Efficacy of antimicrobial agents incorporated in orthodontic bonding systems: a systematic review and meta-analysis.

AIMS: The purpose of this study was to evaluate the efficacy of orthodontic bonding systems containing different antimicrobial agents, as well as the influence of antimicrobial agent incorporation in the bonding properties of these materials. METHODS: Eight databases were searched: PubMed (Medline), Web of Science, Scopus, Lilacs, Ibecs, BBO, Scielo and Google Scholar. Any study that evaluated antimicrobial activity in experimental or commercial orthodontic bonding systems was included. DATA EXTRACTION: Data were tabulated independently and in duplicated by two authors on pre-designed data collection form. DATA SYNTHESIS: The global analysis was carried out using a random-effects model, and pooled-effect estimates were obtained by comparing the standardised mean difference of each antimicrobial orthodontic adhesive with the respective control group. A p-value < .05 was considered as statistically significant. RESULTS: Thirty-two studies were included in the qualitative analysis; of these, 22 studies were included in the meta-analysis. Antimicrobial agents such as silver nanoparticles, benzalkonium chloride, chlorhexidine, triclosan, cetylpyridinium chloride, Galla chinensis extract, acid ursolic, dimethylaminododecyl methacrylate, dimethylaminohexadecyl methacrylate, 2-methacryloyloxyethyl phosphorylcholine, 1,3,5-triacryloylhexahydro-1,3,5-triazine, zinc oxide and titanium oxide have been incorporated into orthodontic bonding systems. The antimicrobial agent incorporation in orthodontic bonding systems showed higher antimicrobial activity than the control group in agar diffusion (overall standardised mean difference: 3.71; 95% CI 2.98 to 4.43) and optical density tests (0.41; 95% CI -0.05 to 0.86) (p < .05). However, for biofilm, the materials did not present antimicrobial activity (6.78; 95% CI 4.78 to 8.77). Regarding bond strength, the global analysis showed antimicrobial orthodontic bonding systems were statistically similar to the control. CONCLUSIONS: Although there is evidence of antibacterial activity from in vitro studies, clinical and long-term studies are still necessary to confirm the effectiveness of antibacterial orthodontic bonding systems in preventing caries disease.

Digital Smile Design for Computer-assisted Esthetic Rehabilitation: Two-year Follow-up.

OBJECTIVE: The esthetics of the smile are related to the color, shape, texture, dental alignment, gingival contour, and the relationship of these with the face. PURPOSE: To present a two-year follow-up for an esthetic rehabilitation clinical case in which the method of digital smile design (DSD) was used to assist and improve diagnosis, communication, and predictability of treatment through an esthetic analysis of the assembly: face, smile, periodontal tissue, and teeth. CLINICAL PROCEDURE: The smile's esthetics were improved through gingival recontouring, dental home bleaching, and a restorative procedure with thin porcelain laminate veneers using lithium disilicate glass-ceramic (e.max Ceram, Ivoclar-Vivadent) laminates on teeth 4 through 13. DISCUSSION: The proposed technique had an acceptable clinical performance at the end of a two-year follow-up. SIGNIFICANCE: DSD can be used to increase professional/patient communication and to provide greater predictability for the smile's esthetic rehabilitation.