HALITOSIS WITH FIXED ORTHODONTIC APPLIANCE VS REMOVABLE ORTHODONTIC ALIGNERS: A PILOT STUDY in a stastically significant way( p = 0,003), which led to a statistically significant increase of the plaque and tongue coating indexes, and confirmed the suspected positive correlation between halitosis and fixed orthodontic appliances 5. The brackets and ligatures have a negative effect on natural cleaning by creating retention areas for plaque, making the mechanical cleaning of the teeth and gingiva by the tongue and lips more difficult, and increasing the viscosity of the saliva 6-8. It has been stated that the accumulation of plaque and the increase in bacterial count 9 and tongue coating 10 are clearly also involved in the formation of halitosis. There are also plenty of studies about the effect of orthodontic treatment on the periodontium 11, 12. Determining the bracket system that causes the less destructive biologic effect has gained importance today. In this perspective, studies have been conducted on self-ligating brackets( SLB), with conflicting opinions. The absence of ligatures should provide fewer retentive sites than other bracket ligation types 13 but, on the other hand, this theoretical advantage may be eliminated in reality because SLB consist in opening and closing mechanisms that may provide additional plaque retention sites 14, 15. Instead, with aligner devices, oral hygiene habits were very good 16. The use of removable orthodontic appliances, particularly invisible aligners, allows adequate oral hygiene and can reduce the risk of dental and periodontal complications such as white spot lesions, caries and periodontitis 17. About the correlation between halitosis and orthodontic aligner treatment, it has been shown that this kind of treatment( Invisalign ®) is characterized by only minimal impairment of overall oral health and the associated quality of life. Neither halitosis, nor oral dryness, nor high plaque or gingival index measurements were observed 4. This is a very interesting study but it does not compare orthodontic aligners and fixed orthodontic appliances, as predisposing conditions to halitosis. The aim of the present study is to evaluate the presence of volatile sulfur compounds( VSCs) in patients with orthodontic aligner compared to patients with orthodontic fixed appliance. The VSC consisting of hydrogen sulfide, dimethyl sulfide, and especially methyl mercaptan released through the proteolytic degradation of saliva, exfoliated epithelium, food debris, gingival crevicolar fluid, plaque, postnasal drip, sulfur-containing amino acids, and peptides in the blood by the anaerobic microorganisms found in the oral cavity are effective on the formation of halitosis 18. The null hypothesis is that there are no differences in oral volatile sulfur compounds( VSC) emissions between patients with fixed orthodontic appliances and orthodontic aligners.
2. Materials and Methods 2.1. Study Sample Fixed Orthodontic and Invisalign ® patients were selected consecutively with the following characteristics: age between 18 and 39 years old,
good general health, non-smokers, absence of systemic diseases, absence of gastro esophageal reflux, no eating disorders( DAC) and not pregnant. The fixed orthodontic treatment we intended was a superior and inferior multi-brackets system at least from first molar to first molar, instead, the Invisalign treatment consisted of superior and inferior aligner devices. Both treatments have to be started since, at least, three months subjects were involved in the study. We considered the following characteristics as exclusion criteria: individuals with systemic diseases, medical treatments, cuts, sores, lesions of the mucosa and wounds, bearers of crowns, veneers or bridges on the upper incisors and active carious lesions. We also left out individuals who declared to not brush their teeth at least three times a day, to not use dental floss and / or dental picks and, in Invisalign ® cases, to not clean aligners with their personal toothbrush and toothpaste( with RDA less than 100) at least two times a week and to not put them in immersion solution of sodium sulfate carbonate at least once a week 19, 20. Among these patients10 patients with aligners( aligners group – AG) and- 10 patients with fixed orthodontic appliance( fixed group – FG) were selected. The study was carried out in accordance with the principles of the Declaration of Helsinki and in compliance with Good Clinical Practice. The study protocol was reviewed and approved by the University of Insubria Research Centre Cranio Facial Disease and Medicine Institutional Ethical Committee. Before taking part in the study each patient was required to sign an informed consent form to which a detailed description of the study protocol was attached. These individuals were asked to come for the orthodontic control, at least an hour after performing the oral hygiene procedures, and for VSC measurements. 2.2. Methodology This experiment aims to detect the presence of halitosis with a gaschromatograph OralChroma™( Fig. 1).
Figure 1. Gaschromatograph OralChroma™
The patient must keep a sterile disposable 1 ml syringe in the oral cavity for 60 seconds, with his mouth closed and without contaminating it with saliva( Fig. 2 a-c). After 60 seconds, the patient must open and close the syringe plunger 2 times,
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