Are self-ligating brackets related to less formation of
                  <i>Streptococcus mutans</i> colonies? A systematic
               review

Nascimento, Leonard Euler Andrade Gomes do; Souza, Margareth Maria Gomes de; Azevedo, Angela Rita Pontes; Maia, Lucianne Cople

doi:10.1590/2176-9451.19.1.060-068.oar

Brasil

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Articles • Dental Press J. Orthod. 19 (01) • Jan-Feb 2014 • https://doi.org/10.1590/2176-9451.19.1.060-068.oar linkcopy

Are self-ligating brackets related to less formation of Streptococcus mutans colonies? A systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

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

Acronym	Description
Population	Patients with fixed orthodontic appliance with conventional or self-ligating edgewise brackets.
Intervention	Assessment of the amount of biofilm and microbiota attached to conventional or self-ligating brackets.
Comparison	Through the levels of biofilm accumulation on conventional or self-ligating brackets.
Outcomes	Measurement of colonies of Streptococcus mutans and/or their effects on periodontal tissues.

Database	Search strategies	Results	Selected papers
Cochrane C.R.C. Trials	conventional OR self-ligating	160	2
Ovid ALL EMB Reviews	exp Orthodontic Appliances / OR edgewise.mp. AND exp Orthodontic Appliance Design/ OR exp Orthodontic Brackets/ OR self-ligating.mp. OR exp Orthodontic Appliances/ AND biofilm.mp. OR exp Dental Biofilm Index/ AND streptococcus mutans.mp. OR exp Streptococcus mutans/	53	4
PubMed (NLM)	conventional AND self-ligating, OR biofilm OR Streptococcus mutans	788	5
Bireme	conventional OR self-ligating	400	1
TOTAL		1,401	12

Author Year Journal	Pellegrini et al³³2009AJODO	Pandis et al⁴⁶2008Orthod Craniofac Res	van Gastel et al⁴⁸2007Journal of Clinical Periodontology	Pithon et al⁵²2011Braz J Oral Sci.	Pejda et al⁵⁴2012Angle Orthod	Pandis et al⁵⁵2010Eur J Orthod
Type of study	Randomized controlled trial	Prospective cohort	Randomized controlled trial	Randomized controlled trial	Randomized controlled trial	Randomized controlled trial
Number of patients	18	100	16	5	38	32
Age	11-17 y	12-17 y	17-27 y	20-30 y	11-18 y	11-17 y
Teeth involved	Lateral incisors	Maxilla and mandible	1^st and 2^nd premolars	Canines; 1^st and 2^nd premolars and molars (lower)	Maxilla and mandible	Maxilla and mandible
Bracket type/brand	14 p: C – Mini Ovation 14 p: SL – Innovation – R GAC	50 p: C – GAC50 p: SL – In-Ovation – R – GAC	16 C – GAC16 SL – Speed	10 C – Morelli40 SL: GAC; Aditek; Ormco; 3M Unitek	19 p: C – Sprint Forestadent19 p: SL – Damon 3MX, Ormco	16 p: C – GAC16 p: SL – In-Ovation R – GAC
Ligature type	Elastomeric ligatures for the C brackets	Elastomeric ligatures for the C brackets	Elastomeric ligatures for the C brackets	Elastomeric ligatures for the C brackets	Metal ligatures for the C brackets	Elastomeric ligatures for the C brackets
Objective of analysis	Accumulation of bacterial plaque around the brackets. To determine if ATP by bioluminescence may be useful in assessing the plaque index	Index of gingival plaque and calculusof the pocket depth	Crevicular fluid andpocket depth. Aerobic (An) colonies	S. mutans and other microorganisms attachment to C and SL.	Accumulation of different microorganisms on C and SL.	Effect of the type of bracket (C or SL) on the levels of S. mutans in saliva
Method of analysis	MSB specific for S. mutans and determination by bioluminescence	Clinical periodontal parameters	Clinical and microbiological periodontal parameters	MSB specific for S. mutans and BHI, not specific for bacteria and fungus	Clinical periodontal parameters and PCR	MSB specific for S. mutans
Follow-up	5 w	18 m	7 d	21 d	18 w	2-3 m
Statistical analysis	T-tests (1-tailed, with P < 0.05).Chi-squared χ²	χ²WilcoxonStata	ANOVA Tukey-Kramer	SPSS 13.0Wilcoxon (P < 0.05)	T-testsSidak post hocFisher’s tests	ANOVAMinitab 14.20χ²
Outcome	SL favor reduced accumulation of S. Mutans and ATP by bioluminescence is useful in assessing plaque index	No advantages of SL over C with respect to the periodontal status of the mandibular anterior teeth	Bracket design can have a significant impact on bacterial load and on periodontal parameters	The hypothesis that self-ligating brackets favor greater aggregation of microorganisms was proved	Bracket design does not seem to have a strong influence on clinical parameters and periodontal pathogens in subgingival plaque.	The total levels of S. mutans do not seem to be significantly different between Cand SL brackets

	Pellegrini et al³³2009AJODO	Pandis et al⁴⁶2008Orthod Craniofac Res	van Gastel et al⁴⁸2007Journal of Clinical Periodontology	Pithon et al⁵²2011Braz J Oral Sci.	Pejda et al⁵⁴2012Angle Orthod	Pandis et al⁵⁵2010Eur J Orthod
Type of study	2.0	2.0	2.0	2.0	2.0	2.0
Study description	1.0	1.0	1.0	1.0	1.0	1.0
Sample size	1.0	1.0	1.0	0.5	1.0	1.0
Sample selection description	1.0	1.0	1.0	1.0	1.0	1.0
Drop out description	1.0	0.5	0.5	1.0	1.0	0.5
Measurement method	0.5	0.5	0.5	0.5	0.5	0.5
Blind study	0.5	---	0.5	---	0.5	0.5
Statistics	1.0	1.0	1.0	1.0	1.0	1.0
Confounding factors	1.0	1.0	1.0	1.0	1.0	1.0
Clinical significance	1.0	1.0	1.0	1.0	1.0	1.0
Scale score (Jadad⁴⁴)	10.0	9.0	9.5	9.0	10.0	9.5
Quality standard assessed	high	high	high	high	high	high

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Acessibilidade / Reportar erro

[TFN01t03] ^p
= patients

[TFN02t03] ^y
= years

[TFN03t03] ^m
= months

[TFN04t03] ^w
= weeks

[TFN05t03] ^d
= days

[TFN06t03] ^h
= hours

[TFN07t03] ^C
= conventional brackets

[TFN08t03] ^SL
= self-ligating brackets

[TFN09t03] ^S.
= Streptococcus

[TFN10t03] ^SEM
= scanning electron microscopy

[TFN11t03] ^ATP
= adenosine triphosphate

[TFN12t03] ^MSB
= Mitis Salivarius agar

[TFN13t03] ^BHI
= brain heart infusion

[TFN14t03] ^PCR
= polymerase chain reaction