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Long-term changes in thickness, live/dead bacterial ratio, and mineral content in biofilm on ceramic and stainless steel orthodontic attachments

Langfristige Veränderungen von Dicke, Verhältnis zwischen aktiven und nichtaktiven Bakterien sowie Mineraliengehalt des Biofilms auf kieferorthopädischen Attachments aus Keramik und aus Edelstahl

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

Abstract

Purpose

Fixed orthodontic appliances induce biofilm deposition, which harbors a microbial population harmful to the periodontal health of the individual. The present study evaluated the changes in thickness, live/dead bacterial ratio, and mineral content in dental biofilm over 6 months in patients with either stainless steel or ceramic orthodontic attachments.

Methods

Eighty patients who require fixed orthodontic appliance treatment with first premolar extraction for correcting their malocclusion were selected and bonded with either stainless steel or ceramic orthodontic attachments on the buccal side. The attached buttons were retrieved at different periods—1 week, 1 month, 3 months, and 6 months. They were stained and visualized through confocal microscopy to detect biofilm thickness and the ratio of live/dead bacteria. X‑ray diffraction was used to identify the presence of calcium and phosphorous.

Results

Ceramic attachments showed a greater increase in biofilm thickness in comparison to stainless steel attachments except in the initial 1‑week evaluation. A higher live/dead bacterial ratio was observed in stainless steel attachments than in their ceramic counterparts at all four evaluation periods. Both stainless steel and ceramic surfaces exhibited the presence of mineral deposition (calcium and phosphorous) at all periods.

Conclusions

More biofilm adhesion was observed over ceramic surfaces than over stainless steel orthodontic attachments. Stainless steel attachments exhibited biofilm with a higher live/dead bacterial ratio than their ceramic counterparts at all evaluation periods. The presence of calcium and phosphorous in the adhered biofilm, pointing toward its calcification process, was identified.

Zusammenfassung

Zielsetzung

Festsitzende kieferorthopädische Apparaturen führen zu Biofilmablagerungen, die eine für die parodontale Gesundheit des Einzelnen schädigende Mikroorganismenpopulation enthalten. In der vorliegenden Studie wurden die Veränderungen von Dicke, Verhältnis zwischen aktiven und nichtaktiven Bakterien und Mineraliengehalt des dentalen Biofilms über 6 Monate bei Patienten mit kieferorthopädischen Attachments aus Edelstahl oder Keramik untersucht.

Methoden

Achtzig Patienten, die eine festsitzende kieferorthopädische Behandlung mit Extraktion der ersten Prämolaren zur Korrektur ihrer Malokklusion benötigten, wurden ausgewählt und mit kieferorthopädischen Attachments aus Edelstahl oder aus Keramik auf der bukkalen Seite verklebt. Die befestigten Buttons wurden nach verschiedenen Zeiträumen – 1 Woche, 1 Monat, 3 Monate und 6 Monate – entnommen. Sie wurden angefärbt und mit Hilfe der konfokalen Mikroskopie visualisiert, um die Dicke des Biofilms und das Verhältnis von aktiven und nichtaktiven Bakterien zu ermitteln. Mittels Röntgendiffraktion wurde das Vorkommen von Kalzium und Phosphor nachgewiesen.

Ergebnisse

Keramikattachments wiesen im Vergleich zu Edelstahlattachments eine stärkere Zunahme der Biofilmdicke auf, außer in der ersten Bewertungsphase nach einer Woche. Das Verhältnis zwischen aktiven und nichtaktiven Bakterien war bei Attachments aus Edelstahl in allen 4 Bewertungszeiträumen höher als bei den Keramikattachments. Sowohl die Edelstahl- als auch die Keramikoberflächen wiesen in allen Zeiträumen Mineralablagerungen (Kalzium und Phosphor) auf.

Schlussfolgerungen

Auf Keramikoberflächen wurde eine stärkere Biofilmadhäsion beobachtet als auf kieferorthopädischen Attachments aus Edelstahl. Attachments aus rostfreiem Stahl wiesen in allen Untersuchungszeiträumen einen Biofilm mit einem höheren Verhältnis zwischen nichtaktiven und toten Bakterien auf als ihre Gegenstücke aus Keramik. Es wurde das Vorhandensein von Kalzium und Phosphor im adhärenten Biofilm festgestellt, was auf einen Kalzifizierungsprozess hindeutet.

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The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthodontics, Sri Sankara Dental College, Akathumuri, Varkala, Trivandrum, Kerala, India

    Anjali Krishnan MDS, Rahul Rajendran S MDS, Deepak Damodaran R MDS, Sreelekshmi K. Manmadhan MDS & Vinod Krishnan MDS. M.Orth RCS FDS RCS PhD

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  1. Anjali Krishnan MDS
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  2. Rahul Rajendran S MDS
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  3. Deepak Damodaran R MDS
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  4. Sreelekshmi K. Manmadhan MDS
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  5. Vinod Krishnan MDS. M.Orth RCS FDS RCS PhD
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Correspondence to Vinod Krishnan MDS. M.Orth RCS FDS RCS PhD.

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Conflict of interest

A. Krishnan, R. Rajendran, D. Damodaran, S.K. Manmadhan and V. Krishnan declare that they have no competing interests.

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Ethical approval for the study was obtained from the Institutional Ethical Committee of Sri Sankara Dental College, Trivandrum, Kerala, India (IEC, SSDC; reference number B2-256/19/IEC-SSDC-07). Consent to participate: Not applicable.

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Krishnan, A., Rajendran, R., Damodaran, D. et al. Long-term changes in thickness, live/dead bacterial ratio, and mineral content in biofilm on ceramic and stainless steel orthodontic attachments. J Orofac Orthop 84 (Suppl 3), 251–258 (2023). https://doi.org/10.1007/s00056-023-00452-8

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