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Nickel ion concentrations in the saliva of patients treated with self-ligating fixed appliances: a prospective cohort study

Nickelionenkonzentration im Speichelvon Patienten mit selbstligierenden festsitzenden Apparaturen: Eine prospektive Kohortenstudie

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

Abstract

Objective

Orthodontic appliances are considered to be highly biocompatible although adverse effects attributed to the release of nickel ions (Ni2+) have been documented. Self-ligating brackets have grown in popularity for economic reasons and supposed friction reduction. The aim of the present prospective cohort study was therefore to determine salivary Ni2+ concentrations in patients undergoing orthodontic treatment with self-ligating fixed appliances.

Materials and methods

A group of 30 patients between 10 and 13 years of age were treated with self-ligating brackets (SmartClip™), molar bands, and nickel–titanium (NiTi) archwires. Unstimulated saliva samples were collected after different time points (before treatment, after self-ligating bracket and band placement, before archwire insertion, after archwire insertion, and finally 4 and 8 weeks afterwards) and analyzed with an ICP mass spectrometer followed by generalized estimating equation modelling with α = 5 %.

Results

The baseline median salivary Ni2+ concentration was 21.85 µg/l, while the Ni2+ concentrations at the following visits ranged between 13.73 and 85.34 µg/l. Significant increases in Ni2+ levels compared to the baseline levels were detected after band/bracket placement [+59.76 µg/l; 95 % confidence interval (CI) 44.88–74.64 µg/l; P < 0.001] and after archwire insertion (+53.55 µg/l; 95 % CI 25.57–81.52 µg/l; P < 0.001). After 4 weeks, Ni2+ concentrations returned to initial control levels or were lower.

Conclusion

Self-ligating orthodontic appliances may affect salivary Ni2+ concentrations in vivo over the short term. However, levels resembled those documented in conjunction with conventional bracket use and remained below the daily dietary Ni intake.

Zusammenfassung

Hintergrund und Ziel

Im Allgemeinen werden kieferorthopädische Apparaturen als hoch biokompatibel eingeschätzt, obwohl verschiedene Nebenwirkungen bedingt durch die Freisetzung von Nickelionen (Ni2+) dokumentiert wurden. Selbstligierende Bracketsysteme erfreuen sich zunehmender Beliebtheit aufgrund wirtschaftlicher Aspekte und propagierter Friktionsreduktion. Ziel der vorliegenden prospektiven Kohortenstudie was es daher, die Ni2+-Konzentrationen im Speichel von Patienten zu bestimmen, die einer Behandlung mit selbstligierenden festsitzenden Multibracketapparaturen unterzogen wurden.

Material und Methodik

Dreißig Patienten im Alter von 10–13 Jahren wurden mit selbstligierenden Brackets (SmartClip™), Molarenbändern und Nickel-Titanium-Bögen behandelt. Unstimulierte Speichelproben wurden nach unterschiedlichen Zeitpunkten (vor Behandlung, nach Insertion selbstligierender Brackets/Bänder, 2 Wochen nach und direkt vor Bogeninsertion, direkt nach Bogeninsertion, 4 und 8 Wochen nach Bogeninsertion) gesammelt und mittels ICP(“inductively coupled plasma”)-Massenspektrometer analysiert. Die Daten wurden mittels eines verallgemeinernden Schätzgleichungsmodells mit einer Signifikanzgrenze von 5 % ausgewertet.

Ergebnisse

Der Medianwert der Ni2+-Konzentrationen im Speichel vor der Behandlung (Referenzwert) lag bei 21,85 µg/l. In den folgenden Sitzungen lagen die Ni2+-Werte zwischen 13,73 und 85,34 µg/l. Ein signifikanter Anstieg der Ni2+-Konzentrationen im Vergleich zum Referenzwert wurde nach der Insertion der selbstligierenden Brackets und Bänder (+59,76 µg/l, 95 %-Konfidenzintervall, KI: 44,88–74,64 µg/l; P < 0,001) und nach Bogeninsertion (+53,55 µg/l; 95 %-KI: 25,57–81,52 µg/l; P < 0,001) ermittelt. Nach 4 Wochen waren die Ni2+-Werte wieder auf dem Referenzniveau bzw. niedriger.

Schlussfolgerung

Die Daten lassen die Schlussfolgerungen zu, dass selbstligierende Multibracketsysteme die Ni2+-Konzentrationen im Speichel in vivo kurzfristig beeinträchtigen. Dennoch lagen die Konzentrationen in Höhe der bei Behandlung mit konventionellen Multibracketsystemen ermittelten Werte sowie unterhalb der täglichen Nickelaufnahme durch die Nahrung.

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Author notes

    Authors and Affiliations

    1. Department of Orthodontics, School of Dentistry, University of Bonn, Bonn, Germany

      Lina Gölz, Spyridon N. Papageorgiou & Andreas Jäger

    2. Department of Oral Technology, School of Dentistry, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany

      Anna Christine Knickenberg, Ludger Keilig, Susanne Reimann, Spyridon N. Papageorgiou & Christoph Bourauel

    3. Department of Prosthetic Dentistry, Preclinical Education and Materials Science, School of Dentistry, University of Bonn, Bonn, Germany

      Ludger Keilig

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    1. Lina Gölz
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    Correspondence to Christoph Bourauel.

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    Lina Gölz, Anna Christine Knickenberg,Ludger Keilig, Susanne Reimann, Spyridon N. Papageorgiou, Andreas Jäger, and Christoph Bourauel state that there are no conflicts of interest.

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    Prof. Christoph Bourauel.

    L. Gölz and A. C. Knickenberg contributed equally to this article.

    Appendix: Protocol for the placement of the fixed orthodontic appliances

    Appendix: Protocol for the placement of the fixed orthodontic appliances

    Teeth were polished with pumice and rubber cup to remove pellicle and food debris and then rinsed with water and air dried. Preformed stainless steel bands (Ormco, Glendora, CA, USA) were fitted to the patients’ upper and lower first molars and cemented with glass-ionomer cement (Ketac Cem mu, 3 M ESPE, Seefeld, Germany). The buccal surfaces of the remaining teeth underwent acid etching (phosphoric acid 37 %, Ormco) for 15 s, rinsed again with water, and air dried. Monomer primer (bonding; Transbond XT, 3M Unitek, Monrovia, CA, USA) was applied on etched surfaces of the teeth followed by application of light cure composite resin (Transbond XT, 3M Unitek) on the bracket bases. Brackets (SmartClip™, 3M Unitek) were pressed lightly onto the tooth surface and material excess removed. Polymerization was done with a halogen lamp for 30 s per tooth.

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    Gölz, L., Knickenberg, A.C., Keilig, L. et al. Nickel ion concentrations in the saliva of patients treated with self-ligating fixed appliances: a prospective cohort study. J Orofac Orthop 77, 85–93 (2016). https://doi.org/10.1007/s00056-016-0012-x

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