Abstracts
OBJECTIVE:
To verify, by means of a systematic review, whether the design of brackets (conventional or self-ligating) influences adhesion and formation of Streptococcus mutans colonies.
METHODS:
Search strategy: four databases (Cochrane Central Register of Controlled Trials, Ovid ALL EMB Reviews, PubMed and BIREME) were selected to search relevant articles covering the period from January 1965 to December 2012. Selection Criteria: in first consensus by reading the title and abstract. The full text was obtained from publications that met the inclusion criteria. Data collection and analysis: Two reviewers independently extracted data using the keywords: conventional, self-ligating, biofilm, Streptococcus mutans, and systematic review; and independently evaluated the quality of the studies. In case of divergence, the technique of consensus was adopted.
RESULTS:
The search strategy resulted in 1,401 articles. The classification of scientific relevance revealed the high quality of the 6 eligible articles of which outcomes were not unanimous in reporting not only the influence of the design of the brackets (conventional or self-ligating) over adhesion and formation of colonies of Streptococcus mutans, but also that other factors such as the quality of the bracket type, the level of individual oral hygiene, bonding and age may have greater influence. Statistical analysis was not feasible because of the heterogeneous methodological design.
CONCLUSIONS:
Within the limitations of this study, it was concluded that there is no evidence for a possible influence of the design of the brackets (conventional or self-ligating) over colony formation and adhesion of Streptococcus mutans.
Biofilms; Orthodontic brackets; Streptococcus mutans ; Review
OBJETIVO:
verificar, por meio de uma revisão sistemática, se o design dos braquetes (convencionais ou autoligáveis) apresenta influência na aderência e formação de colônias de Streptococcus mutans.
MÉTODOS:
quatro bases de dados (Cochrane Central Register of Controlled Trials; Ovid ALL EMB Reviews; PubMed e BIREME) foram selecionadas para a busca por artigos relevantes, do período de janeiro de 1965 a dezembro de 2012. Os critérios de seleção foram inicialmente aplicados aos títulos e abstracts e o texto integral foi obtido de publicações que cumprira os critérios de inclusão. Dois revisores, de forma independente, extraíram os dados utilizando as palavras-chave "convencionais", "autoligados", "biofilme", "Streptococcus mutans" e "revisão sistemática" e avaliaram a qualidade metodológica dos estudos incluídos. No caso de divergência, foi adotada a técnica do consenso.
RESULTADOS:
a estratégia de busca resultou em 1.401 artigos. A classificação da relevância científica revelou alta qualidade dos 6 artigos elegíveis, cujos desfechos não foram unânimes em relatar a influência do design dos braquetes (convencionais ou autoligáveis) sobre a aderência e a formação de colônias de Streptococcus mutans, e que outros fatores como características dos tipos de braquetes, o nível de higiene bucal individual, colagem e idade dos indivíduos, podem ter maior influência. O tratamento estatístico foi inviável por causa do desenho metodológico heterogêneo.
CONCLUSÕES:
dentro das limitações do presente estudo, concluiu-se que não há evidência de uma possível influência do design dos braquetes (convencionais ou autoligáveis) sobre a aderência e a formação de colônias de Streptococcus mutans.
Biofilmes; Braquetes ortodônticos; Streptococcus mutans; Revisão
INTRODUCTION
Increased oral microbiota of Streptococcus mutans and
Lactobacillus is associated with the onset of tooth demineralization
and periodontal disease, especially in orthodontic patients who present greater risk of
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44. Mizrahi E. Surface distribution of enamel opacities following
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1991;100(4):337-40. The devices used in orthodontic appliances (bands, wires, ligatures or brackets)
can promote changes in the oral environment, such as pH, amount of Streptococcus
mutans, biofilm66. Balenseifen JW, Madonia JV. Study of dental plaque in orthodontic
patients. J Dent Res. 1970;49(2):320-4.
7. Menzaghi N, Saletta M, Garattini G, Brambilla E, Strohmenger L.
Changes in the yeast oral flora in patients in orthodontic treatment. Prev Assist
Dent. 1991;17(4):26-30.
8. Forsberg CM, Brattström V, Malmberg E, Nord CE. Ligature wires and
elastomeric rings: two methods of ligation, and their association with microbial
colonization of Streptococcus mutans and lactobacilli. Eur J Orthod.
1991;13(5):416-20.
-
99. Rosenbloom RG, Tinanoff N. Salivary Streptococcus mutans levels in
patients before, during, and after orthodontic treatment. Am J Orthod Dentofacial
Orthop. 1991;100(1):35-7. and enamel decalcification.1010. Saemundsson SR, Bergmann H, Magnusdottir MO, Holbrook WP. Dental
caries and Streptococcus mutans in a rural child population in Iceland. Scand J Dent
Res. 1992;100(5):299-303.
11. Sansone C, Van Houte J, Joshipura K, Kent R, Margolis HC. The
association of mutans streptococci and non-mutans streptococci capable of
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12. Mattousch TJ, van der Veen MH, Zentner A. Caries lesions after
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14. Benson PE, Parkin N, Millett DT, Dyer FE, Vine S, Shah A. Fluorides
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1616. Øgaard B. Prevalence of white spot lesions in 19-year-olds: a study
on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod
Dentofacial Orthop. 1989;96(5):423-7. The clinical characteristics and the physical properties of the bracket types
are very different,1717. Anhoury P, Nathanson D, Hughes CV, Socransky S, Feres M, Chou LL.
Microbial profile on metallic and ceramic bracket materials. Angle Orthod.
2002;72(4):338-43. and, thus, can directly influence the amount of biofilm adhesion and,
consequently, gingivitis.55. Alexander SA. Effects of orthodontic attachments on the gingival
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1991;100(4):337-40.
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2222. van Pelt AW, Weerkamp AH, Uyen MH, Busscher HJ, de Jong HP, Arends
J. Adhesion of Streptococcus sanguis CH3 to polymers with different surface free
energies. Appl Environ Microbiol. 1985;49(5):1270-5. The characteristics of both the surface of the teeth and the gingiva influence
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25. Quirynen M, Dekeyser C, van Steenberghe D. Discriminating power of
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27. Rowshani B, Timmerman MF, Van der Velden U. Plaque development in
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29. Bollen CM, Quirynen M. [Specimen collection in dental plaque and
oral microbiology]. Rev Belge Med Dent. 1994;49(2):44-51.
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3030. Satou J, Fukunaga A, Satou N, Shintani H, Okuda K. Streptococcal
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relation to the periodontal condition and bacterial load of the saliva. J Clin
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Conventional brackets (C) are associated with the use of either elastomeric or stainless
steel ligature to keep the orthodontic wire inside the slot.88. Forsberg CM, Brattström V, Malmberg E, Nord CE. Ligature wires and
elastomeric rings: two methods of ligation, and their association with microbial
colonization of Streptococcus mutans and lactobacilli. Eur J Orthod.
1991;13(5):416-20. In Orthodontics, the term self-ligating (SL) refers to orthodontic brackets that
have their own mechanism for opening and closing the slot, and do not require any metal
or elastomeric ligature as a method for wire ligation.3131. Berger J. The engaging concept of self-ligation. Ont Dent.
1999;76(3):26-33.
,
3232. Cacciafesta V, Sfondrini MF, Ricciardi A, Scribante A, Klersy C,
Auricchio F. Evaluation of friction of stainless steel and esthetic self-ligating
bráquetes in various bracket-archwire combinations. Am J Orthod Dentofacial
Orthop. 2003;124(4):395-402. All these methods have advantages and disadvantages, but in relation to biofilm
retention, the literature88. Forsberg CM, Brattström V, Malmberg E, Nord CE. Ligature wires and
elastomeric rings: two methods of ligation, and their association with microbial
colonization of Streptococcus mutans and lactobacilli. Eur J Orthod.
1991;13(5):416-20.
,
33 33. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr,
Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic
brackets: quantitative comparison or oral bacteria detection with adenosine
triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop.
2009;135(4):426.e1-9.suggests that it is greater with elastomeric ligatures. Orthodontic treatment
with C brackets usually presents some periodontal changes as side effects caused by
difficulty in periodontal hygiene and also by greater accumulation and qualitative
alteration of plaque.33. Gwinnett JA, Ceen F. Plaque distribution on bonded brackets. Am J
Orthod. 1979;75(6):667-77.
,
55. Alexander SA. Effects of orthodontic attachments on the gingival
health of permanent second molars. Am J Orthod Dentofacial Orthop.
1991;100(4):337-40.
,
66. Balenseifen JW, Madonia JV. Study of dental plaque in orthodontic
patients. J Dent Res. 1970;49(2):320-4.
,
88. Forsberg CM, Brattström V, Malmberg E, Nord CE. Ligature wires and
elastomeric rings: two methods of ligation, and their association with microbial
colonization of Streptococcus mutans and lactobacilli. Eur J Orthod.
1991;13(5):416-20.
,
1919. Zachrisson S, Zachrisson BU. Gingival condition associated with
orthodontic treatment. Angle Orthod. 1972;42(1):26-34.
,
2020. Shelley WB. Gingival hyperplasia from dental braces. Cutis.
1981;28:149-50. Thus, in order to improve the deficiency of conventional brackets systems, SL
were developed so as to, according to the manufacturers and some studies,88. Forsberg CM, Brattström V, Malmberg E, Nord CE. Ligature wires and
elastomeric rings: two methods of ligation, and their association with microbial
colonization of Streptococcus mutans and lactobacilli. Eur J Orthod.
1991;13(5):416-20.
,
3434. Damon DH. The rationale, evolution and clinical application of the
self-ligating bracket. Clin Orthod Res. 1998;1(1):52-61.
35. Shivapuja PK, Berger J. A comparative study of conventional ligation
and self-ligation bracket systems. Am J Orthod Dentofacial Orthop.
1994;106(5):472-80.
36. Paduano S, Cioffi I, Iodice G, Rapuano A, Silva R. Time efficiency
of self-ligating vs conventional brackets in orthodontics: effect of appliances and
ligating systems. Prog Orthod. 2008;9(2):74-80.
37. Yu YL, Qian YF. The clinical implication of self-ligating brackets.
Shanghai Kou Qiang Yi Xue. 2007;16(4):431-5.
-
3838. Fernandes C, Almeida R. self-ligating appliances: evolution or
revolution? Aust Orthod. 2008;24(1):97-103. allow better hygiene. They claim that SL brackets are less susceptible to
bacterial colonization due to their shape and absence of elastomeric and metal
ligatures.3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr,
Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic
brackets: quantitative comparison or oral bacteria detection with adenosine
triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop.
2009;135(4):426.e1-9. It is questionable, however, if the adhesion of microorganisms and the
development of biofilm is reduced by the removal of ligatures of conventional brackets
and with the use of the opening and closing mechanism of SL systems. Even with the
changes in modern bracket types, the problem of plaque accumulation around the brackets
is still persistent in daily orthodontic practice.3737. Yu YL, Qian YF. The clinical implication of self-ligating brackets.
Shanghai Kou Qiang Yi Xue. 2007;16(4):431-5.
,
3939. Türkkahraman H, Sayin MO, Bozkurt FY, Yetkin Z, Kaya S, Onal S.
Archwire ligation techniques, microbial colonization, and periodontal status in
orthodontically treated patients. Angle Orthod. 2005;75(2):231-6.
Over the years, many publications66. Balenseifen JW, Madonia JV. Study of dental plaque in orthodontic
patients. J Dent Res. 1970;49(2):320-4.
7. Menzaghi N, Saletta M, Garattini G, Brambilla E, Strohmenger L.
Changes in the yeast oral flora in patients in orthodontic treatment. Prev Assist
Dent. 1991;17(4):26-30.
8. Forsberg CM, Brattström V, Malmberg E, Nord CE. Ligature wires and
elastomeric rings: two methods of ligation, and their association with microbial
colonization of Streptococcus mutans and lactobacilli. Eur J Orthod.
1991;13(5):416-20.
9. Rosenbloom RG, Tinanoff N. Salivary Streptococcus mutans levels in
patients before, during, and after orthodontic treatment. Am J Orthod Dentofacial
Orthop. 1991;100(1):35-7.
10. Saemundsson SR, Bergmann H, Magnusdottir MO, Holbrook WP. Dental
caries and Streptococcus mutans in a rural child population in Iceland. Scand J Dent
Res. 1992;100(5):299-303.
-
1111. Sansone C, Van Houte J, Joshipura K, Kent R, Margolis HC. The
association of mutans streptococci and non-mutans streptococci capable of
acidogenesis at a low pH with dental caries on enamel and root surfaces. J Dent Res.
1993;72(2):508-16.
,
3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr,
Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic
brackets: quantitative comparison or oral bacteria detection with adenosine
triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop.
2009;135(4):426.e1-9.
,
3434. Damon DH. The rationale, evolution and clinical application of the
self-ligating bracket. Clin Orthod Res. 1998;1(1):52-61.
,
3838. Fernandes C, Almeida R. self-ligating appliances: evolution or
revolution? Aust Orthod. 2008;24(1):97-103.
39. Türkkahraman H, Sayin MO, Bozkurt FY, Yetkin Z, Kaya S, Onal S.
Archwire ligation techniques, microbial colonization, and periodontal status in
orthodontically treated patients. Angle Orthod. 2005;75(2):231-6.
40. Polson AM, Subtelny JD, Meitner SW, Polson AP, Sommers EW, Iker HP.
Long-term periodontal status after orthodontic treatment. Am J Orthod Dentofacial
Orthop. 1988;93(1):51-8.
-
4141. Garcez, AS, Suzuki SS, Ribeiro MS, Mada EY, Freitas AZ, Suzuki H.
Biofilm retention by 3 methods of ligation on orthodontic brackets: a microbiologic
and optical coherence tomography analysis. Am J Orthod Dentofacial Orthop.
2011;140(4):e93-8. have reported different results concerning microorganism adhesion and biofilm
development for C and SL brackets. Biofilm adhesion on brackets is measured by different
systems, which hinders the evaluation of scientific quality. Therefore, it was proposed
to verify, through a systematic review, whether bracket design (conventional or
self-ligating) influences adhesion and formation of Streptococcus mutans
colonies. Additionally, the methodological soundness of the studies included in
the review was assessed in terms of quality.
MATERIAL AND METHODS
Search strategy
The strategy of this review was based on the National Health Service Center for
Reviews and Dissemination.4242. National Health Service (NHS) Centre for reviews and dissemination.
Undertaking systematic reviews of research on effectiveness [report]. York (UK): York
Publishing Services; 2001. Available from:
www.york.ac.uk/inst/crd/crdrep.htm.
Available from: www.york.ac.uk/inst/crd/...
Four databases (Cochrane Central Register of Controlled Trials; Ovid ALL EMB
Reviews, PubMed and Bireme) were selected to find relevant articles published between
January 1965 and December 2012. The search used the keywords "conventional" and/or
"self-ligating" crossed with combinations of the terms biofilm and / or
Streptococcus mutans and / or systematic review. Two reviewers
separately sought additional relevant publications, which may not have been in the
searched databases, by manually searching for papers in libraries and contacting
authors. There were no language restrictions. As a first step, the reviewers selected
the articles by reading titles and abstracts. Full texts were obtained from
publications that met the inclusion criteria. After the articles were selected, their
scientific relevance was independently assessed by the reviewers, and in case of
divergence, the technique of consensus was adopted. This review used the PICO
(Population Intervention Comparator Outcomes) strategy4343. European Food Safety Authority. Application of systematic review
methodology to food and feed safety assessments to support decision making. EFSA J.
2010;8(6):1637. Available from: http://www.efsa.europa.eu
Available from:
http:/...
to develop both the research and the bibliography (Table 1).
Description of the PICO (Population Intervention Comparator Outcomes) strategy used to develop the research and the bibliography.
Inclusion and exclusion criteria
The inclusion criteria for the selected studies initially aimed at human beings, only: those who were periodontally healthy before the study began and who were at 11 years of age or older. The randomized and controlled clinical trials had to involve conventional edgewise and/or self-ligating brackets prescriptions. Case reports, review articles, abstracts and letters to the Editor were also included. The exclusion criteria comprised studies carried out with animals, in vitro studies, treatment plans that included extractions of premolars as well as studies that included patients younger than 11 years of age, with periodontal problems, who were users of antibiotics and oral antiseptic solutions, alcoholics and smokers. Articles mentioning patients who used mechanical and anchoring devices, as well as Hyrax, were also excluded.
Assessment of the scientific relevance of the eligible studies
The following data were collected from each one of the papers selected: author/year of publication, journal, study design, age, teeth involved, bracket type and brand, ligature type, objective and method of analysis, follow-up, statistical analysis and outcome. A quality assessment4444. Jadad AR, Moore RA, Carrol D, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials 1996;17(1):1-12. was performed on each article, according to the following ten criteria:
-
Study design (randomized clinical trials [RCT], prospective [P] or controlled clinical trials [CCT]) = 2 points.
-
Adequate study description = 1 point.
-
Adequate sample size = 1 point.
-
Adequate sample selection description = 1 point.
-
Drop outs description = 1 point.
-
Adequate description of biofilm measurement method = 0.5 point.
-
Blind study = 0.5 point.
-
Adequate statistics = 1 point.
-
Confounding factors considered = 1 point; and
-
Clinical significance = 1 point.
The ten criteria specified above were used to identify the scientific relevance of the methodological quality of the reviewed papers. The rating was "low" when the points given were less than or equal to 4, "medium" from 5 to 8 points and "high" for 9 or 10 points.
RESULTS
Search strategy outcomes
The search strategy resulted in 1,401 articles, out of which 195 were repeated
references. The exclusion criteria used by both independent reviewers excluded 1,194
articles, which were not considered as relevant to the review, thus, totalizing
twelve potentially relevant articles.3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr,
Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic
brackets: quantitative comparison or oral bacteria detection with adenosine
triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop.
2009;135(4):426.e1-9.
,
4545. Sukontapatipark W, el-Agroudi MA, Selliseth NJ, Thunold K, Selvig
KA. Bacterial colonization associated with fixed orthodontic appliances. A scanning
electron microscopy study. Eur J Orthod. 2001;23(5):475-84.
46. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T.
Periodontal condition of the mandibular anterior dentition in patients with
conventional and self-ligating brackets. Orthod Craniofac Res.
2008;11(4):211-5.
47. Faltermeier A, Burgers R, Rosentritt M. Bacterial adhesion of
Streptococcus mutans to esthetic bracket materials. Am J Orthod Dentofacial Orthop.
2008;133(4 Suppl):S99-103.
48. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence
of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol
2007;34(5):423-31.
49. Brusca MI, Chara O, Sterin-Borda L, Rosa AC. Influence of different
orthodontic brackets on Adherence of microorganisms in vitro. Angle Orthod.
2007;77(2):331-6.
50. Jordan C, LeBlanc DJ. Influences of orthodontic appliances on oral
populations of mutans streptococci. Oral Microbiol Immunol.
2002;17(2):65-71.
51. Fournier A, Payant L, Bouclin R. Adherence of Streptococcus mutans
to orthodontic bráquetes. Am J Orthod Dentofacial Orthop.
1998;114(4):414-7.
52. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese
AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci.
2011;10(3):208-12.
53. Ristic M, Vlahovic Svabic M, Sasic M, Zelic O. Clinical and
microbiological effects of fixed orthodontic appliances on periodontal tissues in
adolescents. Orthod Craniofac Res. 2007;10(4):187-95.
54. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d,
Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and
conventional brackets during early phase of orthodontic treatment. Angle Orthod.
2013;83(1):133-9.
-
5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T.
Salivary Streptococcus mutans levels in patients with conventional and self-ligating
brackets. Eur J Orthod. 2010;32(1):94-9. They were chosen for retrieval and evaluation of the full text, for which a
summarized data extraction sheet was used (Table
2). Out of the twelve full-text articles that were retrieved, 6 were
excluded because: one article4545. Sukontapatipark W, el-Agroudi MA, Selliseth NJ, Thunold K, Selvig
KA. Bacterial colonization associated with fixed orthodontic appliances. A scanning
electron microscopy study. Eur J Orthod. 2001;23(5):475-84. presented premolar extractions in its sample, three4747. Faltermeier A, Burgers R, Rosentritt M. Bacterial adhesion of
Streptococcus mutans to esthetic bracket materials. Am J Orthod Dentofacial Orthop.
2008;133(4 Suppl):S99-103.
,
4949. Brusca MI, Chara O, Sterin-Borda L, Rosa AC. Influence of different
orthodontic brackets on Adherence of microorganisms in vitro. Angle Orthod.
2007;77(2):331-6.
,
51 51. Fournier A, Payant L, Bouclin R. Adherence of Streptococcus mutans
to orthodontic bráquetes. Am J Orthod Dentofacial Orthop.
1998;114(4):414-7.were in vitro studies, and two5050. Jordan C, LeBlanc DJ. Influences of orthodontic appliances on oral
populations of mutans streptococci. Oral Microbiol Immunol.
2002;17(2):65-71.
,
5353. Ristic M, Vlahovic Svabic M, Sasic M, Zelic O. Clinical and
microbiological effects of fixed orthodontic appliances on periodontal tissues in
adolescents. Orthod Craniofac Res. 2007;10(4):187-95. did not provide a direct comparison between C and SL brackets systems. This
resulted in six articles3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr,
Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic
brackets: quantitative comparison or oral bacteria detection with adenosine
triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop.
2009;135(4):426.e1-9.
,
4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T.
Periodontal condition of the mandibular anterior dentition in patients with
conventional and self-ligating brackets. Orthod Craniofac Res.
2008;11(4):211-5.
,
4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence
of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol
2007;34(5):423-31.
,
5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese
AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci.
2011;10(3):208-12.
,
5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d,
Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and
conventional brackets during early phase of orthodontic treatment. Angle Orthod.
2013;83(1):133-9.
,
5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T.
Salivary Streptococcus mutans levels in patients with conventional and self-ligating
brackets. Eur J Orthod. 2010;32(1):94-9. that were suitable for the final analysis as they evaluated periodontal and
clinical variables originating from bacterial adhesion in patients with C and SL
brackets (Fig 1).
Assessment of the scientific relevance of the eligible studies
The six articles3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. , 4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9. included in this review (Table 3) met the inclusion criteria, although with differences among their methods of study, sampling, analysis and follow-up. All the eligible studies3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. , 4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 55 55. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9.compared both systems: conventional and self-ligating edgewise brackets. Pandis4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. also made reference to gingival plaque and calculus index, whereas the article by van Gastel4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. examined the amount of gingival fluid and anaerobic and aerobic colonies. Another study carried out by Pandis5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. collected saliva 2-3 months after orthodontic appliances had been bonded. Mitis salivarius culture medium (MS), specific for Streptococcus mutans, was used to count the colony forming units (CFU). Pithon5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. collected the plaque samples directly from SL and C brackets of different brands, and 3 weeks after bonding, the CFU was carried out in the following culture medium: MS, specific for S. mutans, and BHI (Brain Heart Infusion), not specific for bacteria and fungi. In this study,5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. CFU was visually performed after 24, 48 and 72 hours of incubation. Pejda et al5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. collected the plaque samples of subgingival sulcus after 18 weeks of treatment, counting 5 periodontal pathogens by PCR, while Pellegrini et al3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. collected the samples from tooth surfaces surrounding the brackets after 5 weeks of bonding, and the CFU was analyzed by MS and bioluminescence of ATP (adenosine triphosphate).
When evaluating the scientific relevance of the six eligible articles,3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. , 4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9. we found that the description of the sample selection was appropriate, however, the number of drop outs was declared in studies by Pellegrini,3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. Pandis,4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. van Gastel4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. and Pejda5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9.. All studies3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. provided the approval of the Institutional Review Board, except for the articles by Pandis,4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9. who asked for the consent of patients / parents before starting the study, only. Considering the confounding factors, similar oral routine and hygiene instructions were given to the subjects taking part in these six studies.3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. , 4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9. In the papers,4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. full alignment of the mandibular arch was necessary to eliminate crowding as a confounding factor, but the clinical variables were assessed by the same periodontist. The examiner in the study carried out by Pandis4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. was not blinded, which could have influenced the outcome of the research, making the results biased. The study conducted by Pithon5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. did not describe whether it had a blinded examiner, however, as a confounding factor, randomized participants were asked whether they had already received any kind of orthodontic treatment with fixed appliances, since this can have consequences for the smoothness of the tooth enamel and for microbial adhesion at the beginning of biofilm formation.55. Alexander SA. Effects of orthodontic attachments on the gingival health of permanent second molars. Am J Orthod Dentofacial Orthop. 1991;100(4):337-40. , 2020. Shelley WB. Gingival hyperplasia from dental braces. Cutis. 1981;28:149-50. , 2121. Theilade E, Wright WH, Jensen SB, Loe H. Experimental gingivitis in man. II. A longitudinal clinical and bacteriological investigation. J Periodontal Res. 1966;1:1-13. All six studies3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. , 4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 55 55. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9.used appropriate statistical methods. The examiner's calibration level was reported in one single study,5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. and only two papers5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 55 55. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9.identified the sample calculation. Smoking or medical conditions were clearly identified in studies by van Gastel,4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. Pejda5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. and Pandis.5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9. As for the other studies,3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. , 4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 52 52. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12.these conditions were declared only after the authors were requested to do so. The final score of the scientific relevance, in accordance with the Jadad scale,4444. Jadad AR, Moore RA, Carrol D, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials 1996;17(1):1-12. was 10.0 for Pellegrini3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. and Pejda5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9., 9.5 for van Gastel4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. and Pandis5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9., and 9.0 for Pandis4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. and Pithon5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. (Table 4), which revealed high-quality researches and methodological soundness.
Assessment of the eligible studies outcomes
Among the selected studies, four4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 55 55. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9.had their outcomes consistent in reporting that (a) SL brackets have no advantages over C in periodontal condition of anterior mandibular teeth;4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. (b) the design of the brackets can have significant impact on bacterial load and periodontal parameters;4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. and (c) in subgingival plaque and saliva, there seems to be no significant differences in the total levels of S. Mutans and periodontal pathogens between C and SL.5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9. However, a study5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. confirmed the hypothesis that SL brackets favor the accumulation of micro-organisms, while another study3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. reported that SL brackets promote lower retention of S. mutans when compared to C (Table 3). The outcomes of the eligible studies3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. , 4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9. were not unanimous in reporting that there is evidence of a possible influence of bracket design (conventional or self-ligating) over adhesion and formation of Streptococcus mutans colonies.
DISCUSSION
A systematic review can confirm the quality of a research as well as the methodological soundness of works selected from the literature. Additionally, it can present them for consideration of the clinical and scientific communities. Evidence-based practice requires the construction of a research question and a literature review.
Conventionally, to attach the wire to the brackets, three methods are used: metal ligature, elastomeric ligatures, and the open-close devices of SL brackets. All these methods have advantages and disadvantages, but with regard to the accumulation of biofilm, the literature88. Forsberg CM, Brattström V, Malmberg E, Nord CE. Ligature wires and elastomeric rings: two methods of ligation, and their association with microbial colonization of Streptococcus mutans and lactobacilli. Eur J Orthod. 1991;13(5):416-20. , 3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. suggests that elastomeric ligatures favor the retention of biofilm in comparison with the other two methods of ligatures. The question prepared for this review aimed to verify whether bracket design (conventional or self-ligating) influences the formation of Streptococcus mutans colonies. Microorganisms exhibit significant adherence to brackets because there are favorable ecological niches in the porous (rough and irregular surfaces of these brackets).3939. Türkkahraman H, Sayin MO, Bozkurt FY, Yetkin Z, Kaya S, Onal S. Archwire ligation techniques, microbial colonization, and periodontal status in orthodontically treated patients. Angle Orthod. 2005;75(2):231-6. , 4747. Faltermeier A, Burgers R, Rosentritt M. Bacterial adhesion of Streptococcus mutans to esthetic bracket materials. Am J Orthod Dentofacial Orthop. 2008;133(4 Suppl):S99-103. , 4949. Brusca MI, Chara O, Sterin-Borda L, Rosa AC. Influence of different orthodontic brackets on Adherence of microorganisms in vitro. Angle Orthod. 2007;77(2):331-6. , 5151. Fournier A, Payant L, Bouclin R. Adherence of Streptococcus mutans to orthodontic bráquetes. Am J Orthod Dentofacial Orthop. 1998;114(4):414-7. , 5656. Carneiro RC. Estudo da microbiota do biofilme supragengival de pacientes em tratamento ortodôntico com diferentes tipos de braquetes [tese]. Belo Horizonte (MG): Pontifícia Universidade Católica; 2008. Thus, the characteristics of the bracket surface can be considered as harboring favorable sites for the adhesion of biofilm.
Search strategy outcomes
This research was highly sensitive, addressing evidence of minimum bias. The study
carried out by Jordan and LeBlanc5050. Jordan C, LeBlanc DJ. Influences of orthodontic appliances on oral
populations of mutans streptococci. Oral Microbiol Immunol.
2002;17(2):65-71. was excluded due to: (a) having assessed one bracket system only, (b) having
a not blinded examiner and (c) presenting unspecified statistical analyses. The
in vitro studies that were excluded4747. Faltermeier A, Burgers R, Rosentritt M. Bacterial adhesion of
Streptococcus mutans to esthetic bracket materials. Am J Orthod Dentofacial Orthop.
2008;133(4 Suppl):S99-103.
,
4949. Brusca MI, Chara O, Sterin-Borda L, Rosa AC. Influence of different
orthodontic brackets on Adherence of microorganisms in vitro. Angle Orthod.
2007;77(2):331-6.
,
5151. Fournier A, Payant L, Bouclin R. Adherence of Streptococcus mutans
to orthodontic bráquetes. Am J Orthod Dentofacial Orthop.
1998;114(4):414-7. did not have the inherent characteristics which contribute to the development
of intraoral biofilm, and may provide bias results for clinical periodontal
conditions.2222. van Pelt AW, Weerkamp AH, Uyen MH, Busscher HJ, de Jong HP, Arends
J. Adhesion of Streptococcus sanguis CH3 to polymers with different surface free
energies. Appl Environ Microbiol. 1985;49(5):1270-5. The differences observed between the results of some papers3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr,
Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic
brackets: quantitative comparison or oral bacteria detection with adenosine
triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop.
2009;135(4):426.e1-9.
,
4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T.
Periodontal condition of the mandibular anterior dentition in patients with
conventional and self-ligating brackets. Orthod Craniofac Res.
2008;11(4):211-5.
,
4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence
of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol
2007;34(5):423-31.
49. Brusca MI, Chara O, Sterin-Borda L, Rosa AC. Influence of different
orthodontic brackets on Adherence of microorganisms in vitro. Angle Orthod.
2007;77(2):331-6.
-
5050. Jordan C, LeBlanc DJ. Influences of orthodontic appliances on oral
populations of mutans streptococci. Oral Microbiol Immunol.
2002;17(2):65-71.
,
5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese
AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci.
2011;10(3):208-12. may be related to factors that include: variations in the shape, material and
size between SL and C brackets, the individual level of oral hygiene, salivary flow,
treatment variables, types of ligatures, bonding procedures and age of the
individuals involved.2424. Quirynen M, Dekeyser C, van Steenberghe D. The influence of gingival
inflammation, tooth type, and timing on the rate of plaque formation. J Periodontol.
1991;62(3):219-22.
,
4545. Sukontapatipark W, el-Agroudi MA, Selliseth NJ, Thunold K, Selvig
KA. Bacterial colonization associated with fixed orthodontic appliances. A scanning
electron microscopy study. Eur J Orthod. 2001;23(5):475-84.
,
4949. Brusca MI, Chara O, Sterin-Borda L, Rosa AC. Influence of different
orthodontic brackets on Adherence of microorganisms in vitro. Angle Orthod.
2007;77(2):331-6.
,
5151. Fournier A, Payant L, Bouclin R. Adherence of Streptococcus mutans
to orthodontic bráquetes. Am J Orthod Dentofacial Orthop.
1998;114(4):414-7.
,
5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T.
Salivary Streptococcus mutans levels in patients with conventional and self-ligating
brackets. Eur J Orthod. 2010;32(1):94-9. Thus, bracket type itself would not be a deciding factor for biofilm
development, but its composition and material type should be included as factors
behind Streptococcus mutans colonies formation.5656. Carneiro RC. Estudo da microbiota do biofilme supragengival de
pacientes em tratamento ortodôntico com diferentes tipos de braquetes [tese].
Belo Horizonte (MG): Pontifícia Universidade Católica;
2008.
Assessment of the scientific relevance of the eligible studies
The statistical analysis of our results was not feasible, given that the methodological designs of the eligible articles were heterogeneous. However, the scientific relevance assessment revealed high-quality researches and methodological soundness of all six studies,3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. , 4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9. as shown in their final scores, according to the Jadad scale.4444. Jadad AR, Moore RA, Carrol D, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials 1996;17(1):1-12.
Although SL brackets do not require ligatures, their opening and closing mechanism may provide sites for biofilm adhesion similarly to conventional brackets.4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. This mechanism of SL brackets is not renewed, as it occurs with elastomeric modules in conventional brackets. Moreover, plaque calcification in SL leads to a malfunction of the opening and closing mechanisms. Thus, the theoretical advantages of self-ligating over conventional brackets can be eliminated, as confirmed by other studies.4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. When using conventional brackets, neither the elastomeric rings nor the metal ligatures seem to affect the distribution of bacterial morphotypes in brackets or on the enamel surface.33. Gwinnett JA, Ceen F. Plaque distribution on bonded brackets. Am J Orthod. 1979;75(6):667-77. Aged elastomeric surfaces can apparently favor plaque retention in comparison with polished stainless steel ligatures, but there are no differences between periodontal conditions of patients treated with these two types of ligatures.88. Forsberg CM, Brattström V, Malmberg E, Nord CE. Ligature wires and elastomeric rings: two methods of ligation, and their association with microbial colonization of Streptococcus mutans and lactobacilli. Eur J Orthod. 1991;13(5):416-20. , 5757. Gameiro GH, Nouer DF, Cenci MS, Cury JA. Enamel demineralization with two forms of archwire ligation investigated using an in situ caries model: a pilot study. Eur J Orthod. 2009;31(5):542-6. Nevertheless, some studies4141. Garcez, AS, Suzuki SS, Ribeiro MS, Mada EY, Freitas AZ, Suzuki H. Biofilm retention by 3 methods of ligation on orthodontic brackets: a microbiologic and optical coherence tomography analysis. Am J Orthod Dentofacial Orthop. 2011;140(4):e93-8. , 58 58. Souza RA, Borges de Araújo Magnani MB, Nouer DF, Oliveira da Silva C, Klein MI, Sallum EA, et al. Periodontal and microbiologic evaluation of 2 methods of archwire ligation: Ligature wires and elastomeric rings. Am J Orthod Dentofacial Orthop. 2008;134(4):506-12.report that brackets with elastomeric rings favor damage to gingival conditions, with significant accumulation of biofilm, while the metal ligature had lower retention of biofilm in comparison with other brackets. Some reports5959. Eliades T, Eliades G, Brantley WA. Microbial attachment on orthodontic appliances: I. Wettability and early pellicle formation on bracket materials. Am J Orthod Dentofacial Orthop. 1995;108(4):351-60. , 6060. Batoni G, Pardini M, Ota F, Guica MR, Gabriele M, Campa M, Senesi S. Effect of removable orthodontic appliances on oral colonization by mutans streptococci in children. Eur J Oral Sci. 2001;109(6):388-92. affirm that C brackets are directly related to the retention of biofilm, however, the study conducted by Pithon et al5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. suggests that cross-infection caused by replacement of elastomeric rings is controllable with the use of C brackets, because this type of brackets favors lower formation of S. Mutans colonies, which agrees with the study by van Gastel et al4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. that showed no difference between C and SL in gingival bleeding.
Assessment of the retrieved studies outcomes
The increase in oral microbiota attachment of Streptococcus mutans and Lactobacillus is associated with the use of orthodontic appliances,66. Balenseifen JW, Madonia JV. Study of dental plaque in orthodontic patients. J Dent Res. 1970;49(2):320-4. , 88. Forsberg CM, Brattström V, Malmberg E, Nord CE. Ligature wires and elastomeric rings: two methods of ligation, and their association with microbial colonization of Streptococcus mutans and lactobacilli. Eur J Orthod. 1991;13(5):416-20. , 99. Rosenbloom RG, Tinanoff N. Salivary Streptococcus mutans levels in patients before, during, and after orthodontic treatment. Am J Orthod Dentofacial Orthop. 1991;100(1):35-7. , 3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. , 4545. Sukontapatipark W, el-Agroudi MA, Selliseth NJ, Thunold K, Selvig KA. Bacterial colonization associated with fixed orthodontic appliances. A scanning electron microscopy study. Eur J Orthod. 2001;23(5):475-84. with both C or SL brackets. This increase leads to higher cariogenic plaque, pH low enough to change the clinical periodontal parameters4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 54 54. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9.and increased risk of enamel demineralization.66. Balenseifen JW, Madonia JV. Study of dental plaque in orthodontic patients. J Dent Res. 1970;49(2):320-4. , 4747. Faltermeier A, Burgers R, Rosentritt M. Bacterial adhesion of Streptococcus mutans to esthetic bracket materials. Am J Orthod Dentofacial Orthop. 2008;133(4 Suppl):S99-103.
Some eligible studies5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. , 54 54. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9.evaluated not only the presence of S. mutans, but also of other microorganisms related to periodontal disease in patients with C or SL brackets. The study conducted by Pejda et al5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. found 23.8 times more chance of finding Aggregatibacter actinomycetemcomitans (AA) in subgingival plaque of patients with C brackets, but the increase in AA does not represent a risk factor for local periodontitis, as studies by Paolantonio et al6161. Paolantonio M, Festa F, di Placido G, D'Attilio M, Catamo G, Piccolomini R. Site-specific subgingival colonization by Actinobacillus actinomycetemcomitans in orthodontic patients. Am J Orthod Dentofacial Orthop. 1999;115(4):423-8. , 6262. Paolantonio M, Pedrazzoli V, di Murro C, di Placido G, Picciani C, Catamo G, et al. Clinical significance of Actinobacillus actinomycetemcomitans in young individuals during orthodontic treatment. A 3-year longitudinal study. J Clin Periodontol. 1997;24(9 Pt 1):610-7 confirm. The differences found between the results of the study by Pithon et al5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. and the other studies assessed3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. , 4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9. may have been due to methodological differences in some of these studies4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9. in which the CFU were counted from material collected from saliva; Pellegrini et al3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9. collected it from tooth surfaces surrounding the bracket; and, in the study by Pithon,5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. it was directly collected from the surface of brackets (winglets, slot and cervical region). That was the reason why this latest study should have found statistically significant differences that reveal greater accumulation of biofilm in SL brackets.
Clinical implications
Some studies88. Forsberg CM, Brattström V, Malmberg E, Nord CE. Ligature wires and
elastomeric rings: two methods of ligation, and their association with microbial
colonization of Streptococcus mutans and lactobacilli. Eur J Orthod.
1991;13(5):416-20.
,
3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr,
Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic
brackets: quantitative comparison or oral bacteria detection with adenosine
triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop.
2009;135(4):426.e1-9.
34. Damon DH. The rationale, evolution and clinical application of the
self-ligating bracket. Clin Orthod Res. 1998;1(1):52-61.
35. Shivapuja PK, Berger J. A comparative study of conventional ligation
and self-ligation bracket systems. Am J Orthod Dentofacial Orthop.
1994;106(5):472-80.
36. Paduano S, Cioffi I, Iodice G, Rapuano A, Silva R. Time efficiency
of self-ligating vs conventional brackets in orthodontics: effect of appliances and
ligating systems. Prog Orthod. 2008;9(2):74-80.
37. Yu YL, Qian YF. The clinical implication of self-ligating brackets.
Shanghai Kou Qiang Yi Xue. 2007;16(4):431-5.
38. Fernandes C, Almeida R. self-ligating appliances: evolution or
revolution? Aust Orthod. 2008;24(1):97-103.
-
3939. Türkkahraman H, Sayin MO, Bozkurt FY, Yetkin Z, Kaya S, Onal S.
Archwire ligation techniques, microbial colonization, and periodontal status in
orthodontically treated patients. Angle Orthod. 2005;75(2):231-6. report that SL brackets are less susceptible to bacterial colonization due to
their shape and lack of metal or elastomeric ligatures. However, adequate control of
biofilm is more strongly influenced by the correct orientation and cooperation of
patients2424. Quirynen M, Dekeyser C, van Steenberghe D. The influence of gingival
inflammation, tooth type, and timing on the rate of plaque formation. J Periodontol.
1991;62(3):219-22.
,
55 55. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T.
Salivary Streptococcus mutans levels in patients with conventional and self-ligating
brackets. Eur J Orthod. 2010;32(1):94-9.than by simply choosing one system of brackets instead of another. The
outcomes of the eligible studies3333. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr,
Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic
brackets: quantitative comparison or oral bacteria detection with adenosine
triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop.
2009;135(4):426.e1-9.
,
4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T.
Periodontal condition of the mandibular anterior dentition in patients with
conventional and self-ligating brackets. Orthod Craniofac Res.
2008;11(4):211-5.
,
4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence
of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol
2007;34(5):423-31.
,
5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese
AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci.
2011;10(3):208-12.
,
5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d,
Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and
conventional brackets during early phase of orthodontic treatment. Angle Orthod.
2013;83(1):133-9.
,
55 55. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T.
Salivary Streptococcus mutans levels in patients with conventional and self-ligating
brackets. Eur J Orthod. 2010;32(1):94-9.were not unanimous in reporting a possible influence of bracket design
(conventional or self-ligating) over the adhesion and formation of
Streptococcus mutans colonies.
The decision of orthodontists on prescribing the use of SL instead of C in their clinical routine, aiming at improving hygiene / plaque accumulation, cannot yet be applied due to lack of scientific evidence.4646. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. , 4848. van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Influence of bracket design on microbial and periodontal parameters in vivo. J Clin Periodontol 2007;34(5):423-31. , 5252. Pithon MM, Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-12. , 5454. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic d, Bosnjak A. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-9. , 5555. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9. After this review, we presume that there is not enough evidence to support the use of fixed appliances with SL brackets in place of systems with C or vice versa, which agrees with the study by Fleming et al.6363. Fleming PS, Johal A. Self-ligating brackets in orthodontics. Angle Orthod. 2010;80:575-584.
Based on the limitations of some works,6464. Maza JL, Elguezabal N, Prado C, Ellacuria J, Soler I, Ponton J. Candida albicans adherence to resin-composite restorative dental material: influence of whole human saliva. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(5):589-92. , 6666. Park JH, Gakunga PT, Aemechi BT. Influence of self-ligating orthodontic brackets on plaque accumulation in vitro. J Dent Res. 2007;86(Spec Issue A), abstract 1937. further studies on other types of brackets, for example, esthetic self-ligating ones, must be performed to visualize the periodontal complications arising from different shapes, sizes and material types of brackets, and with that, guide the development of new systems of brackets design in order to reduce the formation of Streptococcus mutans colonies.
CONCLUSIONS
Within the limitations of this study, it was concluded that there is no evidence for a possible influence of bracket design (conventional or self-ligating) over colony formation and adhesion of Streptococcus mutans.
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33Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA Jr, Maier T, et al. Plaque retention by self-ligation vs elastomeric orthodontic brackets: quantitative comparison or oral bacteria detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426.e1-9.
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34Damon DH. The rationale, evolution and clinical application of the self-ligating bracket. Clin Orthod Res. 1998;1(1):52-61.
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35Shivapuja PK, Berger J. A comparative study of conventional ligation and self-ligation bracket systems. Am J Orthod Dentofacial Orthop. 1994;106(5):472-80.
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The authors report no commercial, proprietary or financial interest in the products or companies described in this article.
Publication Dates
-
Publication in this collection
Jan-Feb 2014
History
-
Received
14 Aug 2012 -
Accepted
01 Feb 2013