Mechanical properties of orthodontic wires covered with a polyether ether ketone tube

Objectives:To evaluate the esthetics and frictional force of an orthodontic wire passed through a newly designed tube made of a polyether ether ketone (PEEK) resin.Materials and Methods:Two types of standard PEEK tubes were prepared at 0.5 × 0.6ф and 0.8 × 0.9ф, and different archwires were passed through the tubes. Color values were determined according to brightness and hues. Friction was assessed with different bracket-wire combinations, and surface roughness was determined by stereomicroscopy before and after the application of friction.Results:The PEEK tube showed a color difference that was almost identical to that of coated wires conventionally used in clinical practice, indicating a sufficient esthetic property. The result of the friction test showed that the frictional force was greatly reduced by passing the archwire through the PEEK tube in almost all of the archwires tested.Conclusions:Use of the new PEEK tube demonstrated a good combination of esthetic and functional properties for use in orthodontic appliances.     

Esthetic comparison of white-spot lesion treatment modalities using spectrometry and fluorescence

Objective:To compare the esthetic improvements of white-spot lesions (WSLs) treated by fluoride, casein phosphopeptide amorphous calcium phosphate (CPP-ACP), or resin infiltration.Materials and Methods:WSLs were created on human enamel and randomly assigned to four groups: NaF (500 ppm), CPP-ACP, resin infiltration (Icon), or distilled deionized water (DDW; control group). The color change (ΔE) of each specimen was measured with a Crystaleye spectrophotometer, and fluorescence loss (ΔQ) was measured by quantitative light-induced fluorescence (QLF), at different time points after treatment: baseline (0 weeks), 2 weeks, 4 weeks, and 6 weeks.Results:The ΔE and ΔQ baseline values for the four groups before the treatments did not differ significantly. Icon treatment improved the WSL color significantly and gave the lowest ΔE (2.9 ± 1.2 on average) compared with other treatments (P < .01). The Icon treatment also resulted in a significant change in the ΔQ of WSLs compared with baseline (P < .01). In the NaF and CPP-ACP treatment groups, ΔQ showed significant recovery compared with the baseline values only after 4 weeks after treatment (P < .05).Conclusions:Resin infiltration is more effective than NaF or CPP-ACP in providing esthetic improvement of WSLs.     

Finite element study of controlling factors of anterior intrusion and torque during Temporary Skeletal Anchorage Device (TSAD) dependent en masse retraction without posterior appliances: Biocreative hybrid retractor (CH-retractor)

Objectives:To evaluate, using the finite element method (FEM), the factors that allow control of the anterior teeth during en masse retraction with the Biocreative hybrid retractor (CH-retractor) using different sizes of nickel-titanium (NiTi) archwires and various gable bends on the stainless-steel (SS) archwires.Materials and Methods:Using FEM, the anterior archwire section, engaged on the anterior dentition, was modeled in NiTi, and another assembly, the posterior guiding archwire, was modeled in SS. Two dimensions (0.016 × 0.022- and 0.017 × 0.025-inch NiTi) of the anterior archwires and different degrees (0°, 15°, 30°, 45°, and 60°) of the gable bends on the guiding wire were applied to the CH-retractor on the anterior segment to evaluate torque and intrusion with 100-g retraction force to TSADs. Finite element analysis permitted sophisticated analysis of anterior tooth displacement.Results:With a 0° gable bend all anterior teeth experienced extrusion. The canines showed a larger amount of extrusion than did the central and lateral incisors. With a gable bend of >15°, all anterior teeth exhibited intrusion. Bodily movement of the central incisor required a 30°∼45° gable bend when using anterior segments of 0.016 × 0.022-inch NiTi and 15°∼30° gable bend with the 0.017 × 0.025-inch NiTi.Conclusions:With the CH-retractor, varying the size of the NiTi archwire and/or varying the amount of gable bend on the SS archwire affects control of the anterior teeth during en masse retraction without a posterior appliance.     

In vitro biocompatibility of nickel-titanium esthetic orthodontic archwires

Objective:To investigate the cytotoxicity of nickel-titanium (NiTi) esthetic orthodontic archwires with different surface coatings.Materials and Methods:Three fully coated, tooth-colored NiTi wires (BioCosmetic, Titanol Cosmetic, EverWhite), two ion-implanted wires (TMA Purple, Sentalloy High Aesthetic), five uncoated NiTi wires (BioStarter, BioTorque, Titanol Superelastic, Memory Wire Superelastic, and Sentalloy), one β-titanium wire (TMA), and one stainless steel wire (Stainless Steel) were considered for this study. The wire samples were placed at 37°C in airtight test tubes containing Dulbecco’s Modified Eagle’s Medium (0.1 mg/mL) for 1, 7, 14, and 30 days. The cell viability of human gingival fibroblasts (HGFs) cultured with this medium was assessed by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Data were analyzed by a two-way analysis of variance (α  =  .05).Results:The highest cytotoxic effect was reached on day 30 for all samples. The archwires exhibited a cytotoxicity on HGFs ranging from “none” to “slight,” with the exception of the BioTorque, which resulted in moderate cytotoxicity on day 30. Significant differences were found between esthetic archwires and their uncoated pairs only for BioCosmetic (P  =  .001) and EverWhite (P < .001).Conclusions:Under the experimental conditions, all of the NiTi esthetic archwires resulted in slight cytotoxicity, as did the respective uncoated wires. For this reason their clinical use may be considered to have similar risks to the uncoated archwires.     

In vitro Streptococcus mutans adhesion and biofilm formation on different esthetic orthodontic archwires

ObjectivesTo evaluate the ability of different esthetic archwires to retain oral biofilms in vitro.Materials and MethodsSeven different brands of coated orthodontic archwires were tested: two epoxy coated, two polytetrafluoroethylene coated, two rhodium coated, and one silver plus polymer coated. Conventional uncoated metallic archwires were used as controls. Streptococus mutans adherence to archwires was quantified by colony count following 24 hours of biolfilm growth, and total wire-associated biofilm was measured using a crystal violet staining assay. For both tests, two conditions were used: 0% sucrose and 3% sucrose. For statistical analysis, P < .05 was considered as statistically significant.ResultsFor S. mutans colony forming units per biofilm, there were no statistically significant differences among the various archwires (P = .795 for 0% sucrose; P = .905 for 3% sucrose). Regarding total biofilm formed on archwires in the 3% sucrose condition, there were statistically significant differences in crystal violet staining only for the comparison between Niti Micro Dental White and Copper Ni-Ti wires (P < .05).ConclusionsThe clinical use of esthetic-coated orthodontic wires may be considered to have similar risks as uncoated archwires for biofilm retention.     

Active and passive self-ligation—a myth?

Objective:To compare the frictional behavior of several self-ligating brackets with that of normal brackets both with and without tipping force-moments and in combination with different archwire dimensions.Materials and Methods:The resistance to sliding (RS) of seven self-ligating brackets, a conventional bracket, and a ceramic bracket with a low-friction clip were evaluated in combination with three different archwires and tipping force-moments of 0 and 10 Nmm. The center of rotation for the measurements was set within the center of the bracket or with a 10-mm offset. Resistance to sliding was measured using an Instron 3344 at a cross-head speed of 10 mm/min at a temperature of 36°C.Results:Without a tipping moment, RS increased with the active self-ligating brackets with increasing archwire size. No RS was found for any of the passive self-ligating brackets. The 10-Nmm tipping moment resulted in more RS and was similar for all bracket and archwire combinations. RS was approximately doubled when the center of rotation was located at the bracket rather than with a 10-mm offset.Conclusions:RS between brackets and archwires is highly dependent on the experimental setup. Different setups can result in contradictory results. Almost 1 N of traction force is lost in RS when a moment of 10 Nmm is placed at a rotational center 10 mm from the bracket.     

The effect of temperature on the mechanical behavior of nickel-titanium orthodontic initial archwires

Objectives:To investigate and compare the characteristics of commonly used types of traditional and heat-activated initial archwires at different temperatures by plotting their load/deflection graphs and quantifying three parameters describing the discharge plateau phase.Materials and Methods:Forty-eight archwires of cross-sectional diameters ranging from 0.010 inches to 0.016 inches were obtained from seven different manufacturers. A modified three-point wire-bending test was performed on three analogous samples of each type of archwire at 55°C and 5°C, simulating an inserted archwire that is subjected to cold or hot drinks during a meal. For each resulting load/deflection curve the plateau section was isolated and the mean value of each parameter for each type of wire was obtained.Results:Permanent strain was exhibited by all wires tested at 55°C. Statistically significant differences were found between almost all wires for the three considered parameters when tested at 55°C and 5°C. Loads were greater at 55°C than at 5°C. Differences were also found between traditional and heat-activated archwires, the latter of which generated longer plateaus at 55°C, shorter plateaus at 5°C, and lighter mean forces at both temperatures. The increase in average force seen with increasing diameter tended to be rather stable at both temperatures.Conclusions:All nickel-titanium wires tested showed a significant change related to temperature in terms of behavior and force for both traditional and heat-activated wires. Stress under high temperatures can induce permanent strain, whereas the residual strain detected at low temperatures can be recovered from as temperature increases.     

Variation in form of mandibular,light, round,preformed NiTi archwires

Objective:To evaluate the variation in form of nickel-titanium (NiTi) archwires by comparing them with the dental arch form of normal Japanese subjects before and after placing them in the first molar tubes.Materials and Methods:The mandibular dental casts of 30 normal subjects were scanned, and the dental arch depths and widths from the canine to the first molar were measured. Standardized images of 34 types of 0.016-inch preformed NiTi archwires were also taken in a 37°C environment, and the widths were measured and then classified by cluster analysis. Images of these archwires placed in a custom jig with brackets attached at the mean locations of the normal mandibular central incisors and first molar were additionally taken. The widths of the pooled and classified archwires were then compared with the normal dental arch widths before and after placement in the jig and among the groups (P < .05).Results:The archwires were classified into three groups: small, medium, and large. The archwire widths in the small and medium groups were narrower than those at all examined tooth widths, except in the case of the premolars of the medium group. After placement in the jig, the pooled archwire widths were found to be significantly narrower and wider at the canine and second premolar, respectively, than at the dental arch, but not in the individual comparisons between groups.Conclusion:The variation observed in the mandibular NiTi archwire forms significantly decreased following fitting into the normal positions of the first molars.     

A prospective randomized split-mouth study on pain experience during chairside archwire manipulation in self-ligating and conventional brackets

Objective:To investigate patient discomfort during archwire engagement and disengagement in patients treated with self-ligating and conventional brackets using a split-mouth design.Materials and Methods:Eighteen consecutive patients (15 female, 3 male; age: 22.2 ± 6.4 years) who requested treatment with fixed orthodontic appliances were randomly assigned for bonding with SmartClip self-ligating brackets on one side of the dentition and conventional standard edgewise brackets on the other. During the course of treatment, patients rated the discomfort experienced during every archwire engagement and disengagement using a numeric rating scale. Results were evaluated for round and rectangular nickel titanium and rectangular stainless steel, titanium molybdenum, and Elgiloy archwires. Patients also rated their overall experience retrospectively for both bracket systems.Results:Regardless of archwire type, disengagement was rated as being significantly more painful on the SmartClip side (P  =  .027). For rigid, rectangular archwires, engagement and disengagement were rated as being significantly more painful on the SmartClip side (P  =  .031; P  =  .004). Retrospective ratings favored conventional brackets beyond ratings recorded during treatment.Conclusion:Engagement and disengagement of rigid rectangular archwires caused more pain with SmartClip self-ligating brackets than with conventional ones. Careful archwire manipulation and patience during full alignment are essential for limiting chairside pain. Low pain levels will help ensure treatment satisfaction and compliance.     

Effect of Aging on the Microstructure and Optical Properties of Translucent ZrO 2 Ceramics

ObjectivesThe development and placement of translucent zirconia ceramics on the dental materials market is in full swing. This research aimed to investigate how aging protocols affect the microstructure, color parameters and translucency of a new-generation monolithic zirconia ceramic.Material and methodsTranslucent zirconia ceramics KATANA-Zirconia STML with different surface treatments (as sintered - control, glazed, polished) was tested using two aging protocols (hydrothermal degradation in autoclave at 134 °C and 2 bars for three hours, chemical degradation in four-percent acetic acid at 80 °C for 16 hours) in order to examine phase composition using X-ray diffraction analysis and ΔE, ΔL and ΔC color parameters through spectrophotometry. The translucency parameter (TP) was calculated using parameters L*, a* and b* on a black and white surface.ResultsRegardless of the surface treatment, aging protocols did not cause a tetragonal-to-monoclinic phase transformation, although hydrothermal degradation in the autoclave transformed the hybrid tetragonal-cubic structure of all specimens to a tetragonal one. All polished and glazed specimens during chemical degradation demonstrated a significant color change ΔE. Lightness ΔL significantly changed in polished specimens aged in the autoclave. In all specimens, ΔC underwent a change manifested through statistically insignificant yellowing. None of the aging protocols altered the translucency of specimens.ConclusionsAging, regardless of the final surface treatment, did not manifest a monoclinic phase in the specimens. A tetragonal-cubic microstructure dominates. Unlike polishing, glazing the surface of translucent zirconia ceramics contributed to minor changes in color, lightness and chromaticity. The translucency of translucent zirconia ceramics remains stable regardless of aging and surface treatment.     

The effect of water storage on the bending properties of esthetic,fiber-reinforced composite orthodontic archwires

Objective:To study the effect of water storage on the bending properties of fiber-reinforced composite archwires and compare it to nickel-titanium (NiTi), stainless steel (SS), and beta-titanium archwires.Materials and Methods:Align A, B, and C and TorQ A and B composite wires from BioMers Products, 0.014-, 0.016, and 0.018-inch, and 0.019 × 0.025-inch NiTi, 0.016-inch SS, and 0.019 × 0.025-inch beta-titanium archwires were tested (n  =  10/type/size/condition). A 20-mm segment was cut from each end of the archwire; one end was then stored in water at 37°C for 30 days, while the other was stored dry. The segments were tested using three-point bending to a maximum deflection of 3.1 mm with force monitored during loading (activation) and unloading (deactivation). Statistical analysis was completed via two-way analysis of variance with wire and condition (dry and water-stored) as factors.Results:In terms of stiffness and force delivery during activation, in general: beta-titanium was > TorQ B > TorQ A > 0.019 × 0.025-inch NiTi and 0.016-inch SS > Align C > 0.018-inch NiTi > Align B > 0.016-inch NiTi > Align A > 0.014-inch NiTi. Water exposure was detrimental to the larger translucent wires (Align B and C, TorQ A and B) because they were more likely to craze during bending, resulting in decreased forces applied at a given deflection. Align A and the alloy wires were not significantly (P > .05) affected by water storage. Overall, the alloy wires possessed more consistent force values compared to the composite wires.Conclusion:Environmental conditions are more likely to affect fiber-reinforced composite archwires compared to alloy wires.     

A clinical comparison of three aligning archwires in terms of alignment efficiency: A prospective clinical trial

Objectives:To clinically evaluate the effectiveness of three orthodontic aligning archwires in relation to tooth alignment speed during the initial alignment stage of treatment.Materials and Methods:A consecutive sample of 74 patients requiring lower only or upper and lower fixed orthodontic appliances were randomly allocated into three different archwires (0.014-inch superelastic nickel-titanium [NiTi], 0.014-inch thermoelastic NiTi, or 0.014-inch conventional NiTi). Good quality impressions were taken of the lower arch before archwire placement (T0) and at designated serial stages of alignment (every 2 weeks: T2, T4, T6, …, T16). The change in tooth alignment was measured in millimeters from the resultant casts using Little''s irregularity index. Demographic and clinical differences among the three groups were compared with the chi-square or analysis of variance (ANOVA) test. The difference in the change of lower anterior tooth alignment over time among the three groups was explored with a Split Plot ANOVA (SPANOVA, or within- and between-groups ANOVA). The Kruskal-Wallis nonparametric test was used when data were not normally distributed.Results:The SPANOVA and Wilks Lambda Multivariate test confirmed that the wire type had no influence on the rate of change in alignment (P  =  .98).Conclusion:The three forms of NiTi wires were similar in terms of their alignment efficiency during the initial aligning stage of orthodontic fixed appliance therapy.     

Torsional strength of computer-aided design/computer-aided manufacturing–fabricated esthetic orthodontic brackets

Objective:To fabricate orthodontic brackets from esthetic materials and determine their fracture resistance during archwire torsion.Materials and Methods:Computer-aided design/computer-aided manufacturing technology (Cerec inLab, Sirona) was used to mill brackets with a 0.018 × 0.025-inch slot. Materials used were Paradigm MZ100 and Lava Ultimate resin composite (3M ESPE), Mark II feldspathic porcelain (Vita Zahnfabrik), and In-Ceram YZ zirconia (Vita Zahnfabrik). Ten brackets of each material were subjected to torque by a 0.018 × 0.025-inch stainless steel archwire (G&H) using a specially designed apparatus. The average moments and degrees of torsion necessary to fracture the brackets were determined and compared with those of commercially available alumina brackets, Mystique MB (Dentsply GAC).Results:The YZ brackets were statistically significantly stronger than any other tested material in their resistance to torsion (P < .05). The mean torques at failure ranged from 3467 g.mm for Mark II to 11,902 g.mm for YZ. The mean torsion angles at failure ranged from 15.3° to 40.9°.Conclusion:Zirconia had the highest torsional strength among the tested esthetic brackets. Resistance of MZ100 and Lava Ultimate composite resin brackets to archwire torsion was comparable to commercially available alumina ceramic brackets.     

Agreement of the clinician's choice of archwire selection on conventional and virtual models

Objectives:To compare archwire selection on dental casts with archwire selection using a three-dimensional (3D) software program (OrthoAid) and assess agreement between clinicians.Materials and Methods:The best-fitting archwires were selected for dental casts of 100 patients with malocclusion using two approaches by three orthodontists. The first method was to visually determine the fitness of five preformed nickel titanium archwires to the arch form on a dental cast (subjective method). The second method was archwire selection on a virtual image of the same cast by means of 3D software (objective method). Agreement between selections performed by the orthodontists was calculated using Kappa statistics. The accuracy of fit of the archwires to the curves fitted to the arch form was also calculated or reversely assessed by means of the root mean square (RMS) for both methods using the Dahlberg formula.Results:The mean RMS of the distances between the patient arch forms and the archwires for the subjective method was 1.163–1.366 mm. The agreement of selections between orthodontists was 42%–58% (Kappa ranged from .074 to .382). Using the 3D software (objective method), the mean RMS decreased to 0.966–1.171 mm, and agreement increased to 47% to 84% (Kappa ranged from .444 to .747).Conclusions:The use of 3D computer software for archwire selection in patients with malocclusion provided better adaptation and interexaminer reliability.     

Color Stability of Dental Composites after Immersion in Beverages and Performed Whitening Procedures

ObjectivesThe study aimed to compare the color stability of two different light-cured composites after immersion in three liquids and the effectiveness of 16% carbamide peroxide (CP) in removing the discoloration.Material and methodsColor stability of a microhybrid (Z250, 3M ESPE) and nanocomposite (Z550, 3M ESPE) was evaluated after immersion in instant coffee, tea, Coca-Cola, and deionized water as a control group (n=5). Samples were kept in liquids for four hours daily at 37°C for 30 days. Furthermore, 16% CP was applied for the following 14 days, simulating night whitening. A digital spectrophotometer was used for color measurement based on the CIEL*a*b* color coordinates. The color changes (∆E) were measured at baseline, after immersion in the beverages, and also after the teeth whitening procedure. Mixed and factorial ANOVA followed by Bonferroni’s post-hoc test were used for statistical evaluation (p≤0.05).ResultsTested resin composites showed a color change over the acceptability threshold (ΔE*> 3.48) after immersion in coffee and tea. Nanocomposite reported a significant increase in discoloration in coffee after 30 days (p <0.05). The color of both materials significantly changed (p<0.05) along all three L*a*b* axes in coffee and tea to darker, yellow, and red. Whitening with 16% CP was effective in removing external discoloration in both examined composite materials.ConclusionCoffee and tea induced clinically detectable color changes in dental composites tested, with cumulative effects. Whitening represents an efficient method for the removal of surface discoloration in composite restorations.     

Effect of low-level laser therapy on the time needed for leveling and alignment of mandibular anterior crowding:: A randomized controlled clinical trial

ObjectivesTo assess the effect of low-level laser therapy (LLLT) on overall leveling and alignment time of mandibular anterior crowding and associated pain after initial archwire placement.Materials and MethodsThirty-two females (18-25 years) with mandibular anterior crowding were randomly allocated into laser and control groups. Eligibility criteria included Angle Class I molar relationship and Little''s irregularity index (LII) from 4 to 10 mm. Randomization was accomplished with a computer-generated random list. A 0.014-inch copper-nickel-titanium (Cu-NiTi) wire was inserted immediately after bonding of 0.022-inch Roth brackets followed by 0.016-inch Cu-NiTi, 0.016 × 0.022-inch NiTi then 0.017 × 0.025-inch stainless steel wire after completion of alignment. In-Ga-As laser was applied to the mandibular anterior segment in the laser group on days 3, 7, and 14, then at 1 month followed by every 2 weeks until completion of leveling and alignment. Visual analogue scale questionnaires were completed by each patient over 7 days from initial archwire placement. Digital models were used to monitor changes in the irregularity index. Blinding was applicable for outcome assessors only.ResultsThe mean time for leveling and alignment was significantly lower in the laser compared to the control group (68.2 ± 28.7 and 109.5 ± 34.7 days, respectively). The laser group displayed a significantly higher mean alignment improvement percentage as well as lower pain scores compared to the control group.ConclusionsWithin the constraints of the current study, LLLT has a potential for acceleration of anterior segment alignment as well as reduction of the pain associated with placement of initial archwires.     

Comparative analysis of real and ideal wire-slot play in square and rectangular archwires

Objective:To evaluate the degree to which the height, width, and cross-section of rectangular and square orthodontic archwires affect the play between the archwires and the bracket slot.Materials and Methods:The stated measurements (height and width) of 43 archwires from six different manufacturers were compared with real values obtained using a digital gauge. The curvature (radius) of the edge bevels was also measured to calculate the play within the slot, and this measurement was compared with the ideal value.Results:The real height and width of the archwires differed from those stated by the manufacturers, falling within the range −6.47% and +5.10%. The curvature of each bevel on each archwire cross-section was shown to differ, and consequently increased the real play between the archwire and slot with respect to the ideal to different degrees.Conclusions:The archwire-slot play was greater than the ideal for each archwire considered, inevitably leading to a loss of information within the system.     

EFFECTIVENESS OF HOME BLEACHING AGENTS IN DISCOLORED TEETH AND INFLUENCE ON ENAMEL MICROHARDNESS

Objectives:

This study evaluated the effectiveness of different home bleaching agents on color alteration and their influence on surface and subsurface microhardness of discolored bovine enamel.

Material and Methods:

Forty-five fragments of bovine incisors were randomly allocated into 3 groups (n=15) according to the bleaching agent: 10% carbamide peroxide gel (CP10), 16% carbamide peroxide gel (CP16) and 6.5%-hydrogen-peroxide-based strip (HP6.5). Before bleaching treatment, initial values of Knoop surface microhardness and color (CIEL*a*b*) were obtained and the fragments were artificially stained in hemolyzed rat blood. Then, bleaching treatments were performed over a 21-day period. Color changes (ΔE) were assessed at 7, 14 and 21 days, and final surface microhardness reading was done after 21 days. Thereafter, the fragments were bisected to obtain subsurface microhardness. Data were subjected to ANOVA and Tukey''s tests (α=5%).

Results:

Color changes produced by CP16 were similar to those of CP10, and the color changes produced by these materials were significantly superior to those produced by HP6.5. Color changes at 21 days were superior to 7 days and similar to 14 days. The time did not influence color changes for CP16, which showed similarity between the 14- and 21-day results. No statistically significant differences were found among the home bleaching agents for surface and subsurface microhardness.

Conclusions:

Microhardness of bovine enamel was not affected by the bleaching agents. The 16% carbamide peroxide gel was the most effective for bleaching the stained substrate.