maxillary
Transbond XT groups at any of the collection times
left lateral incisor (22), mandibular left canine (33)
(Table 1). The 1.23% APF gel application at T35d
and mandibular right central incisor (41) to verify the
reduced the number of SM log(cfu)/mL in saliva,
HIIHFW RI 50*,& DQG WKH WRSLFDO ÀXRULGH DSSOLFDWLRQ
DOWKRXJKQRWVWDWLVWLFDOO\VLJQL¿FDQW
on SM levels.
Regarding the effect of the tested materials on SM
%LR¿OPVDPSOHVZHUHVSUHDGRQ[PPVWHULOH
ORJ FIX P/ PHDQV LQ GHQWDO ELR¿OP QR VWDWLVWLFDOO\
test tubes containing 4 to 5 glass beads and 2.0 mL
significant differences were found among the
SKRVSKDWH EXIIHU VDOLQH 3%6 6DOLYD DQG ELR¿OP
collection times within the Fuji-Ortho group (p=0.08)
samples were vortexed for 2 and 1 min, respectively,
although it could be observed a trend of a gradual
for microbial desorption, and submitted to ten-fold
increase in cfu levels over time (T7d to T35d) (Figure
serial dilutions (10 ). After that, 50 mL of each dilution
2). In addition, the SM log(cfu)/mL means in dental
was plated equidistantly on SB-20M culture medium
ELR¿OPQXPHULFDOO\UHPDLQHGWKHVDPHDIWHUÀXRULGH
and incubated under candle jar system at 37°C for
application (T49d - Table 2). This gradual increase
48 to 72 hours. The number of colony forming units
was also observed in the Transbond XT group, but
(cfu) perPLOOLOLWHURIVDOLYDDQGELR¿OPZDVFRXQWHG
VLJQL¿FDQWGLIIHUHQFHZDVIRXQGRQO\EHWZHHQ77d to
and biotyping of colonies with MS characteristics were
T49d S )LJXUH $IWHUÀXRULGHDSSOLFDWLRQD
-5
J Appl Oral Sci.
198 2017;25(2):196-202
,QÀXHQFHRIUHVLQPRGL¿HGJODVVLRQRPHUDQGWRSLFDOÀXRULGHRQOHYHOVRIStreptococcus mutansLQVDOLYDDQGELR¿OPDGMDFHQWWRPHWDOOLFEUDFNHWV
Figure 1- Means and standard deviations [log(cfu)/mL] of Streptococcus mutans in saliva for experimental (Fuji ORTHO LC) and control (Transbond XT) groups at different times of collection
Table 1- Means of Streptococcus mutans [log(cfu)/mL] in saliva according to the orthodontic bonding material and sample collection time Fuji-Ortho (n=15)
Transbond XT (n=14)
Collection time
Mean (S.D.)
Mean (S.D.)
p value
T0
4.35 (1.03)
4.69 (1.23)
0.42
T7d
4.77 (0.85)
5.28 (0.66)
0.08
T21d
4.98 (1.13)
5.19 (1.19)
0.62
T35d
5.18 (1.09)
5.20 (1.42)
0.97
T49d
4.77 (1.47)
4.79 (1.73)
0.97
T0 = before bracket bonding. T7d, T21d, T35d, T49d = 7, 21, 35, and 49 days after bracket bonding, respectively. The p values express the results of the Student’s t-test for comparison of the materials at each collection time.
numeric increase occurred in SM log(cfu)/mL means
A parallel study design was used to examine the
LQ GHQWDO ELR¿OP GHSRVLWV DGMDFHQW WR WKH EUDFNHWV
DFWXDO HIIHFW RI ÀXRULGH ZKLOH PRVW in vivo studies
bonded with this material. Comparing the orthodontic
RQ ÀXRULGH UHOHDVHG E\ GLIIHUHQW W\SHV RI *,& KDYH
PDWHULDOVXVHGQRVLJQL¿FDQWGLIIHUHQFHVZHUHIRXQG
employed a split-mouth design11,17,29. When examining
in the SM ORJ FIX P/PHDQVLQELR¿OPEHWZHHQWKH
the capacity of fluoride-containing materials to
Fuji-Ortho and Transbond XT groups at any of the
UHGXFH FDULHV RQVHW LW LV XQOLNHO\ WKDW WKH ÀXRULGH
collection times (Table 2).
UHOHDVHGZRXOGEHFRQ¿QHGWRRQO\WKHTXDGUDQWVLQ which the test material has been placed and there
Discussion
would inevitably be some crossover effect onto the FRQWURO VLGH $OWKRXJK WRSLFDOO\ DSSOLHG ÀXRULGH KDV
In this clinical trial, comparisons between two
been reported to have mostly a local effect20, a
orthodontic bonding materials (RMGIC and composite
VOLJKW FURVVRYHU RI ÀXRULGH YLD VDOLYD KDV DOVR EHHQ
UHVLQ VKRZHG QR VLJQL¿FDQW GLIIHUHQFHV LQ 60 FIX
suggested10. This would reduce the difference in
FRXQWV LQ VDOLYD DQG GHQWDO ELR¿OP DGMDFHQW WR WKH
effect between the test materials and the power of
brackets at any collection time. The main difference
WKH H[SHULPHQW WR ¿QG GLIIHUHQFH3,4. According to
between the materials was that RMGIC at least
Rogers, Chadwick and Treasure23 (2010), until better
allowed a better control of SM cfu counts in dental
XQGHUVWDQGLQJ KRZ ÀXRULGH UHOHDVHG RQ RQH VLGH RI
ELR¿OP KLQGHULQJ WKH VLJQL¿FDQW LQFUHDVH RI WKHVH
WKHPRXWKLQÀXHQFHVWKHRWKHUVLGHDSDUDOOHOVWXG\
microorganisms along the trial period that was
design seems to be the most appropriate.
REVHUYHGLQWKHELR¿OPDGMDFHQWWRWKHFRPSRVLWH
J Appl Oral Sci.
,QWKLVVWXG\QRVLJQL¿FDQWGLIIHUHQFHVZHUHIRXQG
199 2017;25(2):196-202
ANDRUCIOLI MCD, FARIA G, NELSON-FILHO P, ROMANO FL, MATSUMOTO MAN
Figure 2- Means and standard deviations [log(cfu)/mL] of Streptococcus mutansLQELR¿OPIRUH[SHULPHQWDO )XML257+2/& DQGFRQWURO (Transbond XT) groups at different times of collection
Table 2- Means of Streptococcus mutans>ORJ FIX P/@LQGHQWDOELR¿OPDGMDFHQWWRWKHEUDFNHWVDFFRUGLQJWRWKHRUWKRGRQWLFERQGLQJ material and sample collection time. Fuji-Ortho (n=15)
Transbond XT (n=14)
Collection time
Mean (S.D.)
Mean (S.D.)
p value
T7d
2.70 (1.38)
2.13 (0.94)
0.13
T21d
3.27 (1.04)
2.61 (1.05)
0.10
T35d
3.35 (1.25)
2.75 (1.14)
0.36
T49d
3.31 (1.03)
3.13 (1.30)
0.72
T0 = before bracket bonding. T7d, T21d, T35d, T49d = 7, 21, 35, and 49 days after bracket bonding, respectively. The p values express the results of the Student’s t-test for comparison of the materials at each collection time.
in SM log(cfu)/mL means in the saliva of the patients
ÀXRULGH DSSOLFDWLRQ DW 735d compared with T49d. It
with brackets bonded with RMGIC and composite resin,
can be assumed that RMGIC was not effective in
DQGLWGLGQRWFKDQJHDIWHUWRSLFDOÀXRULGHDSSOLFDWLRQ
UHGXFLQJ 60 FRXQWV LQ GHQWDO ELR¿OP DGMDFHQW WR
These results mean that the use of RMGIC to retain
orthodontic brackets, but no increase in the number
orthodontic brackets did not reduce the number of
of microorganisms was observed either. On the other
SM cfu counts in saliva. According to Øgaard, et al.
hand, regarding the SM log(cfu)/mL means in dental
(1997), it could be explained by the fact that the
ELR¿OPGHSRVLWVDGMDFHQWWRWKHEUDFNHWVERQGHGZLWK
ÀXRULGHUHOHDVHGE\WKHRUWKRGRQWLFERQGLQJDGKHVLYH
FRPSRVLWHUHVLQDVWDWLVWLFDOO\VLJQL¿FDQWLQFUHDVHZDV
17
GLGQRWLQFUHDVHWKHÀXRULGHOHYHOVLQVDOLYDHYHQZKHQ
observed from T7d to T49d HYHQ DIWHU WRSLF ÀXRULGH
LWZDVDVVRFLDWHGZLWKDÀXRULGHGHQWLIULFH,QWKHVDPH
application at T35d.
way, Gorton and Featherstone9 GLGQRW¿QGDQ\
7RSLFDOÀXRULGHDSSOLFDWLRQZDVQRWDEOHWRUHGXFH
HOHYDWLRQRQVDOLYDU\ÀXRULGHOHYHOVZKLFKLQGLFDWHV
the number of SM along the time of orthodontic
RQO\DORFDOÀXRULGHUHOHDVH
treatment, regardless of the material used to retain
Regarding the SM log(cfu)/mL means in dental
the brackets, although RMGIC allowed a better control
ELR¿OP GHSRVLWV DGMDFHQW WR WKH EUDFNHWV ERQGHG
in SM counts than the composite. According to Ahn, et
with RMGIC, a slight increase was observed from
al.1 ÀXRULGHUHOHDVLQJPDWHULDOVFDQDFWDVD
T7d to T35d WKRXJK ZLWKRXW VWDWLVWLFDO VLJQL¿FDQFH
UHVHUYRLUIRUWRSLFDOÀXRULGDWLRQDQG50*,&UHOHDVHV
In addition, practically no change occurred in SM
WKHKLJKHVWDPRXQWRIÀXRULGHLRQVZKHQUHFKDUJHG
ORJ FIX P/ PHDQV LQ GHQWDO ELR¿OP DIWHU WRSLFDO
)RUWKLVUHDVRQDVLJQL¿FDQWGHFUHDVHLQWKHQXPEHURI
J Appl Oral Sci.
200 2017;25(2):196-202
,QÀXHQFHRIUHVLQPRGL¿HGJODVVLRQRPHUDQGWRSLFDOÀXRULGHRQOHYHOVRIStreptococcus mutansLQVDOLYDDQGELR¿OPDGMDFHQWWRPHWDOOLFEUDFNHWV
PLFURRUJDQLVPVLQWKHELR¿OPDURXQGWKHEUDFNHWVZDV
then followed an upward trend5,13,23,24. These results
expected for the group that used RMGIC in our study.
PD\ EH FRQ¿UPHG LQ WKLV VWXG\ LQ ZKLFK WKH 60
The results of this study differ from those of
cfu counts did not increase after 1.23% APF topical
previous investigations. Hallgren, Oliveby and
application in the RMGIC group, as it occurred in the
Twetman12 REVHUYHGVLJQL¿FDQWO\KLJKHU60FIX
composite group.
FRXQWVLQGHQWDOELR¿OPDGMDFHQWWREUDFNHWVERQGHG with composite (Concise) compared with GIC (Aqua-
Conclusion
Cem) 1 month after the beginning of orthodontic treatment. Wright, et al.29 (1996) found similar results
Considering the results obtained in this study, we
ZLWK VLJQL¿FDQWO\ ORZHU 60 FRXQWV LQ GHQWDO ELR¿OP
may conclude that topical application 1.23% APF gel
adjacent to GIC (Geristore) than to composite resin
did not alter SM FIXFRXQWVLQVDOLYDDQGGHQWDOELR¿OP
(Phase II) 1 week after bracket bonding. After 5 weeks,
adjacent to the orthodontic brackets for both groups;
however, this difference was not detected.
the material used for orthodontic bracket bonding
7KH HI¿FDF\ RI *,& LQ FRQWUROOLQJ 60 FRXQWV LQ
(RMGIC or composite resin) did not alter the SM cfu
GHQWDOELR¿OPLVDWWULEXWHGWRWKHDQWLPLFURELDODFWLYLW\
counts in saliva along the trial period, and the SM cfu
RIÀXRULGHUHOHDVHGIURPWKHVHPDWHULDOV22,28, although
FRXQWVLQGHQWDOELR¿OPDGMDFHQWWREUDFNHWVERQGHG
ÀXRULGHUHOHDVHDQGEDFWHULDOLQKLELWLRQDUHJUHDWHULQ
with RMGIC practically did not change, while there was
conventional GIC than in RMGIC7.
DVLJQL¿FDQWLQFUHDVHLQWKH60 cfu counts adjacent
In agreement to this study, Örthendahl, Thilander and Svanberg
18
(1997) did not find significant
to brackets bonded with composite resin during the trial period.
differences in SM cfu counts LQGHQWDOELR¿OPDGMDFHQW to brackets bonded with GIC (Ketac-Cem) and composite resin (Concise). This result can be attributed
Acknowledgements The authors are indebted to Dr. Izabel Yoko Ito
WR WKH IDFW WKDW ELR¿OP VDPSOHV ZHUH FROOHFWHG
(in memoriam) of Department of Clinical Analysis,
months after bracket bonding. This is an important
Toxicology and Bromatology, School of Pharmaceutical
¿QGLQJ EHFDXVH LW KDV EHHQ UHSRUWHG WKDW *,& KDV
Sciences of Ribeirão Preto, University of São Paulo, for
D VWURQJ DQWLEDFWHULDO DFWLYLW\ RQO\ ZLWKLQ WKH ¿UVW
helpful assistance during microbiological processing
week, diminishing considerably after this time
. In
1,14
and analysis.
the same way, Gillgrass, et al.7 (1999) observed that *,& DQWLEDFWHULDO DFWLYLW\ ZDV VLJQL¿FDQWO\ KLJKHU LQ WKH¿UVWK 6HYHUDOÀXRULGDWHGPDWHULDOVUHOHDVHKLJKOHYHOVRI ÀXRULGHLQLWLDOO\EXWWKHUHOHDVLQJUDWHGURSVUDSLGO\ DQGPLJKWQRWEHVXI¿FLHQWWRSUHYHQWFDULHVRYHUWKH . However,
whole course of orthodontic treatment
2,6,8,9
Hallgren, Oliveby and Twetman12 (1993) observed that
References $KQ6-/HH6-/HH'
,QÀXHQFHRIUHVLQPRGL¿HGJODVV LRQRPHUDQGWRSLFDOÀXRULGHRQOHYHOV of Streptococcus mutans in saliva and ELR¿OPDGMDFHQWWRPHWDOOLFEUDFNHWV
Abstract Marcela Cristina Damião ANDRUCIOLI1 Gisele FARIA2 Paulo NELSON-FILHO1
'HFDOFL¿FDWLRQ RI HQDPHO GXULQJ ¿[HG RUWKRGRQWLF DSSOLDQFH WUHDWPHQW remains a problem. White spot lesions are observed in nearly 50% of SDWLHQWVXQGHUJRLQJRUWKRGRQWLFWUHDWPHQW7KHXVHRIÀXRULGHFRQWDLQLQJ orthodontic materials has shown inconclusive results on their ability to reduce GHFDOFL¿FDWLRQ7KHDLPVRIWKLVLQYHVWLJDWLRQZHUHWRFRPSDUHWKHOHYHOVRI
Fábio Lourenço ROMANO1
Streptococcus mutans 60 LQ VDOLYD DQG ELR¿OP DGMDFHQW WR RUWKRGRQWLF
Mírian Aiko Nakane MATSUMOTO1
EUDFNHWVUHWDLQHGZLWKDUHVLQPRGL¿HGJODVVLRQRPHUFHPHQW 50*,& )XML ORTHO LC) and a light cured composite resin (Transbond XT), and to analyze WKHLQÀXHQFHRIWRSLFDODSSOLFDWLRQRIWKHDFLGXODWHGSKRVSKDWHÀXRULGH (APF) on SM counts. In a parallel study design, two groups (n=14/15) were used with random allocation and high salivary SM counts before treatment. %LR¿OPZDVFROOHFWHGIURPDUHDVDGMDFHQWWRWKHEUDFNHWVRQWHHWK DQG%RWKVDOLYDDQGELR¿OPZHUHFROOHFWHGRQWKHth, 21st, 35th, and 49thGD\VDIWHUDSSOLDQFHSODFHPHQW7RSLFDOÀXRULGHDSSOLFDWLRQZDVFDUULHG out on the 35th day. Bonding with RMGIC did not alter SM counts in saliva RUELR¿OPDGMDFHQWWRWKHEUDFNHWV2QWKHRWKHUKDQGWKHELR¿OPDGMDFHQW WREUDFNHWVUHWDLQHGZLWKFRPSRVLWHUHVLQVKRZHGDVLJQL¿FDQWLQFUHDVHLQ SM counts along the trial period. Topical application of 1.23% APF did not UHGXFH VDOLYDU\ RU ELR¿OP 60 FRXQWV UHJDUGOHVV RI WKH ERQGLQJ PDWHULDO ,QFRQFOXVLRQÀXRULGHWRSLFDODSSOLFDWLRQGLGQRWVKRZHI¿FDF\LQUHGXFLQJ SM. The use of RMGIC as bonding materials allowed a better control of 60FIXFRXQWVLQGHQWDOELR¿OPKLQGHULQJWKHVLJQL¿FDQWLQFUHDVHRIWKHVH PLFURRUJDQLVPV DORQJ WKH WULDO SHULRG ZKLFK ZDV REVHUYHG LQ WKH ELR¿OP adjacent to the composite material. Keywords: Orthodontics. Glass ionomer cements. Streptococcus mutans. $FLGXODWHGSKRVSKDWHÀXRULGH'HQWDOPDWHULDOV
Submitted: June 28, 2016 0RGL¿FDWLRQ 2FWREHU Accepted: December 06, 2016
Corresponding address: Dr. Marcela Cristina Damião Andrucioli Departamento de Clínica Infantil - Faculdade de Odontologia de Ribeirão Preto Universidade de São Paulo Avenida do Café, S/N, Monte Alegre - 14040-904 Ribeirão Preto - SP - Brazil Phone: +55-16-3602-4099 - Fax: +55-16-3633-0999 e-mail: [email protected]
1 Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Clínica Infantil, Ribeirão Preto, SP, Brasil. 2 Universidade Estadual Paulista, Faculdade de Odontologia de Araraquara, Departamento de Odontologia Restauradora, Araraquara, SP, Brasil.
J Appl Oral Sci.
196 2017;25(2):196-202
,QÀXHQFHRIUHVLQPRGL¿HGJODVVLRQRPHUDQGWRSLFDOÀXRULGHRQOHYHOVRIStreptococcus mutansLQVDOLYDDQGELR¿OPDGMDFHQWWRPHWDOOLFEUDFNHWV
Introduction
same cross-over effect onto the control side. The aims of this parallel designed clinical trial was
'HFDOFL¿FDWLRQ DURXQG RUWKRGRQWLF EUDFNHWV LV D common problem and a potential risk of orthodontic treatment, especially in patients with poor oral hygiene13,237KHUHLVDVLJQL¿FDQWLQFUHDVHLQVDOLYDU\ DQG ELR¿OP OHYHOV RI Streptococcus mutans (SM) in QHDUO\RISDWLHQWVXQGHUJRLQJ¿[HGRUWKRGRQWLF treatment, concomitant with an increased risk to dental caries2,14,17. Fixed orthodontic appliances induce
to compare the effect of two orthodontic bonding materials (RMGIC and composite resin) on the levels RI 60 LQ VDOLYD DQG ELR¿OP DGMDFHQW WR RUWKRGRQWLF brackets and to evaluate if a 1.23% acidulated SKRVSKDWH ÀXRULGH JHO DSSOLFDWLRQ FDQ LQÀXHQFH WKH reduction of SM counts.
Material and methods
intraoral changes, such as a low-pH environment, which increase enamel susceptibility to the formation
Eligible participants were screened among patients
of white spot lesions (WSL) caused by organic
ZLWK LQGLFDWLRQ IRU RUWKRGRQWLF WUHDWPHQW ZLWK ¿[HG
DFLGV SURGXFHG E\ GHQWDO ELR¿OP EDFWHULD :6/ DUH
appliances, who had complete permanent dentition,
potentially irreversible and can be observed as early as
were free of caries, had good general health, and had
1 month after the beginning of orthodontic treatment,
not used antibiotics and/or antimicrobial mouthwashes
causing aesthetic problems
in the previous 3 months. The minimum sample size
.
1,3,11,12
$QHIIHFWLYHELR¿OPFRQWUROLVWKHPDLQPHDVXUHWR
IRU HDFK JURXS ZLWK SRZHU DQG D VLJQL¿FDQFH
SUHYHQWHQDPHOGHFDOFL¿FDWLRQLQRUWKRGRQWLFSDWLHQWV
OHYHO RI ZDV LGHQWL¿HG DV IRU DQ H[SHFWHG
but it depends on patient compliance4 and thus, other
difference of 30% between the groups. Twenty-nine
SUHYHQWLYHPHDVXUHVVXFKDVWRSLFDOÀXRULGHVKRXOGEH
12-20-year-old patients who met the inclusion criteria
. There are several forms of delivering
associated
2,8,17
and presented high salivary SM counts were enrolled
WRSLFDO ÀXRULGH GXULQJ RUWKRGRQWLF WUHDWPHQW ZKLFK
in the study. Following the approval of the research
include toothpastes, mouthrinses, gel, varnishes,
project by the institutional Ethics Committee (process
ÀXRULGHUHOHDVLQJPDWHULDOVVXFKDVERQGLQJPDWHULDOV
#2005.1.1013.58.7), all subjects or their parents/
and elastics1,3,4,24.
caregivers received verbal and written information
The use of glass ionomer cement (GIC) for
about the study purposes and procedures and signed
bracket bonding is a mean to release fluoride
an informed consent form for participation. All patients
from a rechargeable source to sites at higher risk
ZHUH UHVLGHQW LQ DQ DUHD ZLWK ÀXRULGDWLRQ RI WKH
. Resin
SXEOLFZDWHUVXSSO\%LR¿OPGHSRVLWVZHUHHOLPLQDWHG
for developing dental caries
1,3,4,9,11,12,19,24,25
modified GIC (RMGIC) is a good alternative for
with meticulous rubber cup/pumice prophylaxis, and
orthodontic bonding as they offer protection against
patients received general oral hygiene instructions
GHPLQHUDOL]DWLRQE\ÀXRULGHUHOHDVHDQGSUHVHQWKLJKHU
and were oriented to brush their teeth 3 times a
resistance to bracket debonding than conventional
day after meals using a toothbrush (Professional®,
GIC1,5,6,14,15,21,22,24,30.
Colgate-Palmolive Indústria and Comércio Ltda., São
The antimicrobial activity of GIC is due to a
3DXOR63%UD]LO DQGDÀXRULGHFRQWDLQLQJGHQWLIULFH
FRPELQDWLRQ RI ÀXRULGH UHOHDVH IURP WKH FHPHQWV
(Colgate Máxima Proteção Anticaries ®, Colgate-
and decrease of pH during the setting reaction,
Palmolive Indústria and Comércio Ltda., São Paulo,
which increases the sensitivity of microorganisms to
SP, Brazil) supplied by the researchers throughout
ÀXRULGH
. Furthermore, the literature shows that
7,14,28
ÀXRULGHUHFKDUJLQJUHVWRUHWKHDQWLEDFWHULDOSURSHUWLHV RIWKHUHVLQPRGL¿HGJODVVLRQRPHUFHPHQWV27.
WKH H[SHULPHQWDO SHULRG 1R RWKHU ÀXRULGH VRXUFHV were used. Before the beginning of the study, the number
7KHLQÀXHQFHRI*,&RQWKHFRQWURORI60FRXQWVLQ
of SM colony-forming units (cfu) in the saliva of all
VDOLYDDQGELR¿OPKDVEHHQH[WHQVLYHO\HYDOXDWHGLQ
eligible individuals was determined. For this purpose,
clinical trials. However, these studies have employed
2.0 mL of non-stimulated saliva were collected from
the split-mouth design whereby the test material
each patient before placement of the appliance (T0).
is allocated to two quadrants of the mouth and the
The material collected was placed in properly labeled
control material is allocated to the other two quadrants
15x100 mm sterile tubes containing 4 to 5 glass beads.
. This trial design can lead to
Aliquots of 0.05 mL of diluted pure non-stimulated
at the same time
11,16,18,29
J Appl Oral Sci.
197 2017;25(2):196-202
ANDRUCIOLI MCD, FARIA G, NELSON-FILHO P, ROMANO FL, MATSUMOTO MAN
saliva samples were seeded on SB-20M solid culture
performed, as describe before for saliva (T0).
medium, prepared according to Saravia, et al.26 (2013). The number of colony forming units (cfu) per
Statistical analysis
milliliter of saliva was counted under aseptic conditions
The original data measured in cfu were transformed
under a stereomicroscope (Nikon, Tokyo, Japan) with
in log10 for statistical analysis and are reported as
UHÀHFWHGOLJKW&RORQLHVZLWK06FKDUDFWHULVWLFVZHUH
log(cfu)/mL. The SM log(cfu)/mL means in saliva
transferred to tubes containing thioglycollate (Difco
before orthodontic treatment (T0) and in saliva and
Laboratories Inc., Detroit, MI, USA) and incubated
ELR¿OP EHWZHHQ WKH WZR JURXSV DW HDFK FROOHFWLRQ
at 37 C during 24 h for biotyping. The growth of
time (T7d, T21d, T35d, and T49d) were compared using
06FIXZDVYHUL¿HGDIWHUWKHLQFXEDWLRQSHULRGDQG
the Student’s t test for independent samples and the
the following tests were performed for biochemical
Levene test was used to evaluate the homogeneity of
LGHQWL¿FDWLRQ IHUPHQWDWLRQ RI PDQQLWRO VRUELWRO
variances. The hypothesis of equality of SM log(cfu)/
UDI¿QRVH DQG PHOLELRVH UHVLVWDQFH WR EDFLWUDFLQ
mL means in saliva before treatment (T0) and in saliva
hydrolysis of arginine and sculin, production of H2O2,
DQGELR¿OPDWWKHGLIIHUHQWFROOHFWLRQWLPHV 77d, T21d,
and sensitivity to 2.0 IU bacitracin.
T35d, and T49d) was tested using repeated measures
o
In all patients, sterile new Edgewise metallic
ANOVA and Tukey’s test. Data were analyzed using
orthodontic brackets (0.022x0.028-inch slot)
a GraphPad Prism statistical software (GraphPad
(Generus, GAC International Inc., Bohemia, NY, USA)
6RIWZDUH,QF6DQ'LHJR&$86$ DQGDVLJQL¿FDQFH
were bonded in all teeth with a RMGIC (Fuji Ortho LC;
level of 5% was set for all analyses.
CG Corporation, Tokyo, Japan - experimental group, n=14) or an orthodontic light-cured composite resin
Results
(Transbond XT, 3M Unitek, Monrovia, CA, USA - control group, n=15). The 29 patients were randomized to
Analysis of the SM log(cfu)/mL means in saliva at
the two groups using the SAS (Statistical Analysis
T0 by the Student’s t test for pairwise comparisons
Systems) version 9.1.3 for Windows (SAS Institute
(p=0.42) and the Levene test for homogeneity
Inc., Cary, NC, USA) statistical software.
(p=0.27) showed that the groups were similar.
6DOLYD DQG ELR¿OP VDPSOHV ZHUH FROOHFWHG IURP
Regarding the effect of the tested materials on
both groups at 7 (T7d), 21 (T21d), 35 (T35d), and 49
SM log(cfu)/mL means in saliva, no statistically
(T49d) days after orthodontic appliance placement. On
VLJQL¿FDQWGLIIHUHQFHVZHUHIRXQGDPRQJWKHFROOHFWLRQ
the 35th day, 1.23% APF gel was topically applied for
times within the Fuji-Ortho (p=0.09) and Transbond
PLQDIWHUFROOHFWLRQRIVDOLYDDQGELR¿OPVDPSOHV$W
XT (p=0.25) groups (Figure 1). Furthermore, no
HDFKFROOHFWLRQWLPHELR¿OPZDVUHPRYHGZLWKDVWHULOH
VLJQL¿FDQWGLIIHUHQFHVZHUHIRXQGLQWKH60 log(cfu)/
probe in a single and continuous movement around
mL means in saliva between the Fuji-Ortho and
brackets of the maxillary right canine (13), maxillary
Transbond XT groups at any of the collection times
left lateral incisor (22), mandibular left canine (33)
(Table 1). The 1.23% APF gel application at T35d
and mandibular right central incisor (41) to verify the
reduced the number of SM log(cfu)/mL in saliva,
HIIHFW RI 50*,& DQG WKH WRSLFDO ÀXRULGH DSSOLFDWLRQ
DOWKRXJKQRWVWDWLVWLFDOO\VLJQL¿FDQW
on SM levels.
Regarding the effect of the tested materials on SM
%LR¿OPVDPSOHVZHUHVSUHDGRQ[PPVWHULOH
ORJ FIX P/ PHDQV LQ GHQWDO ELR¿OP QR VWDWLVWLFDOO\
test tubes containing 4 to 5 glass beads and 2.0 mL
significant differences were found among the
SKRVSKDWH EXIIHU VDOLQH 3%6 6DOLYD DQG ELR¿OP
collection times within the Fuji-Ortho group (p=0.08)
samples were vortexed for 2 and 1 min, respectively,
although it could be observed a trend of a gradual
for microbial desorption, and submitted to ten-fold
increase in cfu levels over time (T7d to T35d) (Figure
serial dilutions (10 ). After that, 50 mL of each dilution
2). In addition, the SM log(cfu)/mL means in dental
was plated equidistantly on SB-20M culture medium
ELR¿OPQXPHULFDOO\UHPDLQHGWKHVDPHDIWHUÀXRULGH
and incubated under candle jar system at 37°C for
application (T49d - Table 2). This gradual increase
48 to 72 hours. The number of colony forming units
was also observed in the Transbond XT group, but
(cfu) perPLOOLOLWHURIVDOLYDDQGELR¿OPZDVFRXQWHG
VLJQL¿FDQWGLIIHUHQFHZDVIRXQGRQO\EHWZHHQ77d to
and biotyping of colonies with MS characteristics were
T49d S )LJXUH $IWHUÀXRULGHDSSOLFDWLRQD
-5
J Appl Oral Sci.
198 2017;25(2):196-202
,QÀXHQFHRIUHVLQPRGL¿HGJODVVLRQRPHUDQGWRSLFDOÀXRULGHRQOHYHOVRIStreptococcus mutansLQVDOLYDDQGELR¿OPDGMDFHQWWRPHWDOOLFEUDFNHWV
Figure 1- Means and standard deviations [log(cfu)/mL] of Streptococcus mutans in saliva for experimental (Fuji ORTHO LC) and control (Transbond XT) groups at different times of collection
Table 1- Means of Streptococcus mutans [log(cfu)/mL] in saliva according to the orthodontic bonding material and sample collection time Fuji-Ortho (n=15)
Transbond XT (n=14)
Collection time
Mean (S.D.)
Mean (S.D.)
p value
T0
4.35 (1.03)
4.69 (1.23)
0.42
T7d
4.77 (0.85)
5.28 (0.66)
0.08
T21d
4.98 (1.13)
5.19 (1.19)
0.62
T35d
5.18 (1.09)
5.20 (1.42)
0.97
T49d
4.77 (1.47)
4.79 (1.73)
0.97
T0 = before bracket bonding. T7d, T21d, T35d, T49d = 7, 21, 35, and 49 days after bracket bonding, respectively. The p values express the results of the Student’s t-test for comparison of the materials at each collection time.
numeric increase occurred in SM log(cfu)/mL means
A parallel study design was used to examine the
LQ GHQWDO ELR¿OP GHSRVLWV DGMDFHQW WR WKH EUDFNHWV
DFWXDO HIIHFW RI ÀXRULGH ZKLOH PRVW in vivo studies
bonded with this material. Comparing the orthodontic
RQ ÀXRULGH UHOHDVHG E\ GLIIHUHQW W\SHV RI *,& KDYH
PDWHULDOVXVHGQRVLJQL¿FDQWGLIIHUHQFHVZHUHIRXQG
employed a split-mouth design11,17,29. When examining
in the SM ORJ FIX P/PHDQVLQELR¿OPEHWZHHQWKH
the capacity of fluoride-containing materials to
Fuji-Ortho and Transbond XT groups at any of the
UHGXFH FDULHV RQVHW LW LV XQOLNHO\ WKDW WKH ÀXRULGH
collection times (Table 2).
UHOHDVHGZRXOGEHFRQ¿QHGWRRQO\WKHTXDGUDQWVLQ which the test material has been placed and there
Discussion
would inevitably be some crossover effect onto the FRQWURO VLGH $OWKRXJK WRSLFDOO\ DSSOLHG ÀXRULGH KDV
In this clinical trial, comparisons between two
been reported to have mostly a local effect20, a
orthodontic bonding materials (RMGIC and composite
VOLJKW FURVVRYHU RI ÀXRULGH YLD VDOLYD KDV DOVR EHHQ
UHVLQ VKRZHG QR VLJQL¿FDQW GLIIHUHQFHV LQ 60 FIX
suggested10. This would reduce the difference in
FRXQWV LQ VDOLYD DQG GHQWDO ELR¿OP DGMDFHQW WR WKH
effect between the test materials and the power of
brackets at any collection time. The main difference
WKH H[SHULPHQW WR ¿QG GLIIHUHQFH3,4. According to
between the materials was that RMGIC at least
Rogers, Chadwick and Treasure23 (2010), until better
allowed a better control of SM cfu counts in dental
XQGHUVWDQGLQJ KRZ ÀXRULGH UHOHDVHG RQ RQH VLGH RI
ELR¿OP KLQGHULQJ WKH VLJQL¿FDQW LQFUHDVH RI WKHVH
WKHPRXWKLQÀXHQFHVWKHRWKHUVLGHDSDUDOOHOVWXG\
microorganisms along the trial period that was
design seems to be the most appropriate.
REVHUYHGLQWKHELR¿OPDGMDFHQWWRWKHFRPSRVLWH
J Appl Oral Sci.
,QWKLVVWXG\QRVLJQL¿FDQWGLIIHUHQFHVZHUHIRXQG
199 2017;25(2):196-202
ANDRUCIOLI MCD, FARIA G, NELSON-FILHO P, ROMANO FL, MATSUMOTO MAN
Figure 2- Means and standard deviations [log(cfu)/mL] of Streptococcus mutansLQELR¿OPIRUH[SHULPHQWDO )XML257+2/& DQGFRQWURO (Transbond XT) groups at different times of collection
Table 2- Means of Streptococcus mutans>ORJ FIX P/@LQGHQWDOELR¿OPDGMDFHQWWRWKHEUDFNHWVDFFRUGLQJWRWKHRUWKRGRQWLFERQGLQJ material and sample collection time. Fuji-Ortho (n=15)
Transbond XT (n=14)
Collection time
Mean (S.D.)
Mean (S.D.)
p value
T7d
2.70 (1.38)
2.13 (0.94)
0.13
T21d
3.27 (1.04)
2.61 (1.05)
0.10
T35d
3.35 (1.25)
2.75 (1.14)
0.36
T49d
3.31 (1.03)
3.13 (1.30)
0.72
T0 = before bracket bonding. T7d, T21d, T35d, T49d = 7, 21, 35, and 49 days after bracket bonding, respectively. The p values express the results of the Student’s t-test for comparison of the materials at each collection time.
in SM log(cfu)/mL means in the saliva of the patients
ÀXRULGH DSSOLFDWLRQ DW 735d compared with T49d. It
with brackets bonded with RMGIC and composite resin,
can be assumed that RMGIC was not effective in
DQGLWGLGQRWFKDQJHDIWHUWRSLFDOÀXRULGHDSSOLFDWLRQ
UHGXFLQJ 60 FRXQWV LQ GHQWDO ELR¿OP DGMDFHQW WR
These results mean that the use of RMGIC to retain
orthodontic brackets, but no increase in the number
orthodontic brackets did not reduce the number of
of microorganisms was observed either. On the other
SM cfu counts in saliva. According to Øgaard, et al.
hand, regarding the SM log(cfu)/mL means in dental
(1997), it could be explained by the fact that the
ELR¿OPGHSRVLWVDGMDFHQWWRWKHEUDFNHWVERQGHGZLWK
ÀXRULGHUHOHDVHGE\WKHRUWKRGRQWLFERQGLQJDGKHVLYH
FRPSRVLWHUHVLQDVWDWLVWLFDOO\VLJQL¿FDQWLQFUHDVHZDV
17
GLGQRWLQFUHDVHWKHÀXRULGHOHYHOVLQVDOLYDHYHQZKHQ
observed from T7d to T49d HYHQ DIWHU WRSLF ÀXRULGH
LWZDVDVVRFLDWHGZLWKDÀXRULGHGHQWLIULFH,QWKHVDPH
application at T35d.
way, Gorton and Featherstone9 GLGQRW¿QGDQ\
7RSLFDOÀXRULGHDSSOLFDWLRQZDVQRWDEOHWRUHGXFH
HOHYDWLRQRQVDOLYDU\ÀXRULGHOHYHOVZKLFKLQGLFDWHV
the number of SM along the time of orthodontic
RQO\DORFDOÀXRULGHUHOHDVH
treatment, regardless of the material used to retain
Regarding the SM log(cfu)/mL means in dental
the brackets, although RMGIC allowed a better control
ELR¿OP GHSRVLWV DGMDFHQW WR WKH EUDFNHWV ERQGHG
in SM counts than the composite. According to Ahn, et
with RMGIC, a slight increase was observed from
al.1 ÀXRULGHUHOHDVLQJPDWHULDOVFDQDFWDVD
T7d to T35d WKRXJK ZLWKRXW VWDWLVWLFDO VLJQL¿FDQFH
UHVHUYRLUIRUWRSLFDOÀXRULGDWLRQDQG50*,&UHOHDVHV
In addition, practically no change occurred in SM
WKHKLJKHVWDPRXQWRIÀXRULGHLRQVZKHQUHFKDUJHG
ORJ FIX P/ PHDQV LQ GHQWDO ELR¿OP DIWHU WRSLFDO
)RUWKLVUHDVRQDVLJQL¿FDQWGHFUHDVHLQWKHQXPEHURI
J Appl Oral Sci.
200 2017;25(2):196-202
,QÀXHQFHRIUHVLQPRGL¿HGJODVVLRQRPHUDQGWRSLFDOÀXRULGHRQOHYHOVRIStreptococcus mutansLQVDOLYDDQGELR¿OPDGMDFHQWWRPHWDOOLFEUDFNHWV
PLFURRUJDQLVPVLQWKHELR¿OPDURXQGWKHEUDFNHWVZDV
then followed an upward trend5,13,23,24. These results
expected for the group that used RMGIC in our study.
PD\ EH FRQ¿UPHG LQ WKLV VWXG\ LQ ZKLFK WKH 60
The results of this study differ from those of
cfu counts did not increase after 1.23% APF topical
previous investigations. Hallgren, Oliveby and
application in the RMGIC group, as it occurred in the
Twetman12 REVHUYHGVLJQL¿FDQWO\KLJKHU60FIX
composite group.
FRXQWVLQGHQWDOELR¿OPDGMDFHQWWREUDFNHWVERQGHG with composite (Concise) compared with GIC (Aqua-
Conclusion
Cem) 1 month after the beginning of orthodontic treatment. Wright, et al.29 (1996) found similar results
Considering the results obtained in this study, we
ZLWK VLJQL¿FDQWO\ ORZHU 60 FRXQWV LQ GHQWDO ELR¿OP
may conclude that topical application 1.23% APF gel
adjacent to GIC (Geristore) than to composite resin
did not alter SM FIXFRXQWVLQVDOLYDDQGGHQWDOELR¿OP
(Phase II) 1 week after bracket bonding. After 5 weeks,
adjacent to the orthodontic brackets for both groups;
however, this difference was not detected.
the material used for orthodontic bracket bonding
7KH HI¿FDF\ RI *,& LQ FRQWUROOLQJ 60 FRXQWV LQ
(RMGIC or composite resin) did not alter the SM cfu
GHQWDOELR¿OPLVDWWULEXWHGWRWKHDQWLPLFURELDODFWLYLW\
counts in saliva along the trial period, and the SM cfu
RIÀXRULGHUHOHDVHGIURPWKHVHPDWHULDOV22,28, although
FRXQWVLQGHQWDOELR¿OPDGMDFHQWWREUDFNHWVERQGHG
ÀXRULGHUHOHDVHDQGEDFWHULDOLQKLELWLRQDUHJUHDWHULQ
with RMGIC practically did not change, while there was
conventional GIC than in RMGIC7.
DVLJQL¿FDQWLQFUHDVHLQWKH60 cfu counts adjacent
In agreement to this study, Örthendahl, Thilander and Svanberg
18
(1997) did not find significant
to brackets bonded with composite resin during the trial period.
differences in SM cfu counts LQGHQWDOELR¿OPDGMDFHQW to brackets bonded with GIC (Ketac-Cem) and composite resin (Concise). This result can be attributed
Acknowledgements The authors are indebted to Dr. Izabel Yoko Ito
WR WKH IDFW WKDW ELR¿OP VDPSOHV ZHUH FROOHFWHG
(in memoriam) of Department of Clinical Analysis,
months after bracket bonding. This is an important
Toxicology and Bromatology, School of Pharmaceutical
¿QGLQJ EHFDXVH LW KDV EHHQ UHSRUWHG WKDW *,& KDV
Sciences of Ribeirão Preto, University of São Paulo, for
D VWURQJ DQWLEDFWHULDO DFWLYLW\ RQO\ ZLWKLQ WKH ¿UVW
helpful assistance during microbiological processing
week, diminishing considerably after this time
. In
1,14
and analysis.
the same way, Gillgrass, et al.7 (1999) observed that *,& DQWLEDFWHULDO DFWLYLW\ ZDV VLJQL¿FDQWO\ KLJKHU LQ WKH¿UVWK 6HYHUDOÀXRULGDWHGPDWHULDOVUHOHDVHKLJKOHYHOVRI ÀXRULGHLQLWLDOO\EXWWKHUHOHDVLQJUDWHGURSVUDSLGO\ DQGPLJKWQRWEHVXI¿FLHQWWRSUHYHQWFDULHVRYHUWKH . However,
whole course of orthodontic treatment
2,6,8,9
Hallgren, Oliveby and Twetman12 (1993) observed that
References $KQ6-/HH6-/HH'
