Abstract
Objectives
The purpose of this study was to explore the microbiological and periodontal changes occurring in adolescents during 12 months of orthodontic therapy with removable aligners and with fixed appliances.
Material and methods
During the years 2012–2013, 50 teenagers aged 10–18 years with similar initial orthodontic conditions participated in this trial in a university clinic in northern Italy. After receiving professional oral hygiene and instructions on a standardized oral hygiene protocol, the adolescents were randomly assigned to either orthodontic treatment with traditional fixed brackets (n = 25) or to treatment with Invisalign® aligners (n = 25). Subgingival microbiological samples, probing depth (PD), plaque index (PI), and bleeding on probing (BOP) were obtained and documented from the mesiovestibular subgingival sulcus of the upper right first molar and left central incisor at the beginning of treatment and 3, 6, and 12 months later. Compliance with oral hygiene procedures, full mouth plaque score (FMPS), and full mouth bleeding score (FMBS) were assessed at the beginning of treatment and 12 months later. Two sample independent t-tests and the χ2 test were used to study whether the indices of periodontal health differed in the teenagers due to the experimental conditions.
Results
None of the patients was positive for the periodontal anaerobes analyzed. The PI, PD, BOP, FMPS, and FMBS scores were significantly lower and compliance with oral hygiene was significantly higher in the group treated with Invisalign® than in the group treated with fixed brackets.
Conclusion
Teenagers treated with removable appliances display better compliance with oral hygiene, less plaque, and fewer gingival inflammatory reactions than their peers with fixed appliances.
Zusammenfassung
Studienziel
Gegenstand dieser Untersuchung waren die mikrobiologischen und parodontalen Veränderungen bei Jugendlichen über 12 Behandlungsmonate mit herausnehmbaren Alignern oder festsitzenden Apparaturen.
Methode
Die Studie umfasst 50 Teenager (10–18 Jahre) mit vergleichbaren kieferorthopädischen Indikationen, behandelt in den Jahren 2012 und 2013 an einer norditalienischen Universitätsklinik. Nach einer professionellen Hygienesitzung und Unterweisung in einem standardisierten Mundhygieneverfahren erfolgte nach dem Zufallsprinzip die Zuordnung der Jugendlichen zu einer von 2 Behandlungsgruppen mit traditionellen Klebebrackets (n = 25) oder Invisalign®-Schienen (n = 25). Zu Behandlungsbeginn sowie 3, 6 und 12 Monate danach erfolgten mikrobiologische Probenentnahmen im Oberkiefer aus dem mesiovestibulären Sulkusbereich des rechten ersten Molaren und linken mittleren Schneidezahns sowie eine Beurteilung auf Sondiertiefen, Plaqueindex und provozierte Blutungen. Außerdem beurteilten wir zu Behandlungsbeginn und 12 Monate danach die Hygienedisziplin sowie die Gesamtindizes FMPS (Full Mouth Plaque Score) und FMBS (Full Mouth Bleeding Score). Zweistichproben-t-Tests für unabhängige Stichproben und der χ2-Test dienten dem Auffinden von Gruppenunterschieden bei den parodontalen Indizes.
Resultate
Tests auf 4 anaerobe Parodontalkeime waren für alle Patienten negativ. Die Invisalign®-Gruppe zeigte gegenüber der Bracket-Gruppe signifikant niedrigere Werte für Plaqueindex, Sondiertiefen, provozierte Blutungen sowie FMPS- und FMBS-Werte. Auch die Hygienedisziplin war in der Invisalign®-Gruppe signifikant besser.
Schlussfolgerung
Im Vergleich zu Gleichaltrigen mit festsitzenden Apparaturen zeigten die mit herausnehmbaren Aligners behandelten Teenager eine bessere Hygienedisziplin sowie weniger Plaque und Entzündungsreaktionen.
References
Alstad S, Zachrisson BU (1979) Longitudinal study of periodontal condition associated with orthodontic treatment in adolescents. Am J Orthod 76:277–286
Atack NE, Sandy JR, Addy M (1996) Periodontal and microbiological changes associated with the placement of orthodontic appliances. A review. J Periodontol 67:78–85
Bollen AM, Cunha-Cruz J, Bakko DW et al (2008) The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence. J Am Dent Assoc 139:413–422
Bommarito S, Peyret N, SantaLucia J Jr (2000) Thermodynamic parameters for DNA sequences with dangling ends. Nucleic Acids Res 28:1929–1934
Boyd RL, Miller R, Vlaskalic V (2000) The invisalign system in adult orthodontics: mild crowding and space closure cases. J Clin Orthod 34:203–212
Denotti G, Piga R, Montaldo C et al (2009) In vitro evaluation of Enterococcus faecalis adhesion on various endodontic medicaments. Open Dent J 3:120–124
Diamanti-Kipioti A, Gusberti FA, Lang NP (1987) Clinical and microbiological effects of fixed orthodontic appliances. J Clin Periodontol 14:326–333
Gomes SC, Varela CC, Veiga SL da et al (2007) Periodontal conditions in subjects following orthodontic therapy. A preliminary study. Eur J Orthod 29:477–481
Huser MC, Baehni PC, Lang R (1990) Effects of orthodontic bands on microbiologie and clinical parameters. Am J Orthod Dentofacial Orthop 97:213–218
Jansson G, Bombonatti R, Brandão AG et al (2003) Comparative radiographic evaluation of the alveolar bone crest after orthodontic treatment. Am J Orthod Dentofacial Orthop 124:157–164
Levrini L, Abbate GM, Migliori F et al (2013) Assessment of the periodontal health status in patients undergoing orthodontic treatment with fixed or removable appliances. A microbiological and preliminary clinical study. Cumhuriyet Dent J 16:296–307
Loe H, Silness J (1963) Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 2:533–551
Mampieri G, Giancotti A (2013) Invisalign technique in the treatment of adults with pre-restorative concerns. Prog Orthod 14:40
Miethke RR, Vogt S (2005) A comparison of the periodontal health of patients during treatment with the Invisalign system and with fixed orthodontic appliances. J Orofac Orthop 66:219–229
Miethke RR, Brauner K (2007) A Comparison of the periodontal health of patients during treatment with the Invisalign system and with fixed lingual appliances. J Orofac Orthop 68:223–231
Mumghamba EGS, Pitiphat W, Matee MIN et al (2004) The usefulness of using Ramfjord teeth in predicting periodontal status of a Tanzanian adult population. J Clin Periodontol 31:16–18
Orrù G, Marini MF, Ciusa ML et al (2006) Usefulness of real time PCR for the differentiation and quantification of 652 and JP2 Actinobacillus actinomycetemcomitans genotypes in dental plaque and saliva. BMC Infect Dis 6:98
Petti S, Barbato E, Simonetti D’Arca A (1997) Effect of orthodontic therapy with fixed and removable appliances on oral microbiota: a six-month longitudinal study. New Microbiol 20:55–62
Rasmussen R (2001) Quantification on the LightCycler. In: Meuer S, Wittwer C, Nakagawara K (eds) Rapid cycle real-time PCR. Methods and applications. Springer, Berlin, pp 21–34
Ristic M, Vlahovic Svabic M et al (2007) Clinical and microbiological effects of fixed orthodontic appliances on periodontal tissues in adolescents. Orthod Craniofac Res 10:187–195
Schaefer I, Braumann B (2010) Halitosis, oral health and quality of life during treatment with Invisalign(®) and the effect of a low-dose chlorhexidine solution. J Orofac Orthop 71:430–441
Silness J, Loe H (1964) Peridontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135
Socransky SS, Haffajee AD (1992) The bacterial etiology of destructive periodontal disease. J Periodontol 63:322–331
Taylor MG, McGorray SP, Durrett S (2003) Effect of Invisalign aligners on periodontal tissues. J Dent Res 82:1483
Tuncay O, Bowman SJ, Amy B, Nicozisis J (2013) Aligner treatment in the teenage patient. J Clin Orthod 47:115–119
Turatti G, Womack R, Bracco P (2006) Incisor intrusion with Invisalign treatment of an adult periodontal patient. J Clin Orthod 40:171–174
Gastel J van, Quirynen M, Teughels W et al (2008) Longitudinal changes in microbiology and clinical periodontal variables after placement of fixed orthodontic appliances. J Periodontol 79:2078–2086
Zachrisson BU, Alnaes L (1974) Periodontal condition in orthodontically treated and untreated individuals. II. Alveolar bone loss: radiographic findings. Angle Orthod 44:48–55
Acknowledgments
The authors wish to acknowledge Dr. Federico Migliori (Department of Orthodontics, University of Insubria, Varese Italy) and Dr. Silvia Margherini (Department of Oral Hygiene, University of Insubria, Varese Italy) for their valuable contribution in data collection.
Danksagung
Die Autoren danken Dr. Federico Migliori (Abteilung für Kieferorthopädie, Universität Insubria, Varese, Italien) und Dr. Silvia Margherini (Abteilung für Oralhygiene, Universität Insubria) für ihre wertvolle Mitwirkung bei der Datenerhebung.
Compliance with ethical guidelines
Conflict of interest. G.M. Abbate, M.P. Caria, P. Montanari, C. Mannu, G. Orrù, A. Caprioglio, and L. Levrini state that there are no conflicts of interest.
All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.
Einhaltung ethischer Richtlinien
Interessenkonflikt. G.M. Abbate, M.P. Caria, P. Montanari, C. Mannu, G. Orrù, A. Caprioglio und L. Levrini geben an, dass kein Interessenkonflikt besteht.
Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.
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Abbate, G., Caria, M., Montanari, P. et al. Periodontal health in teenagers treated with removable aligners and fixed orthodontic appliances. J Orofac Orthop 76, 240–250 (2015). https://doi.org/10.1007/s00056-015-0285-5
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DOI: https://doi.org/10.1007/s00056-015-0285-5