Conformation Effect on the Mechanical and Microbiological Behavior of Invisible Orthodontic Aligners.

Invisible orthodontic aligners are having a great impact on tooth movement in an aesthetic and effective way. Different techniques, models, and clinical aspects have been studied for their proper use. However, the aim of this research has been to determine the effect of the shaping process on mechanical properties and their bacterial behavior. For this study, 40 original polyurethane plates and 40 identical models, obtained by hot forming the original plates, were used. The static tensile mechanical properties were studied with a Zwick testing machine using testing speeds of 5 mm/min at a temperature of 37 °C. The original plate and the aligner have been studied with a creep test by subjecting the samples to a constant tension of 30 N, and determining the elongation using a long-distance, high-resolution microscope at different time periods between 1 and 720 h. Studies of water absorption has been realized with artificial saliva for 5 h. Bacterial cultures of Streptococcus oralis and Actinomyces viscosus strains were grown on the original plates and on new and used models, to determine the proliferation of each bacterium through metabolic activity, colony-forming units, and LIVE/DEAD assays. The mechanical results showed an increase in the strength of the inserts with respect to the models obtained from 3.44 to 3.95 MPa in the elastic limit and a lower deformation capacity. It has been proven that the transition zone in the creep curves lasts longer in the original plate, producing the rapid increase in deformation at a shorter time (400 h) in the aligner. Therefore, the shaping process reduces the time of dental correction exerted by the aligner. The results of the bacterial culture assays show an increase in the number of bacterial colonies when the aligners have been used and when the polyurethane is conformed due to the internal energy of the model, with respect to the original polyurethane. It has been observed that between the original plate and the aligner there are no statistically significant differences in water absorption and therefore the forming process does not affect water absorption. A slight increase in water absorption can be observed, but after five hours of exposure, the increase is very small.

Effect of Fluoride Content of Mouthwashes on the Metallic Ion Release in Different Orthodontics Archwires.

Metal ion release studies were carried out on three of the most commonly used orthodontic wires in the clinic: austenitic stainless steel, Ti-Mo, and superelastic NiTi, using three mouthwashes with different fluoride concentrations: 130, 200, and 380 ppm. Immersions were carried out in these mouthwashes at 37 °C for 1, 4, 7, and 14 days, and the ions released were determined by inductively coupled plasma-mass spectrometry (ICP-MS). All wires were observed by scanning electron microscopy (SEM). The results showed a moderate ion release in the stainless steel wires, with nickel and chromium values of 500 and 1000 ppb in the worst conditions for the wires: concentrations of 380 ppm fluoride and 14 days of immersion. However, in the Ti-Mo and NiTi alloys, an abrupt change in release was observed when the samples were immersed in 380 ppm fluoride concentrations. Titanium releases in Ti-Mo wires reached 200,000 ppb, creating numerous pits on the surface. Under the same conditions, the release of Ni and Ti ions from the superelastic wires also exceeded 220,000 ppb and 180,000 ppb, respectively. This release of ions causes variations in the chemical composition of the wires, causing the appearance of martensite plates in the austenitic matrix after 4 days of immersion. This fact causes it to lose its superelastic properties at a temperature of 37 °C. In the case of immersion in 380 ppm mouthwashes for more than 7 days, rich-nickel precipitates can be seen. These embrittle the wire and lose all tooth-correcting properties. It should be noted that the release of Ni ions can cause hypersensitivity in patients, particularly women. The results indicate that the use of mouthwashes with a high content of fluoride should not be recommended with orthodontic archwires.

Bacteriostatic Poly Ethylene Glycol Plasma Coatings for Orthodontic Titanium Mini-Implants.

Titanium mini-implants are used as anchorage for orthodontic tooth movements. However, these implants present problems due to the infection of surrounding tissues. The aim of this work was to obtain a polyethylene glycol (PEG) layer by plasma in order to achieve a bacteriostatic surface. Titanium surfaces were activated by argon plasma and, after, by PEG plasma with different powers (100, 150 and 200 W) for 30 and 60 min. The roughness was determined by white light interferometer microscopy and the wettability was determined by the contact angle technique. Surface chemical compositions were characterized by X-ray photoelectron spectroscopy (XPS) and cytocompatibility and cell adhesion studies were performed with fibroblast (hFFs) and osteoblast (SAOS-2) cells. Bacterial cultures with Spectrococcus Sanguinis and Lactobacillus Salivarius were performed, and bacterial colonization was determined. The results showed that plasma treatments do not affect the roughness. Plasma makes the surfaces more hydrophilic by decreasing the contact angles from 64.2° for titanium to 5.2° for argon-activated titanium, with values ranging from 12° to 25° for the different PEG treatments. The plasma has two effects: the cleaning of the surface and the formation of the PEG layer. The biocompatibility results were, for all cases, higher than 80%. The polymerization treatment with PEG reduced the adhesion of hFFs from 7000 to 6000 and, for SAOS-2, from 14,000 to 6500, for pure titanium and those treated with PEG, respectively. Bacterial adhesion was also reduced from 600 to 300 CFU/mm2 for Spetrococcuns Sanguinis and from 10,000 to 900 CFU/mm2 for Lactobacillus Salivarius. The best bacteriostatic treatment corresponded to PEG at 100 W and 30 s. As a consequence, the PEG coating would significantly prevent the formation of bacterial biofilm on the surface of titanium mini-implants.

Effect of Fluoride Content of Mouthwashes on Superelastic Properties of NiTi Orthodontic Archwires.

The influence of sodium fluoride (NaF) concentration in mouthwashes on the properties of superelastic NiTi orthodontic wires has been studied. In this work, 55.8%Ni and 44.2%Ti (in weight) wires were introduced in commercial mouthwashes with different NaF contents (0, 130, 200 and 380 ppm). The release of Ni2+ and Ti4+ ions was by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) at 1, 4, 7 and 14 days. Superelastic orthodontic wires present at oral temperature the austenitic phase which is transformed into a plastic phase (martensite) by cooling. The temperatures at which this occurs are influenced by the chemical composition. The release of ions from the wire will produce variations in the temperatures and stresses of the stress-induced martensitic transformation. Ms, Mf, As, Af were determined by Differential Scanning Calorimeter (DSC). The transformation stresses (austenite to stress induce martensite) were determined with a servo-hydraulic testing machine at 37 °C. The surfaces for the different times and mouthwash were observed by Scanning Electron Microscope (SEM). The release of Ni2+ in mouthwashes with 380 ppm NaF concentrations reaches 230,000 ppb in 14 days and for Ti4+ 175,000 ppb. When NaF concentrations are lower than 200 ppm the release of Ni and Ti ions is around 1500 ppb after 14 days. This variation in compositions leads to variations in Ms from 27 °C to 43.5 °C in the case of higher NaF concentration. The increasing immersion time and NaF concentrations produce a decrease of Ni in the wires, increasing Ms which exceed 37 °C with the loss of superelasticity. In the same way, the stresses (tooth position corrective) decrease from 270 MPa to 0 MPa due to the martensitic phase. The degradation can produce the growth of precipitates rich in Ti (Ti2Ni). These results are of great interest in the orthodontic clinic in order to avoid the loss of the therapeutic properties of superelastic NiTi due to long immersion in fluoride mouthwashes.

Development of Biomimetic NiTi Alloy: Influence of Thermo-Chemical Treatment on the Physical, Mechanical and Biological Behavior.

A bioactive layer, free of nickel, has been performed for its greater acceptability and reliability in clinical applications for NiTi shape memory alloys. In the first step, a safe barrier against Ni release has been produced on the surface by means of a thicker rutile/anastase protective layer free of nickel. In the second step, a sodium alkaline titanate hydrogel, which has the ability to induce apatite formation, has been performed from oxidized surface. An improvement of host tissue-implant integration has been achieved in terms of Ni ions release and the bioactivity of the treated NiTi alloys has been corroborated with both in vitro and in vivo studies. The transformation temperatures (As, Af, Ms, and Mf), as well as the critical stresses (σß⇔M), have been slightly changed due to this surface modification. Consequently, this fact must be taken into account in order to design new surface modification on NiTi implants.

Mechanical properties of a new thermoplastic polymer orthodontic archwire.

A new thermoplastic polymer for orthodontic applications was obtained and extruded into wires with round and rectangular cross sections. We evaluated the potential of new aesthetic archwire: tensile, three point bending, friction and stress relaxation behaviour, and formability characteristics were assessed. Stresses delivered were generally slightly lower than typical beta-titanium and nickel-titanium archwires. The polymer wire has good instantaneous mechanical properties; tensile stress decayed about 2% over 2h depending on the initial stress relaxation for up to 120h. High formability allowed shape bending similar to that associated with stainless steel wires. The friction coefficients were lower than the metallic conventional archwires improving the slipping with the brackets. This new polymer could be a good candidate for aesthetic orthodontic archwires.

Fatigue life of bioactive titanium dental implants treated by means of grit-blasting and thermo-chemical treatment.

OBJECTIVE: This study focuses on the fatigue behavior of titanium dental implants as-received, with a grit-blasted surface and with a new bioactive surface treatment (2Steps). BACKGROUND: The 2Step process consists of (1) an initial grit-blasting process to produce a micro-rough surface, followed by (2) a combined thermo-chemical treatment that produces a potentially bioactive surface, that is, that can form an apatitic layer when exposed to biomimetic conditions in vitro. The 2Step treatment produced micro-rough and apatitic coating implants. METHODS: Residual stresses were determined by means of X-ray diffraction. The fatigue tests were carried out at 37°C on 500 dental implants, and the S-N curve was determined. The fatigue-crack nucleation for the different treatments was analyzed. RESULTS: The fatigue tests show that the grit-blasting process improves the fatigue life. This is a consequence of the layer of compressive residual stresses that the treatment generates in titanium surfaces. Dental implants that had its surfaced prepared with the 2Step procedure (grit-blasting and thermo-chemical treatment) had its fatigue life decreased by 10% due to the incorporation of oxygen to the surface and the relaxation of the compressive residual stress produced by the heat treatment. CONCLUSIONS: Thermo-chemical treatment is an excellent compromise between the improvement of bioactive and mechanical long-life behaviors.

Wilson maxillary curve analyzed by CBCT. A study onnormocclusion and malocclusion individuals

The anatomy of dental compensation curve in the frontal plane described by George H. Wilson is one of the occlusal determinants of orthodontic treatment. However, there is few published comparing malocclusion and normocclusion individuals. Objectives: The aim of this study is to compare the curve of Wilson at first and second maxillary molars, normocclusion pattern and malocclusion pattern, with and without bilateral posterior crossbite, using angular references in CBCT studies. Material and Methods: We analyzed 10 cases of malocclusion with bilateral posterior crossbite, 10 cases of malocclusion without bilateral posterior crossbite and 10 cases with non orthodontic normocclusion (patients who underwent cone beam study for other reasons than orthodontic). All of them were adults, more than 19 years. Angular variables from left and right axis (line connecting the occlusal and furcation groove) of first and second molars towards a perpendicular to the frontal palate were measured. There was carried out an Anova test, Bonferroni analysis and Levene´s statistics. Results: The descriptive analysis of the results shows an average values of total maxillary curve of Wilson for first molars (sum of left and right angle) of 8.1° for normocclusion group, 0.4° for the malocclusion pattern with bilateral posterior crossbite and 16.9° for the malocclusion pattern without this alteration. The mean differences was statistical significant (P<0,042) between between malocclusion pattern groups with and without crossbite .Conclusion: The curve of Wilson, measured at maxillary first molars in patients with bilateral posterior crossbiteis more concave than the other groups, suggesting no dentoalveolar compensations (AU)

Wilson maxillary curve analyzed by CBCT. A study on normocclusion and malocclusion individuals.

UNLABELLED: The anatomy of dental compensation curve in the frontal plane described by George H. Wilson is one of the occlusal determinants of orthodontic treatment. However, there is few published comparing malocclusion and normocclusion individuals. OBJECTIVES: The aim of this study is to compare the curve of Wilson at first and second maxillary molars, normocclusion pattern and malocclusion pattern, with and without bilateral posterior crossbite, using angular references in CBCT studies. MATERIAL AND METHODS: We analyzed 10 cases of malocclusion with bilateral posterior crossbite, 10 cases of malocclusion without bilateral posterior crossbite and 10 cases with non orthodontic normocclusion (patients who underwent cone beam study for other reasons than orthodontic). All of them were adults, more than 19 years. Angular variables from left and right axis (line connecting the occlusal and furcation groove) of first and second molars towards a perpendicular to the frontal palate were measured. There was carried out an Anova test, Bonferroni analysis and Levene's statistics. RESULTS: The descriptive analysis of the results shows an average values of total maxillary curve of Wilson for first molars (sum of left and right angle) of 8.1° for normocclusion group, 0.4° for the malocclusion pattern with bilateral posterior crossbite and 16.9° for the malocclusion pattern without this alteration. The mean differences was statistical significant (P<0,042) between between malocclusion pattern groups with and without crossbite . CONCLUSION: The curve of Wilson, measured at maxillary first molars in patients with bilateral posterior crossbite is more concave than the other groups, suggesting no dentoalveolar compensations.

Long-term stability of surgical-orthodontic correction of class III malocclusions with long-face syndrome

Objectives: In the first place, to evaluate skeletal changes of the maxilla and mandible induced by surgical-orthodontic correction of malocclusions class III with long-face syndrome and secondly, to analyze the stability of these skeletal changes in the long term (more than 6 years). Design of Study: A retrospective, unicentric and longitudinal study of 19 patients who had undergone surgical and orthodontic therapy for class III skeletal malocclusion with long-face syndrome was undertaken. A cephalometric analysis based on 8 angle measurements, and statistical analyses at three different points in time (before orthodontic treatment, after orthognathic surgery and after a retention period of at least 6 years) were carried out. Results: The changes produced following surgery show that, with the exception of the maxillary plane and the facial axis, all other variables presented changes of great statistical difference. Conclusions: Skeletal changes after orthodontic-surgical correction present maxillary advance, mandibular regression and mandibular anterorotation. The angles that represent the mandibular vertical position (ramus angle, goniac angle and mandibular plane angle) showed statistically significant relapses and no stability in contrast to the facial axis (AU)

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Effect of oral bacteria on the mechanical behavior of titanium dental implants.

PURPOSE: This study sought to determine whether the mechanical properties of titanium dental implants changed after exposure to bacteria. MATERIALS AND METHODS: Two strains of bacteria (Streptococcus sanguinis and Lactobacillus salivarius) were used in the study. The adhesive properties of the two strains were investigated as follows. Titanium implants were placed in bacteria broth, seeded with the two bacteria strains, and left in the broth for 1 or 3 months. Another group of titanium implants was immersed in artificial saliva at 37°C for 3 months. Ten implants in each group were tested in 37°C artificial saliva to evaluate their mechanical flexural strength and fatigue life. RESULTS: The bacterial cultures grew quickly on titanium surfaces. After 1 month of bacteria culture in vitro, the bacteria had produced corrosion pits on the titanium surfaces. After 3 months of bacterial culture, a 7% decrease in the flexural strength of the implant samples and a decrease of 15% in the number of cycles to failure by fatigue were seen versus implants not exposed to bacteria. CONCLUSIONS: These results demonstrate that, in physiologic conditions in vitro, bacteria have the capacity to produce a pitting corrosion phenomenon on exposed titanium surfaces, leading to a significant deterioration in the mechanical properties of the implant. It is therefore logical to conclude that bacteria may produce corrosion that reduces the useful life of dental implants.

Long-term stability of surgical-orthodontic correction of class III malocclusions with long-face syndrome.

OBJECTIVES: In the first place, to evaluate skeletal changes of the maxilla and mandible induced by surgical-orthodontic correction of malocclusions class III with long-face syndrome and secondly, to analyze the stability of these skeletal changes in the long term (more than 6 years). DESIGN OF STUDY: A retrospective, unicentric and longitudinal study of 19 patients who had undergone surgical and orthodontic therapy for class III skeletal malocclusion with long-face syndrome was undertaken. A cephalometric analysis based on 8 angle measurements, and statistical analyses at three different points in time (before orthodontic treatment, after orthognathic surgery and after a retention period of at least 6 years) were carried out. RESULTS: The changes produced following surgery show that, with the exception of the maxillary plane and the facial axis, all other variables presented changes of great statistical difference. CONCLUSIONS: Skeletal changes after orthodontic-surgical correction present maxillary advance, mandibular regression and mandibular anterorotation. The angles that represent the mandibular vertical position (ramus angle, goniac angle and mandibular plane angle) showed statistically significant relapses and no stability in contrast to the facial axis.