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Potential impact of lingual retainers on oral health: comparison between conventional twistflex retainers and CAD/CAM fabricated nitinol retainers

A clinical in vitro and in vivo investigation

Möglicher Einfluss von lingualen Retainern auf die Mundgesundheit: Vergleich zwischen konventionellen Twist-Flex-Retainern und innovativen CAD/CAM-Retainern

Eine klinische In-vitro- und In-vivo-Untersuchung

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the impact of a novel computer-fabricated lingual nitinol retainer compared to a conventional lingual flexible spiral wire twistflex retainer on oral health.

Methods

The study was based on a retrospective controlled clinical study with pilot character, an in vitro investigation of material-dependent biofilm formation and an analysis of biofilm formation after intraoral incubation. Sixty-one patients with completed fixed orthodontic treatment and retention phase for at least 6 months with twistflex retainers (group 1, n = 31) or computer-aided design/computer-aided manufacturing (CAD/CAM) nitinol retainers (group 2, n = 30) were included and examined regarding plaque index (PI), gingival index (GI), probing depths, bleeding on probing (BOP) and marginal recessions (MR). Material-dependent biofilm formation of twistflex, untreated nitinol and electropolished nitinol wire samples were assessed (1) in vitro: using optical density (OD) measurement of 10 samples of each and (2) in vivo: using histomorphometric analysis of 18 samples of each.

Results

Patients treated with nitinol retainers had significant better oral health indices (PI1 = 1.29 ± 0.06, PI2 = 0.94 ± 0.06; GI1 = 0.71 ± 0.05, GI2 = 0.56 ± 0.04; BOP1 = 0.11 ± 0.01, BOP2 = 0.08 ± 0.01; PD1 = 1.79 ± 0.03 mm, PD2 = 1.59 ± 0.04 mm) except for MR (0.08 ± 0.03 mm versus 0.08 ± 0.02 mm) compared to twistflex retainers. After 24 h intraoral incubation nitinol retainers demonstrated significant less biofilm formation compared to twistflex retainers. In the in vitro investigation the temporary significant differences between the groups were compensated in the end.

Conclusions

Based on the results it can be assumed that nitinol-made CAD/CAM developed lingual retainers have a positive effect on oral health.

Zusammenfassung

Ziel

Beurteilung des Einflusses lingualer konventioneller Twist-Flex-Retainer und innovativer CAD/CAM(„computer-aided design/computer-aided manufacturing“)-Nitinol-Retainer auf die orale Gesundheit.

Methoden

Die Studie basiert auf einer als Pilotstudie konzipierten retrospektiven kontrollierten klinischen Studie, einer In-vitro-Untersuchung der materialabhängigen Biofilmbildung und einer Analyse der Biofilmbildung nach intraoraler Inkubation. Einundsechzig Patienten mit abgeschlossener festsitzender kieferorthopädischer Behandlung und einer Retentionsphase von mindestens 6 Monaten mit Twist-Flex-Retainern (Gruppe 1, n = 31) oder CAD/CAM-Nitinol-Retainern (Gruppe 2, n = 30) wurden hinsichtlich Plaqueindex (PI), Zahnfleischindex (GI), Sondierungstiefen, Blutungen bei Sondierung (BOP) und marginalen Rezessionen (MR) untersucht. Die materialabhängige Biofilmbildung bei Twist-Flex-, unbehandelten Nitinol- und elektropolierten Nitinol-Drahtproben wurde erstens in vitro beurteilt, unter Verwendung der optischen Dichte (OD) und Messung von jeweils 10 Proben, zweitens in vivo, unter Verwendung einer histomorphometrischen Analyse von jeweils 18 Proben.

Ergebnisse

Patienten, die mit Nitinol-Retainern behandelt wurden, hatten signifikant bessere Mundgesundheitsindizes (PI1 = 1,29 ± 0,06, PI2 = 0,94 ± 0,06; GI1 = 0,71 ± 0,05, GI2 = 0,56 ± 0,04; BOP1 = 0,11 ± 0,01, BOP2 = 0,08 ± 0,01; PD1 = 1,79 ± 0,03 mm, PD2 = 1,59 ± 0,04 mm) mit Ausnahme von MR (0,08 ± 0,03 vs. 0,08 ± 0,02 mm) im Vergleich zu mit Twist-Flex-Retainern behandelten. Nach 24 h intraoraler Inkubation zeigten Nitinol-Retainer im Vergleich zu Twist-Flex-Retainern eine deutlich geringere Biofilmbildung. In der In-vitro-Untersuchung wurden die vorübergehenden signifikanten Unterschiede zwischen den Gruppen am Ende kompensiert.

Schlussfolgerungen

Auf Grundlage der Ergebnisse kann davon ausgegangen werden, dass linguale CAD/CAM-Nitinol-Retainer einen positiven Effekt auf die Mundgesundheit haben.

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Acknowledgements

The authors thank the German Association of Orthodontics (DGKFO) for financial support. The authors thank Pascal Schumacher for CAD/CAM material support. The authors also thank C. Kirschneck and P. Proff (University of Regensburg, Department of Orthodontics) for improving data presentation and interpretation.

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Correspondence to I. Knaup.

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I. Knaup, Y. Wagner, J. Wego, U. Fritz, A. Jäger and M. Wolf declare that they have no competing interests.

Ethical standards

The Ethics Committee of University of Aachen approved this study. All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.

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I. Knaup and Y. Wagner contributed equally to this manuscript.

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Knaup, I., Wagner, Y., Wego, J. et al. Potential impact of lingual retainers on oral health: comparison between conventional twistflex retainers and CAD/CAM fabricated nitinol retainers. J Orofac Orthop 80, 88–96 (2019). https://doi.org/10.1007/s00056-019-00169-7

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