The influence of elastomeric ligatures pigmentation on smile aesthetics during orthodontic treatment

ABSTRACT Aim: To assess the influence of elastomeric ligatures, subjected to a previous in vitro pigmentation process using different substances, on smile aesthetics during orthodontic treatment, from the perception of students and professionals. Methods: Eight elastomeric ligatures of five commercial brands (3M/Unitek, American Orthodontics, Morelli, Ortho Technology, and Orthometric) (n=8) were immersed in coffee, Coca-Cola, and red wine for one minute per day, for 28 days; and another group of ligatures was immersed in artificial saliva. All samples were photographed and subsequently analyzed using the Adobe Photoshop software, by the RGB method. Afterwards, the pigmented ligatures were inserted in a patient wearing orthodontic brackets, and zoomed photographs of the smile were taken and presented to 40 evaluators, who filled in a satisfaction scale sheet to express their opinion on the smile aesthetics of each photograph. The color data were subjected to analysis of variance (ANOVA) and Tukey tests. Results: The substance with the highest pigmentation potential was coffee (p< 0.05) followed by red wine (p< 0.05). Comparison among the brands used in this study showed that American Orthodontics and Orthometric had the lowest degree of pigmentation when immersed in coffee and red wine (p< 0.05), respectively. However, the brand that showed the highest level of satisfaction among the evaluators was Ortho Technology. Conclusions: The presence of pigmented elastomeric ligatures affected smile aesthetics, when compared with the control group.

RESUMO Objetivo: Avaliar a influência das ligaduras elásticas submetidas a um processo prévio de pigmentação in vitro, com diferentes substâncias, na estética do sorriso durante o tratamento ortodôntico, segundo a percepção de alunos e profissionais. Métodos: Oito ligaduras elásticas de cinco marcas comerciais (3M Unitek, American Orthodontics, Morelli, Ortho Technology e Orthometric) (n = 8) foram imersas em café, Coca-Cola e vinho tinto por um minuto por dia, por 28 dias, e outro grupo de ligaduras foi imerso em saliva artificial. Todas as amostras foram fotografadas e posteriormente analisadas no software Adobe Photoshop, pelo método RGB. Em seguida, as ligaduras pigmentadas foram inseridas em um paciente com braquetes ortodônticos, e fotografias ampliadas do sorriso foram tiradas e apresentadas a 40 avaliadores, que preencheram uma escala de satisfação para representar sua opinião sobre a estética do sorriso de cada fotografia. Os dados de cor foram submetidos à análise de variância (ANOVA) e testes de Tukey. Resultados: A substância com maior potencial de pigmentação foi o café (p< 0,05), seguido do vinho tinto (p< 0,05). A comparação entre as marcas utilizadas nesse estudo mostrou que a American Orthodontics e a Orthometric apresentaram o menor grau de pigmentação quando imersas em café e vinho tinto (p< 0,05), respectivamente. Porém, a marca que apresentou maior nível de satisfação entre os avaliadores foi a Ortho Technology. Conclusões: A presença de ligaduras elásticas pigmentadas afetou a estética do sorriso, quando comparada à do grupo controle.

“Comparative evaluation of surface modified elastomeric ligatures for microbial colonization”: An in vivo study.

Introduction: Elastomeric ligatures are observed to reduce chair side time; however, they are also seen to have greater bacterial adhesion. Polymeric coating utilizing the Metafasix Technology and the OrthoShield Technology have been introduced in the Super Slick™* and Safe‑T‑Ties™** by TP Orthodontics, Ortho Organizers, respectively, to reduce bacterial adhesion. While each of the elastomers has been individually evaluated, no study compares the two elastomers manufactured by differing technologies together; hence the need for this study was felt. This in vivo study compared the Super Slick and Safe‑T‑Ties with their unmodified counterparts for bacterial adhesion. Materials and Methods: Thirty patients undergoing orthodontic treatment, between 12 and 25 years age group were selected and the modified, and the unmodified elastomers were randomly placed quadrant wise, on all the premolar brackets. After a period of 4 weeks, the elastomeric rings were removed and transported for culture on Mitis–Salivarius, Rogosa SL agar for Streptococcus mutans and Lactobacilli, respectively. The colonies were digitally counted (HiMedia) after 48 h of incubation at 37°C. Results: There was a significant difference in the S. mutans and Lactobacilli counts in both surface modified and unmodified elastomeric modules (P < 0.01). Unmodified elastomeric modules Mini Stix™*, Hand‑EE‑Lasts™** was associated with higher mean values of colony‑forming units/millimeter than the surface modified Super Slick™* and Safe‑T‑Ties™** ligatures. When compared pair‑wise, the surface modified elastomers showed less bacterial accumulations than the unmodified counterparts for both S. mutans and Lactobacillus, and the differences were statistically significant. Conclusion: Technological modifications of the elastomers using the Metafasix or OrthoShield Technology, is a definite improvement over the regular elastomers with regard to adhesion of S. mutans and Lactobacilli.

In vivo color changes of esthetic orthodontic ligatures

OBJECTIVE: To assess the color changes that occur in four commercial brands of esthetic orthodontic elastomeric ligatures after exposure to the oral environment. METHODS: The four elastomeric ligatures manufacturers mostly mentioned by orthodontists were investigated: Morelli, Uniden, American Orthodontics (AO) and TP. The sample comprised 25 patients. The elastomeric ligatures were randomly distributed and arranged in the four dental quadrants of each patient, r for 30 days. After this period, two units of each brand were photographed in a standardized manner. Subsequently, color changes were visually evaluated and assigned a score (0, 1, 2 or 3) by a panel of four examiners. The mean scores assigned by the examiners were statistically analyzed by ANOVA and Tukey's test (p < 0.05). RESULTS: The mean pigmentation scores assigned to Morelli (1.80 ± 0.78) and Uniden (1.92 ± 0.66) elastomeric ligatures after 30 days in the oral environment were not statistically different. However, these brands were significantly more pigmented after 30 days in the oral environment (p < 0.01) compared to American Orthodontics (0.97 ± 0.6) and TP (0.83 ± 0.79). CONCLUSIONS: Although all four brands exhibited an undesirable pigmentation after 30 days in the oral environment, color change for American Orthodontics and TP Orthodontics ligatures was significantly lower than Morelli and Uniden products.

OBJETIVO: avaliar as alterações de cor ocorridas em elastômeros estéticos de quatro marcas comerciais, quando expostos ao meio bucal. MÉTODOS: foram examinadas as quatro marcas comerciais mais citadas por ortodontistas - Morelli, Uniden, American Orthodontics (AO) e TP -, em 25 pacientes consecutivos. Os elastômeros foram distribuídos de forma aleatória e ordenados nas quatro hemiarcadas de cada paciente, permanecendo no meio bucal por 30 dias. Após esse período, duas unidades de cada marca em todos os pacientes foram fotografadas de forma padronizada para, posteriormente, serem analisadas através de avaliação visual quanto à variação de cor, por escores (0, 1, 2, 3), por um painel de quatro examinadores. Os escores médios dos examinadores foram analisados estatisticamente por meio da ANOVA e teste de Tukey, com p<0,05. RESULTADOS: os escores médios de pigmentação, após 30 dias no meio intrabucal, obtidos para os elastômeros Morelli (1,80±0,78) e Uniden (1,92±0,66) não foram estatisticamente diferentes entre si. Entretanto, essas marcas estavam significativamente mais pigmentadas após 30 dias no meio intrabucal (p<0,01) quando comparadas às marcas importadas, American Orthodontics (0,97±0,6) e TP (0,83±0,79). CONCLUSÃO: apesar de todas as quatro marcas apresentarem uma indesejável pigmentação após 30 dias no meio intrabucal, as marcas American Orthodontics e TP apresentaram alterações de cor menos significativas do que as marcas Morelli e Uniden.

Frictional characteristics of the newer orthodontic elastomeric ligatures.

Introduction: Elastomeric ligatures reduce chairside time but increase friction. Polymeric coatings and 45° angulations have been introduced to the ligature modules to combat its disadvantages and reduce friction. This in vitro study compared the frictional characteristics of six different types of the most commonly used elastomeric modules. Materials and Methods: Thecoefficient of friction for six ligation methods: the non-coated Mini Stix† and coated Super Slick Mini Stix™ (TP Orthodontics), 45° angulated but non-coated Alastik Easy-To-Tie™ (3M Unitek) elastomerics and non-angulated non-coated Alastik QuiK-StiK * , 0.110'- and 0.120'-diameter elastomerics™ (Reliance Orthodontics) were measured in dry conditions utilizing a jig according to the protocol of Tidy. Results: A significant difference was observed between the various types of elastomeric ligatures (P<.01). Among the six types of elastomeric ligatures, the 45° angulated elastomeric ligatures produced the least friction, followed by the coated Super Slick† elastomers. No difference in the friction was noted when the diameter of the elastomeric ligatures was varied. Conclusions: Polymeric surface coatings and introduction of angulations into elastomeric ligatures reduce the friction during sliding; however, the diameter of the ligature made no difference to sliding friction.