Salivary Nickel and Chromium Levels in Orthodontic Patients with and Without Periodontitis: a Preliminary Historical Cohort Study

  • Fariborz Amini
  • Elmira AsadiEmail author
  • Diana Hakimpour
  • Aghdas Rakhshan


Many periodontal patients may need orthodontic treatment. Alterations in oral environment particularly the reduction of pH in periodontal patients could affect metal ion release from orthodontic appliances. However, there is no study on metal ion release in periodontal patients. The aim of this preliminary study was to comparatively evaluate, for the first time, salivary levels of nickel and chromium in periodontal patients (versus healthy controls) under orthodontic treatment for 2 months. In this in vivo study, 40 subjects were evaluated. Patient selection and standardization of orthodontic treatment protocols were prospectively designed and performed. Two groups of n = 20 each (control: healthy orthodontic patients, cohort: orthodontic patients with periodontitis) underwent similar protocols of fixed orthodontic treatment for 2 months. After 2 months, salivary nickel and chromium concentrations of the case and cohort groups were measured using inductively coupled plasma mass spectrometry (ICP-MS). The values were compared between the two groups using t test. There were 10 men and 10 women in each group. The mean age of patients was 34.6 ± 3.6 years old. The salivary level of nickel was 338.2 ± 235.5 ng/ml and 182.8 ± 116.5 ng/ml in the cohort and control groups, respectively (P = 0.0118). The salivary level of chromium was 7.4 ± 3.15 ng/ml in the cohort and 6.35 ± 2.39 ng/ml in the control group (P = 0.2214). Salivary level of nickel might be considerably higher in periodontal patients undergoing 2 months of orthodontic treatment compared to orthodontic patients with healthy gingivae.


Metal ion release Nickel Chromium Periodontitis Orthodontic treatment Saliva 



The study was funded by the authors and their institution.

Compliance with Ethical Standards

The study ethics were approved by the research committee of the university (thesis #25542, ethics code: IR.IAU.DENTAL.REC.1395.7). The study protocol was thoroughly explained to patients, and written informed consents were obtained from them prior to participation in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Mikulewicz M, Chojnacka K (2010) Trace metal release from orthodontic appliances by in vivo studies: a systematic literature review. Biol Trace Elem Res 137:127–138CrossRefGoogle Scholar
  2. 2.
    Mikulewicz M, Chojnacka K (2011) Release of metal ions from orthodontic appliances by in vitro studies: a systematic literature review. Biol Trace Elem Res 139:241–256CrossRefGoogle Scholar
  3. 3.
    Hafez HS, Selim EM, Kamel Eid FH, Tawfik WA, Al-Ashkar EA, Mostafa YA (2011) Cytotoxicity, genotoxicity, and metal release in patients with fixed orthodontic appliances: a longitudinal in-vivo study. Am J Orthod Dentofac Orthop 140:298–308CrossRefGoogle Scholar
  4. 4.
    Amini F, Rakhshan V, Mesgarzadeh N (2012) Effects of long-term fixed orthodontic treatment on salivary nickel and chromium levels: a 1-year prospective cohort study. Biol Trace Elem Res 150:15–20CrossRefGoogle Scholar
  5. 5.
    Amini F, Rakhshan V, Sadeghi P (2012) Effect of fixed orthodontic therapy on urinary nickel levels: a long-term retrospective cohort study. Biol Trace Elem Res 150:31–36CrossRefGoogle Scholar
  6. 6.
    House K, Sernetz F, Dymock D, Sandy JR, Ireland AJ (2008) Corrosion of orthodontic appliances--should we care? Am J Orthod Dentofac Orthop 133:584–592CrossRefGoogle Scholar
  7. 7.
    Faccioni F, Franceschetti P, Cerpelloni M, Fracasso ME (2003) In vivo study on metal release from fixed orthodontic appliances and DNA damage in oral mucosa cells. Am J Orthod Dentofac Orthop 124:687–693 discussion 693-684CrossRefGoogle Scholar
  8. 8.
    Amini F, Harandi S, Mollaei M, Rakhshan V (2015) Effects of fixed orthodontic treatment using conventional versus metal-injection molding brackets on salivary nickel and chromium levels: a double-blind randomized clinical trial. Eur J Orthod 37:522–530CrossRefGoogle Scholar
  9. 9.
    Eliades T, Athanasiou AE (2002) In vivo aging of orthodontic alloys: implications for corrosion potential, nickel release, and biocompatibility. Angle Orthod 72:222–237PubMedGoogle Scholar
  10. 10.
    Amini F, Rakhshan V, Pousti M, Rahimi H, Shariati M, Aghamohamadi B (2012) Variations in surface roughness of seven orthodontic archwires: an SEM-profilometry study. Korean J Orthod 42:129–137CrossRefGoogle Scholar
  11. 11.
    Hwang CJ, Shin JS, Cha JY (2001) Metal release from simulated fixed orthodontic appliances. Am J Orthod Dentofac Orthop 120:383–391CrossRefGoogle Scholar
  12. 12.
    Mikulewicz M, Chojnacka K (2011) Cytocompatibility of medical biomaterials containing nickel by osteoblasts: a systematic literature review. Biol Trace Elem Res 142:865–889CrossRefGoogle Scholar
  13. 13.
    Matos de Souza R, Macedo de Menezes L (2008) Nickel, chromium and iron levels in the saliva of patients with simulated fixed orthodontic appliances. Angle Orthod 78:345–350CrossRefGoogle Scholar
  14. 14.
    Freitas MP, Oshima HM, Menezes LM (2011) Release of toxic ions from silver solder used in orthodontics: an in-situ evaluation. Am J Orthod Dentofac Orthop 140:177–181CrossRefGoogle Scholar
  15. 15.
    Agaoglu G, Arun T, Izgi B, Yarat A (2001) Nickel and chromium levels in the saliva and serum of patients with fixed orthodontic appliances. Angle Orthod 71:375–379PubMedGoogle Scholar
  16. 16.
    Macedo de Menezes L, Cardoso Abdo Quintão C (2010) The release of ions from metallic orthodontic appliances. Semin Orthod 16:282–292CrossRefGoogle Scholar
  17. 17.
    Amini F, Mollaei M, Harandi S, Rakhshan V (2015) Effects of fixed orthodontic treatment on hair nickel and chromium levels: a 6-month prospective preliminary study. Biol Trace Elem Res 164:12–17CrossRefGoogle Scholar
  18. 18.
    Amini F, Shariati M, Sobouti F, Rakhshan V (2016) Effects of fixed orthodontic treatment on nickel and chromium levels in gingival crevicular fluid as a novel systemic biomarker of trace elements: a longitudinal study. Am J Orthod Dentofac Orthop 149:666–672CrossRefGoogle Scholar
  19. 19.
    Khaneh Masjedi M, Haghighat Jahromi N, Niknam O, Hormozi E, Rakhshan V (2017) Effects of fixed orthodontic treatment using conventional (two-piece) versus metal injection moulding brackets on hair nickel and chromium levels: a double-blind randomized clinical trial. Eur J Orthod 39:17–24CrossRefGoogle Scholar
  20. 20.
    Khaneh Masjedi M, Niknam O, Haghighat Jahromi N, Javidi P, Rakhshan V (2016) Effects of fixed orthodontic treatment using conventional, copper-included, and epoxy-coated nickel-titanium archwires on salivary nickel levels: a double-blind randomized clinical trial. Biol Trace Elem Res 174:27–31CrossRefGoogle Scholar
  21. 21.
    Eliades T, Trapalis C, Eliades G, Katsavrias E (2003) Salivary metal levels of orthodontic patients: a novel methodological and analytical approach. Eur J Orthod 25:103–106CrossRefGoogle Scholar
  22. 22.
    McMorrow S (2015) Adult orthodontics: internet information and a national survey [PhD Thesis]. University College Cork, National University of Ireland, Cork, IrelandGoogle Scholar
  23. 23.
    American Academy of Periodontology Task Force Report on the Update to the 1999 Classification of periodontal diseases and conditions (2015) J Periodontol 86:835–838CrossRefGoogle Scholar
  24. 24.
    Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ (2012) Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 91:914–920CrossRefGoogle Scholar
  25. 25.
    Socransky SS (1977) Microbiology of periodontal disease—present status and future considerations. J Periodontol 48:497–504CrossRefGoogle Scholar
  26. 26.
    Baliga S, Muglikar S, Kale R (2013) Salivary pH: a diagnostic biomarker. J Indian Soc Periodontol 17:461CrossRefGoogle Scholar
  27. 27.
    Kuhta M, Pavlin D, Slaj M, Varga S, Lapter-Varga M (2009) Type of archwire and level of acidity: effects on the release of metal ions from orthodontic appliances. Angle Orthod 79:102–110CrossRefGoogle Scholar
  28. 28.
    Basir L, Meshki R, Behbudi A, Rakhshan V (2018) Effects of restoring the primary dentition with stainless-steel crowns on children’s salivary nickel and chromium levels, and the associations with saliva pH: a preliminary before-after clinical trial. Biol Trace Elem ResGoogle Scholar
  29. 29.
    Wolowiec P, Chojnacka K, Loster BW, Mikulewicz M (2017) Do dietary habits influence trace elements release from fixed orthodontic appliances? Biol Trace Elem Res 180:214–222CrossRefGoogle Scholar
  30. 30.
    Olmedo P, Pla A, Hernandez AF, Lopez-Guarnido O, Rodrigo L, Gil F (2010) Validation of a method to quantify chromium, cadmium, manganese, nickel and lead in human whole blood, urine, saliva and hair samples by electrothermal atomic absorption spectrometry. Anal Chim Acta 659:60–67CrossRefGoogle Scholar
  31. 31.
    Huang HH, Chiu YH, Lee TH, Wu SC, Yang HW, Su KH, Hsu CC (2003) Ion release from NiTi orthodontic wires in artificial saliva with various acidities. Biomaterials 24:3585–3592CrossRefGoogle Scholar
  32. 32.
    Takahashi N, Schachtele CF (1990) Effect of pH on the growth and proteolytic activity of Porphyromonas gingivalis and Bacteroides intermedius. J Dent Res 69:1266–1269CrossRefGoogle Scholar
  33. 33.
    Takahashl N, Saito K, Schachtele CF, Yamada T (1997) Acid tolerance and acid-neutralizing activity of Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum. Oral Microbiol Immunol 12:323–328CrossRefGoogle Scholar
  34. 34.
    Fujikawa K, Numasaki H, Kobayashi M, Sugano N, Tomura S, Murai S (1989) pH determination in human crevicular fluids. Examination of the pH meter and evaluation of the correlation between pH level and clinical findings or the microflora in each periodontal pocket. Nihon Shishubyo Gakkai Kaishi (Journal of the Japanese Society of Periodontology) 31:241–248Google Scholar
  35. 35.
    Galgut P (2001) The relevance of pH to gingivitis and periodontitis. Journal of the International Academy of Periodontology 3:61–67PubMedGoogle Scholar
  36. 36.
    Seethalakshmi C (2016) Correlation of salivary pH, incidence of dental caries and periodontal status in diabetes mellitus patients: a cross-sectional study. J Clin Diagn ResGoogle Scholar
  37. 37.
    Huang T-H, Yen C-C, Kao C-T (2001) Comparison of ion release from new and recycled orthodontic brackets. Am J Orthod Dentofac Orthop 120:68–75CrossRefGoogle Scholar
  38. 38.
    Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL (1998) Microbial complexes in subgingival plaque. J Clin Periodontol 25:134–144CrossRefGoogle Scholar
  39. 39.
    Sobouti F, Rakhshan V, Heydari M, Keikavusi S, Dadgar S, Shariati M (2018) Effects of fixed orthodontic treatment and two new mouth rinses on gingival health: a prospective cohort followed by a single-blind placebo-controlled randomized clinical trial. Int Orthod 16:12–30PubMedGoogle Scholar
  40. 40.
    Freitas AOA, Marquezan M, Nojima MCG, Alviano DS, Maia LC (2014) The influence of orthodontic fixed appliances on the oral microbiota: a systematic review. Dental Press J Orthod 19:46–55CrossRefGoogle Scholar
  41. 41.
    Paolantonio M, Festa F, di Placido G, D'Attilio M, Catamo G, Piccolomini R (1999) Site-specific subgingival colonization by Actinobacillus actinomycetemcomitans in orthodontic patients. Am J Orthod Dentofac Orthop 115:423–428CrossRefGoogle Scholar
  42. 42.
    Rakhshan H, Rakhshan V (2015) Effects of the initial stage of active fixed orthodontic treatment and sex on dental plaque accumulation: a preliminary prospective cohort study. Saudi J Dent Res 6:86–90CrossRefGoogle Scholar
  43. 43.
    Huang TH (2004) Metal ion release from new and recycled stainless steel brackets. Eur J Orthod 26:171–177CrossRefGoogle Scholar
  44. 44.
    Danaei SM, Safavi A, Roeinpeikar SM, Oshagh M, Iranpour S, Omidkhoda M (2011) Ion release from orthodontic brackets in 3 mouthwashes: an in-vitro study. Am J Orthod Dentofac Orthop 139:730–734CrossRefGoogle Scholar
  45. 45.
    Rajesh KS, Zareena HS, Arun Kumar MS (2015) Assessment of salivary calcium, phosphate, magnesium, pH, and flow rate in healthy subjects, periodontitis, and dental caries. Contemp Clin Dent 6:461–465CrossRefGoogle Scholar
  46. 46.
    Petoumenou E, Arndt M, Keilig L, Reimann S, Hoederath H, Eliades T, Jager A, Bourauel C (2009) Nickel concentration in the saliva of patients with nickel-titanium orthodontic appliances. Am J Orthod Dentofac Orthop 135:59–65CrossRefGoogle Scholar
  47. 47.
    Kerosuo H, Moe G, Hensten-Pettersen A (1997) Salivary nickel and chromium in subjects with different types of fixed orthodontic appliances. Am J Orthod Dentofac Orthop 111:595–598CrossRefGoogle Scholar
  48. 48.
    Kocadereli L, Atac PA, Kale PS, Ozer D (2000) Salivary nickel and chromium in patients with fixed orthodontic appliances. Angle Orthod 70:431–434PubMedGoogle Scholar
  49. 49.
    Fors R, Persson M (2006) Nickel in dental plaque and saliva in patients with and without orthodontic appliances. Eur J Orthod 28:292–297CrossRefGoogle Scholar
  50. 50.
    Singh DP, Sehgal V, Pradhan KL, Chandna A, Gupta R (2008) Estimation of nickel and chromium in saliva of patients with fixed orthodontic appliances. World J Orthod 9:196–202PubMedGoogle Scholar
  51. 51.
    International Programme on Chemical Safety (1991) 108. Nickel. In: Environmental health criteria. World Health Organization, Geneva, pp 16–17Google Scholar
  52. 52.
    Menezes LM, Quintao CA, Bolognese AM (2007) Urinary excretion levels of nickel in orthodontic patients. Am J Orthod Dentofac Orthop 131:635–638CrossRefGoogle Scholar
  53. 53.
    Gjerdet NR, Erichsen ES, Remlo HE, Evjen G (1991) Nickel and iron in saliva of patients with fixed orthodontic appliances. Acta Odontol Scand 49:73–78CrossRefGoogle Scholar
  54. 54.
    Edgar W, O'Mullane D, Dawes C (2004) Saliva and oral health. British Dental Association London,Google Scholar
  55. 55.
    Dawes C (1972) Circadian rhythms in human salivary flow rate and composition. J Physiol 220:529–545CrossRefGoogle Scholar
  56. 56.
    Pazzini CA, Junior GO, Marques LS, Pereira CV, Pereira LJ (2009) Prevalence of nickel allergy and longitudinal evaluation of periodontal abnormalities in orthodontic allergic patients. Angle Orthod 79:922–927CrossRefGoogle Scholar
  57. 57.
    Genelhu MC, Marigo M, Alves-Oliveira LF, Malaquias LC, Gomez RS (2005) Characterization of nickel-induced allergic contact stomatitis associated with fixed orthodontic appliances. Am J Orthod Dentofac Orthop 128:378–381CrossRefGoogle Scholar
  58. 58.
    Bishara SE, Barrett RD, Selim MI (1993) Biodegradation of orthodontic appliances. Part II. Changes in the blood level of nickel. Am J Orthod Dentofac Orthop 103:115–119CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Fariborz Amini
    • 1
  • Elmira Asadi
    • 1
    Email author
  • Diana Hakimpour
    • 2
  • Aghdas Rakhshan
    • 3
  1. 1.Department of Orthodontics, Dental BranchIslamic Azad UniversityTehranIran
  2. 2.TehranIran
  3. 3.Pharmaceutical Chemistry, North BranchIslamic Azad UniversityTehranIran

Personalised recommendations